Brief report:

The use of tramadol and other opioids for pain management has been accompanied by a multitude of challenges and concerns worldwide. The use of tramadol saw a decline in Denmark during 2017-2019 accompanied by a slight increase in the use of morphine and oxycodone. Using the Danish National Prescription Registry and utilizing data until and including 2023, we aimed to provide updated data on the utilization patterns of tramadol and other opioids in Denmark. We found a 35% decline in the use of tramadol from 2017-2023 most likely due to media attention, regulatory actions, health campaigns, and targeted education of physicians and patients by the Danish health authorities. This decline was accompanied by an increase in the number of new (+90%) and current users of morphine (+57%) which surpassed those of tramadol, oxycodone, and other opioids in 2023.

Occult Open Pelvic Fracture in the Female Perineal Area: A Rare Case Report and Review

Introduction: Adenoidectomy is one of the commonest surgical procedures in children. Techniques vary, with different devices (curette, diathermy, plasma ablation, and microdebrider) and approaches (transnasal TN and transoral TO) in widespread use. A systematic review was performed to determine the efficacy, efficiency and outcomes of current techniques and approaches. Methods and analysis: A systematic review following the PRISMA guidelines was conducted. PubMed, EMBASE, The Cochrane Library, Web of Science, CINAHL were used during the literature searches. Quality assessment of included studies was performed using the Newcastle-Ottawa Scale. Results: 3185 studies were identified, 17 were included in the systematic review. 1799 patients underwent adenoidectomy, with a post-operative complication rate of 8.67% patients (n=156). Common complications identified included vomiting 2.33% (n=42); haemorrhage: primary 0.83% (n=15), secondary 0.72% (n=13) and nasal obstruction 1.55% (n=28). The microdebrider had the lowest levels of blood loss (TN 12.26 ml vs TO 12.65 ml; p=0.93) and reduced operating time (TN 6.47 mins vs TO 8.63 mins; p=0.25). Conclusion: Adenoidectomy remains a safe procedure with few post-operative complications. The microdebrider has some advantages over other techniques.

Introduction:Takayasu arteritis (TA), also known as pulseless disease, is a rare systemic inflammatory condition that primarily affects the medium and large arteries, including their branches. It predominantly occurs in young Asian women, with a reported worldwide incidence of only 1 to 2 per million people1.Women are more frequently affected than men2, with a varying incidence rate in different parts of the globe. Male to female ratio is 1:8 in western countries and 1:3 in Japan3.It is a chronic disease primarily impacting the aorta and its large branches. Early diagnosis is crucial to prevent severe end organ damage, including stroke and ischemic heart disease4.However, diagnosis is often challenging due to the non-specific systemic inflammatory symptoms present in the early phase, which can lead to an insidious clinical course until vascular ischemic complications emerge5.The disease typically progresses through two phases: an initial pre-occlusive inflammatory phase that may go unnoticed, followed by an occlusive phase characterized by ischemic vascular symptoms resulting from arterial lesions such as stenosis, occlusion, or aneurysm6.Extremity pain, claudication, bruits, pulselessness and unrecordable blood pressure are the common features of patient visiting health care facility. However, presentation with acute visual loss or stroke may be particularly rare7.18% of patients with large vessel vasculitis presents with unilateral visual loss at diagnosis, often resulting in irreversible damage. Early administration of pulsed intravenous methylprednisolone may provide some benefit to patients experiencing early onset of visual symptoms8.While numerous systematic reviews have explored ocular manifestations in various systemic diseases, few have focused on the eye involvement in Takayasu arteritis.

This study investigates the impact of various surface finishes on the low cycle fatigue (LCF) properties of laser powder bed fusion GRCop-42. The evaluated surfaces include as-built, machined, and chemically polished finishes (1 .0% and 2 .0%). LCF life of polished GRCop-42 was assessed at cryogenic (−195 ◦ C ), ambient, and elevated temperatures (200 ◦ C , 400 ◦ C , 600 ◦ C , and 800 ◦ C ) across three strain amplitudes. Results indicate that surface finish has minimal impact on LCF life. Stress across different strain levels showed minimal effect of surface finish on cyclic hardening/softening. Cryogenic temperatures led to cyclic hardening followed by stabilization, while ambient and 200 ◦ C temperatures showed initial hardening followed by softening. At 400 ◦ C and above, specimens displayed continuous cyclic softening. Fractography showed that surface finish impacts plastic deformation: as-printed and polished surfaces had brittle fractures, while machined specimens were ductile. Specimens at cryogenic and ambient temperatures exhibited brittle fractures, whereas those at elevated temperatures showed plastic deformation and microcracks.

