Endovascular neurointervention is typically performed with iodinated contrast medium (ICM) under fluoroscopy. However, some patients may be contraindicated to such procedures based on their sensitivity to ICM. In this report, we describe a case of successful coil embolization of a direct carotid cavernous fistula using angiography with gadolinium-based contrast agents in a patient with severe allergic reaction to ICM. The clinical decision-making for this patient was further complicated by comorbidities of renal impairment, drug allergies, and previously severe gastrointestinal bleeding.

Steatocystoma multiplex (SM) is an uncommon cutaneous disorder characterised by multiple intradermal cysts distributed over the trunk and proximal extremities. This condition affects both genders and is often inherited as an autosomal dominant trait, although sporadic cases have been described. This report describes the mammographic and sonographic features of the cysts, which presented as breast lumps, for evaluation. The cysts appeared as numerous well-circumscribed, radiolucent nodules with thin radiodense rims on mammography. On sonography, the cysts could be hypoechoic, isoechoic or demonstrate mixed echoes containing debris-fluid levels, depending on the amount of clear oily liquid and keratinous material. SM can be diagnosed based on a clinical setting of multiple asymptomatic small intradermal nodules over the trunk and proximal extremities, positive family history and imaging findings.
Breast Diseases ; diagnosis ; Diagnosis, Differential ; Female ; Humans ; Mammography ; methods ; Middle Aged ; Steatocystoma Multiplex ; diagnosis ; Ultrasonography, Mammary ; methods

The coronavirus disease 2019 (COVID-19) pandemic has challenged health systems globally and prompted the publication of several guidelines. The experiences of our international colleagues should be utilized to protect patients and healthcare workers. The primary aim of this article is to appraise national guidelines for the perioperative anesthetic management of patients with COVID-19 so that they can be enhanced for the management of any resurgence of the epidemic. PubMed and EMBASE databases were systematically searched for guidelines related to SARS-CoV and SARS-CoV-2. Additionally, the World Federation Society of Anesthesiologists COVID-19 resource webpage was searched for national guidelines; the search was expanded to include countries with a high incidence of SARS-CoV. The guidelines were evaluated using the Appraisal of Guidelines for Research and Evaluation II tool. Guidelines from Australia, Canada, China, India, Italy, South Africa, South Korea, Taiwan, the United Kingdom, and the United States of America were evaluated. All the guidelines focused predominantly on intubation and infection control. The scope and purpose of guidelines from China were the most comprehensive. The UK and South Africa provided the best clarity. Editorial independence, the rigor of development, and applicability scored poorly. Heterogeneity and gaps pertaining to preoperative screening, anesthesia technique, subspecialty anesthesia, and the lack of auditing of guidelines were identified. Evidence supporting the recommendations was weak. Early guidelines for the anesthetic management of COVID-19 patients lacked quality and a robust reporting framework. As new evidence emerges, national guidelines should be updated to enhance rigor, clarity, and applicability.

The coronavirus disease 2019 (COVID-19) pandemic has challenged health systems globally and prompted the publication of several guidelines. The experiences of our international colleagues should be utilized to protect patients and healthcare workers. The primary aim of this article is to appraise national guidelines for the perioperative anesthetic management of patients with COVID-19 so that they can be enhanced for the management of any resurgence of the epidemic. PubMed and EMBASE databases were systematically searched for guidelines related to SARS-CoV and SARS-CoV-2. Additionally, the World Federation Society of Anesthesiologists COVID-19 resource webpage was searched for national guidelines; the search was expanded to include countries with a high incidence of SARS-CoV. The guidelines were evaluated using the Appraisal of Guidelines for Research and Evaluation II tool. Guidelines from Australia, Canada, China, India, Italy, South Africa, South Korea, Taiwan, the United Kingdom, and the United States of America were evaluated. All the guidelines focused predominantly on intubation and infection control. The scope and purpose of guidelines from China were the most comprehensive. The UK and South Africa provided the best clarity. Editorial independence, the rigor of development, and applicability scored poorly. Heterogeneity and gaps pertaining to preoperative screening, anesthesia technique, subspecialty anesthesia, and the lack of auditing of guidelines were identified. Evidence supporting the recommendations was weak. Early guidelines for the anesthetic management of COVID-19 patients lacked quality and a robust reporting framework. As new evidence emerges, national guidelines should be updated to enhance rigor, clarity, and applicability.

