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In the REVIVED-BCIS2 (Revascularization for Ischemic Ventricular Dysfunction) trial, percutaneous coronary intervention (PCI) did not reduce the incidence of death or hospitalization for heart failure (HHF).

3D‐Printable Sensors This study investigates the development of 3D printable thermoplastic polyurethane filaments incorporating multi‐walled carbon nanotubes (MWCNT) for enhanced strain‐sensing capabilities. Piezoresistive structures are fabricated and tested to demonstrate the potential applicability of the custom filaments. More details can be found in article number 2300198by Behrad Koohbor and co‐workers.

This study investigates the development of thermoplastic polyurethane (TPU) filaments incorporating multi‐walled carbon nanotubes (MWCNT) to enhance strain‐sensing capabilities. Various MWCNT reinforcement ratios are used to produce customized feedstock for fused filament fabrication (FFF) 3D printing. Mechanical properties and the piezoresistive response of samples printed with these multifunctional filaments are concurrently evaluated. Surface morphology and microstructural observations reveal that higher MWCNT weight percentages increase filament surface roughness and rigidity. The microstructural modifications directly influence the tensile strength and strain energy of the printed samples. The study identifies an apparent percolation threshold within the 10–12 wt.% MWCNT range, indicating the formation of a conductive network. At this threshold, higher gauge factors are achieved at lower strains. A newly introduced Electro‐Mechanical Sensitivity Ratio (ESR) parameter enables the classification of composite behaviors into two distinct zones, offering the ability to tailor self‐sensing structures with on‐demand properties. Finally, flexible structures with proven application in soft robotics and shape morphing are fabricated and tested at different loading conditions to demonstrate the potential applicability of the custom filaments produced. The results highlight a pronounced piezoresistive response and superior load‐bearing performance in the examined structures. This research focuses on 3D printable thermoplastic polyurethane filaments embedded with multi‐walled carbon nanotubes for enhanced strain sensing in large deformations. It explores the electromechanical properties of the filaments, identifying a conductive threshold in the composite material. The study also examines the application of these filaments in flexible structures, particularly for soft robotics and wearable electronics.

•Virtual reality (VR) for paediatric patients is met with high acceptability.•VR improves health literacy and understanding of pending radiation therapy procedures.•Child and parent pre-procedural anxiety decreased following VR intervention.

Ferromagnetism in organic blends of poly(3-hexylthiophene) with phenyl-C61-butyric acid methyl ester (P3HT:PCBM) is known to be highly dependent on the degree of crystallinity. The magnetic response of the blend P3HT:PCBM has been minute due to the relatively small crystalline size. The highest previously reported crystallinity and magnetization for this blend are due to nanometer-scale P3HT crystalline regions with nanometer-scale magnetic domains. The novelty of the work presented herein was the synthesis of colossal millimeter-scale PCBM crystals in the P3HT:PCBM blend, which exhibited large >20 μm magnetic domains based on magnetic force microscopy characterization. The PCBM crystal structure was further analyzed for its composition and structure using scanning electron microscopy, X-ray diffraction analysis, and energy-dispersive X-ray spectroscopy, affirming the largest PCBM crystal reported in the literature. The morphology and mechanical properties of the colossal PCBM crystals were analyzed using atomic force microscopy and force–displacement measurements, reporting phase-dependent mechanical properties. In all, this research pushes organic ferromagnetic materials to be comparable to their inorganic counterparts and feasible to be used in magnetic devices for wearable and flexible electronic applications.

The overarching goal in sports gears to achieve higher levels of impact protection without an increased weight penalty motivated the pursuit of density gradation in cellular solids. The research reported herein studied the impact performance of density-graded polyurea elastomeric foams, including different gradation and interfacing strategies. The latter leveraged the natural adhesion properties of polyurea foam slurry to sequentially assemble graded structures with seamless interfaces. Moreover, conventional discretely graded polyurea foam structures were manufactured using bulk polyurea adhesive by individually bonding pre-fabricated sheets. Six density-graded foam configurations were characterized, including bi- and tri-layered foams with naturally bonded or adhered interfaces. Additionally, standard mono-density polyurea and another benchmark foams were tested as controls. Extracted samples were submitted to impact loading using an instrumented drop weight tower. The impact efficacy of the foams was analyzed using three dynamic performance metrics (DPMs), including the specific energy absorptivity (SEA), absorption efficiency, and local buckling-induced undulation, based on the averaged stress-strain response. The mono-density polyurea foam reported the largest SEA, outperforming all density-graded foam configurations. The limited density gradation is attributed to the inferior performance of graded structures. A brief biomechanics case study is presented to assess the potential interrelationship between the investigated foam structures and the head injury criterion (HIC), showing the superior performance of adhered trilayer polyurea foams. Finally, the average stress-strain responses were fitted using an empirical model, elucidating the effect of strain rates and base materials on their overall impact behavior.

