Bilateral, sequential orbital inflammation secondary to relapsing polychondritis.

This report describes a case of a Caucasian man in his 60s with bilateral sequential orbital inflammatory disease associated with relapsing polychondritis (RPC).He first presented with a subclavian vein periphlebitis/thrombosis and swollen left knee. Two weeks later, he developed right orbital inflammation with restricted eye movements. He was treated initially for possible orbital cellulitis. His inflammation failed to respond to antibiotics but rapidly resolved with oral prednisolone. One year later, he presented with left auricular inflammation, a maculopapular rash on his arms and torso and left orbital inflammation. Again, he failed to respond to antibiotics but had rapid resolution of his inflammatory signs following oral prednisolone.Based on his previous inflammatory arthropathy, auricular inflammation, orbital inflammation and response to oral steroids, he was diagnosed with RPC based on the McAdam diagnostic criteria. His steroids were tapered and he was commenced on methotrexate as maintenance therapy.

The modulator role of Urtica dioica on deleterious effects of retinoic acid high doses on histological parameters and fertilization of rats.

Aim: This study purposed to evaluate the modulator and protective role of Urtica dioica (UD) extract against deleterious effects of retinoic acid (RA) high doses on histological parameters and fertilization of rats. Materials and methods: For the in-vivo phase, 60 female Wistar rats were divided into 6 identical groups as 1) control, 2) 25 mg/kg RA, 3) 25 mg/kg UD extract, 4) 50 mg/kg UD extract, 5) UD extract (25 mg/kg) + RA (25 mg/kg), and 6) UD extract (50 mg/kg) + RA (25 mg/kg). Biochemical parameters, including luteinizing hormone (LH), folliclestimulating hormone (FSH), malondialdehyde (MDA) levels, superoxide dismutase (SOD), and catalase (CAT) activities, were measured. In the in-vitro phase, oocytes were obtained from 10 female rats without injection. In addition to the mentioned parameters, histological parameters (oocytes in various stages) and the results of IVM, IVF, and embryo developments were assessed and compared among the groups with the use of one-way ANOVA and Tukey's post hoc tests. Results: The high dosage of RA significantly reduced the LH and FSH levels; however, UD alone and with RA increased the hormone levels in rats. Regarding the reactive oxygen species (ROS) activity levels in rats' blood samples, RA increased the MDA and decreased the SOD and CAT levels. Treatment with UD extract (UD + RA groups) significantly improved the parameters mentioned, showing UD's antioxidant effect. The rate of oocyte maturation, 2-cell-4-cell and 4-cell-8-cell embryos, and blastocyst formation increased significantly in the groups in which UD extracts were administered compared to the control and RA groups. Furthermore, the increases were significant in the UD + RA groups compared to the RA group. Conclusion: UD extract can significantly reduce RA high doses side effects on histological parameters and fertilization of rats and has the protective potential against RA deleterious effects.

Legg-Calve-Perthes' disease: an opportunity to prevent blindness?

Legg-Calve-Perthes' disease (LCP) is defined as avascular necrosis of the femoral head in a child and may present to a variety of disciplines from general practice to orthopaedics, paediatrics, rheumatology and more. The Stickler syndromes are a group of disorders of type II, IX and XI collagen associated with hip dysplasia, retinal detachment, deafness and cleft palate. The pathogenesis of LCP disease remains an enigma but there have been a small number of cases reporting variants in the gene encoding the α1 chain of type II collagen (COL2A1). Variants in COL2A1 are known to cause type 1 Stickler syndrome (MIM 108300, 609508), which is a connective tissue disorder with a very high risk of childhood blindness, and it is also associated with dysplastic development of the femoral head. It is unclear whether COL2A1 variants make a definitive contribution to both disorders, or whether the two are indistinguishable using current clinical diagnostic techniques. In this paper, we compare the two conditions and present a case series of 19 patients with genetically confirmed type 1 Stickler syndrome presenting with a historic diagnosis of LCP. In contrast to isolated LCP, children with type 1 Stickler syndrome have a very high risk of blindness from giant retinal tear detachment, but this is now largely preventable if a timely diagnosis is made. This paper highlights the potential for avoidable blindness in children presenting to clinicians with features suggestive of LCP disease but with underlying Stickler syndrome and proposes a simple scoring system to assist clinicians.

The ocular manifestations of relapsing polychondritis.

