NEW-ONSET PRIMARY ADRENAL INSUFFICIENCY AFTER COVID-19: CASE REPORT.

COVID-19 primarily affects the respiratory system. What comes after the disease is now a greater concern for the scientific world. It is remarkable for causing endocrine organ involvement, particularly in the adrenal glands. However, its effect on the adrenal gland has not been fully elucidated. A case of primary adrenal insufficiency after COVID-19. A 31-year-old female patient who presented with complaints of weakness, anorexia, nausea, recent onset of vomiting, dizziness, and low blood pressure for two months was admitted to the outpatient Department of Endocrinology and Metabolism. After discharge, the patient had routine follow-ups, and here we present the information on the first and seventh month after discharge. The patient was diagnosed with primary adrenal insufficiency with cortisol <0.054 µg/dL and adrenocorticotropic hormone >1200 pg/mL in the laboratory. In the non-contrast computed tomography taken in the adrenal protocol, the stem and leaves of both adrenal glands are significantly thinned and appear atrophic, the right adrenal gland is hardly distinguished. Hydrocortisone was started. All complaints were resolved within a week, except hyperpigmentation, which was resolved six months later after treatment. Our study support adrenal gland involvement due to COVID-19, further research is needed to obtain data on damage mechanisms.

Height-based formulas for predicting intravascular length of tunnelled neck central venous catheter in paediatric population.

INTRODUCTION: Central venous catheter (CVC) placement is commonly performed in children. We aim to develop simple formulas to predict CVC intravascular length to minimise radiation exposure associated with the procedure. METHODS: 124 paediatric patients who received tunnelled neck CVCs and subsequent CT thorax at Hong Kong Children's Hospital from January 2020 to July 2022 were reviewed retrospectively. Formula development cohorts were subdivided by insertion sites-9 right external jugular vein (REJV), 41 right internal jugular vein (RIJV), 14 left external jugular vein (LEJV), 10 left internal jugular vein (LIJV). Using measurements from CT by two radiologists, formulas predicting the CVC intravascular length based on height and insertion sites were developed using a linear regression model. These formulas were tested with validation cohorts (10 randomly selected cases in REJV and RIJV groups respectively). Validation cohorts were not available for LEJV and LIJV groups due to small sample sizes. RESULT: The goodness-of-fit (R^2) of all formulas are above 0.8. In the validation cohorts, the REJV formula was predictive of intravascular CVC length within 1 cm in 70% of CVC with mean absolute difference of 0.63 cm (SD 0.48 cm), and the RIJV formula was predictive of intravascular CVC length within 1 cm in 80% of CVC with mean absolute difference of 0.67 cm (SD 0.53 cm). CONCLUSION: Intravascular CVC length can be estimated using simple formulas based on height and insertion sites. Further prospective validation of the LEJV and LIJV formulas is needed.

Giant Biquadratic Exchange in 2D Magnets and Its Role in Stabilizing Ferromagnetism of NiCl_{2} Monolayers.

Two-dimensional (2D) van der Waals (vdW) magnets provide an ideal platform for exploring, on the fundamental side, new microscopic mechanisms and for developing, on the technological side, ultracompact spintronic applications. So far, bilinear spin Hamiltonians have been commonly adopted to investigate the magnetic properties of 2D magnets, neglecting higher order magnetic interactions. However, we here provide quantitative evidence of giant biquadratic exchange interactions in monolayer NiX_{2} (X=Cl, Br and I), by combining first-principles calculations and the newly developed machine learning method for constructing Hamiltonian. Interestingly, we show that the ferromagnetic ground state within NiCl_{2} single layers cannot be explained by means of the bilinear Heisenberg Hamiltonian; rather, the nearest-neighbor biquadratic interaction is found to be crucial. Furthermore, using a three-orbitals Hubbard model, we propose that the giant biquadratic exchange interaction originates from large hopping between unoccupied and occupied orbitals on neighboring magnetic ions. On a general framework, our work suggests biquadratic exchange interactions to be important in 2D magnets with edge-shared octahedra.