Life-threatening arrhythmias (LTAs) can trigger sudden cardiac death or provoke implantable cardioverter-defibrillator (ICD) discharges that escalate morbidity and mortality. Longitudinal myofibrils predominate in the subendocardium, which is uniquely sensitive to arrhythmogenic triggers. In this study, we test the hypothesis that mitral annular systolic velocity (S′), a simple routinely obtained tissue Doppler index of LV long-axis systolic function, might predict lethal arrhythmias irrespective of left ventricular ejection fraction (LVEF).

IMPORTANCE: There is widespread interest in associations between maternal perinatal depression and anxiety and offspring development; however, to date, there has been no systematic, meta-analytic review on the long-term developmental outcomes spanning infancy through adolescence. OBJECTIVE: To provide a comprehensive systematic review and meta-analysis of the extant literature on associations between maternal perinatal depression and anxiety and social-emotional, cognitive, language, motor, and adaptability outcomes in offspring during the first 18 years of life. DATA SOURCES: Six databases were searched (CINAHL Complete, Cochrane Library, Embase, Informit, MEDLINE Complete, and PsycInfo) for all extant studies reporting associations between perinatal maternal mental health problems and offspring development to March 1, 2020. STUDY SELECTION: Studies were included if they were published in English; had a human sample, quantitative data, a longitudinal design, and measures of perinatal depression and/or anxiety and social-emotional, cognitive, language, motor, and/or adaptability development in offspring; and investigated an association between perinatal depression or anxiety and childhood development. DATA EXTRACTION AND SYNTHESIS: Of 27 212 articles identified, 191 were eligible for meta-analysis. Data were extracted by multiple independent observers and pooled using a fixed- or a random-effects model. A series of meta-regressions were also conducted. Data were analyzed from January 1, 2019, to March 15, 2020. MAIN OUTCOMES AND MEASURES: Primary outcomes included social-emotional, cognitive, language, motor, and adaptability development in offspring during the first 18 years of life. RESULTS: After screening, 191 unique studies were eligible for meta-analysis, with a combined sample of 195 751 unique mother-child dyads. Maternal perinatal depression and anxiety were associated with poorer offspring social-emotional (antenatal period, r = 0.21 [95% CI, 0.16-0.27]; postnatal period, r = 0.24 [95% CI, 0.19-0.28]), cognitive (antenatal period, r = −0.12 [95% CI, –0.19 to –0.05]; postnatal period, r = −0.25 [95% CI, –0.39 to –0.09]), language (antenatal period, r = −0.11 [95% CI, −0.20 to 0.02]; postnatal period, r = −0.22 [95% CI, −0.40 to 0.03]), motor (antenatal period, r = −0.07 [95% CI, −0.18 to 0.03]; postnatal period, r = −0.07 [95% CI, −0.16 to 0.03]), and adaptive behavior (antenatal period, r = −0.26 [95% CI, −0.39 to −0.12]) development. Findings extended beyond infancy, into childhood and adolescence. Meta-regressions confirmed the robustness of the results. CONCLUSIONS AND RELEVANCE: Evidence suggests that perinatal depression and anxiety in mothers are adversely associated with offspring development and therefore are important targets for prevention and early intervention to support mothers transitioning into parenthood and the health and well-being of next-generation offspring.

A 1–3 strain-mediated multiferroic composite structure is discovered to exhibit unusual increase in magnetoelectric coupling at unprecedented levels of bias magnetic field, above those required for peak magneto-mechanical response and magnetic saturation. This connectivity scheme provides a path for the novel integration of composite multiferroics in high magnetic field applications.

