Primary pulmonary T-cell lymphoma mimicking asthma and community-acquired pneumonia: a rare case report

Primary pulmonary T-cell lymphoma (PPTL) is a rare disease. Diagnosing PPTL is challenging due to non-specific clinical symptoms and imaging. A 32-year-old female presented with persistent fever, cough, and dyspnoea. The symptoms were initially treated as asthma and community-acquired pneumonia without improvement. Chest computed tomography (CT) revealed bilateral consolidations with a CT angiogram sign, and flexible bronchoscopy showed infiltrative lesions causing bronchial stenosis. Histopathological examination of the tissue biopsy identified T-cell lymphoma through immunohistochemical staining positive for CD3. This case highlights the importance of considering differential diagnoses such as PPTL in patients with atypical presentations of asthma or non-resolving pneumonia. This case also demonstrates the diagnostic utility of flexible bronchoscopy in identifying airway obstruction due to malignant cells, which can mimic asthma

Multiple Recurrent Acute Ischemic Strokes Treated by Thrombectomy in a Patient with Acute Pulmonary Embolism

BACKGROUND: Thrombectomy is recommended to treat for an acute ischemic stroke (AIS) patient with anterior large vessel occlusion. However, there were neither detailed guidelines nor systematic reviews of acute ischemic stroke patients having multiple times or re-occluded arteries. CASE REPORT: In our case report, we struggled a multiple (4-times) AIS patient underwent by one intravenous r-tpA and 3 remaining of endovascular treatment of thrombectomy. Especially, the finding of both pulmonary embolism and cerebral arteries occlusion in this patient made us difficult to decide the appropriate treatment plan. The patient was considered having multiple cardiac thrombi pumping out to the brain and pulmonary vessels even in treatment with NOAC (New Oral Anticoagulant). Our priority, normally, was to recanalize the brain vessels compared to the pulmonary arteries. CONCLUSION: In conclusion, based on this noticed case study, we want to share our experiences on the diagnosis of ischemic stroke, the strategy in treatment and prevention with anticoagulant therapy

Design optimization of compliant mechanisms for vibration assisted machining applications using a hybrid Six Sigma, RSM-FEM, and NSGA-II approach

Vibration-assisted machining, a hybrid processing method, has been gaining considerable interest recently due to its advantages, such as increasing material removal rate, enhancing surface quality, reducing cutting forces and tool wear, improving tool life, or minimizing burr formation. Special equipment must be designed to integrate the additional vibration energy into the traditional system to exploit those spectacular characteristics. This paper proposes the design of a new 2-DOF high-precision compliant positioning mechanism using an optimization process combining the response surface method, finite element method, and Six Sigma analysis into a multi-objective genetic algorithm. The TOPSIS method is also used to select the best solution from the Pareto solution set. The optimum design was fabricated to assess its performance in a vibration-assisted milling experiment concerning surface roughness criteria. The results demonstrate significant enhancement in both the manufacturing criteria of surface quality and the design approach criteria since it eliminates modelling errors associated with analytical approaches during the synthesis and analysis of compliant mechanisms

The clinical and subclinical features of spinal cord injury on magnetic resonance imaging of patients with N2O intoxication

Nitrous oxide (N2O) is a weak anesthetic gas that was first used in 1844 in the field of dental anesthesia. However, currently, N2O is being abused for entertainment purposes in the form of N2O-filled balloons, called funky balls, which can cause many adverse effects, especially nervous system injury. This study aimed to investigate the detailed clinical and subclinical features associated with N2O intoxication. We retrospectively reviewed 47 patients diagnosed with N2O intoxication, from May 2018 to July 2019, and collected demographic data, clinical and laboratory tests, and spinal cord magnetic resonance imaging (MRI) findings. The mean time of funky ball use was 8.8 months, with a mean use of 36.3 balls per day. All patients presented with superficial sensory disorders. Reductions in muscle strength, decreased vibration sensation, and decreased or lost tendon reflexes were the most common clinical signs of N2O intoxication. Romberg sign and Lhermitte sign were observed in 39 patients (83%) and 21 patients (44.7%), respectively. Spinal cord lesions on MRI were observed in 32 patients (68.1%), which mostly presented with an inverted V sign. The total duration of N2O use, the number of days of using N2O per week, and the presence of Lhermitte sign (P<0.05) were significantly different between patients with and without spinal cord lesions on MRI. Serum levels of homocysteine and vitamin B12 were significantly different between the time of admission and discharge (P<0.05). Our study indicated that the days of using N2O per week was significantly associated with Spinal Cord Injuries (SCI) on MRI. According to the Receiver Operating Characteristic (ROC) curve analysis, a cutoff days of using per week value of 2.5 days could predict SCI with a sensitivity of 81.3%, a specificity of 73.3%, and an area under the ROC curve (AUC) of 0.813. Changes in the serum levels of homocysteine and vitamin B12 were effective markers for the evaluation of treatment response