Developmental Trajectories for Visuo-Spatial Attention are Altered by Prenatal Alcohol Exposure: A Longitudinal FMRI Study.

Functional magnetic resonance imaging (fMRI) reveals brain activation abnormalities during visuo-spatial attention and working memory among those with fetal alcohol spectrum disorders (FASD) in cross-sectional reports, but little is known about how activation changes over time during development within FASD or typically developing children. We studied 30 controls and 31 individuals with FASD over 2 years (7-14 years at first participation) with a total of 122 scans, as part of the Collaborative Initiative on Fetal Alcohol Spectrum Disorders. Despite comparable performance, there were significant group differences in visuo-spatial activation over time bilaterally in frontal, parietal, and temporal regions. Controls showed an increase in signal intensity in these multiple regions whereas FASD participants showed a decrease in brain activation. Effects were also found in 2 small independent samples from the USA, corroborating the findings from the larger group. Results suggest that the long-lasting effect of prenatal alcohol may impact the maturation of visuo-spatial attention and differentiate those with FASD from controls. Based on this first longitudinal fMRI study in FASD children, our novel findings suggest a possible neural mechanism for attention deficits common among individuals with FASD.

Magnetic resonance imaging of the fetal brain.

INTRODUCTION: This review covers the recent literature on fetal brain magnetic resonance imaging, with emphasis on techniques, advances, common indications, and safety. METHODS: We conducted a search of MEDLINE for articles published after 2010. The search terms used were "(fetal OR foetal OR fetus OR foetus) AND (MR OR MRI OR [magnetic resonance]) AND (brain OR cerebral)". Consensus statements from major authorities were also included. As a result, 44 relevant articles were included and formed the basis of this review. RESULTS: One major challenge is fetal motion that is largely overcome by ultra-fast sequences. Currently, single-shot fast spin-echo T2-weighted imaging remains the mainstay for motion resistance and anatomical delineation. Recently, a snap-shot inversion recovery sequence has enabled robust T1-weighted images to be obtained, which is previously a challenge for standard gradient-echo acquisitions. Fetal diffusion-weighted imaging, diffusion tensor imaging, and magnetic resonance spectroscopy are also being developed. With multiplanar capabilities, superior contrast resolution and field of view, magnetic resonance imaging does not have the limitations of sonography, and can provide additional important information. Common indications include ventriculomegaly, callosum and posterior fossa abnormalities, and twin complications. There are safety concerns about magnetic resonance-induced heating and acoustic damage but current literature showed no conclusive evidence of deleterious fetal effects. The American College of Radiology guideline states that pregnant patients can be accepted to undergo magnetic resonance imaging at any stage of pregnancy if risk-benefit ratio to patients warrants that the study be performed. CONCLUSIONS: Magnetic resonance imaging of the fetal brain is a safe and powerful adjunct to sonography in prenatal diagnosis. It can provide additional information that aids clinical management, prognostication, and counselling.

Combustion smoke-induced inflammation in the cerebellum and hippocampus of adult rats.

