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Article: Importance of Longitudinal Assessments in a Case of Comorbid Polysubstance Use Disorder and Borderline Personality Disorder Misdiagnosed As Bipolar I Disorder.

Tsyngauz, Esther / Chiu, Andrew K / Faruqui, Zeeshan

2023 Volume 15, Issue 9, Page(s) e45253

Abstract: Differentiating between borderline personality disorder (BPD) and bipolar disorder (BD) can be difficult. Both may present with altered mood states, deliberate self-harm, suicidality, impulsivity, unstable relationships, and risky behaviors. A manic ... ...

Abstract	Differentiating between borderline personality disorder (BPD) and bipolar disorder (BD) can be difficult. Both may present with altered mood states, deliberate self-harm, suicidality, impulsivity, unstable relationships, and risky behaviors. A manic episode is characterized by at least one week of elevated or irritated mood and at least three of the following: distractibility, impulsivity, grandiosity, flight of ideas, psychomotor activity, decreased need for sleep, and pressured speech. Borderline personality disorder is characterized by unstable mood and relationships, fear of abandonment, impulsivity, self-mutilation, suicidality, and a feeling of emptiness. In combination with polysubstance use, borderline personality disorder can present similarly to a manic episode and lead to an incorrect diagnosis of bipolar I disorder. In this study, we present a 44-year-old female whose psychiatric history highlights the importance of long-term patient observation in making an accurate diagnosis. Over the course of several years, she was given incorrect psychiatric diagnoses, including attention deficit hyperactivity disorder (ADHD), generalized anxiety disorder, and bipolar I disorder. As a result, her interpersonal relationships remained unstable and significantly affected her quality of life. Over the course of consistent, long-term psychiatric appointments, conversations with family members, and notes from previous psychiatrists, it became evident that substance use had also complicated her psychiatric history, leading to the aforementioned diagnoses. Once this was established, she was diagnosed with borderline personality disorder; subsequent correct medical intervention has been integral in helping her maintain a steady job and improve her interpersonal relationships and quality of life.
Language	English
Publishing date	2023-09-14
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.45253
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Article ; Online: Yttrium-90 Radiation Segmentectomy in Oligometastatic Secondary Hepatic Malignancies.

Chiu, Andrew M / Savoor, Rohan / Gordon, Andrew C / Riaz, Ahsun / Sato, Kent T / Hohlastos, Elias / Salem, Riad / Lewandowski, Robert J

Journal of vascular and interventional radiology : JVIR

2022 Volume 34, Issue 3, Page(s) 362–368

Abstract: Purpose: To evaluate the safety and efficacy of yttrium-90 (: Materials and methods: This institutional review board-approved retrospective study evaluated 16 patients with oligometastatic secondary hepatic malignancies who were treated with RS. The ... ...

Abstract	Purpose: To evaluate the safety and efficacy of yttrium-90 ( Materials and methods: This institutional review board-approved retrospective study evaluated 16 patients with oligometastatic secondary hepatic malignancies who were treated with RS. The median patient age was 61.9 years (range, 38.6-85.7 years). Of the 16 patients, 11 (68.8%) presented with solitary lesions. The median index tumor size was 3.1 cm (95% CI, 2.3-3.9). Primary outcomes were evaluation of clinical and biochemical toxicities using National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0, and imaging response using Response Evaluation Criteria in Solid Tumors, version 1.1. Secondary outcomes were time to progression (TTP) and overall survival (OS) as estimated by the Kaplan-Meier method. Results: Clinical Grade 3 toxicities were limited to 1 (6.7%) patient who experienced fatigue, abdominal pain, nausea, and vomiting. Biochemical Grade 3 toxicities occurred in 1 (6.7%) patient who experienced lymphopenia. No Grade 4 clinical or biochemical toxicities were identified. Disease control was achieved in 14 (93.3%) of 15 patients. The median TTP of the treated tumor was 72.9 months (95% CI, 11.2 to no estimate). The median OS was 60.9 months (95% CI, 24.7 to no estimate). Conclusions: 90
MeSH term(s)	Humans ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Treatment Outcome ; Retrospective Studies ; Pneumonectomy ; Liver Neoplasms/pathology ; Yttrium Radioisotopes/adverse effects
Chemical Substances	Yttrium-90 (1K8M7UR6O1) ; Yttrium Radioisotopes
Language	English
Publishing date	2022-12-13
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1137756-2
ISSN	1535-7732 ; 1051-0443
ISSN (online)	1535-7732
ISSN	1051-0443
DOI	10.1016/j.jvir.2022.12.021
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Article ; Online: An Antibody Feeding Approach to Study Glutamate Receptor Trafficking in Dissociated Primary Hippocampal Cultures.

