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Purpose To report the novel finding of multiple recurrences of full-thickness macular hole in a 70-year-old woman with one episode of spontaneous closure. Methods Case report of a 70-year-old woman who initially presented with a full-thickness macular hole who developed 3 subsequent recurrences of full-thickness macular hole over a duration of 4 years. Spontaneous closure was noted at the second recurrence. Institutional review board was not applicable for this case. Results Combination of three recurrences of full-thickness macular hole with successful closure after vitrectomy as well as a single episode of spontaneous closure. Conclusion This is a novel report in an adult patient with three recurrences of full-thickness macular hole in a previously vitrectomized eye along with an episode of spontaneous closure.

Broadcast in January 1955, a single episode of The Bob Hope Show on the Colgate Comedy Hour, Hope’s first USO show on American television, reflects wider shifts taking place in television in the 19...

The writer Yury Dombrovsky did not leave behind any diaries of memoirs. Glimpses of his life are scattered across autobiographical poems and prose. Although an important source for research, letters and reminiscences of friends are often limited to a single episode or a brief period, usually of the writer’s later life in Moscow. What proved indispensable in the process of recovering facts and compiling a good half of the biography — spanning a lengthy period from the 1920s to the 1950s — were materials of the criminal proceedings. They also help decipher the writer’s major two-part novel, a fact he acknowledged himself. However, the archive materials were only recently declassified. The article aims to reconstruct a period of Yury Dombrovsky’s life and introduces the hitherto unpublished materials of his third criminal case of 1939. The author compares testimonies found in Dombrovsky’s writings and memoirs of his friends and acquaintances with documents preserved in archives, including tip-offs to the authorities.

Aversive and rewarding experiences can exert a strong influence on subsequent behavior. While decisions are often supported by the value of single past episodes, most research has focused on the role of well-learned value associations. Recent studies have begun to investigate the influence of reward-associated episodes, but it is unclear whether these results generalize to negative experiences, such as pain. To investigate whether and how the value of previous aversive experiences modulates behavior and brain activity, in our experiments female and male human participants experienced episodes of high or low pain in conjunction with incidental, trial-unique neutral pictures. In an incentive-compatible surprise test phase, we found that participants avoided pain-paired objects. In a separate fMRI experiment, at test, participants exhibited significant pain value memory. Neurally, when participants were re-exposed to pain-paired objects, we found no evidence for reactivation of pain-related patterns in pain-responsive regions, such as the anterior insula. Critically, however, we found significant reactivation of pain-related patterns of activity in the hippocampus, such that activity significantly discriminated high versus low pain episodes. Further, stronger reactivation in the anterior hippocampus was related to improved pain value memory performance. Our results demonstrate that single incidental aversive experiences can build memories that affect decision-making and that this influence may be supported by the hippocampus. SIGNIFICANCE STATEMENT Aversive and rewarding experiences can exert a strong influence on our subsequent behavior. While decisions are often supported by single past negative or positive episodes, most research has focused on the role of well-learned value associations. In experiments using aversive heat pain in conjunction with incidental objects, we found that participants9 choices were biased by the level of pain associated with the objects. Further, when participants saw the objects again, pain-related neural patterns in the hippocampus were re-expressed, and this was related to pain value memory performance. These results suggest a mechanism by which even single negative experiences can guide our later decisions.

Background/purpose: MS and LB, the primary bacteria groups responsible for dental caries, and high levels of these bacteria in the mother promote transmission from mother to infant. The aim of this study was prevention of maternal MS and LB transmission on infants by using different preventive strategies and inhibition of early childhood caries proggession. Materials and methods: This study was conducted with 50 mother-child pairs who were randomly allocated into either a study group or a control group (n = 25 each). Mothers in the study group were enrolled in a detailed preventive program that included elimination of dental caries with restorative and antibacterial procedures, whereas those in the control group received only a single episode of oral-health education. Results: After 18 months, significant MS and LB inhibition was observed in the study group (p < 0.0001). In addition, caries prevalence in the infants in the study and control groups was 0% and 20% respectively, and the difference between the two groups was statistically significant (p = 0.020). Conclusion: These results indicate that primary preventive intervention and oral-health instruction can significantly inhibit the MS and LB levels of mothers and prevent caries in their children during the early years of life. © 2020 Association for Dental Sciences of the Republic of China 2013/02 This study was financially supported by the Scientific Research Project of Kirikkale University , Turkey (project number: 2013/02 ).

Objectives We investigated the efficacy, safety and acceptance of rectally administered metronidazole for the treatment of giardiasis in children. Patients and Methods This study (ClinicalTrials.gov Identifier: NCT02942485) was an open-labeled randomized comparison of a 3-day-course of rectal metronidazole and single-dose oral tinidazole in children with giardiasis. Clinical cure was defined as the resolution of symptoms by day 10 post-treatment. Microbiological eradication was assessed with stool enzyme immunoassay for G.duodenalis antigen on day 7-10 post-treatment. Results The study was terminated due to the extremely slow enrollment. We describe the outcome for six patients treated with rectal metronidazole and one patient treated with oral tinidazole. All symptomatic patients (4/4) were clinically cured with rectal metronidazole. Microbiological eradication was successful after the first treatment course in all tested patients (6/6), of whom five were treated with rectal metronidazole and one with oral tinidazole. Side effects were reported in one patient and were restricted to a single episode of loose stool after the third dose of rectal metronidazole. The majority of caregivers (4/6) considered the administration of rectal metronidazole relatively easy. Conclusions We provide a proof of principle for the efficacy of rectally administered metronidazole in the treatment of giardiasis.

