Assessment of acute, subacute genetic toxicities and immunomodulatory activity of palm (Trachycarpus fortunei) buds.

ETHNOPHARMACOLOGY RELEVANCE: Palm buds are a natural green resource of the forest, which are not only rich in nutrients but contain a large number of phenolic acids and flavonoids, among other components. It has a variety of biological activities such as antioxidant and uterine smooth muscle stimulation. AIM OF THE STUDY: To evaluate the safety of palm buds for use as a nutraceutical product and food by evaluating the toxicity, subacute toxicity and genotoxicity of the young palm buds. Also studied for its immune-enhancing activity. MATERIALS AND METHODS: Acute toxicity tests were performed in mice using the maximum tolerance method, and the manifestations of toxicity and deaths were recorded after administration of 10,000 mg/mL for 14 consecutive d (days) of observations. To assess subacute toxicity, mice were treated with palm buds (750, 1500, or 3000 mg/mL) daily for 28 days. The teratogenicity of palm buds was assessed by the Ames test, the mouse bone marrow cell micronucleus test, and the mouse spermatozoa malformation test. In addition, we evaluated the immune-enhancing ability of palm buds by the mouse carbon profile test, delayed-type metamorphosis reaction, and serum hemolysin assay. RESULTS: In the acute toxicity study, the Median Lethal Dose (LD50) was greater than 10,000 mg/kg bw in both male and female rats. There were also no deaths or serious toxicities in the subacute study. The no-observed-adverse-effect level (NOAEL) was 3000 mg/kg bw. However, the mice's food intake decreased after one week. The medium and high dose groups had a reducing effect on body weight in mice of both sexes. In addition, the changes in organ coefficients of the liver, kidney and stomach in male mice were significantly higher in the high-dose group (3.23 ± 0.35, 0.75 ± 0.05, 0.57 ± 0.05 g) than in the control group (2.94 ± 0.18, 0.58 ± 0.05, 0.50 ± 0.02 g). Hematological analyses showed that all the indices of the rats in each palm sprout dose group were within the normal range. The results of blood biochemical indicators showed that there was a significant reduction in TP in the blood of male mice in the high-dose group (44.6 ± 7.8 g/L) compared to the control group (58.3 ± 15.1 g/L). In histopathological analysis, none of the significant histopathological changes were observed. The results of the immunological experiment in mice showed that the liver coefficient and thymus coefficient of the high-dose group (8400 mg/kg) were significantly lower than the control group. There was no remarkable difference in auricle swelling between each dose palm bud group (1400, 2800, or 8400 mg/kg) and the control group. The anti-volume number of the high-dose group was significantly increased. CONCLUSION: Palm buds have non-toxic effects in vivo and have little effect on non-specific and cellular immunity in the test mice within the dose range of this experiment. The immunoenhancement in mice is mainly achieved through humoral immunity. In conclusion, our results suggest that palm buds are safe for use as healthcare products and food.

Brodie's Abscess of the Ankle Presenting as a Tumor: A Summary of Five Cases.

Introduction: A Brodie's abscess is a form of subacute osteomyelitis that is often considered in the differential diagnosis of other benign and malignant bone lesions. The authors summarize the findings of five cases of Brodie's abscesses in the distal tibia initially thought to be tumors by the referring physicians. Case Report: All five cases were presented to the referring physicians with a chief complaint of ankle pain. All patients complained of chronic ankle pain and swelling that was aggravated by activity without constitutional symptoms. On physical examination, all patients presented with point tenderness over the distal tibia/malleolar regions. Three out of the five cases had a full range of ankle motion; the other two had limited dorsiflexion secondary to pain. All inflammatory laboratory values were within normal limits or only slightly elevated. All initial radiographs of the cases described demonstrated a well-defined radiolucent lesion within the distal tibia. In all cases, patients were treated with curetting, with or without bone graft. Bacterial and fungal cultures were negative in all five patients and no long-term post-operative antibiotics were administered. Conclusion: In this report, we discuss the clinical, radiographic, and pathologic features of this relatively rare condition in the distal tibia. The distinct clinicopathologic features of the disease process are presented to distinguish Brodie's abscess from a bone tumor.