CT perfusion (CTP) has been applied increasingly in research of ischemic stroke. However, in clinical practice, it is still a relatively new technology. For neurologists and radiologists, the challenge is to interpret CTP results properly in the context of the clinical presentation. In this article, we will illustrate common CTP patterns in acute ischemic stroke using a case-based approach. The aim is to get clinicians more familiar with the information provided by CTP with a view towards inspiring them to incorporate CTP in their routine imaging workup of acute stroke patients.
Cytidine Triphosphate ; Humans ; Perfusion ; Stroke

OBJECTIVES: The questionnaire of occupational stress index (OSI) has been popular in the workplace, and it has been tailored for bus drivers in Taiwan. Nevertheless, its outcomes for participants are based on self-evaluations, thus validation by their physiological stress biomarker is warranted and this is the main goal of this study. METHODS: A cross-sectional study of sixty-three city bus drivers and fifty-four supporting staffs for comparison was conducted. Questionnaire surveys, 24-hour urine cortisol testing, and blood draws for dehydroepiandrosterone-sulfate (DHEA-S) testing were performed. The measured concentrations of these biological measures were logarithmically transformed before the statistical analysis where various scores of stressor factors, moderators, and stress effects of each OSI domain were analyzed by applying multiple linear regression models. RESULTS: For drivers, the elevated 24-hour urine cortisol level was associated with a worker's relationship with their supervisor and any life change events in the most recent 3 months. The DHEA-S level was higher in drivers of younger age as well as drivers with more concerns relating to their salary and bonuses. Non-drivers showed no association between any stressor or satisfaction and urine cortisol and blood DHEA-S levels. CONCLUSION: Measurements of biomarkers may offer additional stress evaluations with OSI questionnaires for bus drivers. Increased DHEA-S and cortisol levels may result from stressors like income security. Prevention efforts towards occupational stress and life events and health promotional efforts for aged driver were important anti-stress remedies.
Aged ; Biomarkers ; Cross-Sectional Studies ; Dehydroepiandrosterone ; Dehydroepiandrosterone Sulfate ; Diagnostic Self Evaluation ; Humans ; Hydrocortisone ; Life Change Events ; Linear Models ; Surveys and Questionnaires ; Salaries and Fringe Benefits ; Stress, Physiological ; Taiwan

INTRODUCTIONOsteosarcoma treatment has experienced a renaissance in the last 3 decades with the institution of multimodality treatment involving multiagent chemotherapy and surgery. Yet globally, treatment success has stagnated at about 70% survival at 5 years in most single institution series. We performed survival analyses on 2 national databases in 2 countries and compared these with corresponding institution specific survival.

MATERIALS AND METHODSAll patients with the diagnostic code of non-metastatic intramedullary osteosarcoma in the long bones of the upper and lower limbs less than 30 years of age were selected from the Surveillance Epidemiology and End Result (SEER) database to ensure uniformity with respect to disease and treatment. We studied the factors: ethnicity, gender, age, grade, histology, size, site, surgery, compartmentalisation, number of primaries and venue of treatment for their contribution to survival. In addition, the data were stratified into 3 decades (seventies, eighties and nineties) to account for variations due to the evolution of treatment paradigms and imaging modalities.

RESULTSInstitution-specific survival was predictably better than national survival in the 4 databases. One thousand patients were selected from the SEER database. Oriental descent, state-specific treatment, female gender, treatment in the nineties, low-grade disease, intra-compartmental disease, small size, wide resections as opposed to forequarter or hindquarter amputations, and single primaries were good prognostic factors on univariate analysis as well as multivariate analysis (P <0.05). Survival was better in the more affluent states (P <0.05). Males were affected at an older age than females (P = 0.004). Blacks tended to have larger tumours although their overall survival was similar to whites. Orientals were more likely to be treated in the nineties with wide resections for smaller tumours and were located around states associated with good treatment. Orientals in Singapore and the United States had the same survival (P = 0.45). Survival in Orientals in Singapore was not significantly different from other races. The standard of healthcare for osteosarcoma varies greatly across the United States but is uniform in Singapore. Hence the observed differences in the United States were likely due to socioeconomic factors.