We investigated the influence of dietary omega-3 polyunsaturated fatty acids (n-3 PUFAs) on glutamatergic system modulation after a single episode of neonatal seizures and their possible effects on seizure-induced long-lasting behavioral deficits.Male Wistar rats receiving an omega-3 diet (n-3) or an n-3 deficient diet (D) from the prenatal period were subjected to a kainate-induced seizure model at P7. Glutamate transporter activity and immunocontents (GLT-1 and GLAST) were assessed in the hippocampus at 12, 24, and 48 h after the seizure episode. Fluorescence intensity for glial cells (GFAP) and neurons (NeuN) was assessed 24 h after seizure in the hippocampus. Behavioral analysis (elevated-plus maze and inhibitory avoidance memory task) was performed at 60 days of age.The D group showed a decrease in glutamate uptake 24 h after seizure. In this group only, the GLT1 content increased at 12 h, followed by a decrease at 24 h. GLAST increased up to 24 h after seizure. GFAP fluorescence was higher, and NeuN fluorescence decreased, in the D group independent of seizures. In adulthood, the D group presented memory deficits independent of seizures, but short-term memory (1.5 h after a training session) was abolished in the D group treated with kainate.N-3 PUFA positively influenced the glutamatergic system during seizure and prevented seizure-related memory deficits in adulthood.

We present a case of non-functioning kidney secondary to a parapelvic cyst in a 45-year-old male who was investigated for a single episode of self-limiting left-sided flank pain. Initial contrast-enhanced computerized tomography (CT) with delayed phases showed a 4 cm left parapelvic cyst and mild renal pelvis dilatation with no other features of obstruction. A Mercaptoacetyltriglycine (MAG3) functional scan showed 52% split function in the affected kidney and prompt drainage with no evidence of obstruction. Although completely asymptomatic after the initial episode we opted to follow him up. Eighteen months on we discovered an atrophic kidney on repeat imaging with a split function of 9% with no change in parapelvic cyst size. We propose that an intermittent silent obstruction, caused by infundibular compression deep inside the kidney, may have caused calyceal dilatation and eventual loss of function in this case. We discuss this rare presentation, review the literature and propose a follow up plan. Level of evidence: Level 5

Background and ObjectiveThere are no current guidelines to manage female retention patients. We aimed to see if a standardized approach could be used to manage these patients. MethodsBetween October 2014 and September 2016, all female patients with urinary retention admitted under a urology consultant were reviewed. ResultsA total of 46 females had a single episode of urinary retention whilst 19 females had recurrent episodes. The commonest cause for a single episode of retention was attributed to anesthesia (general/spinal) (n=9), constipation (n=9) and medication use (n=4). Most of these women (95%) voided on the first attempt fol-lowing catheter removal. In the absence of any neurological symptoms, pelvic ultrasound was the only investigation that revealed any underlying pathology in female retention patients. A pelvic mass was identi-fied in 3 (4.5%) patients. ConclusionFemales with an isolated episode of retention, with an obvious precipitating cause identified during full history and examination, could proceed directly to a nurse-led trial of catheter removal without the need for any further urology review. Others should undergo a pelvic ultrasound and review by a urologist. In our opinion, females with recurrent unexplained episodes of urinary retention should be referred for a trial of sacral neuromodulation if considered appropriate.

The current study explored whether patient characteristics predicted patterns of antidepressant use (i.e., never used, single episode of use, or two or more episodes) in a naturalistic follow-up. Participants in the child/adolescent multimodal (CAMS) extended long-term study. (n = 318) indicated medication use over the course of eight follow-up visits, 3-12 years after receiving treatment in CAMS. 40.6% of participants reported never using an antidepressant during follow-up, 41.4% reported a single episode of antidepressant use, and 18.0% reported multiple episodes of antidepressant use. Greater baseline anxiety severity marginally predicted a single episode of antidepressant use; baseline depression severity predicted multiple episodes of use. Reasons for discontinuing antidepressants included perceived ineffectiveness (31.8%), side effects (25.5%), and improvement in symptoms (18.5%). Exploratory analyses examined predictors of medication use. Findings suggest that antidepressant use is common among anxious youth, as is discontinuation of antidepressant use. Clinical implications and future directions are discussed.

Recent advances in biosensor technology herald a major shift in the way alcohol use will be tracked in humans. Wearable biosensors can passively and continuously monitor wearers' alcohol consumption in real time. An important application of these biosensors is to improve the way medication for alcohol use disorder (AUD) is tested in clinical research. Both laboratory-based screening paradigms and clinical trials have methodological problems that impact their efficiency and predictive validity. Medication screening using laboratory-based methods is a resource-intensive assessment of a single episode of behavior in a non-representative setting. Clinical trials rely on participant self-report to document medication-induced changes in drinking behavior. This review describes how mobile biosensors can be leveraged to improve AUD medication development research. We first review the current state of alcohol biosensor technology with a focus on strengths and limitations of the devices. We describe how multiple biosensors can be combined to create a far more detailed record of drinking compared to single biosensor platforms. We then discuss each phase of the medication development pipeline in turn (i.e., phases 1-4) and describe how mobile biosensors can be incorporated in standard medication testing paradigms to improve efficiency and predictive validity. We conclude with discussion of challenges associated with using currently available biosensors for medication testing and recommendations for researchers wishing to incorporate alcohol biosensors into their own research.

Aim: The aim of the study was to establish the utility of ultrasound scan in detecting renal tract abnormalities following a single episode of epididymitis. Methods: A single-centre retrospective review of all boys diagnosed with epididymitis between October 2012 and 2017 including review of follow up imaging and clinical course was completed. Primary outcome was new diagnosis of renal tract abnormality by ultrasound. Main results: Eighty-four boys with a first diagnosis of epididymitis were identified. Sixty-four cases (76%) were diagnosed at scrotal exploration, the remaining twenty clinically. Median age was 7.30 years (range 0.08–15.83 years), and five had a positive urine culture at presentation. Forty-eight boys (57%) had a follow-up ultrasound scan (at median 4.57 weeks [range 1–31 weeks]). Only two renal tract abnormalities were identified by ultrasound scan, both in boys aged < 6 months, and neither was clinically relevant. Recurrent epididymitis occurred in 4 cases at median 26 days after initial presentation, of whom 3 had been followed up by ultrasound after initial presentation, all of which were normal. Further investigation revealed posterior urethral valves in 1 boy (age 6.5 months at initial presentation). Conclusion: Following a single episode of epididymitis, ultrasound was not helpful at detecting clinically relevant renal tract abnormalities, and furthermore did not identify the only patient with a clinically relevant abnormality. Based on these data, we propose follow-up imaging only in boys ≤ 6 months of age with a positive urine culture or a recurrent episode with consideration given to micturating cystogram even if ultrasound normal. Level of evidence: IV.

