Central and peripheral nervous system involvement by COVID-19: a systematic review of the pathophysiology, clinical manifestations, neuropathology, neuroimaging, electrophysiology, and cerebrospinal fluid findings.

BACKGROUND: SARS-CoV-2 can affect the human brain and other neurological structures. An increasing number of publications report neurological manifestations in patients with COVID-19. However, no studies have comprehensively reviewed the clinical and paraclinical characteristics of the central and peripheral nervous system's involvement in these patients. This study aimed to describe the features of the central and peripheral nervous system involvement by COVID-19 in terms of pathophysiology, clinical manifestations, neuropathology, neuroimaging, electrophysiology, and cerebrospinal fluid findings. METHODS: We conducted a comprehensive systematic review of all the original studies reporting patients with neurological involvement by COVID-19, from December 2019 to June 2020, without language restriction. We excluded studies with animal subjects, studies not related to the nervous system, and opinion articles. Data analysis combined descriptive measures, frequency measures, central tendency measures, and dispersion measures for all studies reporting neurological conditions and abnormal ancillary tests in patients with confirmed COVID-19. RESULTS: A total of 143 observational and descriptive studies reported central and peripheral nervous system involvement by COVID-19 in 10,723 patients. Fifty-one studies described pathophysiologic mechanisms of neurological involvement by COVID-19, 119 focused on clinical manifestations, 4 described neuropathology findings, 62 described neuroimaging findings, 28 electrophysiology findings, and 60 studies reported cerebrospinal fluid results. The reviewed studies reflect a significant prevalence of the nervous system's involvement in patients with COVID-19, ranging from 22.5 to 36.4% among different studies, without mortality rates explicitly associated with neurological involvement by SARS-CoV-2. We thoroughly describe the clinical and paraclinical characteristics of neurological involvement in these patients. CONCLUSIONS: Our evidence synthesis led to a categorical analysis of the central and peripheral neurological involvement by COVID-19 and provided a comprehensive explanation of the reported pathophysiological mechanisms by which SARS-CoV-2 infection may cause neurological impairment. International collaborative efforts and exhaustive neurological registries will enhance the translational knowledge of COVID-19's central and peripheral neurological involvement and generate therapeutic decision-making strategies. REGISTRATION: This review was registered in PROSPERO 2020 CRD42020193140 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020193140.

Incremental value of live/real-time three-dimensional transthoracic echocardiography over the two-dimensional technique in the assessment of left ventricular endocardial rupture with myocardial dissection and contained apical epicardial rupture following myocardial infarction.

We report the incremental value of live/real-time three-dimensional transthoracic echocardiography (3DTTE) over two-dimensional transthoracic echocardiography (2DTTE) in making a definitive diagnosis of left ventricular endocardial rupture with myocardial dissection and contained apical epicardial rupture in an elderly male patient presenting with acute myocardial infarction. To the best of our knowledge, this has not been described previously.

A novel zinc finger protein-based amperometric biosensor for miRNA determination.

This paper reports a simple electrochemical strategy for the determination of microRNAs (miRNAs) using a commercial His-Tag-Zinc finger protein (His-Tag-ZFP) that binds preferably (but non-sequence specifically) RNA hybrids over ssRNAs, ssDNAs, and dsDNAs. The strategy involves the use of magnetic beads (His-Tag-Isolation-MBs) as solid support to capture the conjugate formed in homogenous solution between His-Tag-ZFP and the dsRNA homohybrid formed between the target miRNA (miR-21 selected as a model) and a biotinylated synthetic complementary RNA detector probe (b-RNA-Dp) further conjugated with a streptavidin-horseradish peroxidase (Strep-HRP) conjugate. The electrochemical detection is carried out by amperometry at disposable screen-printed carbon electrodes (SPCEs) (- 0.20 V vs Ag pseudo-reference electrode) upon magnetic capture of the resultant magnetic bioconjugates and H2O2 addition in the presence of hydroquinone (HQ). The as-prepared biosensor exhibits a dynamic concentration range from 3.0 to 100 nM and a detection limit (LOD) of 0.91 nM for miR-21 in just ~ 2 h. An acceptable discrimination was achieved between the target miRNA and other non-target nucleic acids (ssDNA, dsDNA, ssRNA, DNA-RNA, miR-122, miR-205, and single central- or terminal-base mismatched sequences). The biosensor was applied to the analysis of miR-21 from total RNA (RNAt) extracted from epithelial non-tumorigenic and adenocarcinoma breast cells without target amplification, pre-concentration, or reverse transcription steps. The versatility of the methodology due to the ZFP's non-sequence-specific binding behavior makes it easily extendable to determine any target RNA only by modifying the biotinylated detector probe.

