SUNY Upstate Medical University

Introduction Attention‐deficit/Hyperactivity Disorder (ADHD) is increasingly recognized in adult women. However, clinical guidance on prescribing ADHD medications during breastfeeding remains limited. Despite the effectiveness of ADHD medications, concerns about drug transfer into breastmilk often lead to conservative prescribing or discontinuation of therapy during the perinatal period, compromising maternal well‐being. Case Summaries In this report, we present a case of a 25‐year‐old woman at 3 weeks postpartum and exclusively breastfeeding, who presented with ADHD combined type, with inadequate symptom control on extended‐release bupropion 300 mg daily. Given poor tolerance at higher doses of bupropion, she was initiated on immediate‐release methylphenidate and switched later to the extended‐release formulation to minimize the risk of activation previously experienced with antidepressant use. Discussion Both mother and infant were monitored for 6 months after medication initiation, during which the mother reported improvements in hyperactive and impulsive symptoms as reflected by scoring of the Adult ADHD Self‐Report Scale. She also reported improvements in concentration, mood, and functioning. There were no adverse effects on milk supply, and the infant demonstrated normal growth and development. Conclusions This case underscores the feasibility of cautiously escalating stimulant therapy in a breastfeeding mother with ADHD, showing improved functioning in the mother without immediate effects on development in the infant. Significant gaps persist in guidance for postpartum ADHD care, underscoring the need for more research to inform safe and effective treatment.

p> Type 2 diabetes mellitus (T2DM) remains one of the most prevalent chronic metabolic disorders globally, presenting an ongoing challenge in terms of prevention and management. The majority of existing therapeutic strategies focus primarily on glycemic control. However, the role of inflammation in the pathogenesis of the disease is being recognized increasingly, which has brought to light a critical gap in our understanding of diabetes treatment in the context of anti-inflammatory therapeutics. Inflammatory reactions are essential to the development and progression of T2DM. The NLRP3 inflammasome, along with its downstream inflammatory factors, is a key mediator of these responses. Recent data underscore the significance of Interleukin- 1β (IL-1β) in instigating and sustaining inflammation-related organ dysfunction in T2DM. Consequently, factors governing NLRP3 activation and IL-1β expression emerge as potential therapeutic targets. Here, we aim to examine one such therapeutic agent, colchicine, which can potentially manage inflammation associated with T2DM. As an anti-inflammatory medicine, colchicine can inhibit the assembly and activation of the NLRP3 inflammasome via various mechanisms, thereby mitigating inflammation. In this context, the study discusses the mechanisms that link metabolic disorders with the onset of chronic inflammation, evaluates clinical studies and trials that investigate the efficacy and safety of colchicine, as well as discusses its benefits and limitations as an anti-inflammatory therapy in T2DM. The goal is to provide a clear framework for understanding the role of colchicine in the therapeutic landscape of T2DM, potentially leading to novel approaches for managing the disease. </p

Distal radial access (DRA) in the anatomical snuffbox is gaining increasing acceptance as an alternative to conventional transradial access (TRA) for cerebral and coronary angiography and interventions. This chapter describes the learning curve for DRA, highlighting that complication rates during the learning curve are low, with no major adverse event reported. A comparison of left and right DRA is also presented, and the advantages of DRA over conventional TRA are outlined, emphasizing that with commitment and proper technique, a high success rate can be achieved, making it a safe and valuable alternative access in interventional cardiovascular medicine.

Tick cell lines have emerged as a valuable tool in many research areas concerning ticks and tick-borne diseases. This has established a useful model for investigating interactions between ticks and pathogenic agents, as various economically significant tick-borne pathogens can be isolated and propagated in tick cell lines. However, tick cell lines are relatively fragile compared to more common cell types and demand higher maintenance culture conditions. Here, we describe the basic methods for tick cell culture using ISE6, a cell line derived from the embryos of the Ixodes scapularis tick species, to showcase its morphological features. Moreover, this approach can be adapted for in vitro cultivation of viral and bacterial pathogens.

