A Family Physician's Experience in the Removal of Migrating Subdermal Contraceptive Implants.

Subdermal contraceptive implants are among the most effective and reversible contraceptive methods available today. Implanon®ï¸, approved by the US FDA, is widely used for long-term family planning due to its extended contraceptive effects. Although generally safe, these implants can occasionally lead to rare but serious complications, such as migration into deeper axillary structures. In this case report, we describe the experience of a family physician with a 30-year-old Saudi woman whose Implanon implant migrated approximately 11 cm from the original insertion site over three years. The patient presented for removal of the implant, which had reached the end of its contraceptive duration and was to be removed in preparation for future conception. Initial attempts by the family physician to localize and remove the implant were unsuccessful due to its continued migration toward the axilla. Consequently, the case was referred to the obstetrics and gynecology clinic and subsequently to the orthopedic department. The foreign body was successfully removed using an intraoperative, fluoroscopy-guided procedure, with no complications observed post-surgery. This case underscores the importance of physician awareness and a multidisciplinary approach to managing such complications. It also highlights that implant migration is not necessarily related to the physician's skill or patient characteristics, underscoring the unpredictable nature of this complication. This report aims to provide insights and recommendations for handling similar cases, advocating for early intervention, and the use of imaging techniques when managing non-palpable implants.

Neuromodulation strategies in developmental and epileptic encephalopathies.

Developmental and epileptic encephalopathies (DEEs) are a group of childhood-onset epilepsy syndromes characterized by frequent seizures, severe cognitive and behavioral impairments, and poor long-term outcomes. These conditions are typically refractory to currently available medical therapies, prompting recent exploration of neuromodulation treatments such as deep brain stimulation (DBS) and responsive neurostimulation (RNS), which aim to modulate epileptic networks spanning cortical and subcortical regions. These advances have occurred alongside an improved understanding of syndrome-specific and interictal epileptiform discharge/seizure-specific brain networks. By targeting key nodes within these networks, DBS and RNS hold promise for influencing seizures and associated cognitive and behavioral comorbidities. Initial experiences with centromedian (CM) thalamic DBS for Lennox-Gastaut syndrome (LGS) have shown modest efficacy across multiple seizure types. Reports also indicate the application of DBS and RNS across various genetic and structural etiologies commonly associated with DEEs, with mixed success. Although DBS and RNS are increasingly used in LGS and other DEEs, their mixed efficacy highlights a knowledge gap in understanding why some patients with LGS do not respond and which neuromodulation approach is most effective for other DEEs. To address these issues, this review first discusses recent neuroimaging studies showing similarities and differences in the epileptic brain networks underlying various DEEs, revealing the common involvement of the thalamus and the default-mode network (DMN) across multiple DEEs. We then examine thalamic DBS for LGS to illustrate how such network insights may be used to optimize neuromodulation. Although network-based neuromodulation is still in its infancy, the LGS model may serve as a framework for other DEEs, where optimal treatment necessitates consideration of the underlying epileptic networks. Lastly, the review suggests future research directions, including individualized connectivity assessment and biomarker identification through collaborative efforts, which may enhance the therapeutic potential of neuromodulation for individuals living with DEEs.

Case report: A suspected case of chronic pulmonary sparganosis characterized by migrating cavities and tunnel sign.

A 20-year-old male patient with a 15-month history of recurrent cough and hemoptysis presented at our hospital with suspected pulmonary sparganosis. Computed Tomography (CT) revealed migratory and variable lesions ranging from patchy shadows to nodular and cavernous foci. Additionally, the location and morphology of the cavities changed rapidly. The patient's peripheral blood eosinophil count remained within the normal range throughout the course of the infection, and antibiotics (moxifloxacin) alleviated the symptoms. At the early stage of admission, there was a slight increase in neutrophil and basophil counts. Initial treatment with a standard dose of praziquantel led to a significant improvement in symptoms, but the symptoms soon relapsed. However, doubling the dose 4 months later eventually cured the disease. The migratory nature of the CT lesion and the presence of tunnel signs were key to diagnosing a parasitic infection. The variability and rapid changes in the lesion further facilitated the differentiation of the disease, which rarely manifests as a granulomatous cavity.