Diabetes and obesity during pregnancy are associated with oxidative stress genotoxicity in newborns.

Objective To compare the level of oxidative deoxyribonucleic acid (DNA) damage (genotoxicity) between the offspring of mothers with and without diabetes diagnosed during pregnancy and its association with maternal body mass index (BMI). Methods We measured 8-hydroxy-deoxyguanosine (8-OH-dG), a marker of DNA oxidative damage, in venous umbilical cord plasma from newborns of mothers with (n=34) and without (n=56) diabetes diagnoses obtained during pregnancy. Two markers of oxidative stress - namely, nitric oxide degradation products (NOx) and total glutathione (GSH) - were quantified in both mothers and newborns. The effects of BMI, glycated hemoglobin (HbA1c), age and delivery mode were also analyzed. Results Newborns of mothers with diabetes during pregnancy exhibited higher levels of 8-OH-dG than those of mothers without diabetes (P<0.001). The other markers of oxidative stress were also higher in both mothers with diabetes and their newborns, with the exception of NOx in the mothers. The association of diabetes with 8-OH-dG was independent of other analyzed factors. Conclusion The offspring of mothers with diabetes during pregnancy are born with increased genotoxicity than the offspring of mothers without diabetes. BMI and HbA1c display an independent association with 8-OH-dG, particularly in the offspring of mothers not diagnosed with diabetes.

In vitro fermentation of oligosaccharides obtained from enzymatic hydrolysis of Opuntia streptacantha mucilage.

BACKGROUND: Among Cactaceae, the genus Opuntia is widely known for the use of its biomass as cattle fodder and in human nutrition (e.g. species such as Opuntia ficus indica and Opuntia streptacantha). In particular, O. streptacantha (OS) produces abundant mucilage and, hence, the characterization of its properties and nutritional value is important. Accordingly, determination of the dietary fiber content of the OS mucilage and the fermentability of its hydrolysis products (oligosaccharides, OLI) is important for developing new uses of the crop as a functional food. RESULTS: The values for insoluble dietary fiber and soluble dietary fiber in the mucilage were 204.6 and 371.6 g kg-1 , respectively. After hydrolysis of OS mucilage with α-amylase, three purified fractions of OLI were evaluated (OLI-A, OLI-B and OLI-C). OLI (1% w/v) stimulated the growth of the commercial probiotic strains (Lactobacillus acidophilus, Lactobacillus casei and Bifidobacterium animalis subsp. lactis) in vitro, showing behaviors similar to those of commercial inulin. The production of short chain fatty acids (SCFAs) in the fermentation broth was also determined. The final pH of the fermentation broth as well as the identification and concentrations of SCFA depended on the type of OLI and probiotic used. CONCLUSION: The OS mucilage is an unconventional fiber source and can be used to produce non-digestible OLI as functional compounds. This knowledge will be useful for proposing new sustainable ways of processing cacti crops for food and industrial purposes. © 2018 Society of Chemical Industry.

Drugs With Anticholinergic Potential and Risk of Falls With Hip Fracture in the Elderly Patients: A Case-Control Study.

