Median Nerve Measurement and Steroid Injection for Carpal Tunnel Syndrome: A Case Report.

Introduction: Carpal tunnel syndrome is an entrapment neuropathy that affects 3% of adults in the United States. The current techniques used for diagnosis have limited specificity/sensitivity, and the techniques used for treatment have limited efficacy. Case Report: A 34-year-old female presented to the emergency department with two months of worsening painful paresthesias in her right thenar eminence. Ultrasound was performed showing a median nerve area of 20.4 square millimeters within the carpal tunnel. Median nerve block was performed within the carpal tunnel causing complete resolution of her pain. Conclusion: Emergency physicians skilled in point-of-care ultrasound and needle-guided procedures can diagnose and treat carpel tunnel syndrome.

Assessment of Ulnar Carpal Translocation and Carpal Alignment After Volar Plate Fixation With Vascularized Bone Graft for Scaphoid Waist Fracture Nonunions.

PURPOSE: Multiple fixation methods with or without vascularized graft have been described to treat scaphoid nonunions. This study aimed to assess the incidence of carpal malalignment and the degree of ulnar carpal translocation after scaphoid volar plate fixation with pedicled vascularized bone graft in scaphoid waist nonunions with humpback deformity. METHODS: A retrospective cohort study of individuals with recalcitrant scaphoid fracture nonunion treated with volar scaphoid plating and vascularized bone graft was analyzed. All patients had radiographs with the wrist at neutral with clinical follow-up of at least 3 months after surgery. Ulnar subluxation of the carpus was assessed by the change in lunate uncovering and carpal-radial distance before and after surgery. RESULTS: Seventeen patients were included for analysis. Average age was 26 years with an average follow-up interval of 11.0 months. After surgery, 16 patients (94.1%) had fracture union. Between preoperative and initial postoperative imaging, there was an increase in lunate uncovering (mean difference: 8.8%; 95% confidence interval, 4.6% to 13.1%) and carpal-radial distance (mean difference: 3.3% ulnar shift; 95% confidence interval, 1.1% to 5.4%). After surgery, there was minimal change in lunate uncovering and carpal-radial distance from immediately after surgery to final follow-up. CONCLUSIONS: Preoperative lunate uncovering was lower than normal values, suggesting an abnormal radial shift of the carpus with a collapsed scaphoid. Postoperative lunate uncovering was similar to normal values, reflecting an ulnar shift of the carpus after operative intervention. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Complete genome sequence of the Microbacterium rhizosphaerae type strain KACC 19337T.

We report the whole genome sequence of Microbacterium rhizosphaerae KACC 19337T. The genome consists of a 4.05-Mb circular chromosome, with a G + C content of 69.7 %, and 3,627 total coding genes predicted.

Microbacterium horticulturae sp. nov., a novel actinobacterium isolated from flowerpot soil.

Strain CJN36-1NT, a Gram-stain-positive, non-flagellated, strictly aerobic and short rod-shaped bacterium, was isolated from flowerpot soil sampled in the Jeonju region of the Republic of Korea. Based on 16S rRNA gene sequences and the resulting phylogenetic tree, the strain belonged to the genus Microbacterium. Strain CJN36-1NT contained a chromosome of 3.6 Mbp with a G+C content of 68.5 mol%. The strain grew at 10-37 °C (optimally at 28 °C), at pH 5.0-8.0 (optimally at pH 8.0), and in the presence of 0-7 % NaCl (w/v; optimally with 0 % NaCl). Digital DNA-DNA hybridization, average nucleotide identity and average amino acid identity values between strain CJN36-1NT and its closest related species, Microbacterium protaetiae DFW100M-13T, were 82.0, 81.2, and 23.2 %, respectively. We propose naming this novel species Microbacterium horticulturae sp. nov., with CJN36-1NT (=KACC 23027T=NBRC 116065T) as the type strain.

A Simple Laser-Induced Breakdown Spectroscopy Method for Quantification and Classification of Edible Sea Salts Assisted by Surface-Hydrophilicity-Enhanced Silicon Wafer Substrates.