Tick-borne flaviviruses, such as tick-borne encephalitis virus (TBEV), Omsk hemorrhagic fever virus (OHFV), and Powassan virus (POWV), pose significant threats to human health. POWV is an emerging arbovirus and is the only member of the tick-borne encephalitis serogroup causing public health concern in North America, specifically in the Northeastern United States and Eastern Canada (Hermance and Thangamani, Vector Borne Zoonotic Dis 17(7):453–462, 2017; Hassett and Thangamani, Microorganisms 9(11):2317, 2021). POWV lineages currently described, POWV lineage I, referred to as POWV, and POWV lineage II, referred to as Deer tick virus (DTV), are genetically similar and cause similar neurotropic disease in humans during spillover infections. Accurate quantification of POWV or DTV is critical to studying the basic biology, pathogenesis, and transmission physiology of these viruses. Herein, we describe our process to quantify POWV or DTV in a Biosafety Level 3 (BSL-3) setting using a repeatable methodology.

Tick-borne viral infections, like those described in this book, pose real threats to the health of humans across the world. Powassan virus (POWV) and Deer tick virus (DTV) are two examples of tick-borne flaviviruses that are endemic to North America and cause neuroinvasive disease. These two viruses are both genetically similar and are spread by similar vectors but have differing tropism and clinical outcomes. Studies involving these viruses have routinely consisted of mouse models and in vitro studies. These models, effective as they are, are limited in their use as they are either costly or do not meet niche needs. Herein, we describe a method of using an ex vivo human skin model for infection studies that focus on the primary site of infection, the skin.

Ticks may contain a diverse array of both pathogenic and invertebrate-specific viruses. Culture methods can be performed in vitro or in vivo to isolate and culture these viruses. Here, we demonstrate the culture of Deer tick virus (DTV) and Powassan virus (POWV) from ticks collected in Upstate New York. Research into medically significant tick-borne pathogens can be facilitated through in vitro models using cultured mammalian cells. This is especially true of viruses, which require amenable host cells to replicate. This chapter describes the isolation of viruses from field-collected ticks utilizing basic mammalian cell culture techniques.

Tick-borne flaviviruses, such as Powassan virus (POWV) or Deer tick virus (DTV), can elicit robust humoral responses in animal models of disease (Hermanceet al., PLoS Negl Trop Dis 14(6):e0008359, 2020; Stone et al., Cell Rep 38(7):110388, 2022; Reynolds et al., Comp Med 67:232–241, 2017). Several aspects of humoral immunity to tick-borne flaviviruses are unknown; however, convalescent serum can offer partial protection against a POWV challenge naïve immune-competent animals (Stone et al., Cell Rep 38(7):110388, 2022). Accurately quantifying the neutralizing titers of protective antibodies allows us to determine the effectiveness of virus neutralization of a given sample. Understanding the efficacy of convalescent sera or antibody titers post-infection or vaccination facilitates identifying a potential correlate of protection.

As tick-borne viruses such as Powassan virus (POWV) and Deer tick virus (DTV) increase in prevalence, having methodology to isolate circulating strains from field-collected ticks grants an opportunity to better understand viral evolution, to more accurately assess human health risks, and to make research into these viruses more translational. POWV and DTV are genetically similar but distinct emerging tick-borne viruses in North America that can cause severe encephalitic disease with high morbidity and mortality. Research into these viruses typically use prototypical lab strains, which may not reflect characteristics of circulating populations of these viruses. Here we will outline a protocol for reliably isolating DTV and POWV from field-collected ticks using an in vivo system.

Although many hematophagous arthropods transmit pathogens to humans and animals, Ixodid ticks are unique in that the feeding process lasts for days to weeks instead of a few minutes. To facilitate feeding, tick saliva suppresses host responses, which would permit detection and removal and has been shown to impact disease transmission and severity. Using infected ticks to transmit the virus to a host, the resulting disease course and pathology should resemble naturally occurring cases more closely than simply injecting the virus through a needle. In this work, we describe methods to generate virus-infected ticks for use in transmission experiments.

Visualization of tissue and cellular architecture is essential for understanding the pathobiology of tick-borne virus infection. RNA in situ hybridization (ISH) utilizes specific oligonucleotide probes to detect the presence and specific location of complementary RNA transcript targets within a tissue section. Chromogenic or fluorescent staining technologies allow researchers to visualize multiple RNA targets within a single tissue. Herein, we describe an RNA ISH methodology based on a commercially available kit to hybridize specific probes to POWV RNA within infected tissues.

