Coxsackievirus-Induced Myocarditis With Acute Onset of Heart Failure With Pleural Effusion.

This is a case of a 45-year-old Caucasian female with coxsackievirus-induced myocarditis. Myocarditis is an inflammation of the heart muscles, which can be difficult to diagnose at times because its symptoms overlap with other cardiovascular diseases. At times, when the patient presents, the full impact of the etiology would have either improved or resolved. In this case, the patient presented with symptoms closely resembling that of acute coronary syndrome but did not fit the typical age category. After lab and imaging workup, the coxsackievirus panel was positive, complicated with a new diagnosis of systolic heart failure with an ejection fraction of 30%-35% along with pericardial effusion.

A Recurrent Case of Mesothelial Pericardial Cyst.

This is a case of a 37-year-old female patient with past medical history of mitral valve prolapse and benign mesothelial pericardial cyst status post laparoscopic resection who presented to the emergency department with a chief complaint of right-sided sharp non-radiating chest pain due to recurrent case of benign mesothelial pericardial cyst. Though this is not a common pathology, it does overlap with common cardiovascular symptoms/conditions; not limited to but including chest pain, dyspnea, palpitations, pericardial effusions, infections and arrhythmias. It is crucial to have appropriate history and physical exam and appropriate evaluation to rule out pericardial cysts as well as their locations and their potential lethal mechanical implication on crucial nearby structures. This is significant in order to avoid uncommon but lethal cardiac complications in this condition such as cardiac arrhythmias, cardiac tamponade, right ventricular outflow tract and even sudden cardiac death.

Clinical Effectiveness of N-Methyl-D-Aspartate (NMDA) Receptor Antagonists in Adult Obsessive-Compulsive Disorder (OCD) Treatment: A Systematic Review.

Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder that affects approximately 2% of the human population. Traditional treatment of OCD includes selective serotonin reuptake inhibitor (SSRI) or serotonin reuptake inhibitor (SRI) treatment along with cognitive behavioral therapy (CBT). Nearly 25%-30% of OCD patients do not respond to SSRIs. Glutamatergic agents are currently being studied for the treatment of OCD due to the glutamatergic pathway in the brain, related to OCD, and the role of the cortico-striato-thalamic circuit (CSTC). This review assesses the clinical effectiveness of N-methyl-D-aspartate (NMDA) antagonists, ketamine/esketamine, memantine, and amantadine, for adult patients with OCD. Inclusion criteria include human studies published within the last 15 years, with patients diagnosed with OCD, aged over 18 years, with only psychiatric comorbidities, and full-text articles. Papers that included interventions other than CBT, exposure with response prevention (ERP), and SSRI/SRI were excluded. Articles were searched for using PubMed, PubMed Central, Medical Literature Analysis and Retrieval System Online, GeorgiA LIbrary LEarning Online, EBSCO Information Services, OpenAthens, Multidisciplinary Digital Publishing Institute, and Google Scholar databases, last searched on December 2, 2022. The risk of bias was assessed using Cochrane Risk of Bias tools, the Scale for the Assessment of Narrative Review Articles (SANRA) checklist for literature reviews, and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for quasi-experimental studies. Results were presented and synthesized by Excel spreadsheet analysis. The database search yielded 4,221 articles, which was cut down to 18 articles by inclusion/exclusion criteria, including duplications. 80% of the ketamine studies resulted in a significant reduction of obsessions and compulsions based on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), and each of the memantine and amantadine studies displayed clinical effectiveness, also. Limitations include the small number of amantadine studies and the limited availability of other NMDA receptor (NMDAR) antagonist-focused studies. This systematic review shows that ketamine is an effective drug for the treatment of non-refractory, mild to moderate OCD, and memantine and amantadine are effective augmentation agents for the treatment of mild to severe OCD.

From Molecular to Multiasperity Contacts: How Roughness Bridges the Friction Scale Gap.

The tangential force required to observe slip across a whole frictional interface can increase over time under a constant load, due to any combination of creep, chemical, or structural changes of the interface. In macroscopic rate-and-state models, these frictional aging processes are lumped into an ad hoc state variable. Here we explain, for a frictional system exclusively undergoing structural aging, how the macroscopic friction response emerges from the interplay between the surface roughness and the molecular motion within adsorbed monolayers. The existence of contact junctions and their friction dynamics are studied through coupled experimental and computational approaches. The former provides detailed measurements of how the friction force decays, after the stiction peak, to a steady-state value over a few nanometers of sliding distance, while the latter demonstrates how this memory distance is related to the evolution of the number of cross-surface attractive physical links, within contact junctions, between the molecules adsorbed on the rough surfaces. We also show that roughness is a sufficient condition for the appearance of structural aging. Using a unified model for friction between rough adsorbed monolayers, we show how contact junctions are a key component in structural aging and how the infrajunction molecular motion can control the macroscopic response.

