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Button Battery Ingestion: Exploring Socioeconomic Risk Factors
Get PDFObjective: Examine the demographic and social determinants of health linked to pediatric esophageal foreign body removals, with an emphasis on button battery ingestions.
Study design: A retrospective chart review was performed on pediatric patients who underwent operative removal of a foreign body from the esophagus (Current Procedural Terminologies [CPTs] 43215, 43194).
Setting: The study was conducted across four hospitals from November 2010 to December 2023.
Methods: Data on patient demographics and social determinants of health were analyzed. Exclusions included nonaccidental ingestions, patients older than 18 years, and cases with missing social determinants of health data. The Agency for Healthcare Research and Quality (AHRQ) database was used to link patient data to socioeconomic indicators.
Results: Of 825 cases, 50 were button battery ingestions. Age was comparable between button battery and nonbutton battery patients. Button battery patients were predominantly male. Socioeconomic analysis revealed that button battery patients were from households with higher median incomes, lower poverty rates, higher home values, and greater internet access. The incidence of button battery ingestion increased over the study period.
Conclusion: This study highlights significant demographic and socioeconomic differences in pediatric foreign body ingestions compared to button battery ingestions. Male gender and higher socioeconomic status were notable risk factors for button battery ingestion. These findings support the need for educational and preventive strategies to address the risks associated with button battery ingestion
Letter to the Editor Regarding: “Awake Surgery for Isolated Parenchymal Degenerating Neurocysticercosis - Case report and Focused Review of Misdiagnosis of Neurocysticercosis”
No full textEpidemiology of Lower Extremity Amputations in the United States: An Analysis of the Global Burden of Disease Database From 1990 to 2019
No full textBackground: Lower extremity amputations (LEAs) are medically, psychologically, and functionally devastating. The objective of our study was to evaluate region- and sex-specific differences of unilateral and bilateral LEAs across the United States (US) from 1990 to 2019.
Methods: The Global Burden of Disease database was used to analyze years lived with disability (YLDs), prevalence, and incidence rates per 100,000 people for LEAs in the US from 1990 to 2019. Data were stratified into four US Census Bureau-defined regions: Northeast, Midwest, South, and West. Differences between regions and sexes were assessed, with statistical significance defined as p \u3c 0.05.
Results: From 1990 to 2019, the US experienced an overall decrease in YLDs (33.07%), incidence (22.11%), and prevalence (29.93%) of bilateral LEAs. Unilateral LEAs saw a decrease in YLDs (21.43%) and prevalence (15.61%), but an increase in incidence (9.05%). Men surpassed women in YLDs, incidence, and prevalence of unilateral and bilateral LEAs in all regions. The West had the highest incidence and prevalence of both bilateral and unilateral LEAs from 1990 to 2019. By 2019, the South had the lowest incidence, and the Northeast had the lowest YLDs and prevalence of bilateral and unilateral LEAs.
Conclusions: From 1990 to 2019, the US experienced decreases in YLDs, prevalence, and incidence of unilateral and bilateral LEAs, except for an increased incidence of unilateral LEAs. Men experienced higher rates than women across each region. The West generally had the highest overall rates. These trends highlight sex-specific and regional disparities of LEAs
Role of Peripheral Nerve Blocks for Management of Chronic Pain From Inoperable Neurofibromatosis Type 1-Associated Neurofibromas: A Case Report
No full textBackground: Neurofibromatosis (NF) is a genetic condition resulting in tumor formation around neural structures, including peripheral nerves, spinal cord, and brain. Patients afflicted with NF can develop a constellation of symptoms ranging from cutaneous findings to sensory deficits and pain. When pain occurs, it could be associated with compression of neural structures or development of neuropathy itself.
Case report: A 60-year-old woman with a history of NF Type 1 (NF1) presented to our clinic for evaluation of left arm pain. Despite several neuropathic medications and surgical procedures, she continues to have neuropathic arm pain associated with neurofibromas in her brachial plexus. Further surgery was advised against by her surgeons, and she underwent a supraclavicular nerve block with us, with sustained relief of her pain.
