An unusual presentation of giant sebaceous cyst over the back: A case report.

Sebaceous cysts are a prevalent form of benign cutaneous cysts that often manifest as epidermal cysts when their size exceeds 5 cm in diameter. Despite their infrequent occurrence, cases of massive epidermal cysts measuring 5 cm or larger have been documented. Malignant transformations within epidermal cysts are exceedingly rare but not impossible. Although their development into malignancies is a rare event, it is essential to acknowledge the potential for benign epidermal cysts to undergo such transformation. In clinical terminology, these cysts predominantly affect the facial, cervical, and dorsal regions. They usually remain asymptomatic, with their formation attributed to the sequestration of epithelial remnants during embryonic fusion or trauma. In this report, we present a remarkable case of a colossal epidermal cyst found on the upper back of a 75-year-old male individual, highlighting the uncommon nature of such occurrences within the medical domain. This case adds to the literature by presenting a rare case report highlighting the clinical presentation, probable consequences, and surgical therapy of larger epidermal cysts.

The Risk of Adhesive Bowel Obstruction in Children With Appendicitis: A Systematic Review.

OBJECTIVE: Complicated appendicitis is associated with a higher risk of postoperative complications, including adhesive bowel obstruction. The aim of this meta-analysis is to investigate the difference in rates of postoperative bowel obstruction in paediatric patients with complicated versus simple appendicitis and whether this is influenced by the surgical approach. METHODS: A systematic literature search following PRISMA guidelines was conducted using MEDLINE, Embase and Cochrane Library for studies that analysed incidence of adhesive bowel obstruction in paediatric patients after appendicectomy. Studies from 1998 to 2022 were included in analysis. The study protocol was registered on PROSPERO (ID CRD42022309769). RESULTS: Pooled analysis of 6 studies with low risk of bias and adequate follow up periods, considering 58,962 cases of appendicectomy, revealed complex appendicitis was associated with a near two-fold increase in incidence of SBO (pooled odds ratio 2.02 (95% CI 1.35-2.69)). Interestingly, a similar pooled analysis of 10 studies, considering 62,433 cases of appendicectomy, revealed no significant difference between open and laparoscopic management of complex appendicitis (pooled odds ratio 0.93 (95% CI 0.24 to 1.62)). CONCLUSION: Complex appendicitis is associated with a two-fold increase in the rates of adhesive bowel obstruction. Whilst there are cosmetic advantages of a laparoscopic approach, surgical expertise should be favoured in decision making relating to surgical approach (laparoscopic versus open) as the evidence for a laparoscopic approach reducing risks of adhesive bowel obstruction is not convincing. LEVEL OF EVIDENCE: Level II.

Cardiovascular Comorbidities Do Not Impact Prostate Artery Embolisation (PAE) Outcomes: Retrospective Analysis of the National UK-ROPE Registry.

PURPOSE: Prostate artery embolisation (PAE) is a key treatment for the management of symptomatic benign prostatic hyperplasia (BPH). Common cardiovascular risk factors might be associated with suboptimal outcomes and thus influence patient treatment selection. The aim of the study was to evaluate whether cardiovascular comorbidities affect PAE outcomes. METHODS: Retrospective subset analysis of the UK Registry of Prostate Artery Embolisation (UK-ROPE) database was performed with patients who had a full documented past medical histories including hypertension, diabetes, coronary artery disease (CAD), diabetes and smoking status as well as international prostate symptom score (IPSS) at baseline and at 12 months. Multiple regression was performed to assess for any significant predictors. RESULTS: Comorbidity data were available for 100/216 patients (mean age 65.8 ± 6.4 years), baseline IPSS 20.9 ± 7.0). Regression analysis revealed that the presence of hypertension (53.7% IPSS reduction vs. absence 51.4%, p = 0.94), diabetes (52.6% vs. absence 52.1%, p = 0.6), CAD (59.2% vs. absence 51.4%, p = 0.95), no comorbidities (49.8% vs. any comorbidity present 55.3%, p = 0.66), smoking status (non-smoker, 52.6%, current smoker, 61.5%, ex-smoker, 49.8%, p > 0.05), age (p = 0.52) and baseline Qmax (p = 0.41) did not significantly impact IPSS reduction at 12 months post-PAE. Baseline prostate volume significantly influenced IPSS reduction (≥ 80 cc prostates, 58.9% vs. < 80 cc prostates 43.2%, p < 0.05). CONCLUSION: The presence of cardiovascular comorbidities/smoking history does not appear to significantly impact PAE symptom score outcomes at 12 months post procedure. Our findings suggest that if the prostatic artery can be accessed, then clinical success is comparable to those without cardiovascular comorbidities.

