Utilization of early supported discharge and outpatient rehabilitation services following inpatient stroke rehabilitation.

BACKGROUND: Studies examining factors associated with patient referral to early supported discharge (ESD)/outpatient rehabilitation (OPR) programs and utilization of ESD/OPR services after discharge from inpatient stroke rehabilitation (IPR) are scarce. Accordingly, we examined utilization of ESD/OPR services following discharge from IPR and patient factors associated with service utilization. METHODS: Stroke patients discharged from IPR facilities in Alberta between April 2014 and March 2016 were included and followed for one year for ESD/OPR service utilization. Multivariable linear and negative binomial regressions were used to examine association of patients' factors with ESD/OPR use. RESULTS: We included 752 patients (34.4% of 2,187 patients discharged from IPR) who had 40,772 ESD/OPR visits during one year of follow-up in the analysis. Mean and median ESD/OPR visits were 54.2 and 36 visits, respectively. Unadjusted ESD/OPR visits were lower in females and patients aged ≥ 60 years but were similar between urban and rural areas. After adjustment for patient factors, patients in urban areas and discharged home after IPR were associated with 83.5% and 61.9%, respectively, increase in ESD/OPR visits, while having a right-body stroke was associated with 23.5% increase. Older patients used ESD/OPR less than their younger counterparts (1.4% decrease per one year of older age). Available factors explained 12.3% of variation in ESD/OPR use. CONCLUSION: ESD/OPR utilization after IPR in Alberta was low and varied across age and geographic locations. Factors associated with use of ESD/OPR were identified but they could not fully explain variation of ESD/OPR use.

Essential oil of the leaves of psychotria asiatica L.: chemical composition, antioxidant, anti-inflammatory, and cytotoxic properties.

This study is focused on investigating the chemical composition and bioactive properties of the essential oil extracted from Psychotria asiatica L., a plant species known for its medicinal properties. Utilising gas chromatography-mass spectrometry (GC-MS) analysis, the essential oil from P. asiatica was found to contain 53 distinct constituents. Major compounds identified include (E)-citral (20.6%), 10-epi-γ-eudesmol (15.9%), (Z)-citral (10.5%), geraniol (7.4%), α-cadinol (6.7%), 7-epi-α-eudesmol (4.4%), linalool (3.7%), and α-muurolol (3.4%). The essential oil did not exhibit antioxidant activity, as indicated by an IC50 value of > 100 µg/mL, whereas the positive control L-Ascorbic acid had an IC50 of 7.37 ± 0.27 µg/mL in the DPPH model. Assessment of its anti-inflammatory potential revealed an inhibitory effect on NO production, with an IC50 value of 29.08 ± 1.54 µg/mL in Lipopolysaccharide-induced RAW264.7 macrophage cells. Furthermore, the essential oil demonstrated significant cytotoxicity against the SK-LU-1 cancer cell line, with an IC50 value of 39.75 ± 1.79 µg/mL according to the sulforhodamine B (SRB) assay.

Insights into the epidemiology and clinical aspects of post-COVID-19 conditions in adult.

OBJECTIVES: While most individuals infected with COVID-19 recover completely within a few weeks, some continue to experience lingering symptoms. This study was conducted to identify and describe the clinical and subclinical manifestations of adult patients from the long-term effects of COVID-19. METHODS: The study analyzed 205 medical records of inpatients (age ≥ 16 years, ≥ 4 weeks post-COVID-19 recovery, and a negative SARS-CoV-2 status at enrollment) at Thong Nhat Hospital, Vietnam, from 6 September 2021 to 26 August 2022, using R language software. RESULTS: The majority of patients hospitalized with long COVID-19 symptoms (92.68%) had normal consciousness. The most common symptoms on admission were fatigue (59.02%), dyspnea (52.68%), and cough (42.93%). In total, 80% of patients observed respiratory symptoms, primarily dyspnea, while 42.44% reported neurological symptoms, with sleep disturbance being the most common. Noticeably, 42.93% of patients experienced respiratory failure in the post-COVID-19 period, resembling acute respiratory distress syndrome. DISCUSSION: These findings provide crucial insights into the epidemiology, clinical, and subclinical aspects of post-COVID-19 conditions, shedding light on the prevalence of common symptoms and the demographic distribution of affected patients. Understanding these manifestations is vital for patient well-being, improved clinical practice, and targeted healthcare planning, potentially leading to better patient care, management, and future interventions.