We developed a method, ArchaicSeeker 2.0, to identify introgressed hominin sequences and model multiple-wave admixture. The new method enabled us to discern two waves of introgression from both Denisovan-like and Neanderthal-like hominins in present-day Eurasian populations and an ancient Siberian individual. We estimated that an early Denisovan-like introgression occurred in Eurasia around 118.8–94.0 thousand years ago (kya). In contrast, we detected only one single episode of Denisovan-like admixture in indigenous peoples eastern to the Wallace-Line. Modeling ancient admixtures suggested an early dispersal of modern humans throughout Asia before the Toba volcanic super-eruption 74 kya, predating the initial peopling of Asia as proposed by the traditional Out-of-Africa model. Survived archaic sequences are involved in various phenotypes including immune and body mass (e.g., ZNF169), cardiovascular and lung function (e.g., HHAT), UV response and carbohydrate metabolism (e.g., HYAL1/HYAL2/HYAL3), while “archaic deserts” are enriched with genes associated with skin development and keratinization., Existing methods to identify the presence of DNA from other hominin species can be limited in the ability to accurately estimate introgression waves, or can only be applied to specific populations. Here, the authors have developed a generalizable method to identify introgression in multi-wave situations.

Early-life seizures (ELS) are associated with autism spectrum disorder (ASD); however, due to a lack of effective treatments for ELS, it is not clear whether ELS plays a causal role, potentiates the ASD phenotype, or is the result of a common pathophysiology. Deficits in communications are a core feature of ASD. To isolate the impact of ELS on communication, we probed the behavioral consequences of a single episode of kainic acid-induced early-life seizures (KA-ELS) in male and female Sprague-Dawley (CD) rats. Deficits in auditory communication were observed in adult male rats as assessed by behavioral response to ultrasonic vocalization (USV) playback. Ultrasonic vocalizations are classified into two major categories - 50-kHz (positive) calls and 22-kHz (aversive) calls. Behavioral response was assessed via rat preference for different USV playback in a radial arm maze. Response to 22-kHz calls was not impacted by ELS while response to 50-kHz calls was impacted. All rats demonstrated positional preference for the arms adjacent to where 50-kHz calls were playing compared to background noise; however, male ELS rats demonstrated a greater positional preference for the arms adjacent to where 50-kHz calls were playing compared to male control rats. These studies demonstrate that responses to socially relevant auditory cues are chronically altered in adult male rats following a single episode of ELS. We speculate that these changes contribute to previously reported social deficits associated with ELS. ispartof: EPILEPSY & BEHAVIOR vol:127 ispartof: location:United States status: published

BACKGROUND To evaluate periodontal disease progression (PDP) and potentially detectable effects of a single episode of scaling and root planing (se-SRP) in subjects lacking professional dental care and oral hygiene practices for >40 years. METHODS In 2013, se-SRP was offered to all available subjects from the original cohort of 480 males initially established in 1970. From a total of 75 attending the previous examination in 2010 (baseline), 27 consented to receive the intervention while 18 declined and served as controls. Clinical data were recorded again in 2014 (follow-up) similarly to the previous surveys (1970 to 2010). RESULTS Subjects' mean age in 2010 was 62.5 (± 3.6, test) and 61.9 (± 3.8, control) years. At follow-up, both groups presented with elevated tooth loss of 1.2 (from 15.5 ± 9.0, test) and 1.5 (from 17.9 ± 6.6, control) resulting in 1,392 (test) and 1,061 (control) sites available for further analysis. In both groups, clinical attachment level (CAL) loss and probing depths (PD) deteriorated. PD increase of 0.22 mm (± 1.70) in the test group was significantly higher compared with the control group (0.08 mm ± 1.30) (P

Background Syphilis rates have continued to rise in the United States. Florida and Louisiana consistently report high numbers of cases. In a previous study, reinfections accounted for 30.4% of new infections among men in 2018. In this analysis, we evaluated rates of reported reinfections in women. Methods We evaluated all syphilis records, all stages (primary, secondary, early latent, and late latent) in females aged 15–70 years from the Florida and Louisiana Departments of Health surveillance databases during 2000–2018. Demographics of cases and repeaters (individuals reported with 2 or more cases of syphilis) were examined. Percentages of syphilis cases from repeaters by year were calculated as were percentages from HIV+ females. Results From 2000–2018, 124,827 syphilis cases were reported from 107,405 individuals: 33,594(31%) were female accounting for 35,279(28%) of all cases. Of 33,594 females, 32,050(95%) reported a single episode of syphilis and 1,544(5%) were repeaters. Most women with a single case report were African American 18,429(57.5%) and 1,510(4.7%) of single cases were HIV+. Women with a single episode of syphilis were likely in the age range of 20–39 (primary child-bearing years) 20,037(63%). Repeaters were primarily African American 914(59.2%) and 218(14.1%) were HIV+. Women reported with two or more episodes of syphilis also were likely to be of child-bearing age 20–39: 1,065(69%). Repeaters had 1,685 cases reported; range 2 to 5. Mean time to second infection was 3.5 years (median=2.3 years). From 2010–2018, repeaters accounted for a slowly increasing percentage of all syphilis reported: 2010 (5.1%), 2013 (5.9%), 2016 (6.8%), and reached (10.3%) in 2018. Within females living with HIV, cases from repeaters also increased: 2010 (13%), 2014 (16%), 2016 (21%), and 2018 (25%). Conclusion Most syphilis diagnosed in Florida and Louisiana was among persons infected for the first time and among men. However, syphilis infection and reinfections are increasing in women.

