Diplopia in Parkinson's illness: Indication of a new cortical phenotype with psychological dysfunction?
 We present a case of a 13-year old patient with partially reversibly post-operative heart block who underwent leadless pacemaker placement. After post-anesthesia wretching/gagging episode she developed device microdislodgement and increased/intolerable capture thresholds. The device was removed and another placed with adequate thresholds for good longevity. BACKGROUND Although emergency medical service- (EMS-) witnessed out-of-hospital-cardiac arrest (OHCA) has a high survival rate and potential for prevention of progression to cardiac arrest, its characteristics and prodromal symptoms are not well known. The purpose of this study was to investigate the epidemiologic characteristics and outcome of EMS-witnessed OHCA by focusing on its prodromal symptoms. METHODS Population-based observational study was conducted for resuscitation-attempted EMS-witnessed adult OHCAs between 2012 and 2017. The prodromal symptoms were categorized according to the patients' chief complaints, which were checked in the EMS run sheets no prodromal, respiratory, cardiac, neurologic, gastrointestinal (GI), or other symptom. If multiple complaints were checked, the patient was assigned to multiple groups. The OHCA characteristics and time from EMS scene arrival to cardiac arrest were investigated by symptom groups and presumed etiology of OHCA. The age- and sex-standardized survival rate from EMS arrival) than in those with prodromal symptoms (10-14 min). CONCLUSION About 40% of EMS-witnessed OHCA patients had prodromal symptom before cardiac arrest. In cardiac etiology, patients with cardiac symptoms had the best rate of survival to discharge and good neurological outcome. Promoting public awareness of prodromal symptoms is needed to earn time for preparedness and prevention of progression to cardiac arrest.  https://www.selleckchem.com/products/ABT-888.html  To investigate the association between systemic nitrotyrosine (NT) levels and primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG) and the mechanism involved. A case control study was conducted in the Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Fudan University from April 2017 to December 2017. A total of 400 participants were consecutively recruited into this study (100 PACG, 100 POAG and 200 controls). Multivariable logistic regression analysis was performed to identify the association between serum NT level and PACG or POAG. Clinical results were validated in cell and animal models. Among 200 glaucoma patients, 101 (50.5%) were women; the age was 57.07 ± 14.51 years. 106 (53%) control participants were women and age was 58.34 ± 14.04 years. Serum levels of NT in PACG and POAG patients are significantly higher than controls (1808.53 ± 417.76 nmol/L vs.  https://www.selleckchem.com/products/ABT-888.html  1270.62 ± 454.60 nmol/L, p  less then  0.001; 1718.63 ± 437.29 nmol/L vs. 1258.38 ± 460.72 nmol/L, p  less then  0.001). Further, elevated serum NT level increases the risk of developing PACG (OR = 1.003, 95% CI 1.002 to 1.004, p  less then  0.001) and POAG (OR = 1.002, 95% CI 1.002 to 1.003, p  less then  0.001). Consistent with the clinical data, serum and aqueous humour NT levels are significantly higher in caveolin 1 knockout (Cav1 KO) mice, an animal model of glaucoma. More importantly, peroxynitrite (PN) scavenger MnTMPyP and its transduction molecule PARP inhibitor significantly reduce intraocular pressure in Cav1 KO mice. Our data show for the first time that NT is a systemic risk factor and local treatment target of glaucoma. BACKGROUND AND OBJECTIVE There are technical challenges to complete occlusion of small ( less then 5 mm) ruptured intracranial aneurysms (SRAs) using endovascular treatment (EVT). This study analyzed factors influencing immediate angiographic results in SRAs after EVT. MATERIAL AND METHODS Intraoperative angiograms and medical records of 290 patients, who underwent EVT for SRAs at 2 stroke centers in China between January 2009 and October 2016, were retrospectively reviewed and evaluated. RESULTS Immediate complete occlusion was achieved in 213 (73.4%) aneurysms. Aneurysms with a smaller aspect ratio, those less than 3 mm in size, irregular shape, small basal outpouching, multiple aneurysms, poorer Hunt and Hess grade, and location of communication arteries demonstrated higher rates of incomplete occlusion, although the differences were not statistically significant. Multivariate logistic regression analysis revealed that SRAs with parent artery stenosis greater than or equal to 50% and lobulation demonstrateout additional mortality and perioperative complications. OBJECTIVE Japan has the largest elderly population in the world. As data on the clinical outcomes in elderly patients with aneurysmal subarachnoid hemorrhage (aSAH), including those older than 80 years, are lacking, we analyzed the characteristics of 54,805 aSAH patients and recorded their treatments and clinical outcomes using a Japanese nationwide inpatient database. METHODS Using the Japanese Diagnostic Procedure Combination database, we identified aSAH patients aged 18 years or older who were hospitalized between July 1, 2010 and March 31, 2016. They were categorized as less than or equal to 60-, 61-70-, 71-80-, 81-90-, and greater than or equal to 91 years of age. The primary outcome was the modified Rankin Scale (mRS) score at discharge. Multivariable logistic regression analysis was performed to examine factors affecting the mRS score at discharge. RESULTS Of 54,805 patients, 37.5% were aged less than or equal to 60 years; 24.8% were 61-70-, 21.8% were 71-80-, 13.9% were 81-90-, and 2.0% were greater t8.10; 95%CI, 13.96-23.46). CONCLUSIONS As the treatment outcomes in elderly aSAH patients, especially those 80 years old or older, were poor, the appropriate therapy decisions must be made on a case-by-case basis. OBJECTIVE Obesity is one of the greatest risk factors for osteoarthritis (OA) and evidence is accumulating that inflammatory mediators and innate immunity play an important role. The infrapatellar fat pad (IPFP) could be a potential local source of inflammatory mediators in the knee. Here, we combine surgical joint damage with high-fat feeding in mice to investigate inflammatory responses in the IPFP during OA development. DESIGN Mice (n = 30) received either a low-fat diet (LFD), high-fat diet (HFD) for 18 weeks or switched diets (LFD > HFD) after 10 weeks. OA was induced by surgical destabilization of the medial meniscus (DMM), contralateral knees served as sham controls. An additional HFD-only group (n = 15) received no DMM. RESULTS The most pronounced inflammation, characterized by macrophage crown-like structures (CLS), was found in HFD + DMM mice, CLS increased compared to HFD only (mean difference = 7.26, 95%CI [1.52-13.0]) and LFD + DMM (mean difference = 6.35, 95%CI [0.53-12.18). The M1 macrophage marker iNOS increased by DMM (ratio = 2.