Clinical significance of substrate characteristics and ablation outcomes in patients with atrial fibrillation and significant functional mitral regurgitation.

Background: Atrial fibrillation (AF) and mitral regurgitation (MR) have a complex interplay. Catheter ablation (CA) of AF may be a potential method to improve the severity of MR in AF patients. Methods: Patients with symptomatic AF and moderate to severe MR who underwent catheter ablation from 2011 to 2021 were retrospectively included in the study. Patients' baseline characteristics and electrophysiological features were examined. These patients were classified as group 1 with improved MR and group 2 with refractory MR after CA. Results: Fifty patients (age 60.2 ± 11.6 years, 29 males) were included in the study (32 in group 1 and 18 in group 2). Group 1 patients had a lower CHA2DS2-VASc score (1.7 ± 1.5 vs. 2.7 ± 1.5, P = 0.005) and had a lower incidence of hypertension (28.1% vs. 66.7%, P = 0.007) and diabetes mellitus (3.1% vs. 22.2%, P = 0.031) as compared to group 2 patients. Electroanatomic three-dimensional (3D) mapping showed that group 1 patients demonstrated less scars on the posterior bottom of the left atrium compared to group 2 patients (12.5% vs. 66.7%, P < 0.001). AF recurrence was not different between the two groups. After multivariate logistic regression analysis, a posterior bottom scar in the left atrium independently predicted refractory MR despite successful AF ablation. Conclusion: Most patients with AF and MR showed improvement of MR after AF ablation. A scar involving the posterior bottom of the left atrium is associated with poor recovery of MR.

Strategy for High-Energy Li-S Battery Coupling with a Li Metal Anode and a Sulfurized Polyacrylonitrile Cathode.

Among lithium-sulfur (Li-S) battery materials, sulfurized polyacrylonitrile (SPAN) has attracted substantial attention as a cathode material owing to its potential to bypass the problematic polysulfide formation and shuttling effect. Carbonate-based electrolytes have been eschewed compared with ether-based electrolytes because of their poor compatibility with Li metal anodes. In this work, we design and study an electrolyte comprising 0.8 M of lithium bis(trifluoromethanesulfonyl)imide, 0.2 M of lithium difluoro(oxalate)borate, and 0.05 M of lithium hexafluorophosphate in ethyl methyl carbonate/fluoroethylene carbonate = 3:1 v/v solution in the Li-S battery coupled with a Li metal anode and SPAN cathode. The well-designed carbonate-based electrolyte effectively stabilizes both electrodes, delivering high Coulombic efficiencies with stable cyclability. Studies using operando optical microscopy and atomic force microscopy demonstrate that dense, uniform Li deposition is promoted to suppress dendrite growth even at a high current density. Operando Raman spectroscopy reveals a reversible Li+ storage behavior in the SPAN structure through the cleavage of disulfide bonds and their redimerization during lithiation and delithiation. As a result, the proposed Li-S battery delivers an overall capacity retention of 73.5% over 1000 cycles, with high Coulombic efficiencies over 99.9%.

Hybridization Between the Canary Melon and a Vietnamese Non-sweet Melon Cultivar Aiming to Improve the Growth Performance and Fruit Quality in Melon (Cucumis melo L.).

Canary melon has been widely consumed as a dessert fruit due to its fragrance, sweetness, and flavorful taste. However, the cultivation of this cultivar has been challenged in Vietnam because of its weak growth performance and high susceptibility to local pathogens. In this study, we aim to generate the hybrid melon lines between the Canary melon and a local non-sweet melon that are expected to produce good quality fruits as well as to show better growth performance in the local cultivation conditions. Two crossing pairs including (1) MS hybrid (♂ non-sweet melon × â™€ Canary melon) and (2) MN-S hybrid (♂ Canary melon × â™€ non-sweet melon) were carried out and two hybrid lines were subsequently obtained. Next, different phenotypic and physiological parameters such as stem length, stem diameter, 10th leaf diameter, fruit size, fruit weight, and fruit sweetness (pH, °Brix, and soluble sugar contents) were examined and compared between the parental lines (Canary melon and non-sweet melon) and the hybrid lines (MS and MN-S). The results showed that the stem length and fruit size and weight of MS and MN-S hybrids were higher than those of Canary melon. Basically, the content of sugars (sucrose, glucose, and fructose) is a primary and important factor in determining the sweetness of the melon. The pH, °Brix, sucrose and glucose contents of MS hybrid and Canary melon fruits were higher in comparison to MN-S and non-sweet melon fruits. Accordingly, the transcript levels of different sugar metabolism-related genes including SUCROSE SYNTHASE 1 (SUS1), SUS2, UDPGLC EPIMERASE 3 (UGE3), and SUCROSE-P SYNTHASE 2 (SPS2) were examined in all studied lines. In the fruits, the expression levels of these genes were found to be highest in the Canary melon, average in the MS hybrid, and relatively low in the MN-S hybrid and non-sweet melons. Taken together, the heterosis in terms of plant and fruit size was obviously observed in this crossing approach. The relatively high fruit sweetness in the MS hybrid (the mother is Canary melon) also implies that the choice of the mother for crossing is very important since it can determine the fruit quality of the offspring.