PSMA-RADS version 1, introduced by Rowe et al. in 2017, provides a framework for classifying PSMA-targeted PET scans and individual findings based on their likelihood of representing prostate cancer. The system was optimized for findings outside the prostate and was structured as a five-point scale (Rowe et al., Eur Urol 73:485–487, 2018. https://doi.org/10.1016/j.eururo.2017.10.027. In 2022, an updated PSMA-RADS version was proposed to refine category definitions, address limitations of the initial version, and enhance its role in guiding clinical decisions. The framework includes both lesion-level and patient-level classifications, offering confidence and probability scores in support of clinical decision-making (Leung et al., EJNMMI Res. https://doi.org/10.1186/S13550-022-00948-1). This article aims to explore the changes introduced in the updated scale and evaluate their impact on clinical management. It is intended to inform abdominal and general radiologists about recent developments in PSMA-targeted imaging to support multidisciplinary collaboration and patient care.

Lyme carditis, primarily caused by Borrelia burgdorferi , affects 1 to 10% of patients with untreated Lyme disease. This study reviewed 3 cases of Lyme carditis that presented to a tertiary hospital's emergency department in the northeastern United States during the summer months. The cases involved patients with varying degrees of atrioventricular (AV) block: first-degree, second-degree Type 2, and complete heart block. Case 1 involved a 19-y-old male presenting with syncope and diagnosed with first-degree AV block. He received intravenous (IV) ceftriaxone, resulting in resolution of the AV block. Case 2 was a 22-y-old male who experienced an unresponsive episode with bystander chest compressions. He had discrete erythematous patches and was diagnosed with Type 2 second-degree AV block. IV ceftriaxone followed by doxycycline resolved his condition without further incident. Case 3 described a 32-y-old male with lightheadedness and syncope, diagnosed with complete heart block. A temporary pacing lead and IV ceftriaxone were employed, transitioning to doxycycline, which effectively resolved the heart block. All three patients tested positive for Lyme antibodies with reflex Western blot. Lyme carditis presents variably, often without a clear history of tick exposure or erythema migrans. Prompt recognition and treatment in endemic areas are critical to prevent implantation of unnecessary permanent pacemakers. This paper underscores the importance of high clinical suspicion and reviews appropriate management in the emergency department setting for patients with potential Lyme carditis presenting with unexplained cardiac symptoms.

Engorgement of spinal intradural veins on MRI has classically been associated with spinal dural arteriovenous fistulas (sdAVF). We report a novel case of a patient who presented with worsening cognitive impairment, whose spinal MRI demonstrated marked intradural venous engorgement in the form of serpiginous perimedullary flow voids akin to sdAVF. Further investigation led to a diagnosis of CSF-venous fistula (CVF), a sub-type of spontaneous spinal CSF leaks without an associated extradural fluid collection. This is the first reported case of CVF mimicking sdAVF on MRI. While clinical presentations of CVF and sdAVF are typically distinct, there may be overlap and/or uncertainty in atypical presentations, such as in our patient. As such, the differential for spinal intradural venous engorgement should be expanded to include spontaneous CSF leaks, including CVF.

Purpose of review This review describes recent innovations in craniofacial imaging, focusing on emerging techniques such as 3D photogrammetry, smartphone-based scanning, and artificial intelligence applied to cephalometric assessments in facial plastic and reconstructive surgery. Recent findings Traditional methods like occipitofrontal circumference and cephalic index remain widely used, but newer, more precise technologies have recently emerged. 3D photogrammetry is a reproducible, safe, and noninvasive alternative, offering detailed cranial modeling using external landmarks. The integration of smartphone technologies has further democratized craniofacial imaging by enabling accurate 3D scans with minimal cost and radiation exposure. Despite variability in certain facial regions, these technologies have shown promising accuracy for clinical use. Furthermore, AI-driven approaches enhance diagnostic precision by generating synthetic data and improving landmark detection in complex cranial morphologies. Summary Recent technological advances are reshaping craniofacial imaging and optimizing preoperative and postoperative care in facial plastic and reconstructive surgery. 3D imaging and AI applications offer significant improvements over traditional methods and allow for more precise and reliable methods for operative planning and longitudinal assessments. As these tools develop, they are bound to become the new standards for clinical evaluation of craniofacial anomalies.