A Case of Necrotizing Lymphadenitis Misdiagnosed as a Neck Abscess.

Histiocytic necrotizing lymphadenitis (HNL), also known as Kikuchi disease, is a relatively rare sub-acute necrotic localized lymphadenitis. This benign, self-limiting condition is characterized by fever, painful lymphadenopathy, skin rash, and other systemic symptoms. Due to its nonspecific presentation, unclear etiology, and pathogenesis, HNL has a low incidence rate in clinical practice. Insufficient awareness among clinicians and pathologists can easily lead to misdiagnosis. This article reported a 27-year-old female patient who was admitted to the hospital with fever, neck pain, and enlarged lymph nodes in the neck. There were no special medical or personal histories, and postoperative pathology confirmed tissue necrotizing lymphadenitis. After treatment with steroids and symptomatic therapy, she recovered and was discharged from the hospital. Follow-up to date has shown no recurrence.

Oral toxicity assessment and the mitigation of lung carcinogenesis by phytol and α-bisabolol combination treatment in swiss albino mice: insights into redox enzyme modulation and caspase-dependent cell death mechanisms.

This study examined the safety and potential anti-lung cancer effects of combinations of phytol and α-bisabolol in Swiss albino mice. Both acute and subacute toxicity assessments showed that the combination of phytol and α-bisabolol is safe, with no adverse effects observed at higher concentrations. Hematological, biochemical, and histopathological tests showed no signs of toxicity in the heart, lungs, liver, spleen, and kidneys. The LD50 was greater than 2000 mg/kg, indicating a large safety margin. Histopathological analysis confirmed cancer induction in the B(a)P-induced group, which had significantly altered relative lung weights. Lung weight increased slightly pre and post-treatment, but histopathology showed normal alveolar epithelium. GSH and SOD levels increased significantly in B(a)P-exposed groups, indicating an adaptive antioxidant response. CAT levels increased significantly in the post-treatment group, demonstrating the role of combination of phytol and α-bisabolol in protecting against B(a)P-induced oxidative damage. Upregulation of Bax and downregulation of Bcl-2 caused a pro-apoptotic environment, suggesting a way to inhibit malignant cell survival. Modulation of caspase-3 and caspase-9 showed the complexity of carcinogen-induced apoptotic signaling. In conclusion, phytol and α-bisabolol were found to be safe and organ-protective, and demonstrated no acute or subacute toxicity. They modulate antioxidant defenses and apoptotic pathways, which may help prevent and treat lung cancer.

Diaphragm Disease of the Terminal Ileum: The Great Imitator.

Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with an array of intestinal injuries: erosions, ulcers, enteropathy, strictures and diaphragm disease. The diagnosis of diaphragm disease is challenging. Diaphragm disease can cause thin, concentric and stenosing strictures, which can induce intermittent or complete bowel obstruction. NSAID-induced lesions are reversible following discontinuation of the offending agent. Treatment of diaphragm disease can be conservative, endoscopic or surgical through stricturoplasty and/or segmental resection. We report a case of a 59-year-old female presenting with intermittent right lower quadrant pain diagnosed with diaphragm disease upon combined ileo-colonoscopy and histopathological analysis. Her diaphragm disease was successfully treated conservatively through drug cessation, avoiding more invasive procedures like endoscopic and surgical interventions. LEARNING POINTS: The incidence of diaphragm disease has been soaring due to the widespread use of non-steroidal anti-inflammatory drugs (NSAIDs).Diaphragm disease is characterized by diaphragm-like mucosal projections and annular constrictions that induce luminal narrowing and result in bowel obstruction.Physicians should get acquainted with diaphragm disease and include it in their differential diagnosis when approaching a patient with obstruction-like symptoms or non-specific and vague abdominal pain in the setting of chronic NSAIDs usage.

Subacute Osteomyelitis of the Symphysis Pubis After Left Oophoritis Caused by Pseudomonas Aeruginosa. A Case Report.