LASP1, CERS6, and Actin Form a Ternary Complex That Promotes Cancer Cell Migration.

CERS6 is associated with metastasis and poor prognosis in non-small cell lung cancer (NSCLC) patients through d18:1/C16:0 ceramide (C16 ceramide)-mediated cell migration, though the detailed mechanism has not been elucidated. In the present study, examinations including co-immunoprecipitation, liquid chromatography, and tandem mass spectrometry analysis were performed to identify a novel binding partner of CERS6. Among the examined candidates, LASP1 was a top-ranked binding partner, with the LIM domain possibly required for direct interaction. In accord with those findings, CERS6 and LASP1 were found to co-localize on lamellipodia in several lung cancer cell lines. Furthermore, silencing of CERS6 and/or LASP1 significantly suppressed cell migration and lamellipodia formation, whereas ectopic addition of C16 ceramide partially rescued those phenotypes. Both LASP1 and CERS6 showed co-immunoprecipitation with actin, with those interactions markedly reduced when the LASP1-CERS6 complex was abolished. Based on these findings, it is proposed that LASP1-CERS6 interaction promotes cancer cell migration.

Effect of strain rates on the mechanical response of whole muscle bundle.

Muscle injuries frequently happen during sports activities and exercise, which could have serious consequences if not diagnosed and treated promptly. This research aims to investigate the quasi-static and dynamic responses of over 30 fresh frog semitendinosus muscles utilizing Split Hopkinson Pressure Bars (SHPB) and a material testing system under strain rates between 0.001 ~ 200 s-1. To accommodate the special shape of muscle-tendon-bone samples, PLA clampers were produced by the 3D printer to properly hold and prevent slipping during the testing process. The mechanical characteristics of the whole muscle bundle, including Young's modulus and stress-strain curve, are illustrated at various strain rates. The findings showed that the muscle properties were sensitive to strain rate when under passive deformation. Both maximum stress and Young's modulus increased with the rise of strain rate, and modulus at 200 s-1 can be as high as 10 times compared with quasi-static conditions.

Revisiting the roles of dopants in g-C3N4 nanostructures for piezo-photocatalytic production of H2O2: a case study of selenium and sulfur.

The sustainable production of hydrogen peroxide (H2O2) from oxygen and water has become an exciting research hotspot in the scientific community due to the importance of this fine chemical in various fields. Besides, piezo-photocatalysis is an emerging star for generating H2O2 from these green reagents. For developing catalysts for this specific application, doping heteroatoms into carbon-based materials such as graphitic carbon nitrides (g-C3N4) is a growing fascination among worldwide scientists. However, systematic study on the effects of doping precursors on the catalytic results is still rare. Herein, we fabricated sulfur (S) and selenium (Se) doped g-C3N4 with various doping precursors to evaluate the effects of these agents on the production of H2O2 under light and ultrasound irradiation. Based on the results, Se-doped g-C3N4 gave an outstanding catalytic performance compared to S-doped g-C3N4, even in a significantly low quantity of Se. In order to fully understand the chemical, physical, optical, and electronic properties of pristine g-C3N4 and its derivatives, the as-prepared materials were thoroughly analyzed with various tools. Thus, this study would give more profound insights into doping techniques for carbon-based materials and encourage further research on the design and development of piezo-photocatalysts for practical applications.

Bipartite invariance in mouse primary visual cortex.