Catheter ablation of premature ventricular contractions originating from the proximal left anterior fascicle via right coronary cusp

A document by Xueqin Chen. Click on the document to view its contents.

Background: Neuroblastoma is the most common extracranial solid tumor in children, with about half of cases classified as high risk. Treatment varies by risk level, with high-risk patients undergoing aggressive multimodal therapy. Long-term survival has improved, but survivors face significant risks of late treatment effects, including adrenal insufficiency. This study investigates the incidence of adrenal insufficiency among neuroblastoma patients, focusing on high-risk versus non-high-risk cases. Procedure: This retrospective cohort study at a single tertiary children’s hospital reviewed records from 1998 to 2021, identifying 370 neuroblastoma patients, of which 137 had complete risk stratification. The primary outcome was the incidence of adrenal insufficiency, diagnosed based on clinical evaluation and response to hydrocortisone therapy. Demographic and clinical data were collected, and statistical analyses were performed to compare high-risk and non-high-risk groups. Results: Among 137 neuroblastoma patients, 9 (12.0%) high-risk and 3 (4.9%) non-high-risk patients were diagnosed with adrenal insufficiency. The cumulative incidence of adrenal insufficiency was 16.6% in high-risk and 3.5% in non-high-risk patients. High-risk patients with adrenal insufficiency had a median time of 10.2 months from neuroblastoma diagnosis to adrenal insufficiency diagnosis, with all cases occurring in patients with adrenal primary tumors. There were no significant differences in demographic or clinical characteristics between high-risk patients with and without adrenal insufficiency. Conclusions: The study found a higher cumulative incidence of adrenal insufficiency in high-risk neuroblastoma patients, particularly those with adrenal primary tumors. Despite the lack of significant prevalence difference between risk groups, the findings underscore the need for vigilant monitoring and screening for adrenal insufficiency in neuroblastoma patients during and after treatment. Future research should include larger, multi-institutional cohorts to better understand risk factors and optimize screening protocols.

With an increasing share of the electricity grid relying on wind to provide generating capacity and energy, there is an expanding global need for historically accurate high-resolution wind data. Conventional downscaling methods for generating these data based on numerical weather prediction have a high computational burden and require extensive tuning for historical accuracy. In this work, we present a novel deep learning-based spatiotemporal downscaling method, using generative adversarial networks (GANs), for generating historically accurate high-resolution wind resource data from the European Centre for Medium-Range Weather Forecasting Reanalysis version 5 data (ERA5). We show that by training a GAN model with ERA5 low-resolution input and Wind Integration National Dataset Toolkit (WTK; [[1]](#ref-0001)) data as the high-resolution target, we achieved results comparable in historical accuracy and spatiotemporal variability to conventional dynamical downscaling. This GAN-based downscaling method additionally reduces computational costs over dynamical downscaling by two orders of magnitude. GANs are trained on data sampled from the contiguous United States (CONUS), selected to provide a diverse sampling of terrain conditions, and validated on data held out from training, as well as observational data. This cross-validation shows low error and high correlations with observations and excellent agreement with holdout data across distributions of physical metrics. We additionally downscaled the members of the European Centre for Medium-Range Weather Forecasting Ensemble of Data Assimilations (EDA) for 2012–2015 and 2019–2023 to estimate uncertainty over the period for which we have observational data. We applied this approach to downscale 30-km hourly ERA5 data to 2-km 5-minute wind data for January 2000 through December 2023 at multiple hub heights over Ukraine, Moldova, and part of Romania. The geographic extent was motivated by the urgent need for planners in Ukraine to rebuild and decentralize the grid, which has been severely damaged by the conflict between Russia and Ukraine. Comparisons against observational data from the Meteorological Assimilation Data Ingest System (MADIS) and multiple wind farms show comparable performance to the CONUS validation. This 24-year data record is the first member of the super resolution for renewable energy resource data with wind from reanalysis data dataset (Sup3rWind).