Osteomyelitis of the symphysis pubis is a rarely described bone infection. The main strain of bacteria causing this infection is Staphylococcus aureus, while Pseudomonas aeruginosa is seen most commonly in intravenous drug users. Symmetrical involvement of both pubic bones is usually present. Osteomyelitis of the pubic bones following genital infections in females without a history of previous surgery is very unusual. We present a 47-year-old female patient who, to our best knowledge, is the first case in the literature to develop osteomyelitis of the pubic symphysis after adnexitis caused by Pseudomonas aeruginosa without having had previous surgery in that region.

Subacute Thyroiditis Presenting as a Painful Thyroid Nodule and Subclinical Hyperthyroidism: A Case Report.

This case report details the evaluation and management of a 55-year-old woman who presented to our endocrinology clinic due to low TSH and thyroid nodules previously evaluated by her ENT. The patient originally presented with anterior neck pain and dysphagia. Ultrasonography demonstrated thyroid nodules with suspicious features, prompting a fine needle aspiration (FNA). A biopsy showed a follicular lesion/atypia of undetermined significance (Bethesda III). Due to concerns for malignancy, a right lobectomy was recommended. Thyroid function tests showed subclinical hyperthyroidism. She presented to our endocrinology clinic and was diagnosed with subacute thyroiditis based on signs of symptoms, radioactive iodine scanning, and biochemical studies (elevated ESR). Within approximately seven months, thyroid function tests and inflammatory markers returned to baseline, and symptoms and physical findings resolved. The case highlights the importance of understanding the similarities and differences between subacute thyroiditis and malignant pathologies in order to avoid misdiagnosis and unnecessary procedures.

The Rare Case Presentation of Adult-Onset Fulminant Subacute Sclerosing Panencephalitis in a 24-Year-Old Male.

Subacute sclerosing panencephalitis (SSPE) is a late effect of measles in children. Its features include seizures, a gradual loss of physical and cognitive function, and finally death. Despite the absence of a definitive cure for this disorder, a regimen combining intrathecal interferon-α (IFN-α) and daily oral isoprinosine has demonstrated effectiveness. We present the case of a 24-year-old male with spastic seizure epilepsy. He exhibited progressive weakness, frequent postural instability, and recurrent generalized tonic-clonic seizures. Increased measles antibody concentrations in the cerebrospinal fluid (CSF), prominent amplitude spikes on the electroencephalogram (EEG), and heightened fluid-attenuated inversion recovery (FLAIR) signals on brain magnetic resonance imaging (MRI) suggested a diagnosis of SSPE.

Drug-induced subacute cutaneous lupus erythematosus secondary to Dupilumab: A case report.

We present the case of a 63-year-old male with known rheumatoid arthritis, diabetes, hypertension, and peripheral neuropathy who developed drug-induced subacute cutaneous lupus erythematosus secondary to Dupilumab for his chronic hand dermatitis.

Toxicological Evaluation of a Polyherbal Formulation (18KHT01) and Validation of UPLC-DAD Method for Quality Control.

Background: 18KHT01 is a novel synergistic composition of Quercus acutissima, Camellia sinensis, Geranium thunbergii, and a small portion of Citrus limon. Our previous report demonstrated that the 18KHT01 exhibits potent antiobesity effects, with synergistic antioxidant, antiadipogenic, and antiobesity activities in diet-induced obese mice. This study explores the toxicity profile and quality control parameters of the 18KHT01 formulation. Methods: Broad-spectrum acute and subacute oral toxicity studies were performed using male and female ICR mice. In order to simultaneous analysis of the 18KHT01 formulation, an ultraperformance liquid chromatography coupled with a diode array detector (UPLC-DAD) method was developed and validated using six marker compounds. Results: Acute oral toxicity evaluation of 18KHT01, administered at single high doses of 2, 2.5, 3, and 5 g/kg, identified 2 g/kg as the no-observed adverse effect level (NOAEL). The LD50 (50% lethal dose) and LD100 (100% lethal dose) of 18KHT01 for male ICR mice were 3.99 and 7.77 g/kg, and those for the female mice were 2.94 and 4.70 g/kg, respectively. In addition, a 30-day repeated dose oral subacute toxicity evaluation indicated that 18KHT01 is safe below 500 mg/kg/day for long-term administration in ICR mice of either sex. UPLC-DAD method validation revealed that each calibration curve for the marker compounds showed good linearity, as well as the validation parameters such as precision, specificity, and accuracy met the acceptance criteria. Conclusion: The present study evidenced the toxicological profile of 18KHT01 polyherbal formulation in mice as well as developed a simple, rapid, and accurate chromatographic method for quality control.