BACKGROUND/OBJECTIVE: To determine the association between the use of anticholinergic drugs and the risk of falls with hip fracture in a population older than 60 years. METHODS: A case-control study in patients older than 60 years with a diagnosis of hip fracture. All drugs dispensed during the previous 30 days were identified. Sociodemographic, clinical, pharmacological (drugs according to the Anticholinergic Risk Scale [ARS]), and polypharmacy variables were analyzed. MEASUREMENTS: Falls with hip fracture and type of drug according to the ARS. RESULTS: A total of 300 patients with hip fracture and 600 controls were included. The mean age was 81.6 ± 8.9 years, with female predominance (71.3%). The use of drugs with moderate (odds ratio [OR]: 1.97, 95% confidence interval [CI]: 1.19-3.27) or high ARS scores (OR: 1.83, 95% CI: 1.13-2.96) increased the probability of fracture. CONCLUSIONS: There was an association between the use of drugs with anticholinergic properties and the probability of hip fracture in elderly patients and it was possible to establish the level of risk.

Association between the use of benzodiazepines and opioids with the risk of falls and hip fractures in older adults.

ABSTRACTBackground:To determine the association between the use of opioids and benzodiazepines and the risk of falls with hip fracture in populations older than 65 years in Colombia. METHODS: A case-control study with patients older than 65 years with diagnosis of hip fracture. Two controls were obtained per case. The drugs dispensed in the previous 30 days were identified. Sociodemographic, diagnostic, pharmacological (opioids and benzodiazepines), and polypharmacy variables were analyzed. A logistic regression model was used to analyze the risk of fall with hip fracture while using these drugs. RESULTS: We included 287 patients with hip fractures and 574 controls. There was a female predominance (72.1%) and a mean age of 82.4 ± 8.0 years. Of the patients, 12.7% had been prescribed with opioids and 4.2% with benzodiazepines in the previous month. The adjusted multivariate analysis found that using opioids (OR:4.49; 95%CI:2.72-7.42) and benzodiazepines (OR:3.73; 95%CI:1.60-8.70) in the month prior to the event was significantly associated with a greater probability of suffering a fall with hip fracture. CONCLUSIONS: People who are taking opioids and benzodiazepines have increased risk for hip fracture in Colombia. Strategies to educate physicians regarding the pharmacology of older adults should be strengthened.

How I Do It: Hydrogel spacer placement in men scheduled to undergo prostate radiotherapy.

Hydrogel spacer placement between the prostate and rectum in men scheduled to undergo prostate radiotherapy is an emerging technique well suited for urologists. The hydrogel spacer reduces rectal injury during radiotherapy by displacing the rectum away from the high dose region. Following radiotherapy the hydrogel spacer then liquifies, is absorbed, and then clears via renal filtration in approximately 6 months. Herein we describe the appropriate patients eligible for this procedure, and the application technique we use in our clinic.

Single-Step Incubation Determination of miRNAs in Cancer Cells Using an Amperometric Biosensor Based on Competitive Hybridization onto Magnetic Beads.

This work reports an amperometric biosensor for the determination of miRNA-21, a relevant oncogene. The methodology involves a competitive DNA-target miRNA hybridization assay performed on the surface of magnetic microbeads (MBs) and amperometric transduction at screen-printed carbon electrodes (SPCEs). The target miRNA competes with a synthetic fluorescein isothiocyanate (FITC)-modified miRNA with an identical sequence for hybridization with a biotinylated and complementary DNA probe (b-Cp) immobilized on the surface of streptavidin-modified MBs (b-Cp-MBs). Upon labeling, the FITC-modified miRNA attached to the MBs with horseradish peroxidase (HRP)-conjugated anti-FITC Fab fragments and magnetic capturing of the MBs onto the working electrode surface of SPCEs. The cathodic current measured at -0.20 V (versus the Ag pseudo-reference electrode) was demonstrated to be inversely proportional to the concentration of the target miRNA. This convenient biosensing method provided a linear range between 0.7 and 10.0 nM and a limit of detection (LOD) of 0.2 nM (5 fmol in 25 µL of sample) for the synthetic target miRNA without any amplification step. An acceptable selectivity towards single-base mismatched oligonucleotides, a high storage stability of the b-Cp-MBs, and usefulness for the accurate determination of miRNA-21 in raw total RNA (RNAt) extracted from breast cancer cells (MCF-7) were demonstrated.

Photonic lantern kW-class fiber amplifier.