PURPOSE: Relapsing polychondritis (RPC) is a rare, multi-system, inflammatory disorder. Ocular disease is estimated to occur in 14-67% of patients with RPC, and any ocular structure can be affected. Published case reports and series of RPC were analysed to determine the frequency and nature of the ocular manifestations of RPC, including the age and gender distribution. METHODS: A literature search of the MEDLINE database for case reports and series on RPC was conducted in October 2021 using search terms [relapsing polychondritis (MeSH Major Topic)] OR [relapsing polychondritis (Title/Abstract)]. Articles were included if the diagnosis of RPC was confirmed using established diagnostic criteria and if the paper described the clinical features of patients with RPC. RESULTS: 546 articles (454 case reports and 92 case series) described the clinical features in a total of 2414 patients with RPC. 49% of patients with RPC had ocular involvement, and this was a presenting feature in 21%. The most common ocular manifestations were scleritis (32%), episcleritis (31%) and uveitis (23%). CONCLUSION: Many patients with RPC will be seen by an ophthalmologist during the course of their disease. Knowledge and awareness of RPC and its ocular manifestations is therefore essential to enable the ophthalmologist to make the diagnosis.

Injectable Double-Network Hydrogel-Based Three-Dimensional Cell Culture Systems for Regenerating Dental Pulp.

The regeneration of dental pulp tissue is very important, but difficult, in dentistry. The biocompatibility, water content, and viscoelastic properties of pulp-like tissue must be optimized to achieve the efficient transfer of metabolites and nutrients, a suitable degradation rate, distribution of encapsulated cells, injectability, and gelation in situ under physiological conditions. As promising materials for pulp regeneration, hydrogel scaffolds have been produced to simulate the extracellular matrix and transmit signaling molecules. It is imperative to develop hydrogels to effectively regenerate pulp tissue for clinical application. Here, two injectable double-network (DN) hydrogel-based three-dimensional (3D) cell culture systems were developed for regenerating dental pulp. The microstructure, mechanical property, rheology property, and degradation behavior of the injectable DN glycol chitosan-based hydrogels in a simulated root canal model were characterized and compared to a single-network (SN) glycol chitosan-based hydrogel. Human dental pulp stem cells (hDPSCs) were then encapsulated into the GC-based hydrogels for the regeneration of pulp tissue, and the biological performance was investigated both in vitro and in vivo. The results showed that the DN hydrogels had ideal injectability under physiological conditions due to the dynamic nature of the crosslinks. Besides, the DN hydrogels exhibited better mechanical properties and longer degradation duration than the corresponding SN hydrogel. As a 3D cell culture system, the characteristics of the DN hydrogel facilitated odontogenic differentiation and mineralization of hDPSCs in vitro. Further in vivo analysis confirmed that the chemical composition, matrix stiffness, and degradation rate of the DN hydrogel matched those of pulp-like fibrous connective tissue, which might be related to Smad3 activation. These findings demonstrate that DN glycol chitosan-based hydrogels are suitable for the regeneration of pulp tissue.

Development and validation of a nomogram to predict survival for advanced male breast cancer.

Male breast cancer is a rare disease. Many experiences of male breast cancer were derived of female breast cancer. However, there are huge differences between two groups. We conducted this study to find a reliable prognostic model for advanced male breast cancer. The cohort was selected from the Surveillance, Epidemiology, and End Results database. The enrolled patients were randomly divided into training and validation group. The univariate and multivariate analyses were used for prognostic assessment and a nomogram was built. Calibration curves and concordance index were compiled to determine predictive and discriminatory capacity. The time-dependent receiver operating curves and the decision curve analysis was used to verify the model's ability. Two hundred and eighty individuals were enrolled. The cumulative rates of 1-, 3- and 5-year overall survival (OS) rates were 98.6%, 72% and 57.9%. The C-indexes for OS were 0.835 (95%CI, 0.777-0.893) in the training group and 0.765 (95%CI, 0.668-0.862) in the validation group. The calibration curves confirmed the consistency of the nomogram both in the training and validation group. The time-dependent receiver operating curves and decision curve analysis demonstrated that the nomogram had better prediction capacity than TNM stage system for advanced male breast cancer. The nomogram we built was a reliable and solid predictive model.

Study on the preparation of the hierarchical porous CX-TiO2 composites and their selective degradation of PHE solubilized in soil washing eluent.