Efficacy of Gasserian Ganglion High-Voltage, Long-Duration Pulsed Radiofrequency Combined With Block on Acute/Subacute Zoster-Related Trigeminal Neuralgia.

Background: Trigeminal postherpetic neuralgia (TPHN) is a severe chronic pain that can lead to various socioeconomic consequences. Therefore, it is necessary to explore optimal treatment options for acute/subacute herpes zoster (HZ)-related trigeminal neuralgia and prevent the further development of TPHN. High-voltage, long-duration pulsed radiofrequency (HL-PRF) of the Gasserian ganglion is a new surgical intervention used to treat PHN. A ganglion block has been reported to possess anti-inflammatory effects and potential analgesic benefits. Methods: We included 83 patients with HZ-related acute/subacute trigeminal neuralgia admitted from January 1, 2021, to June 1, 2023, and received Gasserian ganglion HL-PRF combined with block. A 6-month follow-up was conducted, including Numerical Rating Scale (NRS) scores, Pittsburgh Sleep Quality Index (PSQI), the incidence of TPHN, the dosage of anticonvulsants and analgesics, efficacy, and adverse events. Results: All patients showed a significant decrease in postoperative NRS scores (p < 0.05). The NRS scores of the acute HZ group were consistently lower than those of the subacute HZ group at different time points (p < 0.01). The overall incidence of TPHN from the onset of HZ to 12 weeks is 21.68%. The incidence of TPHN in the acute phase group was 12.77%, significantly lower than the 33.33% in the subacute phase group (p=0.024). The effective rate was 74.7% in all patients, at 3 months after the treatment. The effective rate was 82.98% in the acute phase group and 63.89% in the subacute phase group, showing a statistically significant difference (p=0.047). The PSQI score of the acute group was consistently lower than that of the subacute group (p < 0.01). The dosage of analgesics and anticonvulsants used in the acute HZ group was lower than that in the subacute group (p < 0.01). All patients did not experience serious adverse reactions. Conclusions: Gasserian ganglion HL-PRF combined with block can be an effective and safe technique to relieve the pain of acute/subacute zoster-related trigeminal neuralgia and prevent the incidence of TPHN.

Grading of Balance Function in Subacute Stroke Patients by Using the Berg Balance Scale Together with Latent Rank Theory.

OBJECTIVES: The Berg Balance Scale (BBS) is a core measure of balance function in patients with stroke. Latent rank theory (LRT) is a statistical method that enables the degree of functional impairment to be ranked from the sub-items of a rating scale; each rank can then be characterized. Identification of the characteristics of balance function by rank would be beneficial for interventions to improve balance function in patients with stroke. This study aims to use LRT to rank and characterize patients with stroke balance impairment. METHODS: This was a multicenter retrospective analysis of 293 patients with subacute stroke. We used LRT and the BBS to estimate the optimal rankings based on the goodness-of-fit index and the information criterion. We compared the obtained ranks with the level of walking independence for each rank. RESULTS: The evaluation of the patient's BBS scores revealed that balance impairment could be divided into six ranks. The average BBS score for each rank rose from 27.1 for rank 1 to 53.9 for rank 6. The scores of the BBS sub-items for each rank also differed. The level of walking independence by rank ranged from rank 1 for assisted walking to rank 6 for independent outdoor walking. CONCLUSIONS: Balance function in patients with subacute stroke was ranked sixth in the BBS, with varying characteristics identified for different ranks. This result helped to determine the therapy to improve the balance function of patients with stroke.

Causal association of epigenetic age acceleration and risk of subacute thyroiditis: a bidirectional Mendelian randomization study.