Effectiveness of Botulinum Toxin in the Treatment of Neuropathic Pain: A Literature Review.

Neuralgia is characterized by chronic pain resulting from damage or diseases in the somatosensory system, including nerves responsible for transmitting sensory information. Current treatments for neuropathic pain, which is a type of neuralgia, have limited success rates and can cause unwanted side effects. Since 1989, botulinum toxin-A (BTX-A), derived from the potent neurotoxin Clostridium botulinum, has been used to treat neuropathic pain in humans. BTX-A has shown analgesic effects by inhibiting the release of neurotransmitters involved in pain transmission. This review aims to evaluate the effectiveness of BTX-A in various types of neuralgia. The research question guiding this review is whether BTX-A is safe and effective in reducing pain in different types of neuralgias. To conduct this review, a literature search was performed using the PubMed, Medline, and PubMed Central databases. The search strategy included relevant keywords related to BTX-A, neuralgia, and neuropathic pain. After screening titles, abstracts, and full texts, a total of 30 articles were included in the review. These studies examined the efficacy of BTX-A in various conditions such as postherpetic neuralgia (PHN), auriculotemporal neuralgia (ATN), occipital neuralgia (ON), leprosy-induced neuropathic pain (LIN), focal painful neuropathies, complex regional pain syndrome (CRPS), trigeminal neuralgia (TN), and neuropathic pain associated with spinal cord injury. However, further research is needed to enhance our understanding of the optimal use of BTX-A in specific neuralgias. It is important to acknowledge the limitations of the included studies. Nevertheless, BTX-A might be considered a viable treatment option for neuralgia.

Inequity in the global distribution of monkeypox vaccines.

Monkeypox (mpox) has been a public health emergency of international concern that emerged in mid-2022 and has spread to 110 countries. The clinical findings of the disease vary according to the seriousness of the cases. Although its case fatality risk has not been high, a significant percentage of patients require hospitalization. In this context, local initiatives were taken to extend the limited supply of vaccines against the disease; however, such measures have not been sufficient to contain the spread of cases and ensure an equitable distribution of health resources. As a result, endemic regions of low-income countries continue to have insufficient access to mpox vaccination. Despite this and considering the global scope of the disease, there is still little discussion in the literature about the difficulties in achieving adequate vaccination coverage rates for the target population of interest. In this article, we briefly discussed general aspects of the disease, including its surveillance, the current global context of challenges for mpox vaccination, and issues on global allocation of health resources as well as proposed related recommendations.

Percutaneous coronary intervention versus coronary artery bypass grafting among patients with left ventricular systolic dysfunction: a systematic review and meta-analysis.