With the use of Immune Checkpoint Inhibitors (ICIs) and targeted therapies, the clinical outcomes of metastatic melanoma have drastically improved. The current scenario has reduced the use of chemotherapy as a first-line treatment. However, in a resource-limited setting, where access to ICIs and targeted therapies is not feasible, and in patients who fail to tolerate these therapies, chemotherapy continues to remain effective. The median survival and response rates with chemotherapy alone are dismally low. Here, we report a case in which a patient with stage IV anorectal melanoma was able to achieve a complete metabolic response and sustain it for 3 years and continue to do so with the first-line single-agent temozolomide.

BACKGROUND: Intervention by hoof care professionals is critical for a functioning equine hoof. Pressure distribution provides information on loading, however information on the effects of such interventions on pressure distribution is lacking OBJECTIVES: To describe the pressure changes of equine fore feet following trimming. STUDY DESIGN: Cross-sectional cohort study METHODS: 50 sound horses were recruited through convenience sampling. 18 external hoof measures of the dorsal, lateral, medial and solar aspects were obtained before and after trimming from 94 fore feet. Horses were walked over a pressure mat before and after trimming and pressure maps of the solar surface created. Percentage change in hoof measures were assessed. Factors associated with an increase in pressure in the frog region after trimming were entered into a forward likelihood ratio logistic regression model. Odd ratios (ORs) with 95% confidence intervals (CI) and area under the curve receiver operator characteristics (AUROC) were calculated. Sensitivity and specificity were calculated at a cut-off value of P=0.5. RESULTS: Trimming resulted in a significant increase in pressure, topographically mapped to the frog region, in 12/94 feet. Percentage difference in bearing border length (OR 0.66 95% CI 0.51; 0.86), heel buttress to centre of pressure distance (OR 1.30 95% CI 1.10; 1.53), heel angle (from the lateral side) (OR 1.11 95% CI 1.04; 1.19) and heel length (from the medial side) (OR 0.92 95% CI 0.85; 0.99) were retained in the final model associated with increased pressure in the frog region following trimming. AUROC was excellent (0.94 95% CI 0.88; 0.99) with fair sensitivity (58%) and excellent specificity (98%) at P=0.5. MAIN LIMITATIONS: Subjective lameness exam only. CONCLUSIONS: Measuring pressure changes over the solar surface of the equine fore foot after trimming identified that an increased pressure in the frog region was linked to specific changes in hoof shape.

Drought stress reduces leaf net assimilation (A N) and phloem export, but the equilibrium between the two is unknown. Consequently, the leaf carbon balance and the primary use of the leaf nonstructural carbohydrates (NSC) under water deficit are unclear. Also, we do not know how quickly leaves can replenish their NSC storage and resume export after rehydration. Hence, we dried grapevines to either zero A N, turgor loss, or complete wilting while following the leaf carbon dynamics. The vines ceased growth and minimized carbon export under drought, conserving the leaves NSC until A N zeroed. Subsequently, the leaves slowly depleted their NSC storage. However, the NSC depletion rate in the leaves was too slow to support the leaf’s energetic requirements, probably transforming the leaves into carbon sinks. Even under extreme drought (-2 MPa), the leaves had substantial NSC reserves (38% of the controls). After rehydration, all surviving leaves recovered their NSC storage within a week, and even leaves that were later shed had functional phloem export in the week after rehydration. The study reveals the leaf carbon relations under drought, highlighting the preference of the leaf to conserve its NSC storage rather than utilize it.

1 INTRODUCTIONRadiofrequency ablation has been demonstrated to be a low-risk and effective treatment for eliminating premature ventricular complexes (PVC).1,2 The retrograde transaortic approach is a widely used access route for the mapping and ablation of ventricular arrhythmias arising from the left ventricle, including the papillary muscles.1 It has been reported that some complications were associated with the retrograde transaortic approach, including iatrogenic aortic dissection, coronary damage, valve leaflets damage, complete atrioventricular block and so on.1,3 However, acute ischemic stroke (AIS) associated with the retrograde transaortic manipulation during radiofrequency ablation of PVC was rarely reported.4 In this case report, we shared a case of AIS encountered after the retrograde transaortic manipulation, during a procedure of PVC ablation.2 CASE HISTORYA 66-year-old woman (Height 164cm, Weight 72Kg) was referred for radiofrequency ablation of frequent PVC (Figure 1A), after the treatment of which by medication had been ineffective. She had a history of palpitation for one year. Her PVC burden was 14.5%, with a total of 12735 PVCs during the 24-hour Holter. Regular examination confirmed the diagnosis of hypercholesteremia (total cholesterol 6.08mmol/L, low-density lipoprotein cholesterol 4.16 mmol/L). No other disease (hypertension, diabetic mellitus, stroke) was recorded. Before the procedure, transthoracic echocardiography revealed the patient had normal cardiac diameters and normal left ventricular ejection function (68%).