Exercise’s protective effects in Alzheimer’s disease (AD) are well recognized, but cell-specific contributions to this phenomenon remain unclear. Here we used single-nucleus RNA sequencing (snRNA-seq) to dissect the response to exercise (free-wheel running) in the neurogenic stem-cell niche of the hippocampal dentate gyrus in male APP/PS1 transgenic AD model mice. Transcriptomic responses to exercise were distinct between wild-type and AD mice, and most prominent in immature neurons. Exercise restored the transcriptional profiles of a proportion of AD-dysregulated genes in a cell type-specific manner. We identified a neurovascular-associated astrocyte subpopulation, the abundance of which was reduced in AD, whereas its gene expression signature was induced with exercise. Exercise also enhanced the gene expression profile of disease-associated microglia. Oligodendrocyte progenitor cells were the cell type with the highest proportion of dysregulated genes recovered by exercise. Last, we validated our key findings in a human AD snRNA-seq dataset. Together, these data present a comprehensive resource for understanding the molecular mediators of neuroprotection by exercise in AD.

Background Most people living with HIV in low and middle-income countries are taking fixed dose combination tenofovir disoproxil fumarate/lamivudine/dolutegravir (TLD). Dolutegravir use has been associated with weight gain, a known risk factor for hypertension. We aimed to determine if weight gain in Ugandan anti-retroviral therapy (ART) naïve patients on TLD correlated with increase in blood pressure. Methods We analyzed data from the ‘Glucose metabolism changes in Ugandan persons with HIV (PLHIV) on Dolutegravir (GLUMED)’ study which was a prospective cohort study with ART naïve persons with HIV ≥ 18 years followed up on TLD over 48 weeks. A scatter plot with 95% confidence intervals and regression line illustrating the relationship between weight change and mean arterial pressure (MAP) change from baseline to 48 weeks was created. To further examine the effect of weight change on MAP, we performed a linear regression analysis, with MAP change as the dependent variable and weight change as the independent variable. Results Of the 220 patients’ data analyzed, 129 (58.6%) were female, the median baseline age was 31 years (interquartile range (IQR): 27.0–38.0), the median baseline CD4 cell count was 319 cells/mm³ (IQR 160.0–524.0). The median weight gain over 48 weeks was 3.0 (IQR: −0.1–6.3). We found a moderate positive linear relationship between weight gain and MAP over 48 weeks. For every increase in weight of 1 kg over 48 weeks, there was an adjusted increase in MAP by 0.62mmHG. Conclusion We provide additional evidence to suggest that the noticed weight gain after starting dolutegravir based ART may be associated with a heightened risk of incident hypertension.

Purpose of Review Because dysphagia occurs when the esophageal luminal diameter is < 13 mm, the traditional goal of dilation is set at 14–16 mm (42–48 Fr) to relieve symptoms. This study was designed to determine whether increasing the size of dilators further would improve durability of response to bougienage. Recent Findings Patients with severe or non-severe esophageal stricture and dysphagia were randomized to two different sizes of dilators. Diet and Dysphagia scores were calculated before and after index dilation, then every 4–8 weeks by phone for 12 months. Of 35 patients (mean age 63.1 yrs, 37.1% male) in the study, 11 had severe post-radiation strictures randomized to 42 Fr (n = 5) vs. 51 Fr (n = 6) Savary, 24 had non-severe strictures randomized to 46 Fr (n = 11) vs. 60 Fr (n = 13) Maloney. For severe strictures, number of dilations was nonsignificantly less with the larger 51 Fr versus 42 Fr (4.0 ± 1.73 vs. 5.2 ± 2.17, p = 1.00), and duration between dilations was longer (167 ± 154 vs. 64 ± 25 days, p = 0.41). For non-severe strictures, the smaller size 46 Fr dilator versus 60 Fr was associated with nonsignificantly fewer dilations (1.74 ± 0.81 vs. 1.77 ± 0.83, p = 0.70) and longer duration between sessions (265 ± 123 vs. 239 ± 103 days, p = 0.63). Summary Bougienage with dilators larger than 14–16 mm (42–48 Fr) does not improve durability of symptomatic relief, either by decreasing the total number of dilations required or by increasing the symptom-free duration of response between sessions.