Salt, one of the most commonly consumed food additives worldwide, is produced in many countries. The chemical composition of edible salts is essential information for quality assessment and origin distinction. In this work, a simple laser-induced breakdown spectroscopy instrument was assembled with a diode-pumped solid-state laser and a miniature spectrometer. Its performances in analyzing Mg and Ca in six popular edible sea salts consumed in South Korea and classification of the products were investigated. Each salt was dissolved in water and a tiny amount of the solution was dropped and dried on the hydrophilicity-enhanced silicon wafer substrate, providing homogeneous distribution of salt crystals. Strong Mg II and Ca II emissions were chosen for both quantification and classification. Calibration curves could be constructed with limits-of-detection of 87 mg/kg for Mg and 45 mg/kg for Ca. Also, the Mg II and Ca II emission peak intensities were used in a k-nearest neighbors model providing 98.6% classification accuracy. In both quantification and classification, intensity normalization using a Na I emission line as a reference signal was effective. A concept of interclass distance was introduced, and the increase in the classification accuracy due to the intensity normalization was rationalized based on it. Our methodology will be useful for analyzing major mineral nutrients in various food materials in liquid phase or soluble in water, including salts.

Epidemiology and survival factors for sarcoma patients in minority populations: a SEER-retrospective study.

Background: Epidemiologic studies have demonstrated race as a predictor of worse oncological outcomes. To better understand the effect of race on oncological outcomes, we utilized the Surveillance, Epidemiology, and End Results (SEER) database to determine what treatment courses are provided to minority patients and how this impacts survival. Materials and methods: A retrospective review of bone and soft tissue sarcoma cases was performed using the SEER database for a minimum 5-year survival rate (SR) using Kaplan-Meier curves. Categorical variables were compared using Pearson's χ2 test and Cramer V. Kaplan-Meier curves were used to determine survival rates (SR) and Cox regression analysis was used to determine hazard ratios (HRs). Results: Races that had an increased risk of death included Native American/Alaska Native (NA/AN) [hazard ratio (HR): 1.36, 95% confidence interval (CI): 1.049-1.761, p = 0.020) and Black (HR = 1.17, 95% CI: 1.091-1.256, p < 0.001). NA/AN individuals had the lowest SR (5-year SR = 70.9%, 95% CI: 63.8-78.0%, p < 0.001). The rate of metastasis at diagnosis for each race was 13.07% - Hispanic, 10.62% - NA/AN, 12.77% - Black, 10.61% - Asian/Pacific Islander (A/PI), and 9.02% - White individuals (p < 0.001). There were increases in the rate of metastasis at diagnosis and decreases in rates of surgical excision for Hispanic and Black patients (p < 0.001). Conclusion: Race is determined to be an independent risk factor for death in NA/AN and Black patients with sarcomas of the extremities. Access to healthcare and delay in seeking treatment may contribute to higher rates of metastasis upon diagnosis for minority patients, and decreased rates of surgical excision could be associated with poor follow up and lack of resources.

Highly Precise Laser-Induced Breakdown Spectroscopy Analysis of Major Mineral Nutrients in Edible Salts Using Miniaturized Salt Ponds and Alternating Laser-Ablation Data Sampling.

In this work, we applied a hydrophilicity-enhanced solid substrate and an alternating laser-ablation data sampling (ALADS) scheme to improve laser-induced breakdown spectroscopy (LIBS) measurement precision and demonstrated the performance in analyzing K, Mg, Ca, and S contained in commercially available edible salt products. Five edible salt products from Australia, Bolivia, France, and South Korea were dissolved in water and a tiny volume of each solution was dropped on the solid substrate, that is, a miniaturized salt pond. After being dried, the residual salt crystals distributed still inhomogeneously, but the homogeneity could be significantly improved in comparison with that from typical drop-and-dry methods. The ALADS scheme was applied to extract three precise measurements from 9798 single-shot LIBS spectra covering the entire salt pond. The measurements obtained by ALADS were found to agree well with one another regardless of the inhomogeneous distribution of salt crystals. As a result, the measurement precision was proved remarkably. Limits of detection for K, Mg, Ca, and S were estimated to be 0.64, 1.7, 14, and 530 mg/kg, respectively, which are enough to analyze those elements contained in salts typically at the level of 100 parts per million (ppm) to ∼3 wt% for the purpose of salt quality assessment.

Ocular and inflammatory markers associated with Gulf War illness symptoms.