AIMS: The effect of combustion smoke inhalation on the respiratory system is widely reported but its effects on the central nervous system remain unclear. Here, we aimed to determine the effects of smoke inhalation on the cerebellum and hippocampus which are areas vulnerable to hypoxia injury. METHODS: Adult male Sprague-Dawley rats were subjected to combustion smoke inhalation and sacrificed at 0.5, 3, 24 and 72 h after exposure. The cerebellum and hippocampus were subjected to Western analysis for VEGF, iNOS, eNOS, nNOS and AQP4 expression; ELISA analysis for cytokine and chemokine levels; and immunohistochemistry for GFAP/AQP4, RECA-1/RITC and TUNEL. Aminoguanidine (AG) was administered to determine the effects of iNOS after smoke inhalation. RESULTS: Both the cerebellum and hippocampus showed a significant increase in VEGF, iNOS, eNOS, nNOS and AQP4 expression with corresponding increases in inflammatory cytokines and chemokines and increased AQP4 expression and RITC permeability after smoke exposure. AG was able to decrease the expression of iNOS, followed by VEGF, eNOS, nNOS, RITC and AQP4 after smoke exposure. There was also a significant increase in TUNEL+ cells in the cerebellum and hippocampus which were not significantly reduced by AG. Beam walk test revealed immediate deficits after smoke inhalation which was attenuated with AG. CONCLUSION: The findings suggest that iNOS plays a major role in the central nervous system inflammatory pathophysiology after smoke inhalation exposure with concomitant increase in proinflammatory molecules, vascular permeability and oedema, for which the cerebellum appears to be more vulnerable to smoke exposure than the hippocampus.

Assessment of balance performance and fear of falling in acromegalic patients: a comparative study.

BACKGROUND: Acromegaly may lead to balance disturbances and fear of falling due to changes in body composition and co-morbidities. AIM: The aim of this study was to evaluate balance and fear of falling in acromegalic patients and their relation with disease characteristics. MATERIALS AND METHODS: Forty-eight acromegalic patients and 41 age- and gender-matched controls were enrolled in the study. The median ages of the patients and controls were 48 (25-75) and 50 (25-67) yr, respectively. Berg Balance Scale (BBS) and one-leg stance test (OLST) were used to compare dynamic and static balance respectively, 50 meters walking test was used to compare functional capacity and falls efficacy scale-international (FES-I) was used to compare fear of falling between the groups. RESULTS: Balance tests (BBS and 50 meter walking test) and fear of falling (FES-I) were significantly disturbed in patients compared with controls. There was no significant difference in OLST. BBS and OLST were negatively and FES-I was positively correlated with age. FES-I was negatively correlated with BBS and OLST was positively correlated with 50 meters walking test. Only OLST was negatively correlated with disease duration. Logistic regression analysis revealed that balance was not affected by the presence of co-morbidities, postoperative vision loss and disease control. CONCLUSIONS: This is the first study showing that balance is disturbed in acromegalic patients. This disturbance is not related to disease control and co-morbidities but somewhat to disease duration.

Cardiac structure and functions in patients with asymptomatic primary hyperparathyroidism.

BACKGROUND: The data about cardiovascular (CV) changes in patients with asymptomatic primary hyperparathyroidism (PHPT) are scarce. AIM: The aim of this study is to compare cardiac structure and functions in patients with asymptomatic PHPT and controls by using tissue Doppler echocardiography. SUBJECTS AND METHODS: Thirty-eight patients with asymptomatic PHPT and 31 sex- and age-matched controls with similar cardiac risk factors were evaluated. RESULTS: There was no significant difference in ejection fraction (EF) between the patients and the controls [64±5.95 vs 62±3.25% (p=0.094)]. Left ventricular mass index (LVMI) was significantly higher in patients than controls [105.96 (66.45-167.24) vs 93.79 (64.25- 139.25) g/m2, p=0.014]. There was a significant correlation between LVMI and serum calcium (Ca) (r=0.240, p<0.005). Myocardial performance index (MPI) was significantly higher in patients than controls [0.49 (0.35-0.60) vs 0.39 (0.33-0.62), p<0.001]. There was positive correlation between theMPI and serumCa levels (r=0.505, p<0.001), parathyroid hormone (PTH) levels (r=0.464, p<0.001) and LVMI (r=0.270, p<0.005). When the normotensive patients and controls were evaluated, the difference between the groups remained statistically significant considering LVMI and MPI [109 (66.45-167.24) g/m2 vs 94.17 (64.25-75.10) g/m2, p=0.03; and 0.49 (0.35-0.60) vs 0.39 (0.33-0.62), p<0.01, respectively]. There were significant correlations between MPI and Ca (r=0.566, p<0.001), and PTH (r=0.472, p<0.001). CONCLUSIONS: Our study results showed that cardiacmorphology and diastolic functions are altered in the patients with asymptomatic PHPT. High serum PTH and Ca levels may have an impact on these CV changes. Whether these subtle CV changes would affect cardiac systolic functions and mortality in patients with asymptomatic PHPT should be investigated in further prospective studies.