BACKGROUND: Epigenetic age accelerations (EAAs) are a promising new avenue of research, yet their investigation in subacute thyroiditis (SAT) remains scarce. Our study endeavors to fill this void by exploring the potential causal association between EAAs and SAT. METHODS: Our study utilized publicly available genome-wide association study (GWAS) data of European ancestry to conduct a bidirectional Mendelian randomization (MR) study. Five MR methods were employed to measure causal association between EAAs and SAT multiple analyses were utilized to perform quality control. RESULTS: Our study evaluated causal association between SAT and four EAAs, included GrimAge acceleration (GrimAA), Hannum age acceleration (HannumAA), PhenoAge acceleration (PhenoAA), intrinsic epigenetic age acceleration (IEAA). Results showed that there is a significant causal association between PhenoAA and SAT (OR 1.109, 95% CI 1.000-1.228, p = 0.049, by IVW method). On the contrary, SAT was associated with IEAA (OR 0.933, 95% CI 0.884-0.984, p = 0.011, by IVW method; OR 0.938, 95% CI 0.881-0.998, p = 0.043, by weighted median method). Leave-one-out sensitivity analysis, heterogeneity test, pleiotropy test, and MR-PRESSO analysis provide good quality control. CONCLUSION: The bidirectional MR analysis concluded that an increase in PhenoAA was correlated with a higher risk of SAT, indicating a potential causal relationship between PhenoAA and risk of SAT. Conversely, SAT was found to be closely associated with IEAA, suggesting that SAT may accelerate the aging process. Slowing down biological aging has emerged as a new research direction in curbing SAT.

Spontaneous Rupture of a Parietal Arachnoid Cyst Causing an Intracystic Hemorrhage and a Subacute Subdural Hematoma.

Arachnoid cysts are extra-axial cerebrospinal fluid collections located in the arachnoid space that usually do not communicate with the ventricular system. They are commonly found in the middle cranial fossa around the Sylvian fissure. Most of them are asymptomatic, but subdural collections or intracystic hemorrhages can complicate their natural course. Cases of intracystic hemorrhage and subdural hematoma, especially in the absence of traumatic events, have been scarcely reported. Arachnoid cysts outside the middle cranial fossa are rarely associated with an intracystic hemorrhage. We present the case of a 10-year-old boy with a known right parietal brain arachnoid cyst who complained of progressive headaches for three days. There was no history of trauma. The head CT scan showed a 2-cm isodense subacute subdural hematoma, causing a mass effect on the underlying brain. It was associated with a right parietal arachnoid cyst containing intracystic subacute blood. The symptoms were relieved after burr-hole surgical drainage of the intracystic hemorrhage and associated subacute subdural hematoma.

Subacute combined degeneration from nitrous oxide abuse.

Nitrous oxide is an anesthetic medication which can also be recreationally abused in the form of whippet canisters. Its prolonged abuse can interfere with Vitamin B12 metabolism and lead to its functional deficiency. We report a case of a 30-year-old male who presented with generalized weakness and was found to have subacute combined degeneration (SCD) of the spinal cord. His laboratory workup showed low Vitamin B12 with elevated homocysteine and methylmalonic Co-A levels, and further questioning revealed prolonged nitrous oxide abuse. Nitrous oxide causes functional inactivation of methylcobalamin by rendering it unable to function as a coenzyme for methionine synthase enzyme. This leads to the decreased production of methionine and subsequent production of myelin. This case describes nitrous oxide abuse as an important etiology to be considered in patients presenting with weakness and myeloneuropathy and describes important imaging findings.

The impact of changes in physical activity on functional recovery for older inpatients in post-acute rehabilitation units.