A series of CX-TiO2(Carbon Xerogel- TiO2) composites with a hierarchical porous structure were obtained through the sol-gel method followed by drying and carbonization, and have been applied to treating solubilizing wastewater containing a high concentration of phenanthrene (PHE). The characterizations demonstrated that the CX-TiO2 exhibits a hierarchical porous structure, with particles of carbon and P25 being uniformly in the matrix. Removal efficiency of CX-TiO2 on PHE in soil washing eluent (SWE) were evaluated under ultraviolet (UV) irradiation or dark condition, and P25 was employed as the reference. The results revealed that CX-TiO2(0.2) had the best removal effect on PHE, with the efficiency as high as 97.8% under UV illumination within 15 h. It demonstrated that in the process of PHE removal by CX-TiO2 whether it was under UV illumination or not, the adsorption plays a dominant role in the early stage. The kinetic behavior of PHE adsorption was fitted using the pseudo-first-order and pseudo-second-order, and Langmuir model and Freundlich models were applied to describe the PHE adsorption isotherms. The results indicating that it was a chemical adsorption process, which was influenced by the interaction between PHE and CX-TiO2, and PHE is adsorbed on the interface of CX-TiO2(0.2) in a single layer form, instead of agglomerating in the admicelle. A possible mechanism of removal of solubilized PHE in SWE was speculated, in which both hierarchical porous structure and appropriate micropores size of CX-TiO2 were indispensable to the selective adsorption and degradation of PHE. Recycling performance certificated that the selective removal efficiency of PHE could still reach 82.09% after five recycles. Thus the excellent performance testified that the CX-TiO2 have great potential in treating SWE containing solubilized PAHs.

Scleral buckling-a brief historical overview and current indications.

The key to successful management of rhegmatogenous retinal detachment (RRD) is to find and seal all of the retinal breaks, and the two main surgical techniques used to achieve this are scleral bucking (SB) or pars plana vitrectomy (PPV). Techniques for SB have remained mostly unchanged for the last 60 years, whilst PPV techniques and instruments have developed substantially over that time and have greatly contributed to increased success rate for types and configurations of retinal detachments unsuitable or difficult to manage with buckling alone. However, there is a growing dependency to rely on PPV as the sole and only approach for repair of all types of retinal detachment, such that some centres are no longer offering training in scleral buckling. There are also many studies comparing SB with PPV, but many of these lack information on the type, technique or rationale for deployment of the buckle. Many studies deploy the same scleral buckle technique without customising it to the type, position or number of tears being treated. Scleral buckling is not a one-size-fits-all technique. It requires careful patient selection and careful buckle selection and orientation tailored to the tear(s) to ensure success. When used appropriately, it is a simple and highly effective technique, particularly for retinal dialyses, round retinal hole detachments and selected cases of retinal detachment associated with horseshoe retinal tears. There is no doubt that for some more complex cases, such as multiple large breaks, giant retinal tears, bullous detachments and cases complicated by proliferative retinopathy, PPV offers a safer and more effective management. However, SB remains an important and relevant surgical technique, and for the right cases, the results can be superior to PPV with reduced comorbidity.

The Clinical Utility of the TYM and RBANS in a One-Stop Memory Clinic in Singapore: A Pilot Study.

BACKGROUND: We aimed to examine the discriminant validity of a brief self-administered cognitive screening test, the Test Your Memory (TYM) and a brief neuropsychological test, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), supplemented with executive and language tests (Color Trail Test [CTT] and modified Boston Naming Test [mBNT], respectively), in detecting cognitive impairment (CI) in a one-stop memory clinic in Singapore. METHODS: Ninety patients ≥50 years old with a diagnosis of no cognitive impairment, mild cognitive impairment, and mild Alzheimer disease were recruited from memory clinic. They received the TYM, Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), RBANS, CTT, mBNT, and a gold-standard formal neuropsychological test battery. RESULTS: The TYM had a significantly larger area under the curve (AUC) than MMSE (0.96 vs 0.88, P = .03) and was equivalent to MoCA in detecting CI (0.96 vs 0.95, P = .80). At the optimal cutoff points, the TYM (<38) was significantly more sensitive than the MMSE (<24) and MoCA (<20; P < .001). The RBANS had an AUC equivalent to the RBANS supplemented with CTT and mBNT (0.92 vs 0.86, P = .22) in detecting CI. The RBANS supplemented with CTT and mBNT was more sensitive than RBANS alone in detecting CI (sensitivity: 0.98 vs 0.93, P = .016) among patients screened negative using TYM. CONCLUSION: The self-administered TYM is superior to MMSE and equivalent to MoCA in detecting CI and could be implemented routinely. The RBANS supplemented with CTT and mBNT is more sensitive in detecting CI than RBANS alone therefore could be used for diagnostic purposes.

Effects of preemptive interferon-α monotherapy in acute leukemia patients with relapse tendency after allogeneic hematopoietic stem cell transplantation: a case-control study.