Comparison of central corneal thickness measurements using three different imaging devices.

PURPOSE: The purpose of this study was to compare central corneal thickness (CCT) values and evaluate the agreement obtained with three different devices in healthy eyes. METHODS: A total of 120 eyes of 60 healthy individuals (36 men and 24 women) were enrolled in this retrospective study. CCT measurements were performed using an optical biometer (AL-Scan), spectral-domain optical coherence tomography (SD-OCT) (Topcon 3D) and ultrasonic pachymetry (UP) (Accupach VI), and the results were compared. Bland-Altman analysis was used to quantify the agreement between methods. MAIN RESULTS: The mean patient age was 28±5.73years (18-40years). The mean CCT values obtained by AL-Scan, UP, and SD-OCT were 532.4µm±29.7, 549µm±30.4, and 547µm±30.6, respectively. The mean differences in CCT were 15.30±9.52µm between AL-Scan and OCT (P<0.01), 17.15±8.42µm between AL-Scan and UP (P<0.01), and 1.85± 8.78µm between UP and OCT (P=0.067). All three methods of CCT measurement were closely correlated with each other. CONCLUSION: The present study results suggest that, despite good agreement between the three devices, AL-Scan significantly underestimated CCT compared to UP and OCT. Therefore, clinicians should be aware that different results can be obtained using different devices for CCT measurements. It would be a better approach not to use them as interchangeable in clinical practice. CCT examination and follow-up should be performed using the same device, especially for patients who will undergo refractive surgery.

General theory for the ferroelectric polarization induced by spin-spiral order.

The ferroelectric polarization of triangular-lattice antiferromagnets induced by helical spin-spiral order is not explained by any existing model of magnetic-order-driven ferroelectricity. We resolve this problem by developing a general theory for the ferroelectric polarization induced by spin-spiral order and then by evaluating the coefficients needed to specify the general theory on the basis of density functional calculations. Our theory correctly describes the ferroelectricity of triangular-lattice antiferromagnets driven by helical spin-spiral order and incorporates known models of magnetic-order-driven ferroelectricity as special cases.

Idiotype-like molecules on cells of a human T cell leukemia.

Two monoclonal antibodies were obtained that showed unique specificities for the leukemic T cells used for immunization. One antibody, S160, was totally specific for the antigen. The other antibody, S511, also reacted with a small population of normal T cells. This was made especially evident by concentrating these normal T cells with the antibody. Considerable evidence was obtained that both antibodies reacted with the same membrane molecules. In the unreduced state a major component of approximately 80 kdaltons was observed; after reduction this split into two components of approximately 43 and approximately 38 kdaltons. The reaction of the two antibodies with different antigenic sites on the same molecule, one representing a private site and the other a more cross-reactive site, strongly suggests an antibodylike molecule, but composed of polypeptide chains differing from immunoglobulins.

Selective stimulation of the JAK/STAT signaling pathway by silica nanoparticles in human endothelial cells.