Current guidelines have shown the superiority of coronary artery bypass grafting (CABG) over medical therapy. However, there is a paucity of data evaluating the optimal revascularization strategy in patients with ischemic left ventricular systolic dysfunction (LVSD). Objective: The authors aimed to evaluate the clinical outcomes of postpercutaneous coronary intervention (PCI) and CABG among patients with LVSD. Methods: The authors performed a systematic literature search using the PubMed, Embase, Scopus, and the Cochrane Libraries for relevant articles from inception until 30 November 2022. Outcomes were reported as pooled odds ratio (OR), and their corresponding 95% CI using STATA (version 17.0, StataCorp). Results: A total of 10 studies with 13 324 patients were included in the analysis. The mean age of patients in PCI was 65.3 years, and 64.1 years in the CABG group. The most common comorbidities included: HTN (80 vs. 78%) and DM (49.2 vs. 49%). The mean follow-up duration was 3.75 years. Compared with CABG, the PCI group had higher odds of all-cause mortality (OR 1.15, 95% CI 1.01-1.31, P=0.03), repeat revascularization (OR 3.57, 95% CI 2.56-4.97, P<0.001), MI (OR 1.92, 95% CI 1.01-3.86, P=0.048) while the incidence of cardiovascular mortality (OR 1.23, 95% CI 0.98-1.55, P=0.07), stroke (OR 0.73 95% CI: 0.51-1.04, P=0.08), major adverse cardiovascular and cerebrovascular events (OR 1.36, 95% CI 0.99-1.87, P=0.06), and ventricular tachycardia (OR 0.79, 95% CI 0.22-2.86, P=0.72) was comparable between both the procedures. Conclusion: The results of this meta-analysis suggest that CABG is superior to PCI for patients with LVSD. CABG was associated with a lower risk of all-cause mortality, repeat revascularization, and incidence of myocardial infarction compared with PCI in patients with LVSD.

Association between nonalcoholic fatty liver disease and atrial fibrillation and other clinical outcomes: a meta-analysis.

The association between nonalcoholic fatty liver disease (NAFLD) with cardiovascular and cerebrovascular outcomes, as well as their clinical impact, has yet to be established in the literature. This meta-analysis aims to evaluate the association between the NAFLD patients and the risk of atrial fibrillation (AF), heart failure (HF), stroke, cardiovascular mortality (CVM), and revascularization incidence. We performed a systematic literature search using PubMed, Embase, Scopus, and Cochrane libraries for relevant articles from inception until August 2022. A total of 12 cohort studies with 18,055,072 patients (2,938,753 NAFLD vs 15,116,319 non-NAFLD) were included in our analysis. The mean age of the NAFLD patients group and the non-NAFLD group was comparable (55.68 vs 55.87). The most common comorbidities among the NAFLD patients group included hypertension (38% vs 24%) and diabetes mellitus (14% vs 8%). The mean follow-up duration was 6.26 years. The likelihood of AF (risk ratio (RR), 1.42 (95% CI 1.19, 1.68), p < 0.001), HF (RR, 1.43(95% CI 1.03, 2.00), p < 0.001), stroke (RR, 1.26(95% CI 1.16, 1.36), p < 0.001), revascularization (RR, 4.06(95% CI 1.44, 11.46), p = 0.01), and CVM (RR, 3.10(95% CI 1.43, 6.73), p < 0.001) was significantly higher in the NAFLD patients group compared to that of the non-NAFLD group. However, all-cause mortality was comparable between both the groups of patients (RR, 1.30 (95% CI 0.63, 2.67), p = 0.48). In conclusion, the patients with NAFLD are at increased risk of AF, HF, and CVM.

Monkeypox-Induced Myocarditis: A Systematic Review.

Monkeypox virus has emerged in different parts of the world with varying clinical symptoms and outcomes. To date, only a few studies have reported cardiac manifestations among monkeypox-infected patients. We aim to systematically evaluate the symptoms, imaging findings, management, and outcomes among monkeypox-induced myocarditis patients. We conducted a systematic literature search in PubMed, Embase, and Scopus from inception till 5th January 2023 by using predefined MESH terms and "AND" and "OR." The following search terms were used: "monkeypox virus" AND "myocarditis." A total of 6 studies with 9 monkeypox-induced myocarditis patients were included in this analysis. The mean age of patients was 33.6 years, with all being male patients. The most common symptoms were fever (89%) and chest pain (100%). Electrocardiogram findings showed 44% of patients had ST-elevation, and 22% had sinus tachycardia. The echocardiographic findings show a mean ejection fraction of 52.14%, while 57% of patients had preserved ejection fraction, and 67% had normal wall motion. Cardiac magnetic resonance findings show 40% of patients had late gadolinium enhancement, and 40% had edema. Management of patients was primarily supportive (33%), and 33% of patients were administered Beta blockers and ACE inhibitors. Overall all patients survived with a good prognosis. Our study's findings show that all cases were reported among male patients with the most common symptoms of chest pain. The overall prognosis was good, with no mortality reported. Infected patients complaining of chest pain should not be ignored, and proper investigation of myocarditis must be considered.

