Insulinoma With Ambiguous Biochemistry, Positive Ga-DOTA-Exendin-4 PET-CT, and Effective Endoscopic Ablation.

A 75-year-old female presented with fasting hypoglycemic episodes. A supervised fast ended at 72 hours fulfilling Whipple triad, with suppressed insulin and C-peptide levels, but discordantly suppressed serum β-hydroxybutyrate levels. After 21 months of recurring symptoms, a repeat fast ended at 48 hours with Whipple triad, suppressed serum β-hydroxybutyrate level, and borderline nonsuppressed C-peptide level, suggesting endogenous hyperinsulinism.

Liver Radioembolization: Predicting Lung Shunt Fraction with Contrast-Enhanced CT, Eliminating the Need for 99mTc-MAA.

Unlabelled: Accurate estimation of the Lung Shunt Fraction (LSF) is a standard of care in yttrium-90 ( Y) radioembolization treatment planning to prevent excessive lung irradiation due to arterio-venous shunting in the liver. LSF is assessed using Tc macroaggregated albumin ( Tc-MAA) imaging, but this approach adds risk, complexity, and expense to the treatment planning. This study investigates the potential of Contrast-Enhanced Computed Tomography (CECT) as a non-invasive alternative for LSF estimation.

Comparative analysis of the fit quality of monolithic zirconia veneers produced through traditional and digital workflows using silicone replica technique: an in vitro study.

Background: The success of a restoration largely depends on the quality of its fit. This study aimed to investigate the fit quality of monolithic zirconia veneers (MZVs) produced through traditional and digital workflows.

Methods: A typodont maxillary right central incisor was prepared.

A case study of lethal neonatal CPT II deficiency: Novel insights from genetic analysis.

Introduction: Carnitine Palmitoyltransferase II (CPT II) deficiency encompasses a spectrum of disorders, with the lethal neonatal form (LNF) representing the rarest and most severe. While there are numerous gene variants that can cause CPT II deficiency, only 16 variants of these are known to be associated with LNF. This report presents the case of a neonatal male diagnosed with lethal CPT II deficiency, characterized by the presence of two heterogeneous variants.

Case Report: A novel hemizygous missense variant in a Vietnamese boy with pyruvate dehydrogenase E1-alpha deficiency.

A pyruvate dehydrogenase complex deficiency causes a reduction in adenosine triphosphate production and energy insufficiency, leading to neurological disorders. An abnormal E1-alpha protein originating from the gene with pathogenic variants is unable to communicate with E1-beta for the formation of the E1 enzyme, decreasing pyruvate dehydrogenase complex activity. In this study, we report a Vietnamese boy with lethargy, severe metabolic acidosis, increased serum lactate, hyperalaninemia, lactic acidosis, and globus pallidus lesions.

How Highly Heterogeneous Sensors with Single-Molecule Resolution can Result in Robust Continuous Monitoring Over Long Time Spans.

Biomolecular sensors with single-molecule resolution are composed of multitudes of transducers that measure state changes related to single-molecular binding and unbinding events. Conventionally, signals are aggregated from many individual transducers in order to achieve sufficient statistics. However, by aggregating signals, transducer-to-transducer differences are lost and heterogeneities cannot be studied.

Low Complication Rates in Olecranon Fracture Fixation With Dual Plating.

Background: Most olecranon fractures are intra-articular, affecting the extensor mechanism of the elbow, and are treated surgically with dorsal plate fixation or tension band. Due to shortcomings of dorsal plates related to prominence, insufficient fixation of sagittal fracture lines, and difficulty matching proximal ulna dorsal angulation (PUDA), dual medial and lateral plating (DP) has been developed. We hypothesized that olecranon fractures treated with DP would have low complication rates and low incidence of hardware removal compared with those treated with traditional methods of fixation.

Hyperornithinemia-Hyperammonemia-Homocitrullinuria Syndrome in Vietnamese Patients.

: Hyperornithinemia-hyperammonemia-homocitrullinuria syndrome (HHH; OMIM 238970) is one of the rare urea cycle disorders. Ornithine carrier 1 deficiency causes HHH syndrome, characterized by failure of mitochondrial ornithine uptake, hyperammonemia, and accumulation of ornithine and lysine in the cytoplasm. The initial presentation and time of diagnosis in HHH highly varies.

Development and validation of an antimicrobial stewardship clinical decision-support tool to improve the management of urinary tract infections versus asymptomatic bacteriuria in hospitalized patients.

Objective: To assess the effectiveness of a 3-question decision-support tool to guide the diagnosis and treatment of urinary tract infections (UTIs) in acute care hospitalized patients as an antibiotic and diagnostic stewardship initiative.

Design: Retrospective cohort study.

Setting: Four acute care hospitals within the same health system in Miami, FL.

Resuscitation from Respiratory Arrest Due to Life-Threatening Ventricular Arrhythmias in a Patient with Amitriptyline Intoxication: An Old Problem in a New Era.

Introduction: Tricyclic antidepressants (TCAs) were once commonly used to treat major depressive disorder (MDD), but are now considered second-line options after SSRIs and SNRIs. Additionally, TCAs are used to treat other conditions such as chronic pain and enuresis in children. Due to their numerous side effects and potential for drug interactions, cases of poisoning and death from TCA overdose, particularly amitriptyline, are on the rise.