Pump-limited kW-class operation in a multimode fiber amplifier using adaptive mode control and a photonic lantern front end was achieved. An array of three single-mode fiber inputs was used to adaptively inject the appropriate superposition of input modes in a three-mode gain fiber to achieve the desired mode at the output. Mode fluctuations at high power were compensated by adjusting the relative phase, amplitude, and polarization of the single-mode fiber inputs. The outlook for further power scaling and adaptive-optic compensation is described.

Consistency of Renal Stone Volume Measurements Across CT Scanner Model and Reconstruction Algorithm Configurations.

OBJECTIVE: The objective of this prospective study is to evaluate the consistency of renal stone volume estimation using dual-energy CT across scanner model and reconstruction algorithm configurations. SUBJECTS AND METHODS: Patients underwent scanning with routine kidney stone composition protocols on both second- and third-generation dual-source CT scanners. Images were reconstructed using filtered back projection and iterative reconstruction (IR). In addition, a modified IR kernel on the third-generation CT scanner was evaluated. Individual kidney stone volumes were determined and compared. RESULTS: No significant difference was noted in measured volumes between filtered back-projection data, IR data from the second-generation scanner, and the modified IR kernel data (p > 0.05). The third-generation commercially available IR kernel yielded lower volumes than did the other configurations (p < 0.0001). CONCLUSION: With the use of a modified kernel for the third-generation scanner, patients being monitored for changes in kidney stone volume can undergo scanning performed with second- or third-generation dual-energy CT scanners, and the images obtained can be reconstructed with either filtered back projection or IR without the introduction of bias into kidney stone volume measurements.

Magnetic Beads-Based Sensor with Tailored Sensitivity for Rapid and Single-Step Amperometric Determination of miRNAs.

This work describes a sensitive amperometric magneto-biosensor for single-step and rapid determination of microRNAs (miRNAs). The developed strategy involves the use of direct hybridization of the target miRNA (miRNA-21) with a specific biotinylated DNA probe immobilized on streptavidin-modified magnetic beads (MBs), and labeling of the resulting heteroduplexes with a specific DNA-RNA antibody and the bacterial protein A (ProtA) conjugated with an horseradish peroxidase (HRP) homopolymer (Poly-HRP40) as an enzymatic label for signal amplification. Amperometric detection is performed upon magnetic capture of the modified MBs onto the working electrode surface of disposable screen-printed carbon electrodes (SPCEs) using the H2O2/hydroquinone (HQ) system. The magnitude of the cathodic signal obtained at -0.20 V (vs. the Ag pseudo-reference electrode) demonstrated linear dependence with the concentration of the synthetic target miRNA over the 1.0 to 100 pM range. The method provided a detection limit (LOD) of 10 attomoles (in a 25 µL sample) without any target miRNA amplification in just 30 min (once the DNA capture probe-MBs were prepared). This approach shows improved sensitivity compared with that of biosensors constructed with the same anti-DNA-RNA Ab as capture instead of a detector antibody and further labeling with a Strep-HRP conjugate instead of the Poly-HRP40 homopolymer. The developed strategy involves a single step working protocol, as well as the possibility to tailor the sensitivity by enlarging the length of the DNA/miRNA heteroduplexes using additional probes and/or performing the labelling with ProtA conjugated with homopolymers prepared with different numbers of HRP molecules. The practical usefulness was demonstrated by determination of the endogenous levels of the mature target miRNA in 250 ng raw total RNA (RNAt) extracted from human mammary epithelial normal (MCF-10A) and cancer (MCF-7) cells and tumor tissues.

Photonic lantern adaptive spatial mode control in LMA fiber amplifiers.

We demonstrate adaptive-spatial mode control (ASMC) in few-moded double-clad large mode area (LMA) fiber amplifiers by using an all-fiber-based photonic lantern. Three single-mode fiber inputs are used to adaptively inject the appropriate superposition of input modes in a multimode gain fiber to achieve the desired mode at the output. By actively adjusting the relative phase of the single-mode inputs, near-unity coherent combination resulting in a single fundamental mode at the output is achieved.