Background Despite fast progress in neuroscientific approaches, the neurobiological continuum links psychotic spectrum, and affective disorder is obscure. White matter WM abnormalities found utilizing Diffusion Tensor Imaging (DTI) showing impaired communication in both disorders have been consistently demonstrated; however, direct comparisons of findings between them are scarce. This study aims to study WM abnormalities in single episode bipolar I disorder, and single episode brief psychotic disorder related to healthy control with the association of executive function. Methods A cross-sectional case-control study was used to assess 60 subjects divided into 20 patients with single episode bipolar I disorder, 20 individuals with single episode brief psychotic disorder (both groups of patients were in remission), and 20 healthy controls. The present study examined the superior longitudinal fasciculus (SLF), and cingulum bundle fractional anisotropy (FA) determined from DTI images symmetrically and connected these results with cognitive functions as assessed by the trail making test (TMT) and Wisconsin card sorting test (WCST). Results DTI data indicated that the psychotic group had a significant decrease in FA of the right SLF (p-value less than 0.001), left SLF (p-value less than 0.001), and left cingulum (p-value less than 0.001) than the bipolar I group. In terms of executive functioning, the psychotic group performed significantly worse than the bipolar I group on the TMT part B (p-value less than 0.001), the WCST (number of classifications fulfilled) (p-value less than 0.001), and perseverative errors (p-value less than 0.001). Conclusion Even after clinical remission, individuals with single episode brief psychotic disorder had more pronounced white matter impairments and executive function deficiencies than individuals with single episode bipolar I disorder.

Hypoglycemia is associated with adrenergic and various neurological symptoms including hemiparesis. Though not common, movement disorders such as chorea and ballism have been reported in hypoglycemia. This case was of an elderly lady, a known diabetic, who developed two episodes of hemiparesis and single episode of jerky head movement with preserved sensorium lasting for few seconds, associated with hypoglycemia on different occasions, 1 week after increasing the dosage of oral hypoglycemic agent with complete recovery each time with correction of sugar levels. Magnetic resonance imaging showed transient bilateral diffusion restriction in posterior limb of internal capsule.

Background Salmonella species commonly causes infection in humans and on occasion leads to serious complications, such as mycotic aneurysms. Here, we present the first case reported of a patient with a mycotic aneurysm likely secondary to Salmonella Rissen infection. Case presentation The patient presented with 4 weeks of lower back pain, chills and a single episode of diarrhoea 2 months prior during a 14-day trip to Hong Kong and Taiwan. Magnetic resonance imaging revealed an aneurysmal left internal iliac artery with adjacent left iliacus rim-enhancing collection. A stool culture was positive for Salmonella Rissen ST 469 EBG 66 on whole genome sequencing. The patient underwent an emergency bifurcated graft of his internal iliac aneurysm and was successfully treated with appropriate antibiotics. Conclusions This case highlights the importance of considering the diagnosis of a mycotic aneurysm in an unusual presentation of back pain with features of infection.

Background Electronic health record (EHR) data are available for research in all UK nations and cross-nation comparative studies are becoming more common. All UK inpatient EHRs are based around episodes, but episode-based analysis may not sufficiently capture the patient journey. There is no UK-wide method for aggregating episodes into standardised person-based spells. This study identifies two data quality issues affecting the creation of person-based spells, and tests four methods to create these spells, for implementation across all UK nations. Methods Welsh inpatient EHRs from 2013 to 2017 were analysed. Phase one described two data quality issues; transfers of care and episode sequencing. Phase two compared four methods for creating person spells. Measures were mean length of stay (LOS, expressed in days) and number of episodes per person spell for each method. Results 3.5% of total admissions were transfers-in and 3.1% of total discharges were transfers-out. 68.7% of total transfers-in and 48.7% of psychiatric transfers-in had an identifiable preceding transfer-out, and 78.2% of total transfers-out and 59.0% of psychiatric transfers-out had an identifiable subsequent transfer-in. 0.2% of total episodes and 4.0% of psychiatric episodes overlapped with at least one other episode of any specialty. Method one (no evidence of transfer required; overlapping episodes grouped together) resulted in the longest mean LOS (4.0 days for all specialties; 48.5 days for psychiatric specialties) and the fewest single episode person spells (82.4% of all specialties; 69.7% for psychiatric specialties). Method three (evidence of transfer required; overlapping episodes separated) resulted in the shortest mean LOS (3.7 days for all specialties; 45.8 days for psychiatric specialties) and the most single episode person spells; (86.9% for all specialties; 86.3% for psychiatric specialties). Conclusions Transfers-in appear better recorded than transfers-out. Transfer coding is incomplete, particularly for psychiatric specialties. The proportion of episodes that overlap is small but psychiatric episodes are disproportionately affected. The most successful method for grouping episodes into person spells aggregated overlapping episodes and required no evidence of transfer from admission source/method or discharge destination codes. The least successful method treated overlapping episodes as distinct and required transfer coding. The impact of all four methods was greater for psychiatric specialties.

BACKGROUND Maintaining glycaemic control during exercise presents a significant challenge for people living with Type 1 diabetes. Significant glycaemic variability has been observed in athletes with Type 1 diabetes in competitive contexts. While very-low-carbohydrate ketogenic diets have been shown to minimize glycaemic excursions, no published data have examined if this translates to exercise. CASE REPORT We report the case of a 37-year-old man with Type 1 diabetes who successfully undertook a 4011 km cycle across Australia over 20 consecutive days whilst consuming a very-low-carbohydrate ketogenic diet. Continuous glucose monitoring data capture was 98.4% for the ride duration and showed remarkable glycaemic stability, with a standard deviation of 2.1 mmol/l (average interstitial glucose 6.1 mmol/l) and 80.4% of time spent within a range of 3.9-10 mmol/l. Interstitial glucose was

What follows is a theoretical, cultural-studies-infused analysis of the shifting representational scripts of the ageing female body and how it is compelled to signify the regulatory laws governing that process in its very media mediated being. This article is about that law inscribed on and through the body of Sex and the City’s Samantha Jones, played by Kim Cattrall, as sanctioned at HBO (Home Box Office), and how it is reiterated in and through time across this media landscape as a way of announcing what made HBO unique. My purpose is to claim how studying a television series as discourse produces a genealogy, in terms of how a show—its institutional context, its screen histories, its paratexts—generates representational scripts as a dynamic process of re-articulation. Sustaining a show for as long as possible makes visible the reiteration of a body in performance in a single episode, across a series, from season to season, and throughout the life of the programme. What happens to representational scripts across time and how a mediated body ages in time is where this article seeks to intervene. In unpacking these ideas, the article draws on key theories relevant to the study of ageing, femininity and the materiality of the body.