Interferon-α (IFN-α) inhibits tumor growth and mimics graft-versus-leukemia after allogeneic hematopoietic stem cell transplantation (allo-HSCT). In the current case-control study, we compared treatment responses in acute leukemia patients with relapse tendency post-allo-HSCT receiving preemptive IFN-α after withdrawal of immunosuppressants (n = 31) vs. receiving no IFN-α (n = 67). In the IFN-α group, 25 patients responded to the treatment without progressing to hematological relapse. In the non-IFN-α group, only 22 patients responded to the treatment. The response rate differed significantly (80.6 vs. 32.8%, P < 0.001). The 2-year cumulative incidence of relapse was 31.6 and 61.2% in the IFN-α and the non-IFN groups, respectively (P = 0.006). The 2-year leukemia-free survival and overall survival rate was 57.4 vs. 28.4% (P < 0.001) and 67.6 vs. 32.9% (P = 0.001), respectively. Among the 31 patients in the IFN-α group, 18 patients (58.1%) developed graft-versus-host disease (GVHD): 6 acute and 12 limited chronic GVHD. Patients who developed GVHD had higher treatment response rate than patients without GVHD (88.9 vs. 53.8%, P = 0.022). In conclusion, preemptive IFN-α therapy is a safe and effective treatment to prevent disease progression in high-risk patients with relapse tendency post-allo-HSCT.

Analysis of curative effect of I125 implantation combined with radiofrequency ablation in treating bone metastases.

The aims of this study were to investigate the clinical effects of I125 implantation combined with radiofrequency ablation in treating bone metastases (BM) and analyze its clinical application so as to provide better treatment protocols for the treatment of BM. A total of 63 BM patients were randomly divided into the I125 implantation group (CON, treated with I125 seeds alone, 33 patients) and the combination group (I125-MA, 30 patients) to compare the clinical efficacy and adverse effects. After treatment, the clinical efficacy of Group I125-MA was significantly better than Group CON, and the quality of life was improved significantly (P< 0.05). I125-MA has relatively better clinical efficacy in treating BM, which can not only significantly improve patients' life quality but also cause no serious adverse reaction. The therapy of I125 implantation combined with radiofrequency ablation provides a new idea for treating bone metastases. Compare Group I125-MA and Group CON, remission rates of bone pain were 76.7% vs 42.4% (P< 0.05); movement ability: 73.3% vs 39.4% (P< 0.05); quality of life: improvement rates: 70% vs 42.4% (P< 0.05), the median initial time of relieve pain: 3.5 days vs 7.6 days (P< 0.05).

Accidental, Non-masturbatory, Non-intercourse Related, Self-Inflicted Penile Fracture: Case Report and Review of Literature.

Penile fracture is a relatively rare condition arising from a rupture of the corpus cavernosum. In the western world, it is most commonly associated with sexual intercourse. We hereby, report a rare case of accidental, non-masturbatory, self-inflicted penile fracture. It was diagnosed promptly based on clinical assessment, confirmed radiologically and managed surgically, resulting in a good long-term clinical outcome. Our case highlights the importance of maintaining a high index of suspicion to diagnose this rare condition, even in the absence of a typical mechanism of injury, in order to ensure that such an injury is not missed.

The role of spatial boundaries in shaping long-term event representations.

When remembering the past, we typically recall 'events' that are bounded in time and space. However, as we navigate our environment our senses receive a continuous stream of information. How do we create discrete long-term episodic memories from continuous input? Although previous research has provided evidence for a role of spatial boundaries in the online segmentation of our sensory experience within working memory, it is not known how this segmentation contributes to subsequent long-term episodic memory. Here we show that the presence of a spatial boundary at encoding (a doorway between two rooms) impairs participants' later ability to remember the order that objects were presented in. A sequence of two objects presented in the same room in a virtual reality environment is more accurately remembered than a sequence of two objects presented in adjoining rooms. The results are captured by a simple model in which items are associated to a context representation that changes gradually over time, and changes more rapidly when crossing a spatial boundary. We therefore provide the first evidence that the structure of long-term episodic memory is shaped by the presence of a spatial boundary and provide constraints on the nature of the interaction between working memory and long-term memory.

Large-scale hydropower system optimization using dynamic programming and object-oriented programming: the case of the Northeast China Power Grid.

This paper examines long-term optimal operation using dynamic programming for a large hydropower system of 10 reservoirs in Northeast China. Besides considering flow and hydraulic head, the optimization explicitly includes time-varying electricity market prices to maximize benefit. Two techniques are used to reduce the 'curse of dimensionality' of dynamic programming with many reservoirs. Discrete differential dynamic programming (DDDP) reduces the search space and computer memory needed. Object-oriented programming (OOP) and the ability to dynamically allocate and release memory with the C++ language greatly reduces the cumulative effect of computer memory for solving multi-dimensional dynamic programming models. The case study shows that the model can reduce the 'curse of dimensionality' and achieve satisfactory results.