Chiu, Andrew M / Barse, Levi / Hubalkova, Pavla / Sanz-Clemente, Antonio

Journal of visualized experiments : JoVE

2019 , Issue 150

Abstract: Cellular responses to external stimuli heavily rely on the set of receptors expressed at the cell surface at a given moment. Accordingly, the population of surface-expressed receptors is constantly adapting and subject to strict mechanisms of regulation. ...

Abstract	Cellular responses to external stimuli heavily rely on the set of receptors expressed at the cell surface at a given moment. Accordingly, the population of surface-expressed receptors is constantly adapting and subject to strict mechanisms of regulation. The paradigmatic example and one of the most studied trafficking events in biology is the regulated control of the synaptic expression of glutamate receptors (GluRs). GluRs mediate the vast majority of excitatory neurotransmission in the central nervous system and control physiological activity-dependent functional and structural changes at the synaptic and neuronal levels (e.g., synaptic plasticity). Modifications in the number, location, and subunit composition of surface expressed GluRs deeply affect neuronal function and, in fact, alterations in these factors are associated with different neuropathies. Presented here is a method to study GluR trafficking in dissociated hippocampal primary neurons. An "antibody-feeding" approach is used to differentially visualize GluR populations expressed at the surface and internal membranes. By labeling surface receptors on live cells and fixing them at different times to allow for receptors endocytosis and/or recycling, these trafficking processes can be evaluated and selectively studied. This is a versatile protocol that can be used in combination with pharmacological approaches or overexpression of altered receptors to gain valuable information about stimuli and molecular mechanisms affecting GluR trafficking. Similarly, it can be easily adapted to study other receptors or surface expressed proteins.
MeSH term(s)	Animals ; Antibodies/metabolism ; Endocytosis/physiology ; Hippocampus/metabolism ; Neuronal Plasticity/physiology ; Protein Transport/physiology ; Quantum Dots ; Receptors, Glutamate/metabolism ; Receptors, N-Methyl-D-Aspartate/metabolism ; Synaptic Transmission/physiology
Chemical Substances	Antibodies ; Receptors, Glutamate ; Receptors, N-Methyl-D-Aspartate
Language	English
Publishing date	2019-08-02
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Video-Audio Media
ZDB-ID	2259946-0
ISSN	1940-087X ; 1940-087X
ISSN (online)	1940-087X
ISSN	1940-087X
DOI	10.3791/59982
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Article ; Online: COVID-19-induced anosmia associated with olfactory bulb atrophy.

Chiu, Andrew / Fischbein, Nancy / Wintermark, Max / Zaharchuk, Greg / Yun, Paul T / Zeineh, Michael

Neuroradiology

2020 Volume 63, Issue 1, Page(s) 147–148

Abstract: As the global COVID-19 pandemic evolves, our knowledge of the respiratory and non-respiratory symptoms continues to grow. One such symptom, anosmia, may be a neurologic marker of coronavirus infection and the initial presentation of infected patients. ... ...

Abstract	As the global COVID-19 pandemic evolves, our knowledge of the respiratory and non-respiratory symptoms continues to grow. One such symptom, anosmia, may be a neurologic marker of coronavirus infection and the initial presentation of infected patients. Because this symptom is not routinely investigated by imaging, there is conflicting literature on neuroimaging abnormalities related to COVID-19-related anosmia. We present a novel case of COVID-19 anosmia with definitive olfactory bulb atrophy compared with pre-COVID imaging. The patient had prior MR imaging related to a history of prolactinoma that provided baseline volumes of her olfactory bulbs. After a positive diagnosis of COVID-19 and approximately 2 months duration of anosmia, an MRI was performed that showed clear interval olfactory bulb atrophy. This diagnostic finding is of prognostic importance and indicates that the olfactory entry point to the brain should be further investigated to improve our understanding of COVID infectious pathophysiology.
MeSH term(s)	Anosmia/etiology ; Atrophy/diagnostic imaging ; Atrophy/etiology ; COVID-19/complications ; Female ; Humans ; Magnetic Resonance Imaging ; Olfactory Bulb/diagnostic imaging ; Olfactory Bulb/pathology ; Young Adult
Keywords	covid19
Language	English
Publishing date	2020-09-15
Publishing country	Germany
Document type	Case Reports ; Journal Article
ZDB-ID	123305-1
ISSN	1432-1920 ; 0028-3940
ISSN (online)	1432-1920
ISSN	0028-3940
DOI	10.1007/s00234-020-02554-1
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Article: An antibody feeding approach to study glutamate receptor trafficking in dissociated primary hippocampal cultures