A defining characteristic of intelligent systems, whether natural or artificial, is the ability to generalize and infer behaviorally relevant latent causes from high-dimensional sensory input, despite significant variations in the environment. To understand how brains achieve generalization, it is crucial to identify the features to which neurons respond selectively and invariantly. However, the high-dimensional nature of visual inputs, the non-linearity of information processing in the brain, and limited experimental time make it challenging to systematically characterize neuronal tuning and invariances, especially for natural stimuli. Here, we extended "inception loops" - a paradigm that iterates between large-scale recordings, neural predictive models, and in silico experiments followed by in vivo verification - to systematically characterize single neuron invariances in the mouse primary visual cortex. Using the predictive model we synthesized Diverse Exciting Inputs (DEIs), a set of inputs that differ substantially from each other while each driving a target neuron strongly, and verified these DEIs' efficacy in vivo. We discovered a novel bipartite invariance: one portion of the receptive field encoded phase-invariant texture-like patterns, while the other portion encoded a fixed spatial pattern. Our analysis revealed that the division between the fixed and invariant portions of the receptive fields aligns with object boundaries defined by spatial frequency differences present in highly activating natural images. These findings suggest that bipartite invariance might play a role in segmentation by detecting texture-defined object boundaries, independent of the phase of the texture. We also replicated these bipartite DEIs in the functional connectomics MICrONs data set, which opens the way towards a circuit-level mechanistic understanding of this novel type of invariance. Our study demonstrates the power of using a data-driven deep learning approach to systematically characterize neuronal invariances. By applying this method across the visual hierarchy, cell types, and sensory modalities, we can decipher how latent variables are robustly extracted from natural scenes, leading to a deeper understanding of generalization.

Pattern completion and disruption characterize contextual modulation in mouse visual cortex.

A key role of sensory processing is integrating information across space. Neuronal responses in the visual system are influenced by both local features in the receptive field center and contextual information from the surround. While center-surround interactions have been extensively studied using simple stimuli like gratings, investigating these interactions with more complex, ecologically-relevant stimuli is challenging due to the high dimensionality of the stimulus space. We used large-scale neuronal recordings in mouse primary visual cortex to train convolutional neural network (CNN) models that accurately predicted center-surround interactions for natural stimuli. These models enabled us to synthesize surround stimuli that strongly suppressed or enhanced neuronal responses to the optimal center stimulus, as confirmed by in vivo experiments. In contrast to the common notion that congruent center and surround stimuli are suppressive, we found that excitatory surrounds appeared to complete spatial patterns in the center, while inhibitory surrounds disrupted them. We quantified this effect by demonstrating that CNN-optimized excitatory surround images have strong similarity in neuronal response space with surround images generated by extrapolating the statistical properties of the center, and with patches of natural scenes, which are known to exhibit high spatial correlations. Our findings cannot be explained by theories like redundancy reduction or predictive coding previously linked to contextual modulation in visual cortex. Instead, we demonstrated that a hierarchical probabilistic model incorporating Bayesian inference, and modulating neuronal responses based on prior knowledge of natural scene statistics, can explain our empirical results. We replicated these center-surround effects in the multi-area functional connectomics MICrONS dataset using natural movies as visual stimuli, which opens the way towards understanding circuit level mechanism, such as the contributions of lateral and feedback recurrent connections. Our data-driven modeling approach provides a new understanding of the role of contextual interactions in sensory processing and can be adapted across brain areas, sensory modalities, and species.

Towards a Foundation Model of the Mouse Visual Cortex.

Understanding the brain's perception algorithm is a highly intricate problem, as the inherent complexity of sensory inputs and the brain's nonlinear processing make characterizing sensory representations difficult. Recent studies have shown that functional models-capable of predicting large-scale neuronal activity in response to arbitrary sensory input-can be powerful tools for characterizing neuronal representations by enabling high-throughput in silico experiments. However, accurately modeling responses to dynamic and ecologically relevant inputs like videos remains challenging, particularly when generalizing to new stimulus domains outside the training distribution. Inspired by recent breakthroughs in artificial intelligence, where foundation models-trained on vast quantities of data-have demonstrated remarkable capabilities and generalization, we developed a "foundation model" of the mouse visual cortex: a deep neural network trained on large amounts of neuronal responses to ecological videos from multiple visual cortical areas and mice. The model accurately predicted neuronal responses not only to natural videos but also to various new stimulus domains, such as coherent moving dots and noise patterns, underscoring its generalization abilities. The foundation model could also be adapted to new mice with minimal natural movie training data. We applied the foundation model to the MICrONS dataset: a study of the brain that integrates structure with function at unprecedented scale, containing nanometer-scale morphology, connectivity with >500,000,000 synapses, and function of >70,000 neurons within a ~1mm3 volume spanning multiple areas of the mouse visual cortex. This accurate functional model of the MICrONS data opens the possibility for a systematic characterization of the relationship between circuit structure and function. By precisely capturing the response properties of the visual cortex and generalizing to new stimulus domains and mice, foundation models can pave the way for a deeper understanding of visual computation.