Silica nanoparticles (SiNP) are frequently used in pharmaceutical formulations. Intravenously administered, these particles are in close contact with the vascular endothelium. However, preliminary safety assessments of these novel excipients have indicated that SiNP are potentially cytotoxic and can trigger inflammation. In order to elucidate mechanisms of SiNP mediated inflammation, cerebral microvascular endothelial cells and primary umbilical endothelial cells were incubated with SiNP at doses between 10ng/ml and 250µg/ml. Two types of 110nm SiNP with different surface charge were synthesized and characterized. Uptake, cell viability, apoptosis, necrosis, oxidative stress, as well as interferences with both JAK/STAT and NF-κB pathways were studied. SiNP uptake leads to a cell viability decrease and promotes generation of reactive oxygen species (ROS) in a time- and dose-dependent manner. Furthermore, SiNP are able to trigger the activation of the STAT1 pathway. In contrast, no significant activation of STAT3, STAT6 or NF-κB could be detected. Additionally, modulation of the major histocompatibility complex (MHC) class I proteins was observed for cationic SiNP at low doses. Our results show the potential of SiNP to trigger selective activation of inflammatory signaling pathways in endothelial cells and thereby contribute to a better understanding of the toxicological profile of SiNP.

Peritonitis in childhood: clinical relevance of cytokines in the peritoneal exudate.

BACKGROUND: The aim of the study was to assess pro-inflammatory cytokine (tumor necrosis factor alpha [TNF-alpha], interleukin 6 [IL-6]) and anti-inflammatory cytokine (interleukin 10 [IL-10]) responses in children with peritonitis secondary to hollow viscus perforation, and to evaluate the influence of peritoneal microbial status on cytokine expression and morbidity. METHODS: The peritoneal fluid of 13 children with perforated appendicitis was examined with qualitative analysis of bacteria, and measurement of cytokine levels, which were compared to cytokine plasma levels, over a five-day period following operation. RESULTS: All fluid specimens showed permanently elevated levels of TNF-alpha and IL-10. IL-6 tended to decrease to normal levels by the 5th postoperative day. Peritoneal exudate levels of TNF-alpha and IL-10 were more than 100 - 1000 times greater than those in plasma. The most common bacterial species isolated in the peritoneal fluid was Escherichia coli. Despite persisting high cytokine concentrations and bacterial load of the peritoneal cavity for 5 days postoperatively, the children recovered uneventfully and the systemic signs of infection disappeared rapidly. CONCLUSION: Neither the bacterial nor the pro-inflammatory cytokine load of the peritoneal cavity proved to be associated with the clinical course. We hypothesize that in peritonitis in childhood a significant and clinically relevant cytokine-mediated inflammatory response is compartmentalized in the peritoneal cavity. Therefore adjuvant surgical measures in addition to appendectomy and intraoperative debridement seem not to be necessary, at least for peritonitis due to perforated appendicitis in children.

Scale-up and cost evaluation of a foamed emulsion bioreactor.

In the present paper, the potential of the foamed emulsion bioreactor (FEBR), a novel biological reactor for air pollution control was evaluated. Experimental data obtained on a laboratory-scale prototype were used to scale-up the process for a hypothetical case consisting of a contaminated air flow rate of 10,000 m(3) h(-1), a toluene inlet concentration of 1 g m(-3) and minimum required treatment efficiency of 92%. Reactor design and operating issues for the full-scale FEBR were identified. They included the requirement for stable foam generation with appropriate air distributors, and recycling of the auxiliary organic phase, surfactants and cells from the discharge of the reactor. The capital and operating costs for the concept full-scale FEBR were evaluated and compared to those of competing technologies, namely biofiltration, biotrickling filtration and catalytic and thermal oxidation. All three biological techniques had significantly lower capital and operating costs. Among the biological techniques, the FEBR had the lowest estimated capital cost since its greater effectiveness allowed a smaller reactor to meet the treatment objectives. The operating costs for the FEBR were higher than those of biofilters and biotrickling filters because of the requirements for nutrients and auxiliary chemicals. Overall, the results highlight that biotreatment is much more cost effective than thermal and catalytic oxidation. They further suggest that the FEBR may an interesting alternative to biofilters and biotrickling filters where the available space for air pollution control equipment is limited.

Structure-activity relationships in platelet-activating factor (PAF). 10. From PAF antagonism to inhibition of HIV-1 replication.