To examine the utility of ocular coherence tomography (OCT) metrics, in conjunction with systemic markers of inflammation, in identifying individuals with Gulf War Illness (GWI) symptoms. Prospective case-control study of 108 Gulf War Era veterans, split into 2 groups based on the presence of GWI symptoms, defined by the Kansas criteria. Information on demographics, deployment history, and co-morbidities were captured. 101 individuals underwent OCT imaging and 105 individuals provided a blood sample which was analyzed for inflammatory cytokines using an enzyme-linked immunosorbent assay-based chemiluminescent assay. The main outcome measure was predictors of GWI symptoms, examined with multivariable forward stepwise logistic regression analysis followed by receiver operating characteristic (ROC) analysis. The mean age of the population was 55 ± 4, 90.7% self-identified as male, 53.3% as White, and 54.3% as Hispanic. A multivariable model that considered demographics and co-morbidities found that a lower inferior temporal ganglion cell layer-inner plexiform layer (GCL‒IPL) thickness, higher temporal nerve fiber layer (NFL) thickness, lower interleukin (IL)-1ß levels, higher IL-1α levels, and lower tumor necrosis factor-receptor I levels correlated with GWI symptoms. ROC analysis demonstrated an area under the curve of 0.78 with the best cut-off value for the prediction model having a sensitivity of 83% and specificity of 58%. RNFL and GCL‒IPL measures, namely increased temporal thickness and decreased inferior temporal thickness, respectively, in conjunction with a number of inflammatory cytokines, had a reasonable sensitivity for the diagnosis of GWI symptoms in our population.

Feasibility of a Low-Power, Low-Resolution Laser-Induced Breakdown Spectroscopy Instrument for Analysis of Nickel Alloys: Quantification of the Major Alloying Elements and Classification.

A simple cost-effective laser-induced breakdown spectroscopy (LIBS) instrument was used for quantification of major elements in several nickel alloys and also sorting them. A compact low-power diode-pumped solid-state laser and a miniature low-resolution spectrometer were assembled for the LIBS instrument. Material properties of the nickel alloys depend mainly on the composition of the major elements, Ni, Cr, and Fe, ranging from a few to ∼60 wt%. The emission peaks at 547.7 nm, 520.4 nm, and 438.1 nm for Ni, Cr, and Fe, respectively, were chosen for this analysis. The analytical performance was found to be enough for the quantification of Ni, Cr, and Fe in the nickel alloys. Limits of detection and accuracy were estimated to be a few weight percent (wt%) and measurement precisions were less than 10% in terms of relative standard deviation. The calibration performance of this intensity-based method was compared with that of the "ratio method" which is used in conventional optical emission spectroscopy analyses. The comparison indicates that the intensity-based method is more appropriate with the low-performance LIBS instrument that detects emission peaks of only a few major elements. Also, multivariate modeling of the six different nickel alloy samples based on the emission peak intensities of Ni, Cr, and Fe was performed using k-nearest neighbors (KNN) and linear discriminant analysis (LDA). The KNN and ordinary LDA models showed 95.0% and 98.3% classification correctness for the separate test data set, respectively. To improve classification performance further, the two-step LDA model was trained. In this approach, the two closest sample classes responsible for the decrease in the classification correctness were separately modeled in the second step to exploit their difference effectively. The two-step LDA model showed 100% correctness in classifying the test objects. Our results indicate that such a low-performance LIBS instrument can be effectively utilized for quantitative analysis of the major elements in the nickel alloys and their rapid identification or sorting in combination with an appropriate multivariate modeling algorithm.

Cooperative combination of LIBS-based elemental analysis and near-infrared molecular fingerprinting for enhanced discrimination of geographical origin of soybean paste.

Laser-induced breakdown spectroscopy (LIBS) and near-infrared (NIR) spectroscopy were combined to enhance discrimination of soybean paste samples according to geographical origin. Since element and organic component compositions of soybean pastes depend on soybean cultivation areas and fermentation conditions, utilization of two complementary spectroscopic signatures would be synergetic for the discrimination. When the areas of C (AC) and Ca (ACa) peaks in the LIBS spectra were used as the inputs for linear discriminant analysis, the accuracy was 95.4%. The accuracy became 92.1%, when the principal component (PC) scores obtained by principal component analysis of the NIR spectra were employed. To enhance NIR discrimination, two-trace two-dimensional (2T2D) correlation analysis was adopted to recognize minute spectral differences. With using the 1st/2nd PC scores of 2T2D slice spectra, accuracy increased to 95.0%. When the ratios of ACa/AC and the 2nd PC scores of the samples were combined together, the accuracy improved to 99.6%.

