Mid-esophageal diverticulum mimicking an aortic aneurysm on chest radiography

BACKGROUND: Mid-esophageal region is an uncommon location of esophageal diverticula, a condition usually diagnosed in elderly individuals. CASE REPORT: We report a case of an elderly male with incidental finding of mediastinal lesion, which was initially thought to be an aortic aneurysm. Further evaluation demonstrated a mid-esophageal diverticulum at the level of the carina. We present patient's medical history and imaging, followed by a discussion on symptoms and management. CONCLUSIONS: Knowledge of benign conditions that might mimic a mediastinal vascular pathology is important for therapeutic and prognostic reasons, as they are often managed conservatively

Maternal, pregnancy and fetal outcomes in de novo anti-glomerular basement membrane antibody disease in pregnancy: A systematic review

Background Outside of pregnancy, anti-glomerular basement membrane (GBM) antibody disease is associated with significant morbidity and mortality. However, there is limited knowledge regarding de novo anti-GBM disease in pregnancy. Methods A systematic review was performed to identify maternal, pregnancy and fetal outcomes in de novo anti-GBM disease in pregnancy. Studies were selected from PubMed, EMBASE, Cochrane Library databases and conference proceedings, without language restriction. Results Data from eight patients were derived from seven case reports and one unpublished case. Most (6/8) patients presented after the first trimester. During pregnancy, acute kidney injury (5/8), anemia (5/8), hematuria (8/8) and proteinuria (8/8) were common. When hemodialysis was required antepartum (5/8), renal function recovery to independence of renal replacement was unlikely (2/5). While pulmonary involvement was common (5/8), no permanent damage was reported (0/8). The majority of cases ended in live births (6/8) although prematurity (6/6), intrauterine growth restriction (2/6), small for gestational age (4/6) and complications of prematurity (1/6) were common. When anti-GBM levels were tested in the living newborn, they were detectable (2/5), but no newborn renal or lung disease was reported (0/6). Complications in pregnancy included gestational diabetes (3/8), hyperemesis gravidarum (2/8) and preeclampsia (2/8). Conclusions Live births can be achieved in de novo anti-GBM disease in pregnancy, but are commonly associated with adverse maternal, pregnancy and fetal outcomes. Only with awareness of common presentations, and management strategies can outcomes be optimized

Safety, feasibility, tolerability, and clinical effects of repeated psilocybin dosing combined with non-directive support in the treatment of obsessive-compulsive disorder: protocol for a randomized, waitlist-controlled trial with blinded ratings

BackgroundTo date, few randomized controlled trials of psilocybin with non-directive support exist for obsessive-compulsive disorder (OCD). Results and participant feedback from an interim analysis of an ongoing single-dose trial (NCT03356483) converged on the possibility of administering a higher fixed dose and/or more doses of psilocybin in future trials for presumably greater benefits.ObjectivesThis trial aims to evaluate the safety, feasibility, tolerability, and clinical effects of two doses of psilocybin paired with non-directive support in the treatment of OCD. This trial also seeks to examine whether two doses of psilocybin lead to greater OCD symptom reduction than a single dose, and to elucidate psychological mechanisms underlying the effects of psilocybin on OCD.DesignA randomized (1:1), waitlist-controlled design with blinded ratings will be used to examine the effects of two doses of oral psilocybin paired with non-directive support vs. waitlist control on OCD symptoms. An adaptive dose selection strategy will be implemented (i.e., first dose: 25 mg; second dose: 25 or 30 mg).Methods and analysisThis single-site trial will enroll 30 adult participants with treatment-refractory OCD. Aside from safety, feasibility, and tolerability metrics, primary outcomes include OCD symptoms assessed on the Yale-Brown Obsessive-Compulsive Scale – Second Edition (Y-BOCS-II). A blinded independent rater will assess primary outcomes at baseline and the primary endpoint at the end of the second dosing week. Participants will be followed up to 12 months post-second dosing. Participants randomized to waitlist will be rescreened after 7 weeks post-randomization, and begin their delayed treatment phase thereafter if still eligible.EthicsWritten informed consent will be obtained from participants. The institutional review board has approved this trial (protocol v. 1.7; HIC #2000032623).DiscussionThis study seeks to advance our ability to treat refractory OCD, and catalyze future research seeking to optimize the process of psilocybin treatment for OCD through understanding relevant psychological mechanisms.Clinical trial registration: ClinicalTrials.gov, identifier NCT05370911