ObjectiveImpulsivity and compulsivity have been implicated as important transdiagnostic dimensional phenotypes with potential relevance to addiction. We aimed to develop a model that conceptualizes these constructs as overlapping dimensional phenotypes and test whether different components of this model explain the co-occurrence of addictive and related behaviors.MethodsA large sample of adults (N= 487) was recruited through Amazon’s Mechanical Turk and completed self-report questionnaires measuring impulsivity, intolerance of uncertainty, obsessive beliefs, and the severity of 6 addictive and related behaviors. Hierarchical clustering was used to organize addictive behaviors into homogenous groups reflecting their co-occurrence. Structural equation modeling was used to evaluate fit of the hypothesized bifactor model of impulsivity and compulsivity and determine the proportion of variance explained in the co-occurrence of addictive and related behaviors by each component of the model.ResultsAddictive and related behaviors clustered into 2 distinct groups: Impulse-Control Problems, consisting of harmful alcohol use, pathological gambling, and compulsive buying, and Obsessive-Compulsive-Related Problems, consisting of obsessive-compulsive symptoms, binge eating, and internet addiction. The hypothesized bifactor model of impulsivity and compulsivity provided the best empirical fit, with 3 uncorrelated factors corresponding to a general Disinhibition dimension, and specific Impulsivity and Compulsivity dimensions. These dimensional phenotypes uniquely and additively explained 39.9% and 68.7% of the total variance in Impulse-Control Problems and Obsessive-Compulsive-Related Problems.ConclusionA model of impulsivity and compulsivity that represents these constructs as overlapping dimensional phenotypes has important implications for understanding addictive and related behaviors in terms of shared etiology, comorbidity, and potential transdiagnostic treatments.

Supplemental Digital Content is available in the text.

ObjectivesCongestion is associated with worse outcomes in critically ill surgical patients but can be difficult to quantify noninvasively. We hypothesised that plasma volume status (PVS), estimated preoperatively using a validated formula that enumerates percentage change from ideal plasma volume (PV), would provide incremental prognostic utility after coronary artery bypass graft (CABG) surgery.MethodsIn this retrospective cohort study, patients who underwent CABG surgery (1999–2010) were identified from a prospectively collected database. Actual ([1-haematocrit] x [a+(b x weight [kg])]) and ideal (c x weight [kg]) PV were obtained from equations where a, b and c are sex-dependent constants. Calculated PVS was then derived (100% x [(actual−ideal)/ideal]).ResultsIn 1887 patients (mean age 67±10 years; 79% male; median European System for Cardiac Operative Risk Evaluation [EuroSCORE] 4), mean PVS was −8.2±9%. While 8% of subjects had clinical evidence of congestion, a relatively increased PV (PVS >0%) was estimated in 17% and correlated with lower serum sodium, higher EuroSCORE and a diagnosis of diabetes mellitus. A PVS≥5.6% was optimally prognostic and associated with greater mortality (HR: 2.31, p=0.009), independently of, and incremental to, EuroSCORE, New York Heart Association class and serum sodium. A PVS≥5.6% also independently predicted longer intensive care (β: 0.65, p=0.007) and hospital (β: 2.01, p=0.006) stays, and greater postoperative renal (OR: 1.61, p=0.008) and arrhythmic (OR: 1.29, p=0.03) complications.ConclusionsHigher PVS values, calculated simply from weight and haematocrit, are associated with worse inpatient outcomes after CABG. PVS could help refine risk stratification and further investigations are warranted to evaluate the potential clinical utility of PVS-guided management in patients undergoing CABG.

ObjectiveWe aimed to determine whether individuals with obsessive-compulsive disorder (OCD) and demographically matched healthy individuals can be clustered into distinct clinical subtypes based on dimensional measures of their self-reported compulsivity (OBQ–44 and IUS–12) and impulsivity (UPPS–P).MethodsParticipants (n=217) were 103 patients with a clinical diagnosis of OCD; 79 individuals from the community who were “OCD-likely” according to self-report (Obsessive-Compulsive Inventory–Revised scores equal or greater than 21); and 35 healthy controls. All data were collected between 2013 and 2015 using self-report measures that assessed different aspects of compulsivity and impulsivity. Principal component analysis revealed two components broadly representing an individual's level of compulsivity and impulsivity. Unsupervised clustering grouped participants into four subgroups, each representing one part of an orthogonal compulsive-impulsive phenotype.ResultsClustering converged to yield four subgroups: one group low on both compulsivity and impulsivity, comprised mostly of healthy controls and demonstrating the lowest OCD symptom severity; two groups showing roughly equal clinical severity, but with opposing drivers (i.e., high compulsivity and low impulsivity, and vice versa); and a final group high on both compulsivity and impulsivity and recording the highest clinical severity. Notably, the largest cluster of individuals with OCD was characterized by high impulsivity and low compulsivity. Our results suggest that bothimpulsivity and compulsivity mediate obsessive-compulsive symptomatology.ConclusionsIndividuals with OCD can be clustered into distinct subtypes based on measures of compulsivity and impulsivity, with the latter being found to be one of the more defining characteristics of the disorder. These dimensions may serve as viable and novel treatment targets.

