A Rare Case of Disseminated Histoplasmosis With Hemophagocytic Syndrome in a Patient With Diabetes Mellitus: A Case Report.

We report a case of Histoplasma-associated hemophagocytic syndrome in a diabetes mellitus patient. The patient presented with a fever, cough, and an ulcer on the tongue. The biopsy confirmed the diagnosis of histoplasmosis from the tongue ulcer. Other investigations revealed normal clusters of differentiation 4 (CD4) count and increased hemoglobin A1c (HbA1c) and lactate dehydrogenase (LDH) levels. The patient was diagnosed with hemophagocytic syndrome secondary to Histoplasma after fulfilling the hemophagocytic lymphohistiocytosis (HLH)-2004 criteria required for diagnosis, including fever (with peak temperatures of >38.5° C), splenomegaly, cytopenia affecting two cell lineages in peripheral blood, hypertriglyceridemia (fasting triglycerides >265 mg/dL), and hemophagocytosis in the bone marrow biopsy. The patient was started on injection amphotericin B with remarkable improvement.

Development of a ZnOS+C Composite as a Potential Adsorbent for the Effective Removal of Fast Green Dye from Real Wastewater.

Wastewater treatment is becoming increasingly important due to the potential shortage of pure drinking water in many parts of the world. Adsorption offers a potential technique for the uptake of contaminants and wastewater purification. In the last two decades, several efforts have been made to remove fast green (FG) dye from wastewater via different adsorbent materials. However, adsorption capacity shown by these adsorbents is low and time-consuming. Herein, we have synthesized for the first time a new powdered adsorbent ZnOS+C, modified zinc peroxide with sulfur and activated carbon to effectively remove FG dye from wastewater. Results of batch adsorption experiments have suggested that ZnOS+C has the maximum adsorption potential of 238.28 mg/g for FG dye within 120 min of adsorption equilibrium for a wide range of pH ranging from 2 to 10 pH. The adsorption process conforms to the Freundlich isotherm model, suggesting a multilayered adsorption process on the outer surface of ZnOS+C. The adsorption kinetics study indicates that the kinetics of the reaction are the intraparticle diffusion model. Briefly, this study shows proof of the application of ZnOS+C powder as a new eco-friendly adsorbent with extremely high efficiency and high surface area for removing FG dye.

Smart data collection for CryoEM.

This report provides an overview of the discussions, presentations, and consensus thinking from the Workshop on Smart Data Collection for CryoEM held at the New York Structural Biology Center on April 6-7, 2022. The goal of the workshop was to address next generation data collection strategies that integrate machine learning and real-time processing into the workflow to reduce or eliminate the need for operator intervention.

Atrial Fibrillation in Scrub Typhus: A Series of Four Cases.

Scrub typhus, also known as bush typhus, is an acute febrile zoonosis caused by Orientia tsutsugamushi, transmitted by the bite of chigger mite. Patients with scrub typhus can have many different presentations such as acute hearing loss, interstitial pneumonitis, acute respiratory distress syndrome, myocarditis, pericarditis, meningoencephalitis, acute renal failure, acute hepatic failure, and septic shock. The occurrence of multi-organ dysfunction is responsible for high mortality seen in scrub typhus patients. Cardiovascular involvement can also occur in the form of arrhythmia, which leads to an increase in mortality in these patients, and if associated with ischemic heart disease and acute heart failure, it leads to higher mortality. The early use of antibiotics and telemetry monitoring along with aggressive management of patients can decrease the complications and mortality seen in these patients. This study describes a series of four scrub typhus patients with new-onset atrial fibrillation who were managed with either direct current (DC) cardioversion, amiodarone, or diltiazem.

deutetrabenazine for the treatment of chorea associated with Huntington's disease.