DEPS-1 is required for piRNA-dependent silencing and PIWI condensate organisation in Caenorhabditis elegans.

Membraneless organelles are sites for RNA biology including small non-coding RNA (ncRNA) mediated gene silencing. How small ncRNAs utilise phase separated environments for their function is unclear. We investigated how the PIWI-interacting RNA (piRNA) pathway engages with the membraneless organelle P granule in Caenorhabditis elegans. Proteomic analysis of the PIWI protein PRG-1 reveals an interaction with the constitutive P granule protein DEPS-1. DEPS-1 is not required for piRNA biogenesis but piRNA-dependent silencing: deps-1 mutants fail to produce the secondary endo-siRNAs required for the silencing of piRNA targets. We identify a motif on DEPS-1 which mediates a direct interaction with PRG-1. DEPS-1 and PRG-1 form intertwining clusters to build elongated condensates in vivo which are dependent on the Piwi-interacting motif of DEPS-1. Additionally, we identify EDG-1 as an interactor of DEPS-1 and PRG-1. Our study reveals how specific protein-protein interactions drive the spatial organisation and piRNA-dependent silencing within membraneless organelles.

Effective locomotion at multiple stride frequencies using proprioceptive feedback on a legged microrobot.

Limitations in actuation, sensing, and computation have forced small legged robots to rely on carefully tuned, mechanically mediated leg trajectories for effective locomotion. Recent advances in manufacturing, however, have enabled in such robots the ability for operation at multiple stride frequencies using multi-degree-of-freedom leg trajectories. Proprioceptive sensing and control is key to extending the capabilities of these robots to a broad range of operating conditions. In this work, we use concomitant sensing for piezoelectric actuation with a computationally efficient framework for estimation and control of leg trajectories on a quadrupedal microrobot. We demonstrate accurate position estimation (<16[Formula: see text] root-mean-square error) and control (<16[Formula: see text] root-mean-square tracking error) during locomotion across a wide range of stride frequencies (10 Hz-50 Hz). This capability enables the exploration of two bioinspired parametric leg trajectories designed to reduce leg slip and increase locomotion performance (e.g. speed, cost-of-transport (COT), etc). Using this approach, we demonstrate high performance locomotion at stride frequencies (10 Hz-30 Hz) where the robot's natural dynamics result in poor open-loop locomotion. Furthermore, we validate the biological hypotheses that inspired the trajectories and identify regions of highly dynamic locomotion, low COT (3.33), and minimal leg slippage (<10%).

Controllable water surface to underwater transition through electrowetting in a hybrid terrestrial-aquatic microrobot.

Several animal species demonstrate remarkable locomotive capabilities on land, on water, and under water. A hybrid terrestrial-aquatic robot with similar capabilities requires multimodal locomotive strategies that reconcile the constraints imposed by the different environments. Here we report the development of a 1.6 g quadrupedal microrobot that can walk on land, swim on water, and transition between the two. This robot utilizes a combination of surface tension and buoyancy to support its weight and generates differential drag using passive flaps to swim forward and turn. Electrowetting is used to break the water surface and transition into water by reducing the contact angle, and subsequently inducing spontaneous wetting. Finally, several design modifications help the robot overcome surface tension and climb a modest incline to transition back onto land. Our results show that microrobots can demonstrate unique locomotive capabilities by leveraging their small size, mesoscale fabrication methods, and surface effects.

