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Total callosotomy and vagus nerve stimulation were not sufficiently effective.

In bilateral RS, FCD may be present in both cerebral hemispheres. In the current case, an autoimmune response to dysmorphic neurons may have contributed to the pathogenesis of intense inflammation.

In bilateral RS, FCD may be present in both cerebral hemispheres. In the current case, an autoimmune response to dysmorphic neurons may have contributed to the pathogenesis of intense inflammation.Novel films based on watermelon peel pectin (WMP) incorporated with purple cabbage extract (PCE) were developed for monitoring the freshness of mutton. The FTIR result showed that WMP and PCE interacted through hydrogen bonds. Low PCE content (≤1.5%) could be well dispersed in the film matrix, resulting in an enhancement in light transmittance, mechanical properties, barrier properties, and thermal stability. Excessive addition of PCE destroyed the compact structure of the film and decreased the comprehensive properties. The antioxidant and antimicrobial activity of WMP/PCE films were proportional to the amount of incorporated PCE. Moreover, the color of the film deepened as the PCE content increased. The film had excellent color stability and pH response properties. The WMP/PCE1.5 film color varied from mauve to baby blue according to the quality of mutton (fresh to spoiled). Our results suggested that the WMP/PCE film might have great potential for monitoring the freshness of mutton.

Ethical issues in trauma surgery are commonplace but scarcely studied. We aim to characterize the ethical dilemmas trauma surgeons encounter in clinical practice and describe perceptions about the ability to manage these dilemmas and strategies they use to address them.

Members of a U.S. trauma society were electronically surveyed on handling ethically challenging scenarios. The survey instrument was developed using published ethics literature and iterative cognitive interviews. Domains included perceived frequency of encountering and self-efficacy of managing ethical situations in trauma surgery. Common situations were defined as those encountered monthly or weekly. Ethical problems were categorized within 7 larger categories general ethics, autonomy, communication, justice, end-of-life, conflict, and other. Descriptive analyses were performed; group comparisons were analyzed using analysis of variance.

Of 1,748 surveyed, 548 responded (30.6%) and 154 (28%) were female. Most were White, under 55 years unter ethical challenges, especially those related to communication. Trauma surgeons encounter ethical issues involving conflict least often, and lowest self-efficacy scores with issues involving autonomy. Experienced trauma surgeons reported higher self-efficacy scores in managing ethical issues. Future work should examine how self-efficacy translates to observed behavior, and how trauma surgeons build and enhance their ethical skillsets in the care of the injured patient.

Racial disparities in accessing postmastectomy breast reconstruction persist despite expansion of insurance coverage. An updated examination with a broad assessment of mediating factors in a “majority minority” community is needed.

Data were collected on all patients undergoing mastectomy for breast cancer from 2011 to 2019 in a private academic center and adjacent safety-net hospital. Multivariable logistic regression was used to assess the effect of race on postmastectomy breast reconstruction, controlling for predetermined potentially mediating and confounding variables.

Of 1,554 patients, 63.8% (n= 203) of non-Hispanic White, 33.4% (n= 102) of Black, and 47.9% (n= 438) of Hispanic patients underwent postmastectomy breast reconstruction. Multivariable logistic regression showed that Black patients (odds ratio [OR] 3.6, 95% confidence internal [CI] 2.2-5.9; P < .0001) undergo significantly less postmastectomy breast reconstruction than White patients. Age, insurance status, stage, and hospital type mediated this relationship.

Black patients have substantially reduced rates of postmastectomy breast reconstruction compared with White patients, which is mediated by socioeconomic factors.

Black patients have substantially reduced rates of postmastectomy breast reconstruction compared with White patients, which is mediated by socioeconomic factors.

The Japanese Gastric Cancer Association provided updated criteria for endoscopic local excision of early-stage gastric cancer in 2018. The purpose of this study was to evaluate utilization patterns for endoscopic local excision in the United States for resectable gastric adenocarcinoma.

Patients with resectable gastric adenocarcinoma were identified from the National Cancer Database between 2010 and 2017. Patients were classified into strict appropriate criteria, expanded criteria, and inappropriate based on the Japanese Gastric Cancer Association guidelines. DL-AP5 Factors associated with endoscopic local excision were identified using univariate and logistic multivariate regression.

Within the National Cancer Database, 46,334 patients were stratified into strict appropriate criteria (n= 1,405), expanded criteria (n= 727), and inappropriate (n= 43,675). Annual cases of local excision increased by 76.9% over the study period, from 273 in 2010 to 483 in 2017. Among patients who underwent local excision, 10.1% were classified as strict appropriate criteria, 1.6% were classified as expanded criteria, and 84.5% were classified as inappropriate. Among inappropriate patients, factors associated with endoscopic local excision were more recent year of diagnosis, increasing age, female sex, tumor located in the cardia, smaller size, low-grade, absence of lymphovascular invasion, and treatment at an academic facility.

The use of endoscopic local excision for gastric cancer has nearly doubled since 2010. However, most patients do not satisfy consensus criteria for endoscopic therapy.