Hierarchically structured bioinspired nanocomposites.

Next-generation structural materials are expected to be lightweight, high-strength and tough composites with embedded functionalities to sense, adapt, self-repair, morph and restore. This Review highlights recent developments and concepts in bioinspired nanocomposites, emphasizing tailoring of the architecture, interphases and confinement to achieve dynamic and synergetic responses. We highlight cornerstone examples from natural materials with unique mechanical property combinations based on relatively simple building blocks produced in aqueous environments under ambient conditions. A particular focus is on structural hierarchies across multiple length scales to achieve multifunctionality and robustness. We further discuss recent advances, trends and emerging opportunities for combining biological and synthetic components, state-of-the-art characterization and modelling approaches to assess the physical principles underlying nature-inspired design and mechanical responses at multiple length scales. These multidisciplinary approaches promote the synergetic enhancement of individual materials properties and an improved predictive and prescriptive design of the next era of structural materials at multilength scales for a wide range of applications.

Foreseeing metal failure from its inception.

The life span of metals can be inferred from early microscopic deformation events.

The Effectiveness of Statins as Potential Therapy for Multiple Sclerosis: A Systematic Review of Randomized Controlled trials.

Evidence of the effectiveness of statins, the lipid-lowering agents in retarding the progression of Multiple Sclerosis (MS), a disabling neurological disease with autoimmune etiology, have been highlighted in animal studies and observational studies. The proposed immune-modulatory actions and neuroprotective effects of statins make them a promising treatment option for MS that needs to be explored further. In this systematic review, we aim to investigate the role of different statins as monotherapy or in combination with the established MS medications in improving the clinical and radiological course of MS variants, including optic neuritis, using randomized controlled trials (RCTs). We systematically searched PubMed, PubMed Central (PMC), MEDLINE, Cochrane library, and Scopus databases using regular keywords and medical subject headings terms. Randomized controlled trials of any statin used in any variants of MS, including studies on statins used in optic neuritis published up to April 2021, were included in the review. Data on the effects on the relapse rate, the Expanded Disability Status Scale (EDSS) alterations, and the changes in Magnetic Resonance Imaging (MRI) lesions were collected from the included studies. Seven studies with a total of 831 patients and an average duration of follow-up of six to 36 months were included in our review. Five trials were of statins add-on to interferon therapy in relapsing-remitting multiple sclerosis (RRMS), of which four studies were assessed to be of good quality while the remaining study featured a high risk of bias. One trial of simvastatin monotherapy in Secondary Progressive Multiple Sclerosis (SPMS) was included, which was assessed to be of good methodological quality with low risk of bias and adequate patient number. A trial of simvastatin monotherapy on patients with optic neuritis was included, which was evaluated as a good quality study. Still, it had a low number of participants and a short duration of follow-up. We used the changes in disease relapse rate and EDSS as primary outcome variables and the MRI lesions changes as a secondary outcome variable. Studies in RRMS showed no significant effects on primary and secondary outcomes. The study on SPMS featured a significant improvement in EDSS in simvastatin-treated patients with no effect on relapse rate or MRI changes. Simvastatin use in optic neuritis enhances clinical visual outcomes with no significant effect on MRI changes or the rate of progression to definite MS. In contrast to animal studies and observational studies, randomized controlled trials do not replicate the positive effects of statins used as monotherapy or combined with interferon beta in patients with RRMS and optic neuritis in relapse rate EDSS or MRI changes. However, trials of statins on SPMS showed a promising effect on disability progression (EDSS score), which might support the proposed immune-modulatory and neuroprotective role of statins and serve as a baseline for further RCTs applying statins as monotherapy or combination with other established MS therapies.

The Relationship Between Caffeine and Caffeinated Drinks in Causing Intracranial Hemorrhage in the Elderly Aspirin-Taking Population: A Systematic Review.