Introduction The aim of this study is to compare the outcomes of surgical management after primary anterior shoulder dislocation to the outcomes of patients who have surgical stabilization after recurrent anterior shoulder instability. Methods A Medline (PubMed) search was performed in November of 2016 using the following key terms: shoulder, labrum, Bankart, instability, repair, outcome, recurrent. In May 2017 a Cochrane search was performed using similar key terms to ensure we included all studies. Only level I and II studies were included. Results There were three studies that compared primary repair to delayed repair. In all three studies, the rate of recurrence was higher in group R than group S. When pooled, there was not a statistically significant difference between these groups, but there was a slightly higher odds of recurrence in group R (pooled OR 2.08, CI 0.69–6.26, p = 0.19). No significant differences were appreciated in functional outcomes or complications in these two groups. Conclusion Further level I and level II studies to compare surgical treatment after first time and recurrent instability are needed. This study failed to find a statistically significant difference in recurrence rates in patients who had stabilization acutely after a single episode compared to patients with recurrent instability events, although results suggest there may be a small benefit in primary stabilization.

Goodpasture Syndrome is described as a single episode disease entity. It is diagnosed with the demonstration of antiglomerular basement (anti-GBM) antibodies in plasma or renal tissue. Although the recurrence of anti-GBM disease is rare, it has been reported in up to 3% of cases. Recurrence with negative anti-GBM antibodies in plasma is even less frequent We report a 63 years old male in whom anti-GBM disease recurred without detectable anti-GBM antibodies in plasma, despite having positive antibodies at the onset.

Clostridium difficile is a major cause of healthcare-associated diarrhea. SlpA is the precursor of the S-layer of C. difficile. The aim of this work was to evaluate the humoral immune response of hospitalized patients to SlpA and its potential role on CDI outcome. Sera of 87 included patients were collected the day of CDI diagnosis as well as at early and late periods after infection. SlpA appeared to be immunogenic with a heterogeneous response between patients after a CDI. Patients with a single episode had a significantly higher anti-SlpA IgG antibody level than patients with recurrent CDI (p = 0.0197). These preliminary results will be useful to understand better the inter-individual variability of immune responses to C. difficile as well as for the development of new therapeutics.

A 65-year-old postmenopausal woman presented with symptoms of uterine prolapse. The patient also complained of a single episode of bleeding that lasted for 5 to 6 days. She had grade IV prolapse for which she underwent vaginal hysterectomy. Grossly, the uterus measured 8.5×4×2.5 cm with an

This chapter asks what the comic televisual representation of apartheid in the late 1960s tells us about its perception in Britain, and what it reveals about race relations in the country. To achieve this, this chapter focuses on a single episode from the situation comedy Till Death Us Do Part broadcast on the BBC on 12 January 1968. The chapter illuminates how the comic mode helped to circulate an anti-apartheid message to a large audience, and, inadvertently, to subvert the explicit intent to protest apartheid. It demonstrates how the protest against a racist system of governance in South Africa highlights racism in Britain.

IntroductionHospital administrative data is a valuable source to measure myocardial infarction (MI) rates. However, admission counts are susceptible to over-inflation if the patient is transferred multiple times during a single episode of care, and variables denoting transfers may not be reliable. To obtain an accurate number of events, hospital transfers need to be correctly identified. Objectives and ApproachWe assessed multivariable logistic regression and various machine-learning models to predict transfers in hospital administrative data. Using Western Australian linked hospital data, we identified records from 2000-2016 with a principal discharge diagnosis of MI. Our standard method to compare against was a 24-hour look-back to identify a transfer using just admission and separation dates from the current and previous records for the same patient. Multivariable logistic regression and decision trees with various boosting algorithms were used to predict if a single record was a transfer, using variables recorded in the admission (e.g. age, sex, type of hospital, admitted from, emergency/elective admission). The performance of each model was calculated using metrics including area under the curve (AUC). ResultsRecords in the training, validation and testing samples had similar characteristics: mean age=68.9 years, 66% were male and 58% admitted to tertiary hospitals. Gradient Boosting Decision Tree (AUC=0.887, 95%CI: 0.886-0.887) outperformed multivariable logistic regression (AUC=0.875; 95% CI: 0.869-0.881) and random forest models (AUC=0.859; 95% CI: 0.853-0.865). Conclusion / ImplicationsMultivariable logistic regression and machine-learning models are able to identify transfers in a single record from existing variables. They can be used in unlinked hospital administrative data where records belonging to the same patient cannot be identified.

This study was designed to investigate the acute effects of nonnicotinized e-cigarette (e-cig) aerosol inhalation in nonsmokers both in terms of blood-based markers of inflammation and oxidative stress and evaluate their association with hemodynamic-metabolic MRI parameters quantifying peripheral vascular reactivity, cerebrovascular reactivity, and aortic stiffness. Thirty-one healthy nonsmokers were subjected to two blood draws and two identical MRI protocols, each one before and after a standardized e-cig vaping session. After vaping, the serum levels of C-reactive protein, soluble intercellular adhesion molecule, and the danger signal machinery high-mobility group box 1 (HMGB1) and its downstream effector and the NLR family pyrin domain containing 3 (NLRP3) inflammasome (as monitored by its adaptor protein ASC) increased significantly relative to the respective baseline (prevaping) values. Moreover, nitric oxide metabolites and reactive oxygen species production decreased and increased, respectively. These observations were paralleled by impaired peripheral vascular reactivity (with reduced flow-mediated dilation and attenuated hyperemic response after a cuff-occlusion test) and metabolic alterations expressed by decreased venous oxygen saturation, postvaping. The current results suggest propagation of inflammation signaling via activation of the danger signaling axis (HMGB1-NLRP3). The findings indicate that a single episode of vaping has adverse impacts on vascular inflammation and function. NEW & NOTWORTHY Endothelial cell signaling and blood biomarkers were found to correlate with functional vascular changes in a single episode e-cigarettes inhalation in healthy adults. This is indicative of the potential of e-cigarettes (even when inhaled acutely) to lead of vascular dysfunction.