Chiu, Andrew M / Barse, Levi / Hubalkova, Pavla / Sanz-Clemente, Antonio

Journal of visualized experiments. 2019 Aug. 02, , no. 150

2019

Abstract	Cellular responses to external stimuli heavily rely on the set of receptors expressed at the cell surface at a given moment. Accordingly, the population of surface-expressed receptors is constantly adapting and subject to strict mechanisms of regulation. The paradigmatic example and one of the most studied trafficking events in biology is the regulated control of the synaptic expression of glutamate receptors (GluRs). GluRs mediate the vast majority of excitatory neurotransmission in the central nervous system and control physiological activity-dependent functional and structural changes at the synaptic and neuronal levels (e.g., synaptic plasticity). Modifications in the number, location, and subunit composition of surface expressed GluRs deeply affect neuronal function and, in fact, alterations in these factors are associated with different neuropathies. Presented here is a method to study GluR trafficking in dissociated hippocampal primary neurons. An "antibody-feeding" approach is used to differentially visualize GluR populations expressed at the surface and internal membranes. By labeling surface receptors on live cells and fixing them at different times to allow for receptors endocytosis and/or recycling, these trafficking processes can be evaluated and selectively studied. This is a versatile protocol that can be used in combination with pharmacological approaches or overexpression of altered receptors to gain valuable information about stimuli and molecular mechanisms affecting GluR trafficking. Similarly, it can be easily adapted to study other receptors or surface expressed proteins.
Keywords	antibodies ; central nervous system ; endocytosis ; glutamate receptors ; neurons ; neuroplasticity ; peripheral nervous system diseases ; protein synthesis
Language	English
Dates of publication	2019-0802
Size	p. e59982.
Publishing place	Journal of Visualized Experiments
Document type	Article
ZDB-ID	2259946-0
ISSN	1940-087X
ISSN	1940-087X
DOI	10.3791/59982
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Association of Pain With Atrial Fibrillation and Delirium After Cardiac Surgery: A DECADE Sub-Study.

Ince, Ilker / Chiu, Andrew / Sagir, Afrin / Chahar, Praveen / Lin, Jia / Douglas, Aaron / Adi, Ahmad / Fang, Jonathan / Mao, Guangmei / Turan, Alparslan

Journal of cardiothoracic and vascular anesthesia

2021 Volume 35, Issue 10, Page(s) 3021–3026

Abstract: Objective: The authors aimed to evaluate the effects of postoperative pain on the incidence of atrial fibrillation and delirium in patients having surgery with cardiopulmonary bypass (CPB).: Design: Post hoc analysis of the (An investigator-initiated, ...