Neuroscientific explanations of gambling disorder can help people make sense of their experiences and guide the development of psychosocial interventions. However, the societal perceptions and implications of these explanations are not always clear or helpful. Two workshops in 2013 and 2014 brought together multidisciplinary researchers aiming to improve the clinical and policy-related effects of neuroscience research on gambling. The workshops revealed that neuroscience can be used to improve identification of the dangers of products used in gambling. Additionally, there was optimism associated with the diagnostic and prognostic uses of neuroscience in problem gambling and the provision of novel tools (eg, virtual reality) to assess the effectiveness of new policy interventions before their implementation. Other messages from these workshops were that neuroscientific models of decision making could provide a strong rationale for precommitment strategies and that interdisciplinary collaborations are needed to reduce the harms of gambling.

Maxillary protraction with the novel N2 mini-implant- and micro-implant-assisted rapid palatal expander (MARPE) can potentially provide significant skeletal effects without surgery, even in older patients where conventional facemask therapy has limited skeletal effects. However, the skeletal effects of altering the location and direction of force from mini-implant-assisted maxillary protraction have not been extensively analyzed. In this study, the application of the novel N2 mini-implant as an orthopedic anchorage device is explored in its ability to treat patients with class III malocclusions. A 3D cranial mesh model with associated sutures was developed from CT images and Mimics modeling software. Utilizing ANSYS simulation software, protraction forces were applied at different locations and directions to simulate conventional facemask therapy and seven maxillary protraction protocols utilizing the novel N2 mini-implant. Stress distribution and displacement were analyzed. Video animations and superimpositions were created. By changing the vector of force and location of N2 mini-implant, the maxilla was displaced differentially. Varying degrees of forward, downward, and rotational movements were observed in each case. For brachyfacial patients, anterior micro-implant-supported protraction at −45° or intermaxillary class III elastics at −45° are recommended. For dolicofacial patients, either anterior micro-implants at −15° or an intermaxillary spring at +30° is recommended. For mesofacial patients with favorable vertical maxillary position, palatal micro-implants at −30° are recommended; anterior micro-implants at −30° are preferred for shallow bites. For patients with a severe mid-facial deficiency, intermaxillary class III elastics at −30° are most effective in promoting anterior growth of the maxilla. By varying the location of N2 mini-implants and vector of class III mechanics, clinicians can differentially alter the magnitude of forward, downward, and rotational movement of the maxilla. As a result, treatment protocol can be customized for each unique class III patient.

The residual effect of thermally and mechanically loaded polyurea samples was investigated in this study using terahertz time-domain spectroscopy (THz-TDS). Samples of different thicknesses were submerged in liquid nitrogen and allowed to reach cryogenic isothermal conditions while another set of samples were extracted from quasi-statically loaded strips. All samples were interrogated using THz-TDS since terahertz waves exhibit non-ionizing, nondestructive interactions with polymers. The time-domain terahertz signals were used to extract the optical and electrical properties as a function of sample thickness and loading conditions. The residual effect was prominent in the mechanically loaded samples compared to a nearly negligible presence in thermally loaded polyurea. On average, the results of the thermally loaded samples were subtle when compared to the virgin samples, whereas samples that were mechanically stretched showed a considerable difference in the characteristics of the time-domain signals. For example, the peak amplitude in the time-domain signal of the stretched thick sample showed a 9% difference from that of the virgin sample, whereas the thermally loaded sample saw only a 4.9% difference. Spectral analysis reported the frequency-dependent, complex refractive index of virgin and loaded polyurea as a function of thickness and spectral peaks associated with fundamental vibrational modes of the polyurea structure. The disappearance of three spectral peaks, 0.56 THz, 0.76 THz, and 0.95 THz, elucidated the residual effect of the mechanically loaded samples. In general, terahertz spectroscopy was shown to be a promising tool for future in situ and in operando investigations of field-dependent polymer responses.

The aim of this study was to assess the effect on adherence to statin therapy and assess the effect of beneficial changes in behavior that resulted in weight loss in patients who underwent coronary artery calcium (CAC) scoring with cardiac computed tomography.