This is a comprehensive review of the literature regarding the use of Deutetrabenazine in treating chorea associated with Huntington's disease. Unfortunately, treatment has been limited for many aspects of this neurodegenerative disease. The present investigation presents the background, evidence, and indications for the use Deutetrabenazine in the setting of Huntington's disease. Huntington's disease is characterized by a variety of motor, psychiatric, and cognitive symptoms with chorea being one of the more notable ones. Chorea is a movement disorder present in multiple neurologic diseases that causes involuntary and irregular muscle movements theorized to be stemming from high dopamine levels. Deutetrabenazine is thought to function as an inhibitor of the VMAT2 vesicular monoamine transporter resulting in decreased monoamine release, including dopamine, in the synaptic cleft which has a therapeutic effect in management of chorea. This drug was approved by the FDA in 2017 with a specific indication for tardive dyskinesia and choreiform movement in Huntington's disease. Currently, there is no definitive treatment for Huntington's disease. Thus, management is primarily focused on symptom management with the use of a variety of pharmaceutical agents. Chorea is one of the many manifestations that significantly alter the quality of life of many patients. Deutetrabenazine is a promising new option for the treatment of chorea in the setting of Huntington's disease. Although studies so far have displayed mixed results, further research, including head-to-head studies, is necessary to elucidate the true potential of this drug.

Role of Intravenous Lidocaine Infusion in the Treatment of Peripheral Neuropathy.

PURPOSE OF REVIEW: This is a comprehensive review of the literature regarding intravenous lidocaine infusion to treat peripheral neuropathy. The clinical symptoms of peripheral neuropathy occur on a broad spectrum and stem from many etiologies resulting in complex treatment approaches. This review presents the background, evidence, and indications for the use of intravenous lidocaine infusions as a treatment option for this condition. RECENT FINDINGS: The clinical range of peripheral neuropathy symptoms includes pain, numbness, muscle weakness, paresthesia, balance difficulty, and autonomic dysfunction. However, severe neuropathic pain remains one of the most debilitating symptoms that significantly affects the quality of life. Current treatment options include antidepressants, anticonvulsants, and, in some cases, opiates, but these are often ineffective, creating the need for other therapeutic approaches.The pathophysiology of neuropathic pain involves sodium channels which create abnormal pain responses. Intravenous lidocaine primarily functions by inhibiting membrane sodium channels which desensitize peripheral nociceptors, thus creating an analgesic effect. The research in using intravenous lidocaine for neuropathic pain is not fully complete and requires further evaluation. SUMMARY: Peripheral neuropathy is a manifestation commonly resulting from diabetes, alcohol abuse, vitamin deficiencies, and chemotherapy, among other causes. One of the most significant complications is neuropathic pain which is often resistant to multi-modal therapeutic regimens. Intravenous lidocaine infusions are a newer treatment option for neuropathic pain, which have additional anti-inflammatory effects with a minimal side effect profile. Studies have concluded it effectively treats neuropathic pain for weeks after administration, but results are variable depending on specific procedures. Further research, including additional direct comparison studies, should be conducted to fully evaluate this drug's usefulness.

Milnacipran for the Treatment of Fibromyalgia.

PURPOSE OF REVIEW: This is a comprehensive review of the literature regarding the use of milnacipran in treating fibromyalgia. A chronic pain disorder with other system disturbances, fibromyalgia is often resistant to many therapeutic approaches. This review presents the background, evidence, and indications for using milnacipran as a treatment option for this condition. RECENT FINDINGS: The definition of fibromyalgia has evolved over many years as it is a relatively tricky syndrome to measure objectively. Today, it is characterized by chronic, widespread pain accompanied by alterations in sleep, mood, and other behavioral aspects. A variety of therapeutic regimens currently used to treat the syndrome as a singular approach are rarely effective.Milnacipran is one of three drugs currently approved by the FDA for the treatment of fibromyalgia. It acts as a serotonin and norepinephrine reuptake inhibitor, which results in decreased pain transmission. Milnacipran remains an effective treatment option for fibromyalgia in adults and needs to be further evaluated with existing therapeutic approaches. SUMMARY: Fibromyalgia is a broad-spectrum disorder primarily characterized by chronic pain coupled with disturbances in cognitive functioning and sleep. The progression of this syndrome is often debilitating and significantly affects the quality of life. Milnacipran is one of three FDA-approved drugs used to alleviate the symptom burden and is comparatively more therapeutic in specific domains of fibromyalgia. A more holistic approach is needed to treat fibromyalgia effectively and further research, including direct comparison studies, should be conducted to fully evaluate the usefulness of this drug.