Migration of Chemical Compounds from Packaging Materials into Packaged Foods: Interaction, Mechanism, Assessment, and Regulations.

The migration of chemical compounds from packaging polymers to food presents a multifaceted challenge with implications for food safety and public health. This review explores the interaction between packaging materials and food products, focusing on permeation, migration, and sorption processes. The different migration mechanisms of contact migration, gas phase migration, penetration migration, set-off migration, and condensation/distillation migration have been discussed comprehensively. The major migrating compounds are plasticizers, nanoparticles, antioxidants, light stabilizers, thermal stabilizers, monomers, oligomers, printing inks, and adhesives, posing potential health risks due to their association with endocrine disruption and carcinogenic effects. Advanced analytical methods help in the monitoring of migrated compounds, facilitating compliance with regulatory standards. Regulatory agencies enforce guidelines to limit migration, prompting the development of barrier coatings and safer packaging alternatives. Furthermore, there is a need to decipher the migration mechanism for mitigating it along with advancements in analytical techniques for monitoring the migration of compounds.

Effect of particle size on gastric emptying of enteric-coated granules in fasted beagle dogs: Relationship with interdigestive migrating motor complex.

This study investigates the particle size threshold at which the interdigestive migrating motor complex (IMMC) becomes active in gastric emptying for fasted beagle dogs. Enteric-coated granules containing cetirizine dihydrochloride (CET) were prepared in three particle sizes, 200, 660, and 1,200 µm (D50). To mark IMMC timing and water movement from the stomach, enteric-coated aspirin tablets and acetaminophen solution were used. To six fasted beagle dogs with 50 mL of acetaminophen solution was administered each granule size as a multiple-unit and a single enteric-coated aspirin tablet (3-period crossover study). No significant difference in pharmacokinetic parameters of CET after oral administration of different particle sizes was observed. However, the appearance time of CET in plasma with smaller granules (200 and 660 µm) was significantly faster than that of salicylic acid (a major metabolite of aspirin) in all dogs. In the case of the largest granules (1,200 µm), no significant time difference was observed in the appearance of both compounds in plasma. Furthermore, in two dogs, both compounds appeared at the same time, implying IMMC-regulated gastric emptying for the largest CET granules. These results support a particle size threshold between 660 and 1,200 µm for gastric emptying without IMMC action in fasted beagle dogs.

IL-38 Aggravates Atopic Dermatitis via Facilitating Migration of Langerhans cells.

Atopic dermatitis (AD) is a common inflammation skin disease that involves dysregulated interplay between immune cells and keratinocytes. Interleukin-38 (IL-38), a poorly characterized IL-1 family cytokine, its role and mechanism in the pathogenesis of AD is elusive. Here, we show that IL-38 is mainly secreted by epidermal keratinocytes and highly expressed in the skin and downregulated in AD lesions. We generated IL-38 keratinocyte-specific knockout mice (K14Cre/+-IL-38f/f ) and induced AD models by 2,4-dinitrofluorobenzene (DNFB). Unexpectedly, after treatment with DNFB, K14Cre/+-IL-38f/f mice were less susceptible to cutaneous inflammation of AD. Moreover, keratinocyte-specific deletion of IL-38 suppressed the migration of Langerhans cells (LCs) into lymph nodes which results in disturbed differentiation of CD4+T cells and decreased the infiltration of immune cells into AD lesions. LCs are a type of dendritic cell that reside specifically in the epidermis and regulate immune responses. We developed LC-like cells in vitro from mouse bone marrow (BM) and treated with recombined IL-38. The results show that IL-38 depended on IL-36R, activated the phosphorylated expression of IRAK4 and NF-κB P65 and upregulated the expression of CCR7 to promoting the migration of LCs, nevertheless, the upregulation disappeared with the addition of IL-36 receptor antagonist (IL-36RA), IRAK4 or NF-κB P65 inhibitor. Furthermore, after treatment with IRAK4 inhibitors, the experimental AD phenotypes were alleviated and so IRAK4 is considered a promising target for the treatment of inflammatory diseases. Overall, our findings indicated a potential pathway that IL-38 depends on IL-36R, leading to LCs migration to promote AD by upregulating CCR7 via IRAK4/NF-κB and implied the prevention and treatment of AD, supporting potential clinical utilization of IRAK4 inhibitors in AD treatment.

