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Out of the Blue: A Case of Acute Limb Ischemia in a Healthy Young Woman
Full text linkAcute limb ischemia (ALI) is a critical condition caused by arterial occlusion, often due to thrombotic or embolic events in atherosclerotic vessels. Early diagnosis and intervention are essential to prevent limb loss and complications. While typically seen in patients with known vascular risk factors, ALI can also affect individuals without them.
We present a case of a 49-year-old female with sudden-onset left foot pain and paresthesia, highlighting the importance of recognizing ALI in seemingly healthy patients. Despite the absence of typical risk factors, imaging revealed significant atherosclerosis and arterial occlusion, leading to the diagnosis of ALI. This case emphasizes the need for rapid identification and intervention, even in patients without common risk factors, to prevent long-term complications
Case Report: Hyperkalemia Secondary to Acute Respiratory Acidosis
Full text linkHyperkalemia is a potentially life-threatening electrolyte disturbance, commonly associated with renal dysfunction, medication effects, and acid-base imbalances. While metabolic acidosis is a well-known cause of transcellular potassium shifts, respiratory acidosis is a less recognized but significant contributor. This case report presents a 74-year-old female with hyperkalemia in the setting of acute respiratory acidosis secondary to impaired ventilation from rib fractures. This case highlights the importance of recognizing respiratory acidosis as a potential cause of hyperkalemia and tailoring management to address the underlying issu
Acetylcholine Release in the Dorsal Lateral Straitum During Social Approach Task
Full text linkNicotine Decreases ACh Release in the DS leading to a Serenic Effect during Social Approach Task
Acetylcholine (ACh) regulates attention, learning, and stress responses (Benarroch E. E., 2012). The dorsal striatum (DS), essential for stimulus-response learning, is also linked to anxiety and compulsivity (Casado-Sainz et al., 2021). We used behavioral pharmacology and in vivo fiber photometry to study ACh responses during social approach tasks in the dorsal striatum. Male and female C57BL/6J mice underwent stereotaxic surgeries to inject a fluorescent ACh sensor (ACh.Sn.Fr) and implant fiber optic cannulas in the DS. Using in vivo fiber photometry, we tracked ACh release during the Three Chamber paradigm, where mice explored a novel conspecific vs. a cage mate. Tests included both same-sex and opposite-sex novel mice. We also measured ACh release after systemic nicotine or saline injections and repeated the Three Chamber Test post-administration. Data was analyzed using custom MATLAB scripts, and behavior was assessed manually or via DeepLabCut for time spent near novel vs. cage mate mice. Our results showed that mice spent more time exploring opposite-sex novel mice than same-sex novel mice. We found that DS ACh increased significantly during the exploration of same-sex novel mice compared to the exploration of opposite-sex mice. Second, our results demonstrated that systemic nicotine injections significantly decreased ACh in the DS compared to saline injections. Finally, we found that systemic nicotine injections vs saline increased the time spent with novel same-sex mice only. We did not find a significant change in time spent with opposite-sex novel mice following nicotine or saline injections. Overall, these results suggest that ACh release in the dorsolateral striatum signals social threat/novelty and Nicotine administration can have a serenic effect
Case Report: A Severe Case of Post-Operative Ogilvie Syndrome Requiring Surgical Intervention
Full text linkOgilvie Syndrome is an acute colonic pseudo-obstruction described as a paralysis of the colon with no real mechanical obstruction. This condition is oftentimes a benign post-surgical complication but can progress in severity if not treated appropriately. This case report presents a unique clinical case in which an adult female patient developed a severe case of Ogilvie syndrome postoperatively requiring surgical intervention
Is Acupuncture at the Auricular Shenmen Point Effective in Treating Anxiety?