To estimate the number of patients who receive a cumulative effective dose (CED) of ≥ 100 mSv from computed tomography (CT) in a single day or episode of care. We examined 28,870 patients who underwent 49,834 CT examinations in a tertiary care centre in Italy in 2.5 years. Radiation exposures were retrieved from the hospital’s automatic exposure monitoring system. Two cohorts were identified as those who received a CED of ≥ 100 mSv in a single day and within a month starting from the first examination. Organ doses were estimated for the first cohort. Among the 1765 (6.1%) patients who received CED ≥ 100 mSv in the observation period, 427 received a CED of ≥ 100 mSv within a month (and 70 patients in a single day). This group represented 1.5% of all patients who underwent CT exams and 24% of those who received CED ≥ 100 mSv in the observation period. The clinical indication for referral included cancer in 132 patients (31%) and non-oncological indications in 295 patients (69%). In 68/70 patients with CED > 100 mSv in a single day, at least one organ/tissue received a dose of ≥ 100 mGy. The finding of a sizeable percentage of patients undergoing CT exams and receiving CED ≥ 100 mSv in a single episode of care points toward the need of imaging appropriateness criteria, to revise the routine protocols, to replace older machines, and to provide to the radiologist the patient’s prior radiation history to facilitate an appropriate decision-making process. • Patients can receive effective doses greater than 100 mSv in a single CT or in multiple CT examinations performed in a single episode of care in 1.5% of patients in a 2.5-year period. • In this study, the clinical indication for CT referral was non-oncological in 69% of patients. • The patient’s prior radiation history should be provided to the referring physicians and the radiological medical practitioner to facilitate an appropriate decision-making process.

There is limited information on the impact of CMV DNAemia episodes developing prior to engraftment (pre-CMV DNAemia) on clinical outcomes following allogeneic hematopoietic stem cell transplantation (allo-HSCT). This issue was addressed in the current retrospective multicenter study including 878 patients. All participant centers used preemptive antiviral therapy strategies for prevention of CMV disease. CMV DNA load in blood was monitored by real-time PCR assays. A total of 144 patients (cumulative incidence 16.5%, 95% CI, 14%-19%) had an episode of pre-CMV DNAemia at a median of 10 days after allo-HSCT. Patients who developed pre-CMV DNAemia had a significantly higher (P = < 0.001) probability of recurrent episodes (50%) than those who experienced post-CMV DNAemia (32.9%); Nevertheless, the incidence of CMV disease was comparable (P = 0.52). Cumulative incidences of overall mortality (OM) and non-relapse mortality (NRM) at 1-year after allo-HSCT were 32% (95% CI, 29-35%) and 23% (95% CI 20-26%), respectively. The risk of OM and NRM in adjusted models appeared comparable in patients developing a single episode of CMV DNAemia, regardless of whether it occurred before or after engraftment, in patients with pre- and post-engraftment CMV DNAemia episodes or in those without CMV DNAemia.

Background Wider availability of continuous rhythm monitoring has made feasible the incorporation of metrics of atrial fibrillation (AF) burden and duration into the decision to initiate anticoagulation. However, the relationship between thresholds of burden and duration and underlying risk factors at which anticoagulation should be considered remains unclear. Objective The purpose of this study was to evaluate the relationships of these metrics with each other and the outcome of stroke/transient ischemic attack (TIA). Methods We identified patients with cardiovascular implantable electronic devices (CIEDs) with atrial leads who had at least 1 interrogation in 2016 demonstrating nonpermanent AF and were not receiving oral anticoagulation (OAC). We evaluated the relationship between burden (ie, percentage of time spent in AF), the longest single episode of AF, and risk factors (ie, CHA2DS2-VASc score) in predicting risk of stroke/TIA. Results The study included 384 patients with mean follow-up of 3.2 ± 0.8 years and incidence of stroke/TIA of 14.8% during follow-up (∼4.6% per year). The burden of AF and the duration of longest episode demonstrated a significant positive correlation to each other but not CHA2DS2-VASc score. Importantly, although the CHA2DS2-VASc score was predictive of stroke/TIA, neither burden nor duration was associated with stroke/TIA. Conclusion Among patients with CIED-detected AF not receiving OAC, the amount of AF (measured by either burden or duration) does not seem to significantly impact stroke risk, whereas CHA2DS2-VASc score does. These data suggest that among patients with CIED-detected AF, once AF occurs, stroke risk seems to be predominantly driven by underlying risk factors.

Major depressive disorder (MDD) is a highly prevalent psychiatric disorder, and recurrent depression is associated with severe and chronic impairment. Identifying markers of risk is imperative to improve our ability to predict which individuals are likely to experience a recurrence. According to cognitive theories, biases in attention for affectively-salient information may serve as one mechanism of risk. Existing research has combined participants with a single episode (sMDD) and those with recurrent MDD (rMDD); therefore, little is known about whether these biases track the severity of disease course. The current study examined attentional biases to facial displays of emotion among 115 women with a history of rMDD, sMDD, or no history of psychopathology using a passive viewing eye-tracking task. Women with rMDD exhibited significantly lower sustained attention to happy faces compared to both healthy controls and sMDD women. These results extend previous research on the presence of attentional avoidance of positive stimuli in individuals with a history of MDD and provide preliminary evidence that this bias is strongest among individuals with a history of rMDD.