Population-based study of rare epilepsy incidence in a US urban population.

OBJECTIVE: This study was undertaken to estimate incidence of rare epilepsies and compare with literature. METHODS: We used electronic health record text search to identify children with 28 rare epilepsies in New York City (2010-2014). We estimated cumulative incidence and compared with literature. RESULTS: Eight of 28 rare epilepsies had five or more prior estimates, and our measurements were within the published range for all. The most common were infantile epileptic spasms syndrome (1 in 2920 live births), Lennox-Gastaut syndrome (1 in 9690), and seizures associated with tuberous sclerosis complex (1 in 14 300). Fifteen of 28 had fewer than five prior estimates, and of these, we provided additional estimates for early infantile developmental and epileptic encephalopathy (1 in 32 700), epilepsy with myoclonic-atonic seizures (1 in 34 100), Sturge-Weber syndrome plus seizures/epilepsy (1 in 40 900), epilepsy in infancy with migrating focal seizures (1 in 54 500), Aicardi syndrome plus seizures/epilepsy (1 in 71 600), hypothalamic hamartoma with seizures (1 in 225 000), and Rasmussen syndrome (1 in 450 000). Five of 28 rare epilepsies had no prior estimates, and of these, we provided a new estimate for developmental/epileptic encephalopathy with spike-and-wave activation in sleep and/or continuous spikes and waves during sleep (1 in 34 100). Data were limited for the remaining 12 rare epilepsies, which were all genetic epilepsies, including PCDH19, CDKL5, Alpers disease, SCN8A, KCNQ2, SCN2A, GLUT1 deficiency, Phelan-McDermid syndrome, myoclonic epilepsy with ragged-red fibers, dup15q syndrome, ring chromosome 14, and ring chromosome 20. SIGNIFICANCE: We estimated the incidence of rare epilepsies using population-based electronic health record data and literature review. More research is needed to better estimate the incidence of genetic epilepsies with nonspecific clinical features. Electronic health records may be a valuable data source for studying rare epilepsies and other rare diseases, particularly as genetic testing becomes more widely adopted.

Diffuse Unilateral Subacute Neuroretinitis: Challenges in Diagnosis and Management.

We report two cases of diffuse unilateral subacute neuroretinitis (DUSN) where multimodal imaging was used to assist in locating the nematode. The first case presented with clusters of migrating choroiditis with a suspicious tiny visualized worm noted on serial fundus photography. The second case had an atypical presentation with extensive exudative retinal detachment and a suspicious coiled worm in the subretinal space noted on optical coherence tomography. Both cases received oral albendazole for six weeks while the first case received additional argon laser photocoagulation to the suspected nematode. Both cases showed resolution of the ocular inflammation upon completion of treatment with no further recurrences. DUSN should be suspected in young and healthy patients with unexplained unilateral inflammatory eye disease with severe loss of vision. This series highlights the challenges faced in identifying the nematode in cases with suspected DUSN.

Both parents migrating and left-behind children's cognitive ability in rural China: does it pay?