Assessment of variations in sphenoid sinus pneumatization in Indian population: A multidetector computed tomography study

Background and Purpose: The purpose of our study was to assess the prevalence of variations in the extent of sphenoid pneumatization in the Indian population and compare with existing literature. Materials and Methods: This retrospective study included 500 patients who underwent CT of the paranasal sinuses. The multiplanar reformations of paranasal sinus were assessed for the type of pneumatization of the sphenoid sinus and type of clival, lateral recess, lesser wing, and anterior recess extensions. Results: The conchal, presellar, incomplete sellar, and complete sellar types comprised 0%, 1.2%, 22.2%, and 76.6% of patients. The extensions of pneumatization subtypes in the study population were clival in 76.6% subjects; lateral recess, lesser wing, and anterior recess in 59.7%, 20.4%, and 20.4% of sinuses, respectively. The pure forms were seen in 25.4% and combined forms in 61% of sinuses. The presellar type (1.2%) was less common and sellar type (98.8%) being common in our population compared to the Caucasian and East Asian population. The sphenoid sinuses were extensively pneumatized in our population compared to the Chinese and Caucasian population, the prevalence being 76.6%, 68%, and 44.5% for clival; 59.7%, 46%, and 28.3% for lateral recess; 20.4%, 32%, and 12% for lesser wing extension, respectively. The pure forms were relatively less common and combined forms being more common compared to the Chinese and Caucasian population in our study. Conclusion: The extent of pneumatization of the sphenoid sinus has clinical and surgical implications in sellar and central skull base lesions, and variability in different populations confirms that ethnicity influences the differences in prevalence

Thetaburst TMS to the posterior superior temporal sulcus decreases resting-state fMRI connectivity across the face processing network

Humans process faces using a network of face-selective regions distributed across the brain. Neuropsychological patient studies demonstrate that focal damage to nodes in this network can impair face recognition, but such patients are rare. We approximated the effects of damage to the face network in neurologically normal human participants using thetaburst transcranial magnetic stimulation (TBS). Multi-echo functional magnetic resonance imaging (fMRI) resting-state data were collected pre and post TBS delivery over the face-selective right superior temporal sulcus (rpSTS), or a control site in the right motor cortex. Results showed that TBS delivered over the rpSTS reduced resting-state connectivity across the extended face-processing network. This connectivity reduction was observed not only between the rpSTS and other face-selective areas, but also between non-stimulated face-selective areas across the ventral, medial and lateral brain surfaces (e.g. between the right amygdala and bilateral fusiform face areas and occipital face areas). TBS delivered over the motor cortex did not produce significant changes in resting-state connectivity across the face-processing network. These results demonstrate that, even without task-induced fMRI signal changes, disrupting a single node in a brain network can decrease the functional connectivity between nodes in that network that have not been directly stimulated

FIGURE 2 in LepNet: The Lepidoptera of North America Network

FIGURE 2. Existing (black) and expected (blue, yellow, and green) number of records to be produced by LepNet for the 3 major groups and 15 families of Lepidoptera that are most common in the collections of the partner institutions. Existing records were obtained from the SCAN and iDigBio data portals

FIGURE 1 in LepNet: The Lepidoptera of North America Network

FIGURE 1. Geographic distribution of the 27 partner institutions in LepNet and their digitization targets for specimen label data (blue) and specimen images (red)

LepNet: The Lepidoptera of North America Network

The Lepidoptera of North America Network, or LepNet, is a digitization effort recently launched to mobilize biodiversity data from 3 million specimens of butterflies and moths in United States natural history collections (http:// www. lepnet. org/). LepNet was initially conceived as a North American effort but the project seeks collaborations with museums and other organizations worldwide. The overall goal is to transform Lepidoptera specimen data into readily available digital formats to foster global research in taxonomy, ecology and evolutionary biology