Abstract	Objective: The authors aimed to evaluate the effects of postoperative pain on the incidence of atrial fibrillation and delirium in patients having surgery with cardiopulmonary bypass (CPB). Design: Post hoc analysis of the (An investigator-initiated, multicentre, double-blind trial (ClinicalTrials NCT02004613) (DECADE)), a randomized, placebo-controlled trial. Setting: Tertiary, academic hospital. Participants: Six hundred five adults from the DECADE enrolled at Cleveland Clinic Main Campus, who had had surgery with CPB. Interventions: Dexmedetomidine versus placebo started before surgical incision and postoperatively was maintained until 24 hours. Measurements: Primary outcomes were atrial fibrillation, diagnosed by clinicians in the intensive care unit (ICU), presence of delirium assessed with the Confusion Assessment Method for the ICU, data on pain scores, and opioid consumption, occurring between ICU admission and the earlier of postoperative day five or hospital discharge. Results: Postoperative pain levels were similar among patients with or without atrial fibrillation. Two hundred six (34%) patients had atrial fibrillation and ninety-two (15%) had delirium before hospital discharge within the first five postoperative days. The risk of atrial fibrillation was not significantly different between groups (hazard ratio: 1.09; 97.5% confidence interval [CI]: 0.99, 1.20, p = 0.039); there were no associations between postoperative pain and the risk of postoperative delirium (hazard ratio: 0.96; 97.5% CI: 0.84-1.11; p = 0.57). Postoperative opioid consumption was neither significantly associated with postoperative atrial fibrillation nor delirium. Conclusions: Atrial fibrillation and delirium was not associated with pain after cardiac surgery. Opioid use was not associated with atrial fibrillation and delirium. Because both atrial fibrillation and delirium have a multifactorial nature, further studies should be focused on other plausible mechanisms.
MeSH term(s)	Adult ; Atrial Fibrillation/diagnosis ; Atrial Fibrillation/epidemiology ; Cardiac Surgical Procedures/adverse effects ; Delirium/diagnosis ; Delirium/epidemiology ; Delirium/etiology ; Dexmedetomidine ; Humans ; Pain, Postoperative/diagnosis ; Pain, Postoperative/drug therapy ; Pain, Postoperative/epidemiology
Chemical Substances	Dexmedetomidine (67VB76HONO)
Language	English
Publishing date	2021-05-15
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Randomized Controlled Trial
ZDB-ID	1067317-9
ISSN	1532-8422 ; 1053-0770
ISSN (online)	1532-8422
ISSN	1053-0770
DOI	10.1053/j.jvca.2021.05.013
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Zs.A 2203: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Failure to detect ward hypoxaemia and hypotension: contributions of insufficient assessment frequency and patient arousal during nursing assessments.

Saab, Remie / Wu, Bernie P / Rivas, Eva / Chiu, Andrew / Lozovoskiy, Sofia / Ma, Chao / Yang, Dongsheng / Turan, Alparslan / Sessler, Daniel I

British journal of anaesthesia

2021 Volume 127, Issue 5, Page(s) 760–768

Abstract: Background: Postoperative hypotension and hypoxaemia are common and often unrecognised. With intermittent nursing vital signs, hypotensive or hypoxaemic episodes might be missed because they occur between scheduled measurements, or because the process ... ...

Abstract	Background: Postoperative hypotension and hypoxaemia are common and often unrecognised. With intermittent nursing vital signs, hypotensive or hypoxaemic episodes might be missed because they occur between scheduled measurements, or because the process of taking vital signs arouses patients and temporarily improves arterial blood pressure and ventilation. We therefore estimated the fraction of desaturation and hypotension episodes that did not overlap nursing assessments and would therefore usually be missed. We also evaluated the effect of taking vital signs on blood pressure and oxygen saturation. Methods: We estimated the fraction of desaturated episodes (arterial oxygen saturation <90% for at least 90% of the time within 30 continuous minutes) and hypotensive episodes (MAP <70 mm Hg for 15 continuous minutes) that did not overlap nursing assessments in patients recovering from noncardiac surgery. We also evaluated changes over time before and after nursing visits. Results: Among 782 patients, we identified 878 hypotensive episodes and 2893 desaturation episodes, of which 79% of the hypotensive episodes and 82% of the desaturation episodes did not occur within 10 min of a nursing assessment and would therefore usually be missed. Mean BP and oxygen saturation did not improve by clinically meaningful amounts during nursing vital sign assessments. Conclusions: Hypotensive and desaturation episodes are mostly missed because vital sign assessments on surgical wards are sparse, rather than being falsely negative because the assessment process itself increases blood pressure and oxygen saturation. Continuous vital sign monitoring will detect more disturbances, potentially giving clinicians time to intervene before critical events occur.
MeSH term(s)	Adult ; Aged ; Arousal/physiology ; Blood Pressure/physiology ; Female ; Humans ; Hypotension/diagnosis ; Hypotension/epidemiology ; Hypoxia/diagnosis ; Hypoxia/epidemiology ; Male ; Middle Aged ; Nursing Assessment/methods ; Nursing Assessment/standards ; Oxygen/metabolism ; Postoperative Complications/diagnosis ; Postoperative Complications/epidemiology ; Time Factors ; Vital Signs
Chemical Substances	Oxygen (S88TT14065)
Language	English
Publishing date	2021-07-21
Publishing country	England
Document type	Journal Article
ZDB-ID	80074-0
ISSN	1471-6771 ; 0007-0912
ISSN (online)	1471-6771
ISSN	0007-0912
DOI	10.1016/j.bja.2021.06.014
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Article ; Online: High-resolution hippocampal diffusion tensor imaging of mesial temporal sclerosis in refractory epilepsy.