Full text linkAnxiety disorders are the most prevalent mental health condition in the United States and are often managed with pharmacological interventions, which can lead to adverse side effects. As a result, alternative therapies such as acupuncture are gaining attention. This study investigates the effectiveness of auricular acupuncture, specifically targeting the Shenmen point, in reducing symptoms of anxiety. We analyzed ten randomized controlled trials that included quantitative outcome measures. The results suggest that auricular acupuncture at the Shenmen point is an effective and well-tolerated adjunctive treatment for anxiety. While further research with larger sample sizes and extended follow-up periods is warranted, these findings support the growing body of evidence advocating for the integration of acupuncture as an adjunct therapy in anxiety treatment strategies
A Ticking Time Bomb: An Overview of a Case Report of Neutropenic Fever Secondary to Tick-Borne Illness
Full text linkThe advent of immunomodulatory therapies and their ever-expanding number of treatment indications necessitates the understanding of their associated complications. Neutropenic fever serves as an example of these complications often encountered in clinical practice. Although neutropenic fever can result from virtually any pathogen, episodes of the syndrome secondary to tick-borne illness remain relatively undocumented in the scientific literature. In the case presented, a 77-year-old female with a pertinent past medical history of smoldering IgG multiple myeloma on active immunosuppressive therapy presented with a first-time episode of neutropenic fever likely secondary to tick-borne illness. Through this overview of a broader report, attention is drawn to an additional source pathogen for neutropenic fever and its management, thus expanding upon clinician understanding of this all-too-common complication of immunosuppression
Dabigatran Reduced Acute Microgliosis in a Mouse Model with TBI
Full text linkObjective:
The study objective was to investigate the acute anti-inflammatory effects of dabigatran in a preclinical mouse controlled cortical impact (CCI) model of severe traumatic brain injury (TBI).
Design
Mice were separated into three groups: controlled cortical impact (CCI) with dabigatran (drug treatment, n=5), CCI with saline (positive control, n=5), and sham CCI without saline or dabigatran (negative control, n=3). Dabigatran (80mg/kg) or saline was administered orally at 2, 10, 18, 26, 34, and 42 hours following experimental CCI in the drug treatment or positive control groups, respectively. Animals in the negative control group received sham CCI only. 48h following CCI or sham CCI, mice were euthanized via transcardial perfusion. Brains were processed for immunohistochemistry (IHC) assessment. IHC was performed for both IBA-1 and IgG. Immunoreactivity was quantified using a Leica Aperio ScanScope and Leica’s image analysis color deconvolution tool. Percent Total Positive (PTP) immunoreactivity was calculated and used for analysis.
Results
We observed a statistically significant difference in IBA-1 microglial immunoreactivity amongst the three experimental groups (p=0.006), with an increase in IBA-1 immunoreactivity in the positive control group compared to the negative control group (p=0.008) and a decrease in IBA-1 immunoreactivity in the drug treatment group compared to the positive control group (p=0.019). There was no observed difference in IBA-1 immunoreactivity between the drug treatment and negative control groups (p=0.623).
We observed a statistically significant difference in intraparenchymal IgG immunoreactivity amongst the three experimental groups (p=0.001), with an increase in IgG immunoreactivity in both the positive control group and the drug treatment group compared to the negative control group (p=0.004 and p=0.001, respectively). There was no observed difference in IgG immunoreactivity between the drug treatment and positive treatment groups (p=0.426).
Conclusion
Our results suggest that dabigatran reduces brain intraparenchymal microgliosis without significantly increasing BBB pathology in a preclinical model of severe TBI
Musculoskeletal Changes in Pregnancy: Implications for Long-Term Bone & Joint Health
Full text linkPregnancy and lactation represent significant physiological challenges to maternal skeletal health, with substantial implications for both short and long-term musculoskeletal integrity. Research emphasizes that lactation induces notable skeletal adaptations, with up to 10% bone mineral density loss occurring in trabecular-rich regions such as the spine and hip (1,5). While most women experience substantial recovery post-weaning, the research indicates that recovery patterns vary significantly, with some women experiencing incomplete restoration of bone mass, potentially compromising long-term skeletal strength (3).
The underlying mechanisms driving these changes are primarily hormonal, with elevated parathyroid hormone-related protein (PTHrP) and decreased estrogen levels during lactation facilitating bone resorption and contributing to joint instability (3,6). Advanced imaging studies have revealed that women with pregnancy and lactation-associated osteoporosis (PLO) exhibit significantly degraded bone microarchitecture directly correlating with increased fracture susceptibility (7). Through animal model research, it is determined that reproductive history may have lasting effects on joint durability through alterations in the tendon-to-bone interface and proximal humerus morphology (2).
Identifying risk factors associated with greater bone loss and delayed recovery, such as low BMI, vitamin D deficiency, prolonged breastfeeding duration, and genetic predisposition, provides valuable clinical markers for identifying women at heightened risk. Many women report fractures or significant musculoskeletal pain in the postpartum period before receiving an appropriate diagnosis and intervention (8). This highlights a critical gap in current maternal healthcare protocols and emphasizes the need for improved postnatal bone health screening, especially for women with multiple risk factors.