Caffeinated drinks are the most widely consumed beverages globally and their intake has increased in the elderly. Caffeine exhibits dose-dependent adverse effects. Low to moderate doses cause anxiety, restlessness, irritability, and nausea. High doses of 3-5g can affect different physiological systems and lead to detrimental effects like palpitations, hypertension, agitation, seizures, and coma. Low-dose aspirin is the most used anticoagulant in preventing ischemic vascular events. An increased risk of intracranial hemorrhage is associated with low-dose aspirin with an intensified intracerebral hemorrhage risk. The aim of this research is to explore the association between caffeine and aspirin in causing lethal intracranial hemorrhage in the older population. Because of the devastating nature of intracranial hemorrhages and the inconsistent published data on the risk of intracranial hemorrhage in individuals taking both aspirin and caffeine, we conducted a systematic review considering the elderly population. We conducted the study following the reporting guidelines for systematic review and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist. Inclusion and exclusion criteria were determined. Data was collected from PubMed, PubMed Central® (PMC), National Library of Medicine (MEDLINE), Google Scholar, Multidisciplinary Digital Publishing Institute (MDPI), and Web of Science by applying keywords and Medical Subject Headings (MeSH) terms individually. Our initial search yielded 155,270 articles, which were scrutinized, and duplicates were removed for accuracy. Of these, a total of 13 research papers were finally extracted using the PRISMA recommendations and applying other inclusion and exclusion criteria. With the help of our systematic review, we could determine that both aspirin and caffeine portrayed a role in causing intracranial hemorrhage independently, but further studies are recommended to evaluate if both could lead to similar adverse effects when taken collectively.

Protective Role of Vitamin D Therapy in Diabetes Mellitus Type II.

Diabetes Mellitus type II (DM II) is a worldwide disease with a rapidly growing parallel prevalence and adversities affecting multi-body systems. Hence, it is imperative to treat DM II effectively, maintaining glucose homeostasis to avoid complications such as diabetic nephropathy, peripheral neuropathy, and retinopathy. Vitamin D, among many benefits, has positive outcomes on hemoglobin A1c (HbA1c) control. It aids in insulin secretion and sensitivity. We systematically screened four databases for relevant information; PubMed, Medline, PMC, and Google scholar. Inclusion and exclusion criteria were applied, and quality appraisal was then done using certain checklist tools: Newcastle-Ottawa tool, AMSTAR (A Measurement Tool to Assess Systematic Reviews) checklist, SANRA (Scale for the Assessment of Narrative Review Articles) checklist, and Cochrane bias assessment. Data were collected from 14 articles, of which eight are systematic reviews and meta-analysis, one is a narrative review, five are randomized controlled trials and three are general information about DM II and Vitamin D. In addition, this article evaluates the clinical significance of Vitamin D administration in DM II from a glucose homeostasis perspective, and complications such as nephropathy, neuropathy, and retinopathy. Vitamin D had a clinical positive impact on glucose level, particularly on hemoglobin A1c (HbA1c) reduction, alleviation of diabetic neuropathy and nephropathy symptoms, and hyperglycemia induced-oxidative stress on the retinal cells.

Drug-Eluting Stents: Their Preventative/Prophylactic Role Against Gemcitabine Induced Acute Coronary Syndrome.

Acute coronary syndrome (ACS), a subdivision of ischemic cardiac disease, is the sudden occlusion of coronary vessels that results in decreased blood supply to heart muscles and possible infarction. Though some of the etiologies are hypertension, hyperlipidemia, diabetes mellitus, and tobacco; certain types of chemotherapies play a major role. Percutaneous coronary intervention (PCI) has shown lifesaving results via drug-eluting stent (DES) deployment into occluded vessels. In this study, DES utilization among patients receiving chemotherapy will be assessed to observe if it provides any prevention against ACS. Articles were systematically screened in three databases such as PubMed, PubMed Central (PMC), and Medical Literature Analysis and Retrieval System Online (MEDLINE) using keywords and Medical Subject Heading (MeSH) terms for applicable articles. Additionally, a few relevant articles from the Cochrane Library, Molecular Diversity Preservation International (MDPI), and The New England Journal of Medicine were also used. Inclusion/exclusion criteria were applied post article screening via title and abstracts. Quality appraisal check was done using the Scale for the Assessment of Narrative Review Articles (SANRA) checklist, A Measurement Tool to Assess Systematic Reviews (AMSTAR) checklist, Cochrane bias assessment tool, and Joanna Briggs Institute (JBI) checklist. Ten related studies were strictly reviewed. DES did not appear to play a preventable role against ACS during chemotherapy as no study was found assessing DES prophylactically and its efficacy in cancer patients. Future clinical trials on DES prophylactic use might be beneficial to evaluate if ACS adversities of chemotherapy can be prevented. This review is of significant benefit as cardiovascular adversities would not impede chemotherapy efficacy as cardiac adversities would not be part of the equation.

Strain rate dependency of dislocation plasticity.