Chau Loo Kung, Gustavo / Chiu, Andrew / Davey, Zach / Mouchawar, Nicole / Carlson, Mackenzie / Moein Taghavi, Hossein / Martin, Douglas / Graber, Kevin / Razavi, Babak / McNab, Jennifer / Zeineh, Michael

Epilepsia

2022 Volume 63, Issue 9, Page(s) 2301–2311

Abstract: Objective: We explore the possibility of using diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) to discern microstructural abnormalities in the hippocampus indicative of mesial temporal sclerosis (MTS) at the ...

Abstract	Objective: We explore the possibility of using diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) to discern microstructural abnormalities in the hippocampus indicative of mesial temporal sclerosis (MTS) at the subfield level. Methods: We analyzed data from 57 patients with refractory epilepsy who previously underwent 3.0-T magnetic resonance imaging (MRI) including DTI as a standard part of presurgical workup. We collected information about each subject's seizure semiology, conventional electroencephalography (EEG), high-density EEG, positron emission tomography reports, surgical outcome, and available histopathological findings to assign a final diagnostic category. We also reviewed the radiology MRI report to determine the radiographic category. DTI- and NODDI-based metrics were obtained in the hippocampal subfields. Results: By examining diffusion characteristics among subfields in the final diagnostic categories, we found lower orientation dispersion indices and elevated axial diffusivity in the dentate gyrus in MTS compared to no MTS. By similarly examining among subfields in the different radiographic categories, we found all diffusion metrics were abnormal in the dentate gyrus and CA1. We finally examined whether diffusion imaging would better inform a radiographic diagnosis with respect to the final diagnosis, and found that dentate diffusivity suggested subtle changes that may help confirm a positive radiologic diagnosis. Significance: The results suggest that diffusion metric analysis at the subfield level, especially in dentate gyrus and CA1, maybe useful for clinical confirmation of MTS.
MeSH term(s)	Diffusion Tensor Imaging/methods ; Drug Resistant Epilepsy/diagnostic imaging ; Drug Resistant Epilepsy/pathology ; Drug Resistant Epilepsy/surgery ; Epilepsy, Temporal Lobe/diagnostic imaging ; Epilepsy, Temporal Lobe/pathology ; Epilepsy, Temporal Lobe/surgery ; Hippocampus/pathology ; Humans ; Sclerosis/diagnostic imaging ; Sclerosis/pathology
Language	English
Publishing date	2022-06-25
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	216382-2
ISSN	1528-1167 ; 0013-9580
ISSN (online)	1528-1167
ISSN	0013-9580
DOI	10.1111/epi.17330
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Article: COVID-19-induced anosmia associated with olfactory bulb atrophy

Chiu, Andrew / Fischbein, Nancy / Wintermark, Max / Zaharchuk, Greg / Yun, Paul T / Zeineh, Michael

Neuroradiology

Abstract	As the global COVID-19 pandemic evolves, our knowledge of the respiratory and non-respiratory symptoms continues to grow. One such symptom, anosmia, may be a neurologic marker of coronavirus infection and the initial presentation of infected patients. Because this symptom is not routinely investigated by imaging, there is conflicting literature on neuroimaging abnormalities related to COVID-19-related anosmia. We present a novel case of COVID-19 anosmia with definitive olfactory bulb atrophy compared with pre-COVID imaging. The patient had prior MR imaging related to a history of prolactinoma that provided baseline volumes of her olfactory bulbs. After a positive diagnosis of COVID-19 and approximately 2 months duration of anosmia, an MRI was performed that showed clear interval olfactory bulb atrophy. This diagnostic finding is of prognostic importance and indicates that the olfactory entry point to the brain should be further investigated to improve our understanding of COVID infectious pathophysiology.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #757901
Database	COVID19

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Article ; Online: COVID-19-induced anosmia associated with olfactory bulb atrophy

Chiu, Andrew / Fischbein, Nancy / Wintermark, Max / Zaharchuk, Greg / Yun, Paul T. / Zeineh, Michael

Neuroradiology ; ISSN 0028-3940 1432-1920

2020

Keywords	Radiology Nuclear Medicine and imaging ; Clinical Neurology ; Cardiology and Cardiovascular Medicine ; covid19
Language	English
Publisher	Springer Science and Business Media LLC
Publishing country	us
Document type	Article ; Online
DOI	10.1007/s00234-020-02554-1
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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