Introduction: While the well-documented negative correlation between both parents migrating and the academic performance of left-behind children (LBC) in rural China is widely acknowledged, it's important to recognize that statistical data reveals millions of children experiencing both parents migrating. This discrepancy between the documented negative impact and the prevalence of both parents migrating can be attributed to previous studies primarily focusing on the direct effects. Methods: Employing national representative panel data and FE model, this study estimates the direct impact of both parents migrating and the indirect effects of both parents migrating through private tutoring, family tutoring, family income, and boarding school participation. Finally, we consolidate the direct and indirect impacts to determine whether both parents migrating has a positive or negative net effect on LBC's cognitive ability. Results: The direct effect of both parents migrating on LBC's standardized cognitive ability is -0.140, indicating a negative direct impact of both parents migrating on LBC's cognitive ability. However, the indirect effects of both parents migrating through private tutoring, family tutoring, family income, and boarding school participation are -0.017, -0.008, 0.306 and 0.119 respectively. The toal effect of both parents migrating on LBC's standardized cognitive ability is 0.260. Conclusion: The initially observed negative direct impact of both parents' migrating can be completely offset by the indirect impact channels, including private tutoring, family tutoring, family income, and boarding school participation. In contrast to prior research, this study unveils a positive overall impact of both parents' migration on LBC's school performance.

Light over mechanics: microbial community structure and activity in simulated migrating bedforms are controlled by oscillating light rather than by mechanical forces.

Sandy sediments of lowland streams are transported as migrating ripples. Benthic microorganisms colonizing sandy grains are exposed to frequent moving-resting cycles and are believed to be shaped by two dominant environmental factors: mechanical stress during the moving phase causing biofilm abrasion, and alternating light-dark cycles during the resting phase. Our study consisted of two laboratory experiments and aimed to decipher which environmental factor causes the previously observed hampered sediment-associated microbial activity and altered community structure during ripple migration. The first experiment tested the effect of three different migration velocities under comparable light conditions. The second experiment compared migrating and stationary sediments under either constant light exposure or light oscillation. We hypothesized that microbial activity and community structure would be more strongly affected by (1) higher compared to lower migration velocities, and by (2) light oscillation compared to mechanical stress. Combining the results from both experiments, we observed lower microbial activity and an altered community structure in sediments exposed to light oscillation, whereas migration velocity had less impact on community activity and structure. Our findings indicate that light oscillation is the predominating environmental factor acting during ripple migration, resulting in an increased vulnerability of light-dependent photoautotrophs and a possible shift toward heterotrophy.

Application of surface-modified functional packaging in food storage: A comprehensive review.

Innovations in food packaging systems could meet the evolving needs of the market; emerging concepts of non-migrating technologies reduce the negative migration of preservatives from packaging materials, extend shelf life, and improve food quality and safety. Non-migratory packaging activates the surface of inert materials through pretreatment to generate different active groups. The preservative is covalently grafted with the resin of the pretreated packaging substrate through the graft polymerization of the monomer and the coupling reaction of the polymer chain. The covalent link not only provides the required surface properties of the material for a long time but also retains the inherent properties of the polymer. This technique is applied to the processing for durable, stable, and easily controllable packaging widely. This article reviews the principles of various techniques for packaging materials, surface graft modification, and performance characterization of materials after grafting modification. Potential applications in the food industry and future research trends are also discussed.

Determination of nurses' happiness, hope, future expectations, and the factors influencing them: a descriptive study that can guide policy development to prevent nurse migration.

BACKGROUND: The happiness and hopefulness of nurses are not only known that contribute to their emotional well-being but also professional creativity, improve the quality of nursing services and organizational performance. Therefore, knowing which factors affect nurses' mental well-being and future expectations can provide information for nursing workforce planning policies. This study was conducted to determination of Nurses' happiness, hope, and future expectations and the factors influencing them. METHOD: 326 nurses from 52 provinces of Turkey participated in this descriptive study. The data collection instruments included a Demographic Characteristics Form and questions from the Turkish Statistical Institute's Life Satisfaction Survey to assess overall happiness, hope, and expectation levels. The study data was collected using an e-survey prepared through Google Forms in line with the principle of voluntarism. In the study adhered to the EQUATOR checklist for descriptive studies. RESULTS: The average scores for overall happiness, hope, and future expectations among the participating nurses were found to be 2.34 ± 0.98, 2.22 ± 0.95, and 1.26 ± 0.54, respectively. It was determined that the levels of happiness, hope, and future expectations of nurses are influenced by satisfaction with income, income's ability to meet needs, and personal development over the last five years. CONCLUSION: The study concluded that the overall happiness and hope levels of nurses are low, while their future expectations are at a moderate level. Satisfaction with income affects the happiness and hope levels of nurses. Three quarters of the nurses participating in the study want to work abroad. This situation may lead to a need for qualified nurses in the future.