Orthodontic palatal expansion appliances have been widely used with satisfactory and, most often, predictable clinical results. Recently, clinicians have successfully utilized micro-implants with palatal expander designs to work as anchors to the palate to achieve more efficient skeletal expansion and to decrease undesired dental effects. The purpose of the study was to use finite element method (FEM) to determine the stress distribution and displacement within the craniofacial complex when simulated conventional and micro-implant-assisted rapid palatal expansion (MARPE) expansion forces are applied to the maxilla. The simulated stress distribution produced within the palate and maxillary buttresses in addition to the displacement and rotation of the maxilla could then be analyzed to determine if micro-implants aid in skeletal expansion. A three-dimensional (3D) mesh model of the cranium with associated maxillary sutures was developed using computed tomography (CT) images and Mimics modeling software. To compare transverse expansion stresses in rapid palatal expansion (RPE) and MARPE, expansion forces were distributed to differing points on the maxilla and evaluated with ANSYS simulation software. The stresses distributed from forces applied to the maxillary teeth are distributed mainly along the trajectories of the three maxillary buttresses. In comparison, the MARPE showed tension and compression directed to the palate, while showing less rotation, and tipping of the maxillary complex. In addition, the conventional hyrax displayed a rotation of the maxilla around the teeth as opposed to the midpalatal suture of the MARPE. This data suggests that the MARPE causes the maxilla to bend laterally, while preventing unwanted rotation of the complex. In conclusion, the MARPE may be beneficial for hyperdivergent patients, or those that have already experienced closure of the midpalatal suture, who require palatal expansion and would worsen from buccal tipping of the teeth or maxillary complex.

A growing body of evidence suggests that parenting behaviors may affect child mental health via altering brain development. There is a scarcity of research, however, that has investigated associations between parenting behavior and brain structure using longitudinal magnetic resonance imaging. This study aimed to investigate associations between parenting behaviors and structural brain development across the transition from childhood to adolescence.

Abstract

Retrospective chart review.

The sustained, independent advancements in additive manufacturing and magnetoelectric composites motivate the hybridization of these exciting technologies, as is the case in the current research study, leading to the fabrication of materials conducive to flexible and wearable electronic applications. The resulting additively manufactured composite materials exhibit tailorable mechanical, electrical, and magnetic properties by adjusting the ratios of the photopolymer framework, electroactive polymer, and magnetic particles. Moreover, the outcomes of this research exemplify the process-property-performance interrelationship, hence providing a pathway to realizing deployable magnetoelectric devices. Several resin versions were synthesized and used to print various geometries using the digital light projection approach, including neat photopolymer and photopolymer/polyvinylidene difluoride with and without magnetic particles. The addition of magnetic particles did not substantially affect the mechanical performance of the composites, contrary to the expected results based on the rules of mixture. The insensitivity of the mechanical performance to the addition of magnetite particles was attributed to agglomeration, where the particles acted as pores rather than enforcements. Remarkably, the addition of merely 2% by weight of polyvinylidene difluoride improved the mechanical and magnetic properties of the composite samples by increasing ductility by 25% and magnetization by >160% compared to their PVDF-free counterparts. PVDF chains acted as a suspended network, preventing particle settling during printing and improving the distribution of the magnetic particles within the samples. The outcomes of this research highlight the opportunities and challenges of additively manufacturing magnetoelectric composite materials using digital light projection while primarily emphasizing the tailorability of the mechano-electro-magnetic properties.

Puberty triggers a period of structural “re-organization” in the brain, when rising hormone levels act via receptors to influence morphology. However, our understanding of these neuroendocrine processes in humans remains poor. As such, the current longitudinal study characterized development of the human subcortex during puberty, including changes in relation to pubertal (Tanner) stage and hormone (testosterone, dehydroepiandrosterone [DHEA]) levels. Beyond normative group-level patterns of development, we also examined whether individual differences in the rate of pubertal maturation (i.e., “pubertal/hormonal tempo”) were associated with variations in subcortical trajectories. Participants (N = 192; scans = 366) completed up to three waves of MRI assessments between 8.5 and 14.5 years of age. Parents completed questionnaire assessments of pubertal stage at each wave, and adolescents provided hormone samples on a subset of waves. Generalized additive mixture models were used to characterize trajectories of subcortical development. Results showed that development of most subcortical structures was related to pubertal stage, although findings were mostly non-significant when controlling for age. Testosterone and DHEA levels were related to development of the amygdala, hippocampus and pallidum in both sexes, and findings in the amygdala remained significant when controlling for age. Additionally, we found that variability in hormonal (specifically testosterone) tempo was related to right hippocampal development in males, with an accelerated pattern of hippocampal development in those with greater increases in testosterone levels. Overall, our findings suggest prominent hormonal influences on the amygdala and hippocampus, consistent with the prevalence of androgen and estrogen receptors in these regions. We speculate that these findings are most likely reflective of the important role of adrenarcheal processes on adolescent brain development.