Conclusions: Here, we present a patient diagnosed with NF1 and neuropathic pain due to an inoperable brachial plexus neurofibroma burden in the left axilla, successfully managed by supraclavicular nerve blocks
Involvement of a Tick-borne Orthomyxovirus Matrix Protein in vRNP Nuclear Export
No full textThogotoviruses are arthropod-borne viruses belonging to the genus Thogotovirus within the family Orthomyxoviridae. Like other orthomyxoviruses, such as the influenza A viruses (IAV), thogotoviruses replicate in the nucleus. As a result, progeny viral ribonucleoprotein complexes (vRNPs) must be exported to the cytoplasm prior to virion assembly and budding at the plasma membrane. In IAV, this export depends on binding of the viral nuclear export protein (NEP) to the cellular exportin chromosomal maintenance 1 (CRM1). In contrast, the mechanism of vRNP nuclear export, including identification of a protein with NEP functionality, has not been characterized for any thogotoviruses. Here, we characterized vRNP nuclear export in Dhori virus (DHOV), a prototypic member of the Thogotovirus genus. DHOV replication and nuclear export of the viral nucleoprotein were inhibited by the canonical CRM1 inhibitor leptomycin B (LMB), suggesting that DHOV vRNP export also utilizes CRM1. Interestingly, LMB treatment led to nuclear retention of the DHOV matrix (M) protein in both infected and transfected cells. Using a mammalian two-hybrid system, we found that DHOV M interacts with CRM1 through a nuclear export sequence (NES) located between amino acids 111 and 128. Mutation of hydrophobic residues within this NES reduced M-CRM1 interaction, abolished the NES phenotype when fused to a fluorescent protein, and impaired rescue of recombinant DHOV by reverse genetics. Together, our results reveal that DHOV vRNP nuclear export is CRM1-dependent and mediated by the M protein rather than a dedicated NEP-like protein, providing the first mechanistic insight into vRNP egress in the genus Thogotovirus.
Importance: Dhori virus (DHOV) is a pathogenic tick-borne virus in the genus Thogotovirus, in the family Orthomyxoviridae. Despite evidence of DHOV exposure in various mammals, including humans, its basic biology is not well understood. We investigated how DHOV\u27s progeny genome and protein complexes-viral ribonucleoprotein complexes (vRNPs)-are transported out of the nucleus. Our findings show that DHOV, like the influenza viruses, uses the cellular protein chromosomal maintenance protein 1 (CRM1) for vRNP export. We found that chemically inhibiting CRM1 completely blocked DHOV vRNP export, preventing the production of progeny viruses from infected cells. Screening of all known DHOV proteins revealed that the matrix protein, which forms the virus\u27 scaffold, interacted with CRM1, suggesting it may link CRM1 to the vRNPs. These results advance our understanding of DHOV replication and suggest that chemically inhibiting vRNP export could be a way to treat thogotovirus infections
Worth the Risk? Standardized Screening to Identify Substance Use Among Patients Before Surgery
No full textObjective:
We sought to compare the identification of unhealthy substance use before surgery using Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS), a standardized 4-item instrument, versus routine clinical documentation in the electronic medical record (EHR).
Background:
Over 20% of individuals exhibit unhealthy substance use before elective surgery. Routine EHR documentation is often based on nonstandard questions that may not fully capture the extent of substance use and are subject to bias. In contrast, brief standardized screening could provide a more efficient and systematic approach.
Methods:
We conducted a cross-sectional study among adults (≥18 y) at a preoperative clinic from August to September 2021. Positive screens for unhealthy substances by TAPS were compared with data from the EHR. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were reported. Receiver operating characteristic curves were used to assess diagnostic ability. Multivariable logistic regression was used to estimate the predictors of positive screens by TAPS.
Results:
The cohort included 240 surgical patients. TAPS screening identified significantly more positive screens than EHR documentation (43.3% vs. 14.2%). Patients with unhealthy substance use were younger (50.8 vs. 56.7 y; P=0.003), and TAPS revealed alcohol misuse in 30.8% of cases, contrasting with 0% in clinician documentation (P\u3c0.001). Of the 104 TAPS-positive patients, 69.2% were missed by EHR documentation. Sensitivity (31%) and accuracy (AUC=0.65) of clinician documentation for any unhealthy substance use were lower compared with TAPS.