Management of migrating spinal schwannomas: a surgeon's dilemma. Illustrative case.

BACKGROUND: A migrating spinal tumor is a rare phenomenon in the medical literature. Efficient management of these tumors is critical to avoid extended laminectomies. OBSERVATIONS: In this article, the authors present the case of a patient with a migrating lumbar schwannoma. They summarize a literature review of similar cases, highlighting the intraoperative challenges faced, and provide management guidelines for similar cases from their experience. LESSONS: Surgeons dealing with spinal intradural extramedullary lesions should always consider the possibility of tumor migration. Routine preoperative counseling regarding potential tumor migration and its efficient management is essential, as it reduces the risk of unplanned extensive laminectomy or durotomy, minimizing morbidity and medicolegal concerns and enhancing patient care.

Pathological migrating intramural hematoma in stenting for carotid artery dissection: A ten-year consecutive cohort study.

OBJECTIVE: To study the phenomenon, incidence and management of pathological migrating intramural hematoma in stenting for carotid artery dissection. METHODS: We consecutively enrolled CAD patients with stenting treatment over 10-year period, and retrospectively analyzed the pathological migrating intramural hematoma (PMIH) incidence of these CAD patients. Besides, we also explored the related factors with PMIH and provided an appropriate management strategy. RESULTS: A total of 67 CAD underwent stenting. PMIH occurred in 7 cases (10.4%). The median time from onset of symptoms to stenting was 5 days (3 to 11 days). There were 4 cases of PMIH in the proximal segment of stent and 3 cases of PMIH in the distal segment of stent. All the patients presented with new stenosis and no patient presented with dissecting aneurysm. Through proper management, none of the patients had occurred clinical complications. CONCLUSION: Pathological migrating intramural hematoma phenomenon exists in the stenting for carotid artery dissection, rescue angioplasty or stenting is needed for early treatment of moderate and severe stenosis due to migrating intramural hematoma on preventing further ischemic events.

HCN1 pathogenic variants associated with childhood epilepsy in a cohort of Chinese patients.

OBJECTIVE: HCN ion channel family has a widespread expression in neurons, and recently, increasing studies have demonstrated their roles in epilepsies. METHODS: Clinical data of the patients were gathered in a retrospective study. Exon sequencing was used for the patients with unexplained recurrent seizures and varying levels of developmental delay. RESULTS: In this study, eight de novo variants of HCN1 genes were uncovered in eight patients, including six missense variants, one nonsense variant and one frameshift insertion variant; five of them were reported for the first time. The onset age for eight patients ranges from one month to one year. Their main clinical manifestations are epilepsy and varying degrees of developmental delay, and the main type of seizure is focal secondary generalized tonic-clonic seizure. Importantly, in our study, one case presented with a form of migrating focal seizure that has not been reported in the literature. Seizures from five of the eight children were effectively controlled with antiepileptic drugs including valproic acid, levetiracetam and oxcarbazepine. One child developed normally and four children developed mild delay. One child was treated with topiramate, and the convulsion was partially controlled and showed moderate to severe developmental delay. The antiepileptic treatment failed for the other two children, and the two children were treated with sodium valproate, oxcarbazepine, lamotrigine, chlorbazan, levetiracetam and nitrodiazepam successively, but their convulsions were not controlled and showed moderate to severe developmental delay. SIGNIFICANCE: Our research reported eight variants in HCN1 gene causing epilepsy; among these variants, five variants were never reported before. HCN1-related epilepsy usually starts infantile period, and focal secondary generalized tonic-clonic seizure is the most common seizure type. Importantly, we reported the case with migrating focal seizure was rarely reported. Our study expanded both genotype and phenotype for HCN1-related epilepsy.

