An unusual case of suprascapular nerve neuropathy: a case report

<p>Abstract</p> <p>Introduction</p> <p>Suprascapular nerve neuropathy constitutes an unusual cause of shoulder weakness, with the most common etiology being nerve compression from a ganglion cyst at the suprascapular or spinoglenoid notch. We present a puzzling case of a man with suprascapular nerve neuropathy that may have been associated with an appendectomy. The case was attributed to nerve injury as the most likely cause that may have occurred during improper post-operative patient mobilization.</p> <p>Case presentation</p> <p>A 23-year-old Caucasian man presented to an orthopedic surgeon with a history of left shoulder weakness of several weeks' duration. The patient complained of pain and inability to lift minimal weight, such as a glass of water, following an appendectomy. His orthopedic clinical examination revealed obvious atrophy of the supraspinatus and infraspinatus muscles and 2 of 5 muscle strength scores on flexion resistance and external rotation resistance. Magnetic resonance imaging showed diffuse high signal intensity within the supraspinatus and infraspinatus muscles and early signs of minimal fatty infiltration consistent with denervation changes. No compression of the suprascapular nerve in the suprascapular or spinoglenoid notch was noted. Electromyographic studies showed active denervation effects in the supraspinatus muscle and more prominent in the left infraspinatus muscle. The findings were compatible with damage to the suprascapular nerve, especially the part supplying the infraspinatus muscle. On the basis of the patient's history, clinical examination, and imaging studies, the diagnosis was suspected to be associated with a possible traction injury of the suprascapular nerve that could have occurred during the patient's transfer from the operating table following an appendectomy.</p> <p>Conclusion</p> <p>Our case report may provide important insight into patient transfer techniques used by hospital personnel, may elucidate the clinical significance of careful movement of patients following general anesthesia, and may have important implications for patient safety techniques, including those outlined in the World Health Organization Surgical Safety Checklist program.</p

Is the inflammasome a potential therapeutic target in renal disease?

The inflammasome is a large, multiprotein complex that drives proinflammatory cytokine production in response to infection and tissue injury. Pattern recognition receptors that are either membrane bound or cytoplasmic trigger inflammasome assembly. These receptors sense danger signals including damage-associated molecular patterns and pathogen-associated molecular patterns (DAMPS and PAMPS respectively). The best-characterized inflammasome is the NLRP3 inflammasome. On assembly of the NLRP3 inflammasome, post-translational processing and secretion of pro-inflammatory cytokines IL-1β and IL-18 occurs; in addition, cell death may be mediated via caspase-1. Intrinsic renal cells express components of the inflammasome pathway. This is most prominent in tubular epithelial cells and, to a lesser degree, in glomeruli. Several primary renal diseases and systemic diseases affecting the kidney are associated with NLRP3 inflammasome/IL-1β/IL-18 axis activation. Most of the disorders studied have been acute inflammatory diseases. The disease spectrum includes ureteric obstruction, ischaemia reperfusion injury, glomerulonephritis, sepsis, hypoxia, glycerol-induced renal failure, and crystal nephropathy. In addition to mediating renal disease, the IL-1/ IL-18 axis may also be responsible for development of CKD itself and its related complications, including vascular calcification and sepsis. Experimental models using genetic deletions and/or receptor antagonists/antiserum against the NLRP3 inflammasome pathway have shown decreased severity of disease. As such, the inflammasome is an attractive potential therapeutic target in a variety of renal diseases

Folic Acid Transport to the Human Fetus Is Decreased in Pregnancies with Chronic Alcohol Exposure

During pregnancy, the demand for folic acid increases since the fetus requires this nutrient for its rapid growth and cell proliferation. The placenta concentrates folic acid into the fetal circulation; as a result the fetal levels are 2 to 4 times higher than the maternal level. Animal and in vitro studies have suggested that alcohol may impair transport of folic acid across the placenta by decreasing expression of transport proteins. We aim to determine if folate transfer to the fetus is altered in human pregnancies with chronic alcohol consumption.Serum folate was measured in maternal blood and umbilical cord blood at the time of delivery in pregnancies with chronic and heavy alcohol exposure (n = 23) and in non-drinking controls (n = 24). In the alcohol-exposed pairs, the fetal:maternal serum folate ratio was ≤ 1.0 in over half (n = 14), whereas all but one of the controls were >1.0. Mean folate in cord samples was lower in the alcohol-exposed group than in the controls (33.15 ± 19.89 vs 45.91 ± 20.73, p = 0.04).Our results demonstrate that chronic and heavy alcohol use in pregnancy impairs folate transport to the fetus. Altered folate concentrations within the placenta and in the fetus may in part contribute to the deficits observed in the fetal alcohol spectrum disorders

Game Theoretic Path Selection to Support Security in Device-to-Device Communications

1 Device-to-Device (D2D) communication is expected to be a key feature supported by 5G networks, especially due to the proliferation of Mobile Edge Computing (MEC), which has a prominent role in reducing network stress by shifting computational tasks from the Internet to the mobile edge. Apart from being part of MEC, D2D can extend cellular coverage allowing users to communicate directly when telecommunication infrastructure is highly congested or absent. This significant departure from the typical cellular paradigm imposes the need for decentralised network routing protocols. Moreover, enhanced capabilities of mobile devices and D2D networking will likely result in proliferation of new malware types and epidemics. Although the literature is rich in terms of D2D routing protocols that enhance quality-of-service and energy consumption, they provide only basic security support, e.g., in the form of encryption. Routing decisions can, however, contribute to collaborative detection of mobile malware by leveraging different kinds of anti-malware software installed on mobile devices. Benefiting from the cooperative nature of D2D communications, devices can rely on each other's contributions to detect malware. The impact of our work is geared towards having more malware-free D2D networks. To achieve this, we designed and implemented a novel routing protocol for D2D communications that optimises routing decisions for explicitly improving malware detection. The protocol identifies optimal network paths, in terms of malware mitigation and energy spent for malware detection, based on a game theoretic model. Diverse capabilities of network devices running different types of anti-malware software and their potential for inspecting messages relayed towards an intended destination device are leveraged using game theoretic tools. An optimality analysis of both Nash and Stackelberg security games is undertaken, including both zero and nonzero sum variants, and the Defender's equilibrium strategies. By undertaking network simulations, theoretical results obtained are illustrated through randomly generated network scenarios showing how our protocol outperforms conventional routing protocols, in terms of expected payoff, which consists of: security damage inflicted by malware and malware detection cost

Mobile Money Systems as Avant-Garde in the Digital Transition of Financial Relations

Mobile money is an electronic form of currency, which has become popular, particularly in developing countries over the last decade. This chapter summarizes the main findings from the empirical literature of the positive impacts (economic and social) of deploying mobile money platforms. They are reconfiguring and transforming pre-existing financial practices, including the unbanked segments of the population into formal economic relations, and providing self-reliance and security to local communities. This chapter also clarifies the types of data required to conduct more reliable empirical research and enhance cooperation among the parties involved in deploying and studying the effects of mobile money (MM) systems (i.e., among the academic community, policymakers/regulators, central banks, telecommunication companies, and entrepreneurs). Overall, this chapter presents a road map to establish a unified field of MM research by putting forward some lessons of improved inquiry and practice