Time-Dependent Deep Image Prior for Dynamic MRI.

We propose a novel unsupervised deep-learning-based algorithm for dynamic magnetic resonance imaging (MRI) reconstruction. Dynamic MRI requires rapid data acquisition for the study of moving organs such as the heart. We introduce a generalized version of the deep-image-prior approach, which optimizes the weights of a reconstruction network to fit a sequence of sparsely acquired dynamic MRI measurements. Our method needs neither prior training nor additional data. In particular, for cardiac images, it does not require the marking of heartbeats or the reordering of spokes. The key ingredients of our method are threefold: 1) a fixed low-dimensional manifold that encodes the temporal variations of images; 2) a network that maps the manifold into a more expressive latent space; and 3) a convolutional neural network that generates a dynamic series of MRI images from the latent variables and that favors their consistency with the measurements in k -space. Our method outperforms the state-of-the-art methods quantitatively and qualitatively in both retrospective and real fetal cardiac datasets. To the best of our knowledge, this is the first unsupervised deep-learning-based method that can reconstruct the continuous variation of dynamic MRI sequences with high spatial resolution.

Valbenazine for the Treatment of Adults with Tardive Dyskinesia.

PURPOSE OF REVIEW: This a comprehensive review of the literature regarding the use of Valbenazine in treating tardive dyskinesia. A primarily oral movement disorder induced by chronic exposure to certain classes of medications, tardive dyskinesia is often resistant to many therapeutic approaches. This review presents the background, evidence, and indications for the use of Valbenazine as a treatment option for this condition. RECENT FINDINGS: Tardive dyskinesia is a disorder arising from long-term exposure to medications that blocked dopamine receptors, primarily antipsychotics. It is characterized by abnormal movements of the oral-buccal-lingual structures as well as associated pain and hypertrophy. Simply stopping the use of the dopamine blocking agents effectively alleviates the symptoms but is not always reliable hence the need for another therapeutic approach.Valbenazine is thought to function as a highly selective inhibitor of the VMAT2 vesicular monoamine transporter resulting in decreased availability of dopamine in the presynaptic cleft. This leads to decreased dopaminergic activation of the striatal motor pathway. The FDA approved Valbenazine in 2017 to treat tardive dyskinesia in adults and needs to be evaluated with existing therapeutic approaches. SUMMARY: The chronic use of dopamine receptor blocking agents, most commonly antipsychotics, can lead to a movement disorder called tardive dyskinesia. Once symptom onset has occurred, these movement abnormalities can persist for years to permanently, depending on the speed and effectiveness of treatment. Valbenazine is a relatively newer option for the treatment of tardive dyskinesia in adults. Compared to other pharmaceutical agents, it is more selective and has limited toxicities making it an effective treatment regimen. However, further research, including additional direct comparison studies, should be conducted to fully evaluate this drug's usefulness.

Deep-learning projector for optical diffraction tomography.

Optical diffraction tomography is an effective tool to estimate the refractive indices of unknown objects. It proceeds by solving an ill-posed inverse problem for which the wave equation governs the scattering events. The solution has traditionally been derived by the minimization of an objective function in which the data-fidelity term encourages measurement consistency while the regularization term enforces prior constraints. In this work, we propose to train a convolutional neural network (CNN) as the projector in a projected-gradient-descent method. We iteratively produce high-quality estimates and ensure measurement consistency, thus keeping the best of CNN-based and regularization-based worlds. Our experiments on two-dimensional-simulated and real data show an improvement over other conventional or deep-learning-based methods. Furthermore, our trained CNN projector is general enough to accommodate various forward models for the handling of multiple-scattering events.