Dislocation glide is a general deformation mode, governing the strength of metals. Via discrete dislocation dynamics and molecular dynamics simulations, we investigate the strain rate and dislocation density dependence of the strength of bulk copper and aluminum single crystals. An analytical relationship between material strength, dislocation density, strain rate and dislocation mobility is proposed, which agrees well with current simulations and published experiments. Results show that material strength displays a decreasing regime (strain rate hardening) and then increasing regime (classical forest hardening) as the dislocation density increases. Accordingly, the strength displays universally, as the strain rate increases, a strain rate-independent regime followed by a strain rate hardening regime. All results are captured by a single scaling function, which relates the scaled strength to a coupling parameter between dislocation density and strain rate. Such coupling parameter also controls the localization of plasticity, fluctuations of dislocation flow and distribution of dislocation velocity.

Hierarchical Multiscale Approach for Modeling the Deformation and Failure of Epoxy-Based Polymer Matrix Composites.

Coarse-grained molecular dynamics (CG-MD) simulations were conducted to characterize the molecular structure and mechanical properties in the epoxy matrix around fibers in polymer matrix composites (PMCs). From these simulations, the molecular structure was quantified by measuring the free-volume hole radius distribution as a function of position from the matrix-fiber interface. Additionally, correlations between the epoxy mechanical properties and the average free-volume hole radius were established for different degrees of cross-linking. These results were then upscaled into a finite element model (FEM) of a PMC representative volume. The results from the CG-MD-informed FEM model were compared to conventional FEM simulations that assume uniform epoxy mechanical properties, and the results indicate that conventional FEM simulations overestimate the strength of PMCs and predict a symmetric damage evolution in the matrix. On the other hand, the CG-MD-informed FEM simulations predict a more realistic localization of damage around the fiber-matrix interface.

Scanning transmission electron microscopy image simulations of complex dislocation structures generated by discrete dislocation dynamics.

Scanning Transmission Electron Microscopy Diffraction Contrast Imaging (STEM-DCI) has been gaining popularity for the identification and analysis of dislocations in crystalline materials due to its ability to supress undesirable image features that are often present in conventional TEM images. However, there does not yet exist a robust body of work demonstrating expected contrast in these imaging conditions. A novel approach for the simulation of STEM-DCI images was developed using a modified form of the scattering matrix formalism. This algorithm was used to simulate a variety of dislocation configurations generated using three-dimensional discrete dislocation dynamics.

The heterogeneity of persistent slip band nucleation and evolution in metals at the micrometer scale.

Fatigue damage in metals manifests itself as irreversible dislocation motion followed by crack initiation and propagation. Characterizing the transition from a crack-free to a cracked metal remains one of the most challenging problems in fatigue. Persistent slip bands (PSBs) form in metals during cyclic loading and are one of the most important aspects of this transition. We used in situ microfatigue experiments to investigate PSB formation and evolution mechanisms, and we discovered that PSBs are prevalent at the micrometer scale. Dislocation accumulation rates at this scale are smaller than those in bulk samples, which delays PSB nucleation. Our results suggest the need to refine PSB and crack-initiation models in metals to account for gradual and heterogeneous evolution. These findings also connect micrometer-scale deformation mechanisms with fatigue failure at the bulk scale in metals.

Evaluation the Health Impact of Some Heavy Metals in Milk from Markets

This study focuses on the heavy metals concentrations (Fe, Cu, Zn, Pb, and Cd) in certain common milk species are collected from Iraqi markets using Flame Atomic Absorption Spectrophotometer-6300 AA, Shimadzu, Japan, respectively. This study shows the pollution in the environment obtained by heavy metals. The results showed that Cr, Cd, Cu, Zn, and Fe were varying according to the order: Zn>Fe>Cr>Cd>Cu. levels of heavy metals were 0.610(Cr), 0.125(Cd), 0.052(Cu), and 6.902(Zn), and 0.759(Fe). All the heavy metals were observed within maximum limit in milk. Overall, the number of analyzed heavy metals and sample size were limited in present study. Keywords: Heavy metals; Milk; Najaf; Flame atomic absorption; Spectrophotometer This study focuses on the heavy metals concentrations (Fe, Cu, Zn, Pb, and Cd) in certain common milk species are collected from Iraqi markets using Flame Atomic Absorption Spectrophotometer-6300 AA, Shimadzu, Japan, respectively. This study shows the pollution in the environment obtained by heavy metals. The results showed that Cr, Cd, Cu, Zn, and Fe were varying according to the order: Zn>Fe>Cr>Cd>Cu. levels of heavy metals were 0.610(Cr), 0.125(Cd), 0.052(Cu), and 6.902(Zn), and 0.759(Fe). All the heavy metals were observed within maximum limit in milk. Overall, the number of analyzed heavy metals and sample size were limited in present study

Carpal tunnel syndrome due to hibernoma of the wrist: Case report.