Bidirectional tick transport by migratory birds of the African-Western Palearctic flyway over Turkish Thrace: observation of the current situation and future projection.

This study was carried out at a vital stopover site of migrating birds in the Turkish Thrace, European part of Turkey, on the Mediterranean/Black Sea Flyway. Ticks were collected from the birds captured in the four migration periods, i.e., autumn 2020, spring 2021, autumn 2021, and spring 2022, and identified morphologically. Throughout the study, 10,651 birds from 77 species were examined, and 671 belonging to 34 species were found infested. The infestation prevalence in total birds and the mean number of ticks per infested bird were 6.3% and 3.8 (range: 1-142), respectively. A total of 2573 ticks were collected with the following species distribution and numbers: Ixodes spp. 70 larvae, I. frontalis 1829 larvae, 337 nymphs, and 30 adults, I. acuminatus 16 nymphs and 42 adults, I. ricinus 39 larvae, 141 nymphs, and one adult, Hyalomma spp. seven larvae and 60 nymphs, and Haemaphysalis sp. one larva. Prevalence, intensity, and species distribution of the ticks in birds varied depending on the month, season, year, and species-specific migration phenology of the birds. The results show that precise determination of the tick-borne risk associated with migratory birds for a particular region necessarily requires long-term and comprehensive studies and indicates that anthropogenic climate change and habitat degradation can significantly differentiate the risk by influencing the migration phenology in birds and by making new regions suitable for the establishment of different ticks.

Non-adherence to antiretroviral treatment among migrating fishermen in western Kenya's islands: a rapid qualitative study.

Fishing communities in many Sub-Saharan African countries are a high-risk population group disproportionately affected by the HIV epidemic. The association of migration with HIV and AIDS in sub-Saharan Africa is well documented. Frequent mobility, high consumption of alcohol, multiple sexual partners, transactional and commercial sex, poor health infrastructure and limited access to health services are reported among the main factors shaping the HIV epidemic in fishing communities. Moreover, studies have been conducted in sub-Saharan Africa on adherence to antiretroviral treatment (ART) among fishers; however, non-adherence to ART remains poorly understood among migrating fishermen in the western Kenya islands. This qualitative study investigated factors contributing to non-adherence among fishermen in the western Kenya islands. This study utilised 51 in-depth interviews and six focus group discussions to highlight factors contributing to non-adherence to ART by mobile fishermen. Data were analysed using a contextualised thematic analysis. Results show that migration, alcohol consumption and ART sharing contributed to non-adherence. Adherence to ART is a powerful predictor of survival for individuals living with HIV and AIDS. The Kenyan government can use lessons from this study to target fishermen to achieve the UNAIDS 2025 recommendations on people-centred and context-specific service responses to AIDS as this would move Kenya closer to the 90% reduction in annual infections by 2030. This article contributes to a deeper understanding of how and why fishermen from the islands in western Kenya struggle to adhere to treatment even though they can access ARTs through the public health care system. Longitudinal studies should be conducted to explore how the factors associated with non-adherence correlate with other key health outcomes such as drug resistance.

Social Capital and Mental Wellbeing of Older People Migrating along with Adult Children in Shenzhen, China.

The phenomenon of 'older people migrating along' (OPMA) with adult children is a unique outcome of social changes that have occurred in China. These individuals generally experience different challenges and needs associated with mental wellbeing. However, there is limited research on the relationship between the social capital and mental health of OPMA in China. This study aims to examine the mental health status of OPMA and the effects of bonding social capital and bridging social capital on their mental wellbeing in China by conducting a quantitative research survey among 399 OPMA participants. We found that bonding social capital correlated to only one indicator of mental wellbeing, subjective happiness. Bridging social capital had significant relationships with four mental health indicators, namely, the 12-item General Health Questionnaire (GHQ-12), Geriatric Depression Scale (GDS), subjective happiness, and life satisfaction. Through strengthening bridging social capital, these older adults can benefit from more opportunities for participation in formal or informal organizations in their communities and improve their mental wellbeing.