Outbreaks of SARS-CoV-2 Infections in Nursing Homes during Periods of Delta and Omicron Predominance, United States, July 2021-March 2022.

SARS-CoV-2 infections among vaccinated nursing home residents increased after the Omicron variant emerged. Data on booster dose effectiveness in this population are limited. During July 2021-March 2022, nursing home outbreaks in 11 US jurisdictions involving >3 infections within 14 days among residents who had received at least the primary COVID-19 vaccine(s) were monitored. Among 2,188 nursing homes, 1,247 outbreaks were reported in the periods of Delta (n = 356, 29%), mixed Delta/Omicron (n = 354, 28%), and Omicron (n = 536, 43%) predominance. During the Omicron-predominant period, the risk for infection within 14 days of an outbreak start was lower among boosted residents than among residents who had received the primary vaccine series alone (risk ratio [RR] 0.25, 95% CI 0.19-0.33). Once infected, boosted residents were at lower risk for all-cause hospitalization (RR 0.48, 95% CI 0.40-0.49) and death (RR 0.45, 95% CI 0.34-0.59) than primary vaccine-only residents.

Severe acute respiratory coronavirus virus 2 (SARS-CoV-2) outbreaks in nursing homes involving residents who had completed a primary coronavirus disease 2019 (COVID-19) vaccine series-13 US jurisdictions, July-November 2021.

Among nursing home outbreaks of coronavirus disease 2019 (COVID-19) with ≥3 breakthrough infections when the predominant severe acute respiratory coronavirus virus 2 (SARS-CoV-2) variant circulating was the SARS-CoV-2 δ (delta) variant, fully vaccinated residents were 28% less likely to be infected than were unvaccinated residents. Once infected, they had approximately half the risk for all-cause hospitalization and all-cause death compared with unvaccinated infected residents.

Length of Stay and Home Discharge for Patients with Inpatient Stroke Rehabilitation.

OBJECTIVE: To examine temporal trends and geographic variations and predict inpatient rehabilitation (IPR) length of stay (LOS) and home discharge for stroke patients. METHODS: Patients aged ≥18 years who were admitted to an IPR facility in Alberta, Canada, between 04/2014 and 03/2018 (years 2014-2017) were included. Predictors of LOS and home discharge were examined using 2014-2016 data and validated using 2017 data. Multivariable linear regression (MLR), multivariable negative binomial (MNB), and multivariable quantile regressions (MQR) were used to examine LOS, and logistic regression was used for home discharge. RESULTS: We included 2686 rehabilitation admissions between 2014 and 2017. The mean LOS decreased (2014: 71 days; 2017: 62.1 days; p = 0.003) during the study period and was shortest in Edmonton (59.1 days) compared to Calgary (66 days) or other localities (70.8 days; p < 0.001). Three-quarters of patients were discharged home and this proportion remained unchanged between 2014 and 2017. Calgary patients were more likely to be discharged home than those in Edmonton (OR = 0.62; p = 0.019) or other localities (OR = 0.39; p = 0.011). The MLR and MNB models provided accurate prediction for the mean LOS (predicted = 59.9 and 60.8 days, respectively, vs. actual = 62.1 days; both p > 0.5), while the MQR model did so for the median LOS (predicted = 44.3 days vs. actual = 44 days; p = 0.09). The logistic regression resulted in 82.4% of correct prediction, a sensitivity of 91.6%, and a specificity of 50.7% for home discharge. CONCLUSIONS: Rehabilitation LOS decreased while the proportion of home discharge remained unchanged during the study period. Both varied across health zones. Identifiable statistical models provided accurate prediction with a separate patient cohort.

Economic impact of self-administered subcutaneous versus clinic-administered intravenous immunoglobulin G therapy in Alberta, Canada: a population-based cohort study.