Metallic Taste (MT) is frequently described during head and neck cancer treatments but very little is known about its etiologies. One hypothesis to explain the MT is the removal of facial nerve inhibition on the glossopharyngeal nerve. Indeed, the decrease of taste afferents mediated by the facial nerve (anterior two-thirds of the tongue) due to cancer or its treatments, would reveal those mediated by the glossopharyngeal nerve (posterior one-third of the tongue) and thus lead to MT perception. The aim of this study was to evaluate the validity of this hypothesis. Selective supraliminar taste tests on the tip and the base of the tongue were regularly performed on 44 patients with head and neck cancers before, during, and after their treatment. Sweet, salty, bitter, sour, and MT were tested. Patients were grouped based on whether they reported experiencing MT or not. 12 patients complained about MT (27.2%), always during the treatment phase. Most of them (83.3%) were treated by surgery and radiotherapy or radiochemotherapy. Supraliminar tastes were altered in every patient, especially during the treatment phase. Test results showed that perceived intensity was significantly reduced in patients reporting MT for salt, sweet and sour. This was observed more on the base of tongue than on the tip of the tongue. MT was significantly linked with mucositis (p=0.027) but with neither candidiasis (p=0.38) nor salivary flow (p=0.63). The hypothesis of removal of facial nerve inhibition on the glossopharyngeal nerve cannot explain MT in head and neck cancer.

Post-traumatic stress disorder (PTSD) often results in significant cognitive impairments and neuronal apoptosis, presenting a critical challenge for effective therapeutic intervention. This study explores the potential of N-acetylcysteine (NAC) in ameliorating PTSD-induced cognitive dysfunction and neuronal damage in a mouse model, with a specific focus on the modulation of activating transcription factor 4 (ATF4) expression and its m6A RNA methylation. Using the single prolonged stress (SPS) model to induce PTSD-like symptoms, mice were administered NAC and subsequently subjected to Morris water maze and open field tests to assess cognitive performance. Immunohistochemistry, Western blot, and enzyme assays were employed to evaluate neuronal apoptosis in the hippocampus. Methylation-specific RNA immunoprecipitation and qRT-PCR were used to analyze the regulation of ATF4 expression and m6A methylation. Results demonstrated that NAC treatment significantly improved cognitive function and reduced hippocampal neuronal apoptosis. These effects were closely associated with decreased m6A methylation levels and reduced expression of ATF4. Silencing of ATF4 further diminished neuronal apoptosis and cognitive impairments, underscoring the crucial role of ATF4 methylation in PTSD pathology. This study highlights the therapeutic potential of NAC in PTSD, revealing a novel mechanism through the modulation of ATF4 methylation, and paving the way for innovative treatment strategies.

In everyday conversation, bilingual individuals switch between languages not only in reaction to monolinguals with different language profiles but also voluntarily and naturally. However, whether and how various switching contexts dynamically modulate the domain-general control were still illusive. Using a cross-task paradigm which flanker task was interleaved with language switching task trial-by-trial, the present study manipulated forced, voluntary and natural switching contexts. A group of unbalanced Chinese-English bilinguals performed a flanker task in the three switching contexts. The results showed that the cross-domain interaction on the P3 effect revealed an atypical flanker effect in forced switching contexts only, and P3 amplitude of incongruent trials in forced switching contexts was smaller than both natural and voluntary switching contexts. Furthermore, the robust brain-brain and brain-behavior relationships between language control and domain-general control were significantly emerged in the forced switching context only. Altogether, our findings support the dynamic adaptation of language control to cognitive control and highlight the importance of switching contexts.

A document by Na Wang. Click on the document to view its contents.