Hebrew University of Jerusalem

To describe a novel optical coherence tomography finding called "scolex sign" in cases of central serous chorioretinopathy. This retrospective multicenter study included patients with central serous chorioretinopathy with serous pigment epithelial detachments (PEDs) greater than 100 µ m, with or without subretinal fluid. Eyes showing a distinct hyperreflective focus on the PED wall (scolex sign) were analyzed. An equal number of age-matched controls with PEDs but without the scolex sign were included. Multimodal imaging data were reviewed. A subgroup analysis based on subretinal fluid status was also performed. Of 291 eyes with large serous PEDs, 52 eyes exhibited the "scolex sign" and were compared with 52 age-matched controls. Baseline characteristics including sex, systemic comorbidities, best-recorded visual acuity and optical coherence tomography parameters were similar in both the groups. However, eyes with the "scolex" sign exhibited a greater number of central PEDs and shorter distance from the foveal center. On follow-up, eyes with the "scolex" sign showed a higher rate of PED flattening and subretinal fluid resolution trended to be higher compared with controls. The "scolex" sign represents a novel, benign optical coherence tomography feature seen in a subset of central serous chorioretinopathy cases. While not associated with poorer outcomes or adverse sequelae, it may reflect ongoing reparative changes, indicating a resolving stage of the disease.

Reconstructing the complex human behaviours that manifest in the Palaeolithic archaeological record remains an elusive but important challenge for capturing traces of how the human mind evolved. The roughly 1.5 million years of handaxe-making throughout the Acheulean provides a consistently preserved manifestation of hominin technological skills. Here, we analyse 1108 3D scans of handaxes from 12 sites in the Great Rift Valley of eastern Africa and the southern Levant spanning much of the Acheulean. We set out to chart the evolution of Acheulean toolmaking skill using a suite of computational 3D methods to quantify how well these handaxes have been thinned, shaped, and sharpened; traits which demand manual dexterity, planning, and hierarchical cognition. We find evidence that cognitive evolution likely played a role in improvements in handaxe-making skill, but only in the first half of the Acheulean. The most skilfully made handaxes among our sample begin to be made by about one million years ago. Any increases in cranial capacity, cognitive complexity, or manual dexterity after this point do not make a noticeable impact on how skilfully handaxes were made, and nor does raw material quality. Instead, the techno-morphology of handaxes appears to be relatively untethered from evolutionary constraints after about a million years ago, at which point we need to seek alternative explanations for handaxe variability. Above all, we show that the difficult pursuit of lowering bifacial asymmetry was more often achieved than any other skilful attribute, suggesting it was a fundamental goal of handaxe-making. Attempting to maintain 3D symmetry appears to be a common goal throughout the entire Acheulean and was routinely achieved by its second half. This capacity to consistently maintain bifacial balance while knapping was in place by at least 1.0 Ma, revealing the evolved technological abilities and hierarchical cognition of Acheulean hominins. • We analyse 1108 3D scans of Acheulean handaxes from 12 sites from the Great Rift Valley. • Computational 3D methods were used to estimate how skilfully each handaxe was made. • Hominins enacted handaxe reduction sequences with equivalent fidelity on raw materials of different qualities. • Early improvements in handaxe-making skill were likely governed by cognitive evolution, but not later improvements. • Acheulean knappers appear to be aiming to minimise bifacial asymmetry and routinely achieved this by one million years ago.

To describe the clinical and laboratory findings, disease course, and treatment effectiveness of a large, genetically homogenous group of patients with deficiency of adenosine deaminase 2 (DADA2), and to identify factors associated with disease-related damage. We conducted a retrospective cohort study that included 45 patients with DADA2 vasculitis with long-term follow-up. Information was collected from patients' charts, including demographic information, clinical presentations, laboratory findings, and treatment. The extent of disease-related damage was determined based on the Vasculitis Damage Index. In this large homogenous cohort, we found that a young age at disease onset and periodic illness that included recurrent episodes of fever, myalgia, and abdominal pain were associated with disease-related damage. Patients with severe DADA2 disease responded favorably to tumor necrosis factor inhibitors (TNFi). Early age of onset and the periodic nature of the disease warrant prompt initiation of TNFi treatment to prevent later complications and severe disease progression.

Parenteral nutrition (PN) supports patients unable to absorb sufficient nutrients from their gastrointestinal tracts. Yet, information about the patterns and extent of PN's in-hospital use is lacking. Data on this topic should provide comparison points for nutrition support teams and hospital administrators examining PN use in their institutions. A retrospective cohort study using 9 years of routinely collected administrative data from a healthcare system with tertiary care and community hospitals explored the extent, patterns, and trends of PN use in hospitals and individual clinical departments. PN was administered to 2984 patients during 4121 admissions to the tertiary facility for 68,047 days and to 298 patients on 367 admissions to the community hospital for 4925 days. Both hospitals' general surgery, surgical intensive care unit, and other surgical services accounted for half the patients receiving PN. The tertiary care hospital's adult and pediatric oncology/hematology/bone marrow transplantation services, services not provided in the community hospital, accounted for 29% of the hospital's patients receiving PN. Fifty-two percent of surgical patients accounted for 46% of PN-days, whereas the 29% of patients from the hematology/oncology/bone marrow transplantation services utilized 39% of PN-days, with longer durations of PN administration reflected in the latter group. Adult oncology admissions involving PN tripled (from 38 to 116 patients) between the first and last 3 years. Different case mixes in the tertiary and community hospitals affected the extent and patterns of PN use. Dataset analysis provided an analytic framework for examining PN usage within and among hospitals.