Conclusions:
Standardized TAPS screening detected preoperative unhealthy substance use more frequently than routine clinician documentation, emphasizing the need for integrating standardized measures into surgical practice to ensure safer perioperative care and outcomes
CRISPR Disruption of scaRNA1 Reduces Pseudouridylation in Spliceosomal RNA U2 at U89 and Perturbs the Transcriptome in HEK293T Cells
No full textSmall Cajal body-associated RNAs (scaRNAs) are essential for biochemical modification of spliceosomal RNAs and spliceosome function. Changes in scaRNA expression level have been associated with developmental issues, including cancer and congenital heart defects (CHDs), although the mechanism remains unclear. Small Cajal body-associated RNA 1 (scaRNA1) guides pseudouridylation at uridine 89 (Ψ89) of the spliceosomal RNA U2, a highly conserved modification that may be critical for spliceosome function. To investigate the role of scaRNA1 in splicing regulation, CRISPR-Cas9 genome editing was used to introduce targeted deletions in the scaRNA1 locus in HEK293T cells. Edited clones were identified by T7 endonuclease I assay and confirmed by Sanger sequencing. Pseudouridylation at Ψ89 was quantified using CMC-based reverse transcription followed by quantitative PCR, and global mRNA splicing alterations were assessed by RNA sequencing. Clones harboring scaRNA1 disruptions exhibited a significant reduction in Ψ89 pseudouridylation, consistent with impaired scaRNA1 function. Transcriptome analysis (of mRNA from two clones) revealed \u3e300 protein coding genes with significant changes in transcript isoform level, including \u3e100 genes related to RNA-binding activity. These results indicate that scaRNA1 disruption alters spliceosomal function and leads to substantial changes in mRNA splicing. The dysregulated splicing of RNA-binding proteins may impair RNA processing and gene expression programs required for normal development, providing new insight into how noncoding RNA dysfunction may contribute to developmental pathogenesis
Atypical Spindle Cell Lipomatous Tumor: A Scoping Review of Current Insights Into Diagnosis, Pathogenesis, and Management
No full textAtypical spindle cell/pleomorphic lipomatous tumor (ASPLT) is a recently recognized benign adipocytic neoplasm, distinguished by specific histopathological and immunohistochemical features. Although traditionally classified as a tumor of the limbs and limb girdles, emerging evidence suggests a broader anatomic distribution. A systematic review of the literature was conducted using PubMed to identify ASPLT case reports published within the past decade. Cases were included if they had a confirmed ASPLT diagnosis, while reports describing unrelated neoplasms or limited by language barriers were excluded. Thirteen cases met the inclusion criteria. Data on patient demographics, tumor characteristics, immunohistochemical profiles, and diagnostic methodologies were extracted and analyzed.
CD34 expression was observed in 90% of cases, while desmin staining was inconsistently reported and lacked clear diagnostic value. Notably, 69% of cases omitted testing for Rb protein loss, a key marker in ASPLT classification. Unexpected MDM2 positivity was identified in 44% of tested cases, with one demonstrating gene amplification, suggesting potential overlap with atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDL). Additionally, ASPLT occurred more frequently in axial locations than previously recognized, with eight cases located in the head, neck, and thoraco-lumbar regions. These findings emphasize the need for standardized diagnostic protocols, including routine Rb evaluation and MDM2 analysis, to ensure accurate classification. Future studies should explore the significance of MDM2 expression in ASPLT and reassess its anatomic predilection to refine diagnostic criteria and clinical management strategies
Suprascapular Nerve Anatomy and its Implication for Approaches to Peripheral Nerve Stimulation of its Sensory Branching: A Morphometric Cadaveric Study
No full textBackground: The suprascapular notch (SNo) is used to guide lead placement during peripheral nerve stimulation (PNS) of the suprascapular nerve (SNe) for refractory shoulder pain. Understanding branching patterns of the SNe can help determine the most effective site for lead placement to improve coverage and effective stimulation.
Methods: Ninety-three formalin-embalmed cadaveric shoulders were dissected and a morphometric analysis was conducted. The course and initial branch point of the SNe relative to the superior transverse scapular ligament (STSL) at the SNo were described. The width and depth of the SNo, and the diameter of the SNe within the SNo, were measured. Comparisons were performed between donor sex, laterality, and age.
Results: The SNe branched proximal to the SNo in 15% of shoulders, directly at the SNo in 54%, and distal to the SNo in 31%. The SNe occupied the medial third of the SNo in 15%, middle third in 59%, and lateral third in 26%. The SNe branched a mean of 1.5 mm from the SNo. The mean depth of the SNo was 5.8 mm and the mean width was 7.8 mm. The mean diameter of the SNe was significantly greater in males (2.6 mm) than females (2.2 mm) (P \u3c 0.001).
Conclusions: The main branching of the SNe tends to occur proximal to, or directly under, the STSL and in the middle third of the SNo. This knowledge can help guide clinicians when placing PNS leads under fluoroscopic or ultrasound guidance to achieve maximum stimulatory coverage