Adolescence is a period of increased sensitivity to stress and vulnerability to the manifestation of psychiatric disorders, such as attention-deficit/hyperactivity disorder (ADHD). Nevertheless, the relationship between stress during adolescence and ADHD is still unclear. Knowing that stress can have long-term consequences, the aim of this study was to evaluate the impact of a single episode of restraint stress during adolescence on locomotion, risk behaviour and short-term memory in adult spontaneously hypertensive rats (SHR), a validated animal model of ADHD. A single episode of stress during adolescence increased risk behaviour and impaired short-term recognition memory, but did not alter locomotion in adult SHR. These findings show that stress during adolescence, even acute, may lead to long-term behavioural consequences in an animal model of ADHD.

This paper demonstrates ways in which vision is integrated with other modalities of perception in a manner relevant to a temporally unfolding activity. It will do so by analyzing a single episode extracted from an abdominal palpation conducted on a pregnant woman by a midwife in Japan. The episode forms a “natural experiment” through which one can demonstrate that the integrated visual and tactile perception of an object is organized differently according to the status of the ongoing activity in which it is embedded. Data are in Japanese with English translations.

Chronic wounds represent a large and growing disease burden. Infection and biofilm formation are two of the leading impediments of wound healing, suggesting an important role for the microbiome of these wounds. Debridement is a common and effective treatment for chronic wounds. We analyzed the bacterial content of the wound surface from 20 outpatients with chronic wounds before and immediately after debridement, as well as healthy skin. Given the large variation observed among different wounds, we introduce a Bayesian statistical method that models patient-to-patient variability and identify several genera that were significantly enriched in wounds vs. healthy skin. We found no difference between the microbiome of the original wound surface and that exposed by a single episode of sharp debridement, suggesting that this debridement did not directly alter the wound microbiome. However, we found that aerobes and especially facultative anaerobes were significantly associated with wounds that did not heal within 6 months. The facultative anaerobic genus Enterobacter was significantly associated with lack of healing. The results suggest that an abundance of facultative anaerobes is a negative prognostic factor in the chronic wound microbiome, possibly due to the increased robustness of such communities to different metabolic environments.

We present an uncommon case of a patient presenting at the emergency department for severe vomiting, persisting for at least 12 hours, without nausea or abdominal pain. She initially referred vomiting food eaten several hours earlier and eventually a single episode of haematemesis with emission of a small amount of red blood and clots. She also reported the occurrence of acute dysphagia for solid food. The patient underwent oesophagogastroduodenoscopy (OGD), which showed that the lumen was almost completely narrowed by a submucosal bluish bulging from midoesophagus (19 cm from the incisors) to the cardia (located at 35 cm from the incisors). She therefore underwent chest CT showing a 15 cm long intramural oesophageal haematoma. Although the combination of vomiting and haematemesis is usually associated with Mallory-Weiss syndrome, in which a prompt OGD has a key role in the patient management, when these symptoms are associated with acute dysphagia, a possible intramural haematoma might be suspected. In this case, chest CT should take precedence, because it allows a quick and complete diagnostic appraisal. However, in this setting, although OGD can directly show typical findings (bluish swelling mucosa with or without a superficial tears), it might increase the risk of oesophageal haematoma rupture and intraluminal bleeding.

Highlights • Very rare case report, isolated congenital upper lip midline sinus. • Surgical excision is curative, no recurrence. • Upper lip midline sinus can be associated with syndromes or conditions., Introduction Congenital pits of the lip are uncommon and may be associated with conditions such as Van der Woude syndrome. Isolated lip pits are extremely rare developmental defects. Presentation of case A 7 year old Caucasian girl presented to plastic surgery clinic in Jordan University academic hospital complaining of an upper lip pit that has been present since birth. It was associated with a single episode of whitish discharge. On examination, an isolated upper lip midline sinus was found. She is otherwise fit and healthy. Surgical excision was curative with good cosmetic outcome. Discussion The prevalence of lower lip sinuses has been estimated to be about 0.00001% of the white population. Upper lip sinuses are even more uncommon. To date, there have been several case reports of upper lip sinuses and fistulas. A total of 55 cases was found upon reviewing the English literature. No similar cases were reported in Jordan. Different presentations are mentioned in this review. Several embryologic theories are presented. Conclusion Upper lip sinus formations are rare developmental events, and the pathogenesis of these lesions still needs further evaluation. Simple surgical excision is the treatment of choice.

Young people who go missing face significant risks and vulnerabilities, yet there has been limited research looking their longer-term criminal justice-related outcomes. The aim of this study was to explore the criminal justice and mental health-related trajectories of a random sample of 215 young people reported missing for the first time in 2005, followed up for a decade. Two thirds (64.7%) of the sample had accumulated an offence history and 68.4% a victimisation history. More than a third were reported missing multiple times; these youth were characteristically different to single episode missing persons with respect to police contacts and mental health-related vulnerability. Results highlight a significant level of mental health concern among a population that police are not adequately equipped to respond to. Further research is needed to better understand motivations for going missing and the extent of risks and vulnerabilities they face while missing and upon return.

Women of advanced age present a major challenge for fertility treatments. This study was designed to assess whether poor ovarian response (POR) according to the Bologna criteria is a significant predictor for live birth in women over 40. The outcomes of subsequent IVF cycles were also studied. The results of 1870 fresh IVF cycles in 1212 women were retrospectively analysed. The live birth per cycle was 3.3 times higher (11.61% versus 3.54%, P < 0.001) in good responders with more than three oocytes collected compared with women with less. Ovarian response defined by oocytes collected, but not by the number of follicles, was independently associated with live birth (odds ratio, 2.0; 95% confidence interval, 1.18 to 3.54; P = 0.009). The occurrence of POR in subsequent IVF cycles was only 55%. No differences in live births were found in persistent POR compared with women with at least one good response. A single episode of POR in a first IVF cycle in older women has a limited predictive value for the outcomes of subsequent cycles. POR in women aged 40-43 years, defined by the number of oocytes retrieved, is a predictor for live birth in IVF.