Note: Biochemical samples centrifuged in-flight on drones.

The ability to conduct en-route centrifugation of samples improves quality and timeliness in the pre-analytical phase. This is demonstrated here on a quadcopter whereby the propellers were adapted to house and apply centrifugal forces to sample-containing capillary tubes instead of incorporating a centrifuge. Tests revealed the ability of the method to separate non-homogenized milk into a cream portion and a skim milk portion, and human whole blood into plasma, buffy coat, and red blood cell components.

CNN-Based Projected Gradient Descent for Consistent CT Image Reconstruction.

We present a new image reconstruction method that replaces the projector in a projected gradient descent (PGD) with a convolutional neural network (CNN). Recently, CNNs trained as image-to-image regressors have been successfully used to solve inverse problems in imaging. However, unlike existing iterative image reconstruction algorithms, these CNN-based approaches usually lack a feedback mechanism to enforce that the reconstructed image is consistent with the measurements. We propose a relaxed version of PGD wherein gradient descent enforces measurement consistency, while a CNN recursively projects the solution closer to the space of desired reconstruction images. We show that this algorithm is guaranteed to converge and, under certain conditions, converges to a local minimum of a non-convex inverse problem. Finally, we propose a simple scheme to train the CNN to act like a projector. Our experiments on sparse-view computed-tomography reconstruction show an improvement over total variation-based regularization, dictionary learning, and a state-of-the-art deep learning-based direct reconstruction technique.

Flexible, Disposable Cellulose-Paper-Based MoS2/Cu2S Hybrid for Wireless Environmental Monitoring and Multifunctional Sensing of Chemical Stimuli.

Multifunctional sensors responding to different chemical stimuli fabricated using functional nanomaterials still remain a challenge because of the usage of the same sensor multiple times for different sensing applications and unreliable front-end processing of the sensing data. This challenge is intensified by the lack of suitable techniques for fabricating disposable sensors, which can be integrated into smartphones with a dedicated application developed for each sensing application. A novel MoS2/Cu2S hybrid grown on disposable cellulose paper by the hydrothermal method is reported for its utilization in sensing humidity, temperature, breath, and ethanol adulteration, wherein the data can be wirelessly transmitted to a smartphone with the dedicated application module for each sensing application. The sensor can be utilized for a particular sensing application and then can be disposed, avoiding the need for utilizing the same sensor for different sensing applications, thereby increasing the accuracy of the sensing data. The sensing mechanism of the fabricated sensor is explained for each stimulus in terms of change in the transport properties of the MoS2/Cu2S hybrid. The development of such unique hybrid materials for wireless disposable multifunctional sensors is a great step ahead in flexible and wearable electronics having potential applications in medical, security, Internet of things, etc.

Drone inflight mixing of biochemical samples.

Autonomous systems for sample transport to the laboratory for analysis can be improved in terms of timeliness, cost and error mitigation in the pre-analytical testing phase. Drones have been reported for outdoor sample transport but incorporating devices on them to attain homogenous mixing of reagents during flight to enhance sample processing timeliness is limited by payload issues. It is shown here that flipping maneuvers conducted with quadcopters are able to facilitate complete and gentle mixing. This capability incorporated during automated sample transport serves to address an important factor contributing to pre-analytical variability which ultimately impacts on test result reliability.

Stimuli-responsively porating gels by condensation.

A polyurethane (PU) resin derived from glycerol and hexamethylene diisocyanate and an imidazolium bromide ionic liquid chain terminator yield a stimuli-responsive resin that reversibly porates as a solvation response.