Carpal tunnel syndrome (CTS) is the most frequent among entrapment neuropathies. The usual etiology is idiopathic, but can be caused by space-occupying lesions, a relatively rare condition. This condition becomes exceptional when the space-occupying lesion corresponds to a rare tumor whose location is atypical. The authors report the case of a 36-year-old woman with CTS due to hibernoma of the wrist.

Lipomatosis of interdigital nerves: Unusual localization.

Lipomatosis of the nerve (LN) is a rare benign tumor that is characterized by proliferating fibrous fatty tissue surrounding and infiltrating the peripheral nerves. While there are numerous case reports of LN affecting the median nerve and its branches, there are few reports, to the authors' knowledge, of their occurrence in the foot and ankle. A rare case of LN involving the second and third interdigital nerve in a 41-year-old man, which was successfully treated with surgical excision, is reported.

Importance of Soil Temperature for the Growth of Temperate Crops under a Tropical Climate and Functional Role of Soil Microbial Diversity.

A soil cooling system that prepares soil for temperate soil temperatures for the growth of temperate crops under a tropical climate is described herein. Temperate agriculture has been threatened by the negative impact of temperature increases caused by climate change. Soil temperature closely correlates with the growth of temperate crops, and affects plant processes and soil microbial diversity. The present study focuses on the effects of soil temperatures on lettuce growth and soil microbial diversity that maintains the growth of lettuce at low soil temperatures. A model temperate crop, loose leaf lettuce, was grown on eutrophic soil under soil cooling and a number of parameters, such as fresh weight, height, the number of leaves, and root length, were evaluated upon harvest. Under soil cooling, significant differences were observed in the average fresh weight (P<0.05) and positive development of the roots, shoots, and leaves of lettuce. Janthinobacterium (8.142%), Rhodoplanes (1.991%), Arthrospira (1.138%), Flavobacterium (0.857%), Sphingomonas (0.790%), Mycoplana (0.726%), and Pseudomonas (0.688%) were the dominant bacterial genera present in cooled soil. Key soil fungal communities, including Pseudaleuria (18.307%), Phoma (9.968%), Eocronartium (3.527%), Trichosporon (1.791%), and Pyrenochaeta (0.171%), were also recovered from cooled soil. The present results demonstrate that the growth of temperate crops is dependent on soil temperature, which subsequently affects the abundance and diversity of soil microbial communities that maintain the growth of temperate crops at low soil temperatures.

Chronic anterior shoulder instability with significant Hill-Sachs lesion: Arthroscopic Bankart with remplissage versus open Latarjet procedure.

BACKGROUND: The objective of this study was to compare short-term shoulder stability after arthroscopic Bankart repair with remplissage versus the open Latarjet procedure in patients who had chronic anterior shoulder instability with a significant Hill-Sachs lesion. HYPOTHESIS: The dislocation recurrence rate is higher after Bankart repair with remplissage than after open Latarjet. PATIENTS AND METHODS: An observational non-randomised retrospective cohort study was conducted at two surgical centres in patients treated for chronic anterior shoulder instability with a significant Hill-Sachs defect between January 2009 and July 2014. The study compared 43 patients managed by arthroscopic Bankart repair and remplissage and 43 patients managed with open Latarjet. The two groups were matched on age at surgery and on follow-up duration. All patients were evaluated by independent observers based on a questionnaire including recurrences, range of motion, and functional outcomes (Shoulder Subjective Value [SSV], Walch-Duplay score, and Rowe score). RESULTS: Mean follow-up was 47.3 months (range, 24-67 months). The recurrence rate at last follow-up was not significantly different between the two groups (9.3% versus 11.2%; P=0.67). The Bankart group had significantly greater loss of external rotation and a significantly higher proportion of patients with residual pain (21% versus 9%, P=0.023). The SSV, Walch-Duplay score, and Rowe score values were similar between groups. DISCUSSION: In patients who had chronic anterior shoulder instability with a significant Hill-Sachs lesion, arthroscopic Bankart repair with remplissage and open Latarjet were reliable and safe procedures associated with low and similar recurrence rates. However, loss of external rotation and residual pain were significantly more common with the combined Bankart-remplissage procedure. LEVEL OF EVIDENCE: III; comparative retrospective study.