A 49-year-old woman developed steroid-responsive right painful ophthalmoplegia. Repeated attempts to withdraw steroids proved futile until ten months after onset when radiotherapy was administered to the involved cavernous sinus. Following this treatment she was weaned from steroids without a relapse. Radiotherapy may be of value in the Tolosa-Hunt syndrome when steroid therapy is contra-indicated or the course of the disease is prolonged.

The applicability of additive manufacturing (AM) continues to expand because of research and development efforts in industrial, academic, and governmental institutions. The lure of additive manufacturing lies in the quick time-to-market and ability to produce parts and components with high degrees of topographical complexity empowered by the layer-by-layer production approach. One challenge that is attracting a significant amount of attention is improving the multi-functionality of additively manufactured parts, as enabling multi-functionality will result in transitioning AM to a broader application domain. The objective of this paper is to report novel developments that improve the functionality of polymer-based parts by adding electrical conductivity and fluid management to the existing load-bearing capabilities. A space structure was 3D-printed using acrylonitrile butadiene styrene (ABS) with embedded internal channels throughout the entire structure and then sealed using an acetone-diluted epoxy. The inner surfaces of the embedded channels of the sealed structure were then metallized using an electroless silver-coating process; these processes were found to be robust and independent of the inner diameter and length of the structure. The electromechanical performance of the structure was verified by applying mechanical loading while monitoring the change in electrical resistivity. The latter was found to remain nearly constant up to the point of ultimate mechanical failure. Finite element modeling was used to identify the areas of structural weaknesses and assist in elucidating the failure modes. The results were found to be in good agreement with the experimental data.

Background:Traditional dialysis management of ethylene glycol and methanol poisoning includes frequent intradialytic measurements of concentrations of the involved alcohol and its metabolite. A simple formula to predict the required dialysis time in advance by using patient age, sex, weight, height, dialyzer specifications, and initial toxin level was proposed and tested by us previously in 5 cases. To reach a 5-mmol/L-or-less toxin concentration target, required hemodialysis time, in hours, would be [–V ln (5/A)/0.06k], where V is the Watson estimate of total-body water in liters, A is the initial toxin concentration in mmol/L, and k is 80% of the manufacturer-specified dialyzer urea clearance in milliliters per minute at the initial observed blood flow rate. Methods:We further assessed the accuracy of this formula by reviewing all dialyzed new patients with methanol or ethylene glycol poisoning from March 2001 to March 2004 (N = 13). Results:There were no clinically or statistically significant differences between mean predicted (8.7±3.4 [SD] hours) and required (8.4±3.2 hours) dialysis time. No rebound increase in toxin levels occurred. Conclusion:The proposed formula is a simple, yet accurate, method to predict dialysis time for patients with methanol and ethylene glycol toxicity, confirmed by validation on an independent data set. Only initial, 2 hours before termination of dialysis, and 1 to 2 hours postdialysis measurements of toxin levels are required to ensure adequate dialysis therapy.

Abstract:Bupivacaine is a long‐acting amide local anesthetic that was introduced to clinical practice in the early 1980s. Since then it has been extensively used for both peripheral blocks as well as neuraxial blockade in concentrations varying from 0.125% to 0.75%. Despite the relatively narrow safety margin, bupivacaine has become the most frequently used local anesthetic in obstetric anesthesia.1It is 95% metabolized in the liver and 5% excreted unchanged in urine.2Bupivacaine cardiotoxicity is related to the total dose rather than to the concentration of bupivacaine administere.3It produces a dose‐dependent delay in the transmission of impulses through the cardiac conduction system by blocking sodium channels.4Transient neurologic symptoms (TNS) defined as bilateral symmetrical pain in the lower back and buttocks with radiation to both lower extremities after 5% lidocaine spinal anesthetic was first described by Schneider in 1993.7Several studies have failed to show TNS after spinal anesthesia using bupivacaine 0.5% or 0.75%.8,9In the literature there is only 1 case report10of TNS after spinal anesthesia using bupivacaine and morphine. The following report describes a case of TNS following spinal anesthesia with bupivacaine 0.75%.

This case depicts rarely seen images of infective endocarditis in a patient who was managed non-surgically. We present various echocardiograms which closely follow the progression the infective endocarditis in a patient with previous cardiac surgery and prosthetic material in situ.