A phytosociological analysis and synopsis of the dry woodlands and succulent vegetation of the Peruvian Andes.

A phytosociological approach to dry forest and cactus communities on the occidental slopes of the Peruvian Andes is presented in base of 164 plots carried out following the Braun-Blanquet method. From them, 52 have been made recently, and the other 112 were taken from the literature. After a multivariate analysis, using a hierarchical clustering and a detendred correspondence analysis, the Acacio-Prosopidetea class (dry forest and cactus communities, developed on soils with some edaphic humidity or precipitations derived from El Niño Current), the Opuntietea sphaericae class (cactus communities of central and southern Peru, on few stabilized rocky or sandy soils) and the Carico-Caesalpinietea class (dry forests of the Peruvian coastal desert, influenced by the maritime humidity of the cold Humboldt Current), are differentiated. Within the Acacio-Prosopidetea class, two alliances are commented: the Bursero-Prosopidion pallidae (with two new associations Loxopterygio huasanginis-Neoraimondietum arequipensis and Crotono ruiziani-Acacietum macracanthae), and the new alliance Baccharido-Jacarandion acutifoliae (with the new associations Armatocereo balsasensis-Cercidietum praecocis and Diplopterydo leiocarpae-Acacietum macracanthae). For the Opuntietea sphaericae class, the association Haageocereo versicoloris-Armatocereetum proceri (Espostoo-Neoraimondion) is described on the basis of plots from hyperarid localities of central Peru. Finally, a typological classification of the studied plant communities is given.

Application of a Box-Behnken design for optimizing the extraction process of agave fructans (Agave tequilana Weber var. Azul).

BACKGROUND: Agave (Agave tequilana Weber var. Azul) is an industrially important crop in México since it is the only raw material appropriate to produce tequila, an alcoholic beverage. Nowadays, however, these plants have also a nutritional interest as a source of functional food ingredients, owing to the prebiotic potential of agave fructans. In this study, a Box-Behnken design was employed to determine the influence of temperature, liquid:solid ratio and time in a maceration process for agave fructan extraction and optimization. RESULTS: The developed regression model indicates that the selected study variables were statistical determinants for the extraction yield, and the optimal conditions for maximum extraction were a temperature of 60 °C, a liquid:solid ratio of 10:1 (v/w) and a time of 26.7 min, corresponding to a predicted extraction yield of 37.84%. Through selective separation via precipitation with ethanol, fructans with a degree of polymerization of 29.1 were obtained. CONCLUSION: Box-Behnken designs are useful statistical methods for optimizing the extraction process of agave fructans. A mixture of carbohydrates was obtained from agave powder. This optimized method can be used to obtain fructans for use as prebiotics or as raw material for obtaining functional oligosaccharides. © 2015 Society of Chemical Industry.

Catalytic role of TiO(2) terminal oxygen atoms in liquid-phase photocatalytic reactions: oxidation of aromatic compounds in anhydrous acetonitrile.

On the basis of experiments carried out with controlled amounts of residual oxygen and water, or by using oxygen-isotope-labeled Ti(18) O2 as the photocatalyst, we demonstrate that (18) Os atoms behave as real catalytic species in the photo-oxidation of acetonitrile-dissolved aromatic compounds such as benzene, phenol, and benzaldehyde with TiO2 . The experimental evidence allows a terminal-oxygen indirect electron-transfer (TOIET) mechanism to be proposed, which is a new pathway that involves the trapping of free photogenerated valence-band holes at Os species and their incorporation into the reaction products, with simultaneous generation of oxygen vacancies at the TiO2 surface and their subsequent healing with oxygen atoms from either O2 or H2 O molecules that are dissolved in the liquid phase. According to the TOIET mechanism, the TiO2 surface is not considered to remain stable, but is continuously changing in the course of the photocatalytic reaction, challenging earlier interpretations of TiO2 photocatalytic phenomena.

Optical phased-array ladar.