In this paper, we use δ 13 C and δ 15 N of serial samples of dentine collagen from archaeological springbok teeth as a novel high-resolution but short-term palaeoenvironmental proxy. Two adult and seven juvenile springbok ( Antidorcas marsupialis ) teeth from the archaeological site SK400 were analyzed. This site, located in the Namaqualand desert on the west coast of South Africa has yielded a large number of small-medium bovids, likely all springbok. These springbok were killed in a single episode between 1438 and 1641 CE, during the Little Ice Age (LIA). The juvenile springbok were significantly more depleted in 13 C and enriched in 15 N compared with the adults. During the four to six months over which their teeth developed, the juveniles consumed a higher proportion of C 3 plants and were exposed to greater aridity than the adults at equivalent ages. Based on dental wear, the adults are estimated to be between 3.5 and 7.5 years old at death, so the isotope values in their teeth record diet and environmental conditions several years earlier. In addition, the juveniles (but not the adults) show a trend towards more negative δ 13 C values and very high δ 15 N (up to + 18.9‰) during the period of tooth formation, truncated by the animals' death. We infer that the animals were killed during an extreme drought. Informed by the archaeological evidence, we surmise that this was probably a herd of springbok on ‘trek’ in search of food and water, as this species is known to do during droughts. Although palaeoenvironmental proxies for the region as a whole suggest that Namaqualand was cool and wet during the Little Ice Age, this study indicates at least one period of drought, contributing to the developing picture of highly variable climates in southern Africa during the Holocene.

Post-traumatic stress disorder (PTSD) is a stress-related psychiatric/mental condition. Tangeretin (TAN), a major polymethoxylated flavone of citrus plants, exhibits anti-inflammatory and neuroprotective activities. However, whether TAN leads to cognitive improvement in PTSD patients remains unclear. In the present study, we explored whether TAN improved cognitive impairment induced in rats by single prolonged stress (SPS episode mimicking PTSD induction) and determined whether TAN reversed reductions in dopamine (DA) and serotonin (5-HT) levels. Rats were intraperitoneally injected with TAN for 14 consecutive days after the SPS, which had induced cognitive deficits evident in the object recognition task and the Morris water maze test; the impairments were improved by TAN (100 mg/kg). TAN rescued the neurochemical abnormalities and the SPS-induced decreases in DA and 5-HT levels in the hippocampus and amygdala. These effects may be attributable in part to induction of hippocampal genes encoding tyrosine hydroxylase and tryptophan hydroxylase-1. Our results support the idea that rats with PTSD exhibit changes in DAergic and serotonergic transmission and in memory impairment. Thus, TAN mediated reversal of memory-related behavioral dysfunction associated with traumatic stress may be a useful therapeutic intervention in PTSD patients.

Purpose To present ophthalmic imaging findings in the case of a 40-year-old male with sustained visual loss after a single episode of acute central serous retinopathy (CSR). Observations A male subject presented with visual acuity decline to 20/50 OS and was diagnosed with acute CSR. The initial pigment epithelial detachment and subretinal fluid resolved within 6 weeks, but visual acuity remained impaired. Using directional optical coherence tomography (D-OCT) and confocal and split-detector adaptive optics scanning light ophthalmoscopy (AOSLO), we imaged pathologic alterations in the photoreceptor mosaic of the affected eye. A foveal region of intermittent missing cones, a temporal parafoveal region of confluent missing cones, and a nasal parafoveal region of misdirected cones were observed. Conclusions and Importance Pathologic alterations in photoreceptor microanatomy underlie residual visual acuity deficits in this case of acute CSR. Observations of missing cones correlated well across all imaging modalities in the fovea and the temporal parafoveal region of missing cones. However, in the nasal parafovea where cones were present but misdirected, D-OCT and AOSLO may be able to identify and image photoreceptors with greater fidelity as compared to non-directional SDOCT (spectral domain OCT). D-OCT may thus have a clinical role in rapidly assessing photoreceptor mosaic integrity in pathology.

Study Objective Identifying risk factors for recurrent ovarian torsion and evaluation of the efficacy of ovarian fixation techniques. Design Retrospective cohort study. Setting Tertiary-care medical center. Patients or Participants Seventy-nine women with recurrent ovarian torsion (study group) were matched with 158 women with a single episode of ovarian torsion (control) during the same year of their first episode. Interventions Demographic data, clinical and surgical characteristics were retrieved between the years 2001-2020. In order to identify risk factors for recurrent ovarian torsion, the first episode of ovarian torsion in the study group was compared to the only episode of the control group. A second analysis was performed between women with ovarian fixation (success and failure). Measurements and Main Results Women with recurrent torsion were significantly younger and the percentage of premenarchal women was significantly higher (25.6±8.6 vs. 30.6±7.1, P Ovarian pathology was significantly more common in the control group (89.0% vs. 38.1%, P Conclusion Recurrent ovarian torsion is more common in young premenarchal women. Ovarian fixation is a safe procedure with a 70% success rate. We found no advantage in one fixation techniques over the others.

Key Clinical Message Adult-onset Still's disease (AOSD) due to visceral leishmaniasis (VL) has not been previously reported. This case report analyzes a single episode of AOSD probably due to a visceral leishmaniasis successfully treated with pentamidine isethionate and prednisone.

Purpose The relationship between exposure to violence and adverse behavioral outcomes is well-documented. But, heterogeneity in this relationship across different operational strategies for exposure to violence is less well understood. This study examines the effects of repeat victimization, exposure to different types of violence, and poly-victimization on property crime, violent offending, and substance use. Methods We analyze two waves of data from the National Longitudinal Study of Adolescent to Adult Health (N = 12,603). We operationalize exposure to violence as: a dichotomous indicator of overall occurrence; exposure to multiple incidents of violence (repeat exposure); types of exposure to violence (witnessed, threatened, and experienced violence); and poly-victimization (i.e., repeat exposure to violence and exposure to multiple types of violence). Results Exposure to violence – regardless of how it is measured – increases offending risk. The strongest effects are observed for poly-victimization, followed by repeat exposure to violence and exposure to a single episode of violence. There is little variation in effect sizes across types of exposure to violence. Conclusions The results speak to the utility of preventing the onset of exposure to violence and addressing ongoing exposure to violence in order to interrupt the link between exposure to violence and offending.