The use of endoscopic local excision for gastric cancer has nearly doubled since 2010. However, most patients do not satisfy consensus criteria for endoscopic therapy.Predictive clinical factors associated with favorable responses to BNT162b2 mRNA vaccine against SARS-CoV-2 have been reported in some studies; however, there is a subgroup with low antibodytiters without well-known clinical factors reducing antibody responses. To clarify the immunological backgrounds that underlie the difference in antibody responses, we analyzed peripheral blood mononuclear cells (PBMCs) of each 20 individuals with a high anti-SARS-CoV-2 antibody titer and a low antibody titer out of 1774 healthcare workers who received BNT162b2 mRNA vaccine. A higher percentage of B cells before vaccination was associated with a higher antibody titer. Among B cells, naïve and transitional B cell frequencies were positively correlated with a higher antibody titer, whereas the frequencies of late memory B cells and plasmablasts were associated with a lower antibody titer. Fold change in the frequency of activated CD8+ T cells upon vaccination was also correlated with high antibody titers.

During liver transplantation (LT), patients and surgical factors potentially influence the pharmacokinetics of the anesthetic agents. The aim of this study was to investigate the requirement of isoflurane and remifentanil according to severity of liver disease during LT under balanced anesthesia.

We enrolled 44 patients undergoing LT. Anesthetic depth was maintained within the bispectral index score of 40 to 60 and Surgical Pleth Index of 20 to 60. Patients were divided into 2 groups according to their median Model for End-Stage Liver Disease (MELD) score low MELD group and high MELD group. We compared end-tidal inhaled anesthetics and remifentanil consumption.

Patients were divided into 2 groups according to median value of MELD score MELD score <16 (low MELD group; n=20) or MELD ≥16 (high MELD group; n=20). There was no significant difference between the 2 groups in end-tidal concentration of isoflurane during 3 phases. However, the remifentanil requirement was lower in the high MELD group during the dissection and anhepatic phases (mean (SD), 0.105 (0.067) vs 0.064 (0.055) µg/kg/min; P=.037, and 0.167 (0.096) vs 0.108 (0.079) µg/kg/min; P=.039, respectively; low MELD group vs high MELD group) with no significant difference during the neohepatic phase.

The severity of liver dysfunction based on MELD score affected the intraoperative remifentanil requirement during LT. Patients with cirrhosis are required to use analgesics appropriate to their individual patient characteristics in clinical practice.

The severity of liver dysfunction based on MELD score affected the intraoperative remifentanil requirement during LT. Patients with cirrhosis are required to use analgesics appropriate to their individual patient characteristics in clinical practice.Hereditary gelsolin amyloidosis (HGA) is an autosomal dominant systemic amyloidosis, characterized by cranial and sensory peripheral neuropathy, corneal lattice dystrophy, and cutis laxa. We report a case of HGA presenting with bilateral facial palsy. A 70-year-old Japanese man presented with slowly progressive bilateral facial palsy and facial twitching, which had started in his 40s. His mother also had the same symptoms due to an unknown cause but rest of the family did not. He showed incomplete facial palsy with no frontal muscle movement and partial movement of the orbicularis oris and orbicularis oculi muscles. The patient showed no synkinesis. Electroneurography revealed symmetric low compound motor action potential amplitude of the orbicularis oris muscle, and a nerve excitability test showed a symmetric increase in the response threshold. Despite the partial voluntary movement of the orbicularis oculi muscle, bilateral blink reflexes were absent. He also showed facial spasms after contraction of the orbicularis oris muscle. Genetic testing revealed a heterozygous c.640G>A mutation (p. Asp214Asn); therefore, the patient was diagnosed with HGA. HGA related facial palsy showed moderate bilateral, upper blanch-dominant axonal degeneration of the facial nerve without reinnervation, and trigeminal nerve neuropathy.Superior mesenteric artery (SMA) syndrome is a potentially fatal condition that can be difficult to diagnose for emergency medicine physicians due to its rarity and vague gastrointestinal symptom presentation. Patients arriving at the emergency department (ED) with this condition may encounter delays in proper supportive care and treatment. We present the case of a 21-year-old female who was seen in the ED for nausea, non-bloody vomiting, and rapid weight loss. Through point-of-care ultrasound (POCUS) findings, she was diagnosed with SMA syndrome and received appropriate, supportive care for her condition before catastrophic complications could occur. This case demonstrates the utility of POCUS in SMA syndrome and the importance of considering this diagnosis despite its rarity.

Despite current treatment modalities, frostbite remains an injury with a poor prognosis which may cause functional morbidities. Several experimental and clinical studies have demonstrated that stromal vascular fraction is an autologous mixture, which can improve wound healing and vasculogenesis. The aim of this study was to show the beneficial effects of stromal vascular fraction on experimental frostbite healing.

Stromal vascular fraction (SVF) was harvested from 5 rats after excision of the inguinal fat pads. Another 20 rats were separated into 2 groups of 10 as the SVF group and the control group. A frostbite injury was created on each rat using a cryoprobe frozen with liquid nitrogen (-196°C). SVF was applied to the SVF group and phosphate-buffered saline to the control group. All injections were performed subcutaneously within the frostbite injury area. Biopsies were performed on days 5 and 14 for histopathological and immunochemical evaluations. The tissue perfusion rates of both groups were assessed on day 14 using indocyanine green angiography (SPY system).