Epidemiology and survival factors of appendicular myxofibrosarcoma: a SEER-retrospective study.

Background: The low incidence of myxofibrosarcoma (MFS) makes high power studies difficult to perform. Demographic and prognostic factors for MFS and how they differ from all extremity soft tissue sarcomas (STS) are not well understood. The purpose of this study was to characterize a large cohort of patients with MFS and evaluate epidemiologic and survival factors when compared to all STS. Materials and methods: We performed a retrospective review of the Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2015 to identify 1,440 patients diagnosed with MFS and 12,324 with STS. Survival curves were creased using Kaplan-Meier, and Cox regression analyses were performed to identify hazard ratios (HRs). Results: Overall survival was greater for STS than MFS (79% vs. 67%). Patients with MFS had a higher average age at diagnosis than STS (62 vs. 56), and older age was strongly associated with decreased survivorship for MFS (HR = 7.94). A greater proportion of patients under 30 diagnosed with MFS were female when compared to STS (49.6% vs. 45.4%). The incidence of MFS and STS increased over the 15-year period, with MFS increasing at a greater rate than STS (1.25% vs. 2.59%). Survival increased for patients diagnosed after 2008 for both STS (9.4%) and MFS (13.2%). Conclusions: There are differences between patient demographics and survival factors when comparing MFS to all STS. Monitoring changes in demographic and survival trends for rare STS subtypes like MFS is important to improve diagnostic algorithms and treatment options.

Combination of LIBS-based elemental analysis and near-infrared molecular fingerprinting of bile juice to enhance identification of gallbladder cancer.

Laser-induced breakdown spectroscopy (LIBS) and near-infrared (NIR) spectroscopy, enabling the measurement of raw bile directly without sample pretreatment, were cooperatively combined to enhance the discrimination of gallbladder cancer (GBC) from other diseases of gallstone and gallbladder (GB) polyp. Since elemental contents and metabolite compositions of bile vary according to the pathological conditions of pancreaticobiliary patients, the use of complementary information could be synergetic to improve disease identification accuracy. The ratios of Mg and Na peak areas (AMg/ANa) and Na and K peak areas (ANa/AK) in the LIBS spectra of GBC samples were different from those of the remaining samples. Also, the intensity ratios of main NIR peaks differed in GBC. Nonetheless, the use of only element peak area ratio or NIR peak intensity ratio was not sufficient to clearly discriminate GBC. On the other hand, when the ANa/AK values and second NIR principal component scores were combined, the discrimination of GBC from normal/gallstone/GB polyp was substantially enhanced owing to incorporation of both complementary GBC-discriminant spectroscopic signatures.

Two-Step Partial Least Squares-Discriminant Analysis Modeling for Accurate Classification of Edible Sea Salt Products Using Laser-Induced Breakdown Spectroscopy.

Laser-induced breakdown spectroscopy (LIBS) has been widely applied to material classification in various fields, and partial least squares-discriminant analysis (PLS-DA) is one of the frequently used classical multivariate statistics to construct classification models based on the LIBS spectra. However, classification accuracy of the PLS-DA model is sensitive to the number of classes and their similarities. Considering this characteristic of PLS-DA, we suggest a two-step PLS-DA modeling approach to improve the classification accuracy. This strategy was demonstrated for a six-class problem in which six commercial edible sea salts produced in Japan, South Korea, and France are classified using their LIBS spectra. At the first step, test spectra were sorted into four classes and one extended class, composed of the two other most confusing classes, and then the test spectra in the extended class were further classified into each of the two constituent classes which were modeled separately from the other four classes. This two-step classification has been found to remarkably improve the PLS-DA classification accuracy by maximizing the difference between the confusing classes in the second-step modeling.

Comparative risk of anemia and related micronutrient deficiencies after Roux-en-Y gastric bypass and sleeve gastrectomy in patients with obesity: An updated meta-analysis of randomized controlled trials.