BACKGROUND: Self-administered subcutaneous immunoglobulin G (SCIg) reduces nursing time and eliminates the need for treatment at ambulatory care clinics, as compared with clinic-based intravenously administered IgG (IVIg), and are therapeutically equivalent. Estimating the economic impact of self-administered SCIg versus clinic-administered IVIg therapy may guide treatment recommendations. METHODS: A retrospective population-based cohort study using administrative data from Alberta was performed; those treated with IgG between April 1, 2012 and March 31, 2019 were included. Costs for medical laboratory staff and nursing time, as well as ambulatory care visits were considered. Univariate generalized linear model regression with gamma distribution and log link was used to compare cost ($CDN 2020) between SCIg and IVIg administration. Stratified analysis by age (≥ 18-years; < 18-years) was performed. RESULTS: Among 7,890 (6,148 adults; 1,742 children) individuals who received IgG, the average administration cost per patient-year of self-administered SCIg was $5,386 (95% confidence interval [CI] $5,039, $5,734) lower than clinic-administered IVIg; per patient-year cost of self-administered SCIg was $817 (95% CI $723, $912) versus $6,204 (95% CI $6,100, $6,308) for clinic-administered IVIg. The per patient-year cost of self-administered SCIg was $5,931 (95% CI $5,543, $6,319) lower among adults and $3,177 (95% CI $2,473, $3,882) lower among children compared with clinic-administered IVIg. An estimated $31.0 million (95% CI $29.0, $33.0) in cost savings to the health system would be realised if 80% of individuals switched from clinic-administered IVIg to self-administered SCIg. CONCLUSIONS: Self-administered SCIg is substantially less costly from a health care payer perspective in Canada. Within this type of health system, switching to self-administered SCIg has the potential to reduce overall health care costs, lessen nursing burden, and may increase clinic-based capacity for others.

Thrombosis and thromboembolism: Brighton collaboration case definition and guidelines for data collection, analysis, and presentation of immunization safety data.

This is a Brighton Collaboration case definition of thrombosis and thromboembolism to be used in the evaluation of adverse events following immunization, and for epidemiologic studies for the assessment of background incidence or hypothesis testing. The case definition was developed by a group of experts convened by the Coalition for Epidemic Preparedness Innovations (CEPI) in the context of active development of SARS-CoV-2 vaccines. The case definition format of the Brighton Collaboration was followed to develop a consensus definition and defined levels of certainty, after an exhaustive review of the literature and expert consultation. The document underwent peer review by the Brighton Collaboration Network and by selected expert reviewers prior to submission.

VinDr-CXR: An open dataset of chest X-rays with radiologist's annotations.

Most of the existing chest X-ray datasets include labels from a list of findings without specifying their locations on the radiographs. This limits the development of machine learning algorithms for the detection and localization of chest abnormalities. In this work, we describe a dataset of more than 100,000 chest X-ray scans that were retrospectively collected from two major hospitals in Vietnam. Out of this raw data, we release 18,000 images that were manually annotated by a total of 17 experienced radiologists with 22 local labels of rectangles surrounding abnormalities and 6 global labels of suspected diseases. The released dataset is divided into a training set of 15,000 and a test set of 3,000. Each scan in the training set was independently labeled by 3 radiologists, while each scan in the test set was labeled by the consensus of 5 radiologists. We designed and built a labeling platform for DICOM images to facilitate these annotation procedures. All images are made publicly available in DICOM format along with the labels of both the training set and the test set.

Blurry Vision as a Presentation of Waldenström's Macroglobulinemia: A Case Report With Review of Current Management.

A patient was diagnosed with Waldenström's macroglobulinemia (WM) after the initial findings of anemia and ophthalmological findings of retinal hemorrhage. Upon further workup, the patient was found to have an IgM predominant monoclonal gammopathy on serum protein electrophoresis (SPEP) and urine protein electrophoresis (UPEP). This highlights the need for open communication between different specialties, streamlining rapid and accurate diagnosis. Also highlighted are the unique pathophysiological changes involved in the development of WM. A patient's primary complaint was blurry vision. After the patient was noted to have a monoclonal gammopathy on SPEP, bone marrow biopsy was performed. The bone marrow biopsy findings were consistent with lymphoplasmacytic lymphoma (LPL). The patient received plasmapheresis and chemotherapy. The disease course is described. The patient saw rapid improvement in all lab abnormalities after the beginning of the appropriate therapy of plasmapheresis and chemotherapy. Remission is common with WM. Regular follow-up with this patient is important.