Excessive levels of PAF and cells of macrophage lineage appear to play an important role in neuronal cell injury, inflammatory syndrome, and HIV replication in CNS resulting in AIDS dementia complex (ADC). The beneficial effects of PAF receptor antagonists are evident and give rise to expected therapeutic strategies for neurotrauma. Piperazine derivatives bearing a "cache-oreilles" (ear-muff) electronic distribution are able to inhibit in vitro PAF effects and, thus, could be used in pathologies where this mediator is involved. Therefore, their potential anti-HIV activity was investigated, and we find that (i) these PAF antagonists are effectively active in HIV-infected monocyte-derived macrophages (MDM) but there is no correlation between both anti-HIV and anti-PAF activities; (ii) the presence of a carbamate function (compounds 1a-d) is favorable to the antiviral activity; (iii) the lipophilicity of the substituent on the piperazinic cycle seems to be less important for the anti-PAF activity than for the antiviral one. Our leading compound, PMS 601 (compound 1a), presents a dual activity with IC(50) of 8 and 11 microM for anti-PAF and anti-HIV activity, respectively, without cytotoxic events at 1000 microM in MDM. Although its mode of action is not clearly defined, these data suggest that PMS 601, which displays no effect on acellular reverse transcriptase or protease tests, deserves further investigation in the treatment of HIV-1-associated dementia.

Accuracy, precision and user-acceptability of self blood glucose monitoring machines.

The performance of six self-monitoring blood glucose (SMBG) machines (Accutrend, Reflolux S, Companion 2, Glucometer GX, Glucometer IV and One Touch II) were examined using venous blood samples from 88 patients. Whole blood glucose (BG) values were measured by four machines from each brand. Machine-generated whole blood glucose (BG) values were corrected before comparison with laboratory plasma glucose values, measured by a glucose oxidase method. Based on error grid analysis, most of the corrected machine-generated BG values were clinically acceptable. Accutrend, Glucometer IV and Companion 2 showed the greatest consistency between machines of the same brand. Over 80% of corrected BG values generated by Glucometer IV fell within +/-10% of the reference values. One Touch II yielded the most reproducible results with a mean CV of 2.7% and was considered the most user friendly machine. More studies are required to examine the performance of these machines in the hands of patients.

An action research study into the development of nurses as reflective practitioners.

This study adopted an action research approach in addressing the question: How could nurses be prepared to be reflective practitioners? The study took place among a group of registered nurses who enrolled in the first year of their degree studies at the Hong Kong Polytechnic University. The methods of data collection included observation, interview, students' written material, and teacher reflection. The experience of this study suggested that teachers and students should be partners in the promotion of reflective learning among students. As teachers reflected on their teaching arrangement and the progress of student learning, students could accordingly be offered appropriate guidance. Throughout the span of their studies, students learned to gradually develop different perspectives in viewing professional nursing practice. The reconceptualization of nursing practice helped students challenge taken-for-granted views and eventually reconstruct their conception of nursing.

[Antigenic structure of the foot-and-mouth virus. VI. Functional segments of the immunodominant region of the VP1 protein of foot-and-mouth virus strains O1K and A22]. / Antigennaia struktura virusa iashchura. VI. Funktsional'nye uchastki immunodominantnogo raiona belka VP1 virusa iashchura shtammov O1K i A22.

B- and T-epitopes have been localized within the protective fragments of VP1 protein, viz., 136-152 of the O1K strain and 135-159 of the A22 strain of the foot-and-mouth disease virus (FMDV). Antibodies eliciting after immunization of various animals with the 135-159 A22 peptide are directed to different sites of the peptide. Immunogenicity of fragments of the 135-159 A22 peptide on mice correlates with their activity on T-cells of the same animals and protective activity on guinea pigs. The investigations were carried out using synthetic fragments of the 136-152-O1K and 135-159-A22 peptides.