Although Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most prevalent bariatric surgical procedures, high-level evidence is scarce regarding the assessment of postoperative nutritional risk in RYGB versus SG. Therefore, we performed a systematic review and meta-analysis to compare the risk of anemia and related micronutrient deficiencies after RYGB and SG. We analyzed 10 randomized controlled trials that compared RYGB and SG with reported incidence of postoperative anemia and/or anemia-related micronutrient deficiencies (iron, vitamin B12 , or folate). There were no significant differences in the risk of postoperative anemia (moderate level of evidence), iron deficiency (high level of evidence), or folate deficiency (moderate level of evidence). Patients undergoing RYGB had a higher risk of postoperative vitamin B12 deficiency than those undergoing SG (relative risk, 1.86; 95% confidence interval, 1.15-3.02; p = 0.012; high level of evidence). Our findings imply that patients undergoing RYGB require more stringent vitamin B12 supplementation and surveillance than those undergoing SG. Additionally, our results may aid patients with high concern for anemia and related micronutrient deficiencies in making informed decisions regarding surgical methods based on nutritional risk.

Quantitative analysis of ceria co-doped with samarium and gadolinium using laser-induced breakdown spectroscopy.

Ceria doped with low-valence lanthanide cations has been introduced for use as an electrolyte in solid oxide fuel cells (SOFCs). Improving the performance of SOFCs using doped ceria requires an increase in ion mobility across the solid electrolyte. Recently, ceria doped with multiple low-valence lanthanide ions has been found to show better ion mobility than that of the singly doped one. In this work, the feasibility of laser-induced breakdown spectroscopy (LIBS) for stoichiometric analysis of doubly doped ceria, SmxGd0.1-xCe0.9O2-δ, was investigated. The three lanthanide elements pouring out plenty of emission lines made identifying the well-resolved single emission line of the dopants (Sm and Gd) rarely feasible. However, the spectral feature of the dopants could be extracted from the unresolved spectra successfully by partial least squares-regression (PLS-R). The PLS-R model performance calibrating the LIBS spectra to the concentration of Sm or Gd was dependent on the contribution of the matrix element (Ce) to the latent variable chosen for modeling. The residual feature of Ce in the latent variable could be reduced further by smoothing LIBS spectra using a moving average. The best model showed dependable detection limit (0.83 mol% of Sm) and accuracy (0.24 mol% of Sm) performances. Spectral denoising by moving average and PLS-R modeling based on LIBS spectra can be used as a rapid and reliable methodology for the multiply doped ceria and assist the manufacturing and recycling processes of SOFCs.

Prognostic factors in patients hospitalized with community-acquired aspiration pneumonia.

INTRODUCTION: Patients with aspiration pneumonia (AP) exhibit higher mortality than those with non-AP. However, data regarding predictors of short-term prognosis in patients with community-acquired AP are limited. METHODS: Patients hospitalized with community-acquired pneumonia (CAP) were retrospectively classified into aspiration pneumonia (AP) and non-AP groups. The AP patients were further divided into nonsurvivors and survivors by 30-day mortality, and various clinical variables were compared between the groups. RESULTS: Of 1249 CAP patients, 254 (20.3%) were classified into the AP group, of whom 76 patients (29.9%) died within 30 days. CURB-65, pneumonia severity index (PSI), and Infectious Diseases Society of America/American Thoracic Society criteria for severe CAP (SCAP) showed only modest prognostic performance for the prediction of 30-day mortality (c-statistics, 0.635, 0.647, and 0.681, respectively). Along with the PSI and SCAP, Eastern Cooperative Oncology Group performance status (ECOG-PS) and blood biomarkers, including, N-terminal of prohormone brain natriuretic peptide (NT-proBNP) and albumin, were independent predictors of 30-day mortality. In models based on clinical prediction rules, including CURB-65, PSI, and SCAP, the addition of ECOG-PS further improved their c-statistics compared to the clinical prediction rules alone. In the four combinations based on SCAP, ECOG-PS, and two blood biomarkers (NT-proBNP and albumin), the c-statistics further increased to reach approximately 0.8. CONCLUSIONS: CURB-65, PSI, and SCAP exhibited only modest discriminatory power in predicting the 30-day mortality of patients with community-acquired AP. The addition of performance status and blood biomarkers, including NT-proBNP and albumin, further increased prognostic performance, showing good predictive accuracy in the SCAP-based model.