CONCLUSIONThis analysis confirms the importance of a number of prognostic variables in osteosarcoma and suggests the possibility of an ethnic and economic bias for good survival.

Adolescent ; Adult ; African Continental Ancestry Group ; Asian Continental Ancestry Group ; Bone Neoplasms ; epidemiology ; ethnology ; mortality ; Child ; Child, Preschool ; Databases, Factual ; European Continental Ancestry Group ; Female ; Humans ; Infant ; Infant, Newborn ; Internationality ; Kaplan-Meier Estimate ; Male ; Osteosarcoma ; epidemiology ; ethnology ; mortality ; Prognosis ; Registries ; Singapore ; epidemiology ; Young Adult

Epididymal maturation is associated with the activation of a cAMP-induced tyrosine phosphorylation cascade, which is ultimately associated with the expression of capacitation-dependent sperm functions, such as hyperactivated movement and acrosomal exocytosis. As spermatozoa progress through the epididymis they first acquire the capacity to phosphorylate tyrosine on targets on the principal piece, followed by the midpiece. By the time these cells have reached the cauda epididymidis they can phosphorylate the entire tail from neck to endpiece. This particular pattern of phosphorylation is associated with the ontogeny of fully functional spermatozoa that are capable of fertilizing the oocyte. Proteomic analyses indicate that this change is associated with the phosphorylation of several mitochondrial proteins, creation of a mitochondrial membrane potential and activation of mitochondrial free radical generation. At least in rodent species, activation of sperm mitochondria appears to be a particularly important part of epididymal maturation.
Acrosome Reaction ; Aging ; Animals ; Epididymis ; growth & development ; physiology ; Humans ; Male ; Mammals ; Mice ; Proteome ; Sperm Capacitation ; physiology ; Spermatozoa ; physiology

OBJECTIVEWe aimed to examine the current developments and challenges confronted by old age security in rural China.

DATA SOURCESThis study is based on the data from PubMed, Elsevier, Wiley, EBSCO, EMBASE, SCI Expanded, ProQuest, Google, and CNKI which is the most informative database in Chinese.

STUDY SELECTIONArticles were selected with the search terms "rural", "China", "old", "older", or "elder", "elderly", or "aged", "aging", "security", "culture", "value", "medical insurance" or "community based medical insurance" or "cooperative medical scheme". Related websites and yearbooks were searched as well.

RESULTSThe socio-economic development has made the burden of traditional care for the rural elderly heavier than ever, and new challenges are emerging in rural communities, such as poor economic, deteriorating natural environment and health crisis.

CONCLUSIONSThe governments should improve the scale and caliber of rural old age security and strengthen regulations with great efforts in developing the rural economy and protecting the natural environment of rural communities.

Aged ; Aged, 80 and over ; China ; Female ; Humans ; Male ; Middle Aged ; Old Age Assistance ; legislation & jurisprudence ; statistics & numerical data ; trends ; Rural Population ; statistics & numerical data

Magnetic resonance neurography (MRN) is increasingly used to visualize peripheral nerves in vivo. However, the implementation and interpretation of MRN in the brachial and lumbosacral plexi are challenging because of the anatomical complexity and technical limitations. The purpose of this article was to review the clinical context of MRN, describe advanced magnetic resonance (MR) techniques for plexus imaging, and list the general categories of utility of MRN with pertinent imaging examples. The selection and optimization of MR sequences are centered on the homogeneous suppression of fat and blood vessels while enhancing the visibility of the plexus and its branches. Standard 2D fast spin-echo sequences are essential to assess morphology and signal intensity of nerves. Moreover, nerve-selective 3D isotropic images allow improved visualization of nerves and multiplanar reconstruction along their course. Diffusion-weighted and diffusion-tensor images offer microscopic and functional insights into peripheral nerves. The interpretation of MRN in the brachial and lumbosacral plexi should be based on a thorough understanding of their anatomy and pathophysiology. Anatomical landmarks assist in identifying brachial and lumbosacral plexus components of interest. Thus, understanding the varying patterns of nerve abnormalities facilitates the interpretation of aberrant findings.