Inverted and vertical climbing of a quadrupedal microrobot using electroadhesion.

The ability to climb greatly increases the reachable workspace of terrestrial robots, improving their utility for inspection and exploration tasks. This is particularly desirable for small (millimeter-scale) legged robots operating in confined environments. This paper presents a 1.48-gram and 4.5-centimeter-long tethered quadrupedal microrobot, the Harvard Ambulatory MicroRobot with Electroadhesion (HAMR-E). The design of HAMR-E enables precise leg motions and voltage-controlled electroadhesion for repeatable and reliable climbing of inverted and vertical surfaces. The innovations that enable this behavior are an integrated leg structure with electroadhesive pads and passive alignment ankles and a parametric tripedal crawling gait. At a relatively low adhesion voltage of 250 volts, HAMR-E achieves speeds up to 1.2 (4.6) millimeters per second and can ambulate for a maximum of 215 (162) steps during vertical (inverted) locomotion. Furthermore, HAMR-E still retains the ability for high-speed locomotion at 140 millimeters per second on horizontal surfaces. As a demonstration of its potential for industrial applications, such as in situ inspection of high-value assets, we show that HAMR-E is capable of achieving open-loop, inverted locomotion inside a curved portion of a commercial jet engine.

The milliDelta: A high-bandwidth, high-precision, millimeter-scale Delta robot.

Delta robots have been widely used in industrial contexts for pick-and-place applications because of their high precision and speed. These qualities are also desirable at the millimeter scale for applications such as vibration cancellation in microsurgery and microassembly or micromanipulation. Developing a millimeter-scale Delta robot that maintains the characteristic input-output behavior and operates with high speed and precision requires overcoming manufacturing and actuation challenges. We present the design, fabrication, and characterization of an adapted Delta robot at the millimeter scale (the "milliDelta") that leverages printed circuit microelectromechanical system manufacturing techniques and is driven by three independently controlled piezoelectric bending actuators. We validated the design of the milliDelta, where two nonintersecting perpendicular revolute joints were used to replace an ideal universal joint. In addition, a transmission linkage system for actuation was introduced to the laminate structure of the milliDelta. This 15 millimeter-by-15 millimeter-by-20 millimeter robot has a total mass of 430 milligrams and a payload capacity of 1.31 grams and operates with precision down to ~5 micrometers in a 7.01-cubic-millimeter workspace. In addition, the milliDelta can follow periodic trajectories at frequencies up to 75 hertz, experiencing velocities of ~0.45 meters per second and accelerations of ~215 meters per squared second. We demonstrate its potential utility for high-bandwidth, high-precision applications that require a compact design.

Gait studies for a quadrupedal microrobot reveal contrasting running templates in two frequency regimes.

Performance metrics such as speed, cost of transport, and stability are the driving factors behind gait selection in legged locomotion. To help understand the effect of gait on the performance and dynamics of small-scale ambulation, we explore four quadrupedal gaits over a wide range of stride frequencies on a 1.43 g, biologically-inspired microrobot, the Harvard Ambulatory MicroRobot (HAMR). Despite its small size, HAMR can precisely control leg frequency, phasing, and trajectory, making it an exceptional platform for gait studies at scales relevant to insect locomotion. The natural frequencies of the body dynamics are used to identify frequency regimes where the choice of gait has varying influence on speed and cost of transport (CoT). To further quantify these effects, two new metrics, ineffective stance and stride correlation, are leveraged to capture effects of foot slippage and observed footfall patterns on locomotion performance. At stride frequencies near body resonant modes, gait is found to drastically alter speed and CoT. When running well above these stride frequencies we find a gait-agnostic shift towards energy characteristics that support 'kinematic running', which is defined as a gait with a Froude number greater than one with energy profiles more similar to walking than running. This kinematic running is rapid (8.5 body lengths per second), efficient (CoT = 9.4), different from widely observed SLIP templates of running, and has the potential to simplify design and control for insect-scale runners.