Role of Chest Computed Tomography in Patients Hospitalized with Community-Acquired Complicated Parapneumonic Effusion or Empyema.

BACKGROUND: Data regarding predictors of the outcome in patients with community-acquired complicated parapneumonic effusion (CPPE) or empyema are insufficient. The aim of the present study was to investigate the prognostic factors in these patients. METHODS: Patients with community-acquired pneumonia (CAP) were classified into a CPPE or empyema group and a control group. The patients with CPPE or empyema were further divided into longer and shorter length of stay (LOS) groups, and clinical variables and computed tomographic (CT) findings were compared between the 2 groups. RESULTS: Of outcome variables, LOS was significantly longer in the CPPE or empyema group than in the control group (13 days [interquartile range, 10‒17 days] versus 8 days [6‒12 days], p < 0.001), whereas 30-day mortality and in-hospital mortality were not significantly different between the 2 groups. Patients with CPPE or empyema were divided into shorter LOS (<14 days) and longer LOS (≥14 days) groups. Pneumonia severity index (PSI) class IV‒V (odds ratio [OR], 2.79; 95% confidence interval [CI]: 1.35, 5.76; p = 0.006), increased attenuation of extrapleural fat (OR, 2.26; 95% CI: 1.06, 4.80; p = 0.034), and pleural microbubbles (OR 3.93; 95% CI: 1.03, 14.98; p = 0.045) were independent predictors for prolonged LOS in CAP patients with CPPE or empyema. CONCLUSIONS: Increased attenuation of extrapleural fat and pleural microbubbles assessed with CT and PSI class IV‒V independently predicted prolonged LOS in CAP patients with CPPE or empyema. These findings may be helpful to identify patients who need more intensive evaluation and intervention.

Beyond dry eye: how co-morbidities influence disease phenotype in dry eye disease.

Dry Eye Disease (DED) is a complex and multifactorial disorder of tear homoeostasis that results in pain, visual disturbance, and ocular surface damage. It is highly prevalent around the world and is associated with many co-morbidities that may contribute to or exacerbate symptoms and signs of disease and affect disease phenotype. However, DED is not one disease and can manifest with a variety of symptoms and/or signs. In this review, we discuss relationships between various co-morbidities and DED phenotypes. For example, individuals with immune mediated diseases, like Sjögren's Syndrome and Graft versus Host Disease, often present with aqueous tear deficiency (ADDE) in the setting of lacrimal gland dysfunction. Individuals with disorders that affect the periocular skin, like rosacea and seborrhoeic dermatitis, often present with evaporative dry eye (EDE) in the setting of eyelid and/or meibomian gland abnormalities. Individuals with pain related disorders, such as chronic pain syndrome and migraine, often present with ocular pain out of proportion to tear film abnormalities, often with accompanying corneal nerve hypersensitivity. Individuals with diabetes mellitus often present with an epitheliopathy in the setting of decreased sensation (neurotrophic keratitis). While not absolute, understanding relationships between co-morbidities and DED phenotypes can help tailor a therapeutic plan to the individual patient.

COVID-19 Related Racial Discrimination in Small Asian Communities: A Cross Sectional Study.

Since the outbreak of COVID-19, there has been a surge of discrimination against Asians across the globe. However, there is a knowledge gap of COVID-19 related racial discrimination against Asians in smaller Asian populations. A total of 221 adults living in Florida completed an online survey between June-July 2020. Adjusted logistic regression assessed associations between sociodemographic factors and experienced discrimination, hypervigilance of safety, nervousness in public, and anticipated discrimination. Statistical analyses were performed using SPSS. Asian respondents were more likely than non-Asians to experience discrimination during COVID-19 (AOR = 12.58; 95% CI 4.74, 33.38; p ≤ 0.001). Asians were more likely to anticipate discrimination after the pandemic ends (AOR = 4.35, 95% CI 1.33, 14.17; p < 0.05). We found that Asians in smaller Asian populations suffer from a disproportionate level of discrimination due to COVID-19, relative to non-Asians. Our findings support previous research that racial discrimination exists on a continuum of violence and can have severe negative health consequences.