External ear malformations and cardiac and renal anomalies: A systematic review and meta-analysis.

Context: External Ear Malformations (EEM) continue to be a common malformation seen in the pediatric patient population. This study aims to further elucidate the correlation between EEM and cardiac and renal anomalies.

Objective: A systematic review and meta-analysis to study the incidence of cardiac and renal anomalies associated with syndromic and isolated (EEM).

Duration of antibiotic therapy for multidrug resistant Pseudomonas aeruginosa pneumonia: is shorter truly better?

Background: The 2016 IDSA guideline recommends a treatment duration of at least 7 days for hospital-acquired (HAP)/ventilator-associated pneumonia (VAP). The limited literature has demonstrated higher rates of recurrence for non-glucose fermenting gram-negative bacilli with short course therapy, raising the concern of optimal treatment duration for these pathogens. Therefore, we aimed to compare the outcomes for patients receiving shorter therapy treatment (≤ 8 days) versus longer regimen (> 8 days) for the treatment of multidrug resistant (MDR) Pseudomonas pneumonia.

Deep learning for contour quality assurance for RTOG 0933: In-silico evaluation.

Purpose: To validate a CT-based deep learning (DL) hippocampal segmentation model trained on a single-institutional dataset and explore its utility for multi-institutional contour quality assurance (QA).

Methods: A DL model was trained to contour hippocampi from a dataset generated by an institutional observer (IO) contouring on brain MRIs from a single-institution cohort. The model was then evaluated on the RTOG 0933 dataset by comparing the treating physician (TP) contours to blinded IO and DL contours using Dice and Haussdorf distance (HD) agreement metrics as well as evaluating differences in dose to hippocampi when TP vs.

Deterministic positioning of few aqueous colloidal quantum dots.

Emerging quantum technologies that critically require the integration of quantum emitters on photonic platforms are hindered by the control over their position, quantity, and scalability. Herein, we describe a facile strategy to deposit aqueous silica-coated quantum dots (QDs) in a template of polymethyl methacrylate (PMMA) nanoholes that leverages saturated ethanol vapor drop-casting and subsequent lift-off of the template. Ethanol vapor incorporation into water droplets during the drying process reduces the meniscus contact angle, which increases capillary forces and enhances particle confinement within the pinning contact region.

Interventions to Reduce Surgical Waste Burden: A Systematic Review.

Background: Operating suites are significant drivers of waste, pollution, and costs. Surgeons can help fight the climate crisis by implementing innovative strategies aimed at mitigating the environmental impact of surgical procedures and decreasing operational costs, and moving toward a more sustainable healthcare system. This study aims to review the literature describing interventions that reduce surgical waste.

Intermittent lysis on a single paper-based device to extract exosomal nucleic acid biomarkers from biological samples for downstream analysis.

As the role of exosomes in physiological and pathological processes has been properly perceived, harvesting them and their internal components is critical for subsequent applications. This study is a debut of intermittent lysis, which has been integrated into a simple and easy-to-operate procedure on a single paper-based device to extract exosomal nucleic acid biomarkers for downstream analysis. Exosomes from biological samples were captured by anti-CD63-modified papers before being intermittently lysed by high-temperature, short-time treatment with double-distilled water to release their internal components.

Identifying SCS Trial Responders Immediately After Postoperative Programming with ECAP Dose-Controlled Closed-Loop Therapy.

Introduction: Drawbacks of fixed-output spinal cord stimulation (SCS) screening trials may lead to compromised trial outcomes and poor predictability of long-term success. Evoked compound action potential (ECAP) dose-controlled closed-loop (CL) SCS allows objective confirmation of therapeutic neural activation and pulse-to-pulse stimulation adjustment. We report on the immediate patient-reported and neurophysiologic treatment response post-physiologic CL-SCS and feasibility of early SCS trial responder prediction.

Pyomyositis in an Immunocompetent Patient Following Gardening Activity.

Nocardia pyomyositis in immunocompetent patients is a rare occurrence. The diagnosis may be missed or delayed with the risk of progressive infection and suboptimal or inappropriate treatment. We present the case of a 48-year-old immunocompetent firefighter diagnosed with pyomyositis caused by acquired by direct skin inoculation from gardening activity.

Pembrolizumab-induced Stevens-Johnson syndrome/Toxic Epidermal Necrolysis in a Vietnamese patient with nonsmall-cell lung cancer.

Chemoimmunotherapy is an effective therapy for an individual with nonsmall-cell lung cancer (NSCLC) without anaplastic lymphoma kinase or epidermal growth factor receptor mutations. However, it can also be related to adverse cutaneous reactions such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) with high morbidities and mortality rates. We present a case of a 65-year-old male with NSCLC who underwent first-line chemotherapy with paclitaxel, carboplatin, and pembrolizumab, which was later followed by a second cycle of the same therapies.

Right Ventricular Assist Device With an Oxygenator for the Management of Combined Right Ventricular and Respiratory Failure: A Systematic Review.

Background: Severe lung disease frequently presents with both refractory hypoxemia and right ventricular (RV) failure. Right ventricular assist device with an oxygenator (OxyRVAD) is an extracorporeal membrane oxygenation (ECMO) configuration of RV bypass that also supplements gas exchange. This systematic review summarises the available literature regarding the use of OxyRVAD in the setting of severe lung disease with associated RV failure.