PURPOSE: The effect of increased physical activity duration on functional recovery in older inpatients in subacute settings is not well established. This study aimed to investigate the relationship between physical activity and functional recovery in older patients receiving post-acute and subacute care. METHODS: We analyzed cohort data of hospitalized older patients (age ≥ 65 years) in the post-acute rehabilitation units. The main outcome was functional independence measure (FIM) gain. Physical activity was measured using a triaxial accelerometer. Changes in sedentary behavior and total physical activity time from admission to discharge were measured as changes in each physical activity time. Logistic regression analysis was performed to examine the relationship between changes in physical activity and FIM gain. RESULTS: A total of 210 patients were eligible for analysis. The mean age of the study patients was 83.6 ± 7.2 years, and 63.8% (n = 134) were female. According to the multivariate regression analysis, changes in sedentary behavior time were significantly associated with high recovery of FIM gain (odds ratio [OR] 0.996, 95% confidence interval [CI]: 0.993-1.000; p = 0.026), and changes in total physical activity time also showed a similar association (OR 1.006, 95% CI 1.000-1.011; p = 0.041). CONCLUSION: Decreased sedentary behavior time and increased total physical activity time were significantly associated with high functional recovery in post-acute rehabilitation units. These results suggest that interventions for physical activity duration may be effective in improving activities of daily living in older post-acute and subacute patients.

Subacute thyroiditis: a rare presentation in pregnancy.

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Subacute Combined Degeneration of the Spine: A Case Study of Delayed Diagnosis in the Emergency Department.

Subacute combined degeneration of the spine (SCDS) is a well-known disease that classically presents with progressive sensory and motor deficits and characteristic magnetic resonance imaging (MRI) findings, leading to its use as a key diagnostic tool. However, clinical and MRI findings in SCDS may be diverse, and thus, a high index of suspicion should be maintained for this disease, which can cause irreversible neurological damage if left untreated. In this article, we report the case of a 29-year-old female with significant recent life stressors and otherwise unremarkable medical history who presented with progressive weakness of the bilateral lower extremities who previously had unremarkable computed tomography (CT) and MRI completed at an outside hospital for the same symptoms, which had since continued to worsen. Her presentation at our emergency department (ED) prompted urgent evaluation with an MR cord compression study and neurology consultation. This workup resulted in an unremarkable preliminary MR read, and she was without anemia in laboratory studies. Given this, she was ultimately discharged with high suspicion for conversion disorder. After an addendum report from radiology with concern for subacute combined degeneration of the spine, she was called back to the ED where further workup revealed pernicious anemia leading to SCDS. This case highlights the importance of maintaining suspicion and avoiding premature closure in patients with reported neurological deficits.

Subacute Thyroiditis: A Rare Cause of Pyrexia of an Unknown Origin.

Subacute thyroiditis is inflammation of the thyroid gland, classically presenting with neck pain or discomfort and sometimes with associated diffuse tender goiter and overt hyperthyroid symptoms. Only a few rare cases of subacute thyroiditis presenting as pyrexia of unknown origin (PUO) without any of the aforementioned clinical features have been reported in the literature. A 62-year-old male, with a past history of diabetes mellitus, presented with a history of intermittent fever lasting for one month duration. He did not have any significant localizing symptoms, except for a mild headache, and his examination findings were unremarkable as well. Investigations revealed a high erythrocyte sedimentation rate (ESR), high C-reactive protein (CRP) levels, and a deranged thyroid profile, with high free T3 and T4 and suppressed thyroid-stimulating hormone (TSH) levels, suggestive of subacute thyroiditis. The diagnosis was further reinforced by the findings of a supportive ultrasound scan of the neck. The patient was started on steroids, to which he showed a significant clinical and biochemical response. Here, we aim to highlight atypical presentations of subacute thyroiditis and the importance of early consideration of endocrine diseases in the workup of PUO, sometimes even in the absence of suggestive clinical features.

Diagnosis of Graves' Disease During Treatment for Subacute Thyroiditis: A Case Report.

The co-occurrence of subacute thyroiditis (SAT) and Graves' disease (GD) is rare. A 62-year-old Japanese man presented with shifting neck pain and elevated thyroid hormone level. The patient tested positive for thyroid-stimulating hormone receptor antibodies. Additionally, thyroid hormone levels did not decrease during treatment with prednisolone for SAT. Consequently, concurrent GD was suspected, and diagnostic assistance was obtained by confirming increased uptake on99mtechnetium thyroid scintigraphy. A genetic analysis of human leukocyte antigen (HLA) revealed genotypes associated with susceptibility to SAT (HLA-B*35:01) and GD (HLA-DPB1*05:01). Furthermore, the possibility of COVID-19 as a related environmental factor cannot be ruled out in this case.