Future Directions
These findings demonstrate a need for clinical guidelines for monitoring and supporting maternal bone health throughout pregnancy, lactation, and the postpartum recovery period. Healthcare providers should consider reproductive history as a potential risk factor for musculoskeletal conditions later in life, particularly for women who experienced complications or delayed recovery. Implementation of targeted screening protocols, provider-patient education, and weight-bearing exercise recommendations, may help mitigate adverse skeletal outcomes associated with reproduction and lactation (4,6,8).
The long-term implications of reproductive-associated bone changes deserve further investigation, particularly regarding the potential cumulative effects of multiple pregnancies and extended lactation periods on lifetime fracture risk and joint stability. Additionally, research into genetic and molecular factors influencing individual recovery patterns could lead to more personalized approaches to maternal bone health management during this vulnerable period
Changes in Matches into Surgical Residencies and Fellowships Following the ACGME Merger.
Full text linkOBJECTIVE: In 2015, a transition was initiated among the Accreditation Council for Graduate Medical Education (ACGME), American Osteopathic Association (AOA), and American Association of Colleges of Osteopathic Medicine (AACOM), resulting in a single accrediting body for residencies and fellowships as of 2020. This study aims to elucidate whether this had an impact on osteopathic students\u27 matching into general surgery residencies, integrated surgery residencies, and surgical fellowships.
DESIGN, SETTING, AND PARTICIPANTS: Using the Results and Data Residency Match data file and the Results and Data: Specialties Matching Service data from the National Resident Matching Program from 2015 to 2024, data was extracted regarding osteopathic and allopathic match rates into general surgery residency and surgical fellowships, respectively. Applicants were grouped on matching in 2015-2019 (premerger) or 2020-2024 (postmerger). Statistical analysis using the Chi-Square test was performed to determine if there was a significant difference in the mean number of matches in the pre and postmerger groups (p \u3c 0.05).
RESULTS: Postmerger, the proportion of osteopathic students matching into general surgery residency increased significantly (DO, 5.77% vs 14.25%, p = 0.032). However, the proportion of osteopathic students who matched into integrated residencies, such as thoracic, plastic, and thoracic surgery, did not increase (p \u3e 0.05). For surgical fellowships, there was no significant increase in the proportion of osteopathic students matching (DO, 6.36% vs 9.59%, p = 0.389). Independently, an increase was seen in osteopathic matches across fellowships; however, it was only significant for vascular (8.16% vs 14.17%, p = 0.013) and hand surgery (3.79% vs 5.86%, p = 0.019).
CONCLUSIONS: Postmerger, there was an increase in osteopathic students and physicians filling general surgery residency, vascular, and hand surgery fellowship positions. However, the proportion of osteopathic students who matched into integrated surgery residencies remained the same
Cryptology with Bitcoin and Blockchain Applications
Full text linkThis book is intended to be used for a first course in cryptography for computer science students. It assumes that the student has had at least one programming course and a discrete structures or discrete math course. This book places an emphasis on algorithms and the internals of cryptographic systems.
The book begins with some classical cryptographic algorithms used for confidentiality. Then it exposes modern cryptographic algorithms for confidentiality, integrity, and authenticity. Both private key (symmetric) and public key (asymmetric) algorithms are covered. This book also describes the workings of the most common cryptocurrency, Bitcoin, as well as blockchain technology.
Most sections conclude with a list of exercises (solutions are available to instructors who have adopted this text in a course). Some exercises refer to a repository of data and/or computer software. This repository can be found at: http://cs.rowan.edu/~bergmann/books/cryptology
Chapter 4 consists of several topics from elementary discrete mathematics which are necessary to understand cryptographic algorithms. The more advanced reader may skip this chapter and refer to it as needed. Each subsequent chapter which requires an understanding of these topics will list the relevant sections at the beginning of the chapter.
This book is an open source book. This means that not only is the pdf version available (to potential students and teachers) for free download, but that the original (LaTeX) source files are also available (to potential authors and contributors). Based on the model of open source software, open source for textbooks is a relatively new paradigm in which many authors and contributors can cooperate to produce a high quality product, for no compensation. For details on the rationale of this new paradigm, and citations for other open source textbooks, see the journal Publishing Research Quarterly, Vol. 30, No. 1, March 2014. The source materials and pdf files of this book are licensed with the Creative Commons NonCommercial license, which means that they may be freely used, copied, or modified, but not for financial gain.
This book is available at rdw.rowan.edu (search for Bergmann). The source files for this book are available at cs.rowan.edu/∼bergmann/bookshttps://rdw.rowan.edu/textbooks/1000/thumbnail.jp