We demonstrate a ladar with 0.5 m class range resolution obtained by integrating a continuous-wave optical phased-array transmitter with a Geiger-mode avalanche photodiode receiver array. In contrast with conventional ladar systems, an array of continuous-wave sources is used to effectively pulse illuminate a target by electro-optically steering far-field fringes. From the reference frame of a point in the far field, a steered fringe appears as a pulse. Range information is thus obtained by measuring the arrival time of a pulse return from a target to a receiver pixel. This ladar system offers a number of benefits, including broad spectral coverage, high efficiency, small size, power scalability, and versatility.

Hallucinations in patients with obstructive sleep apnea-hypopnea syndrome: report of 3 cases.

Hallucinations are false sensory perceptions that occur in the absence of an external stimulus. Three cases of hallucinations related to obstructive sleep apnea-hypopnea syndrome are reported, 2 of which improved with the initiation of continuous positive airway pressure therapy. So far there are no published reports in the literature that account for this relationship in the absence of primary or structural mental pathology. All 3 reported patients had visual hallucinations that were uncomfortable and frightening. Polysomnography showed moderate-to-severe obstructive sleep apnea-hypopnea syndrome with severe oxygen desaturation. Initiation of continuous positive airway pressure therapy achieved control of hallucinations in 2 patients during follow-up. Very little information is available on the coexistence of obstructive sleep apnea-hypopnea syndrome and hallucinations. Observational and experimental studies are required to clarify whether there is a causal relationship between the 2 pathologies as well as the therapeutic role that continuous positive airway pressure may have. CITATION: Venegas MA, Montoya JS. Hallucinations in patients with obstructive sleep apnea-hypopnea syndrome: report of 3 cases. J Clin Sleep Med. 2024;20(1):165-167.

Optic nerve haemangioblastoma in association with von Hippel-Lindau syndrome: case report and literature review.

Optic nerve haemangioblastoma (ONH) is an uncommon, benign, non-meningothelial, mesenchymal tumour of unclear origin. Most are associated with von Hippel-Lindau (VHL) syndrome (71%), and only 40 cases have been reported in the medical literature. Most of the patients develop non-specific visual symptoms, including decreased visual acuity and/or loss of visual fields, exophthalmos, trigeminal neuralgia, and retroorbital pain. Optic nerve sheath meningioma and optic nerve glioma are among the differential diagnoses that may be considered in this location. Contrast-enhanced MRI is considered an optimal diagnostic tool, which helps to determine some characteristics that guide towards an adequate diagnosis and treatment. We present a 42-year-old patient with a history of VHL syndrome in whom a cerebellar lesion and optic nerve lesions were evidenced, and we did a review of the literature and case analysis.

Lumbosacral Traumatic Spondylolisthesis L5 to S1-Classification and Surgical Management of a Difficult Presentation.

INTRODUCTION: Lumbosacral traumatic spondylolisthesis L5-S1 is a rare clinical entity that compromises the stability of the L5 vertebra by displacing it anteriorly, laterally, or posteriorly on the S1 vertebral body secondary to osteotendinous and/or articular compromise of this segment due to trauma. This pathology is difficult to classify and manage; although surgical management remains the gold standard, short- and long-term results in the literature are scarce and highly variable. PATIENT PRESENTATION: We present the case of a 53-year-old patient with lumbar trauma due to a free fall from a height of 6 meters. The fall resulted in cauda equina syndrome secondary to lumbosacral traumatic spondylolisthesis L5-S1, which required immediate surgical management. INTERVENTION AND OUTCOME: For surgical management, we used a posterior approach for L5-S1 transpedicular screw fixation, spinal decompression, bilateral root foraminotomy of L5, and L5-S1 open transforaminal lumbar interbody fusion with open reduction. After the operation, the patient reported immediate improvement of postoperative lower extremities pain and was discharged on the third postoperative day after achieving clinical improvement with physical therapy and bladder rehabilitation exercises. CONCLUSION: Lumbosacral traumatic spondylolisthesis L5-S1 is an unusual pathology that requires further study as there is currently no standardized classification. Surgical management is the gold standard and includes open reduction with short transpedicular screw fixation in segment L5-S1 and other surgical interventions such as extension to the pelvis with iliac screws, screws to the L4 vertebral body, and use of lumbar interbody fusion cages.