Granulocyte colony-stimulating factor reduces biliary fibrosis and ductular reaction in a mouse model of chronic cholestasis

Background: Biliary atresia is a rare congenital bile duct disease that is the leading cause of liver fibrosis in neonates. Granulocyte colony-stimulating factor (GCSF) is a potential therapy for hepatocellular diseases, but data on GCSF for cholestatic conditions remain limited. Materials and methods: The current study examines the role of GCSF in improving bile duct obstruction in mice. Two doses were administered: 10.0 μg/kg/day and 61.5 μg/kg/day, which is the animal equivalent dose of 5.0 μg/kg in humans. Seven days (D7) after bile duct ligation (BDL), Swiss mice were treated with phosphate buffered saline or GCSF for 5 days. The intrahepatic adaptive response of BDL mice was evaluated on postsurgical days D12, D19, and D26. Results: Treatment with 61.5 μg/kg of GCSF resulted in a significant increase in circulating leukocytes and neutrophils on D12. Amelioration of liver injury, as shown by reduced aspartate aminotransferase levels, increased albumin levels and survival rate, as well as reduced intrahepatic inflammation and hepatic myeloperoxidase expression, downregulated ductular proliferation, periportal fibroblast activation, and fibrosis, enhanced expressions of hepatocyte growth factor, peroxisome proliferator-activated receptor-alpha, and ki67, and suppressed expression of cleaved caspase-3 protein, was noted after treatment with 61.5 μg/kg of GCSF. Additionally, GCSF treatment was associated with an increased number of intrahepatic cd3-Sca1+c-Kit+ bone marrow cells. Conclusions: Treatment with 61.5 μg/kg of GCSF resulted in liver regeneration and survival in BDL mice was seen, suggesting its potential use for human liver diseases

Hydropower dams, river drought and health effects: a detection and attribution study in the lower Mekong Delta Region

The upstream construction of hydropower dams may drastically intensify climate change impacts due to changing the natural river flood-drought cycle and reducing the amount of water that flows into the lower Mekong Delta river, leading to hydrological and environmental health impacts. However, until now the influence of drought on residents’ health in the lower MDR, where river drought is highly sensitive to recently built hydropower plants, has not been examined. The objectives of this study are, for the first time, to detect the health impacts of river drought on residents and to evaluate the contribution of hydropower dams to the impacts of drought on health in the lower Mekong Delta Region (MDR). We applied the multi-step approaches of a Detection and Attribution study. First, we detected the effects of the river drought on the risk of hospitalization using a Multivariable Fractional Polynomials algorithm (MFP). Second, we linked the long-term changes of the river water level (RWL) to the operation of the first hydropower dam in the upper MDR using the interrupted time-series model (ITS). Finally, we quantified the hospitalizations and related economic loss attributed to the river drought. The results show that the percentage changes in risk of all-cause, respiratory, and renal hospitalizations attributed to the river drought were 2%, 2%, and 7%. There were significant reductions in average level and trend of the RWL during the post-1995 period, when the first hydropower dam began operation in the upper MDR, even though the cumulative rainfall in the MDR had not changed. The all-cause hospitalizations attributed to the river drought were 1134 cases during the period 1995–2014, which resulted in total additional cost at two provincial hospitals of US $360,385. This current study demonstrates the link between hydropower dams, river drought, and health impacts. As the MDR is highly vulnerable to climate change, these findings about the devastating impacts of hydropower dams and environmental change have important implications for the lives of downstream residents