Search

Systemic juvenile idiopathic arthritis–associated lung disease (SJIA‐LD) is a life‐threatening disease complication. Key questions remain regarding clinical course and optimal treatment approaches. The objectives of the study were to detail management strategies after SJIA‐LD detection, characterize overall disease courses, and measure long‐term outcomes. This was a prospective cohort study. Clinical data were abstracted from the electronic medical record, including current clinical status and changes since diagnosis. Serum biomarkers were determined and correlated with presence of LD. We enrolled 41 patients with SJIA‐LD, 85% with at least one episode of macrophage activation syndrome and 41% with adverse reactions to a biologic. Although 93% of patients were alive at last follow‐up (median 2.9 years), 37% progressed to requiring chronic oxygen or other ventilator support, and 65% of patients had abnormal overnight oximetry studies, which changed over time. Eighty‐four percent of patients carried the HLA‐DRB1*15 haplotype, significantly more than patients without LD. Patients with SJIA‐LD also showed markedly elevated serum interleukin‐18 (IL‐18), variable C‐X‐C motif chemokine ligand 9 (CXCL9), and significantly elevated matrix metalloproteinase 7. Treatment strategies showed variable use of anti–IL‐1/6 biologics and addition of other immunomodulatory treatments and lung‐directed therapies. We found a broad range of current clinical status independent of time from diagnosis or continued biologic treatment. Multidomain measures of change showed imaging features were the least likely to improve with time. Patients with SJIA‐LD had highly varied courses, with lower mortality than previously reported but frequent hypoxia and requirement for respiratory support. Treatment strategies were highly varied, highlighting an urgent need for focused clinical trials.

Background:Many health care organizations offer pediatric infusions in outpatient infusion centers or, as in our organization, in a hospital-based outpatient Pediatric Infusion Therapy Center (PITC). When restrictions related to the COVID-19 pandemic decreased our PITC appointment capacity by 40%, other patient and family satisfaction issues were exacerbated. We implemented a new approach to pediatric infusions with the aim of improving patient and family satisfaction and reducing the amount of time in an appointment itinerary without negatively affecting patient safety. Methods:Our team used a phased approach to pilot the administration of short chemotherapy infusions in the same outpatient clinic examination rooms where consultation and routine office visits were conducted. Patients saw their specialist for an examination and, if clinically indicated, their infusion was administered in the same room. Appointment itineraries were then completed. The team tracked efficiency, satisfaction, and safety metrics related to the new process. Results:All efficiency metrics improved. No harm came to the 49 unique patients who received a total of 184 infusions. Patient appointment itineraries were shortened by an average of 1.03 hr. Satisfaction survey responses indicated a clear preference (93%) for the new process. Discussion:The novel approach of offering short infusions in outpatient clinic examination rooms provides an opportunity to ease capacity constraints and further increase patient and family satisfaction. This method may be especially helpful for health care organizations when external influences (e.g., lack of physical space, challenging patient volumes, and pandemics) necessitate a change.

To characterize the incidence and prevalence of childhood‐onset systemic lupus erythematosus (SLE), and to estimate the proportion of patients who are diagnosed with SLE during childhood. A cohort of patients with incident childhood‐onset SLE from 1976 to 2018 from an 8‐county region in the US were identified based on comprehensive medical record review. All patients met the European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) classification criteria for SLE or the ACR SLE classification criteria from 1997 at or before age 18 years. Incidence rates were estimated using Poisson methods. We estimated the childhood‐onset SLE point prevalence for January 1, 2015. Results were sex and age adjusted to the US 2000 population. Among all the SLE patients living in the 8‐county region on January 1, 2015, the proportion of patients diagnosed at ≤18 years was estimated. A total of 13 children were diagnosed with childhood‐onset SLE during the study period (using the EULAR/ACR definition; mean age at diagnosis 15.1 years, 85% female, 69% White). Childhood‐onset SLE overall adjusted incidence rate was 0.7 (95% confidence interval [95% CI] 0.2–1.1) per 100,000 children. The incidence rate in girls was 1.2 (95% CI 0.5–1.9) per 100,000 children, while in boys it was 0.2 (95% CI 0.0–0.5) per 100,000. The adjusted prevalence of childhood‐onset SLE was 1.1 (95% CI 0.0–3.1) per 100,000 children. The proportion of patients with SLE diagnosed as children was 9% (95% CI 6–13%). In this population‐based study, both the incidence and prevalence rates of childhood‐onset SLE were ~1 per 100,000 children. One in 10 adults with SLE was diagnosed in childhood. More studies are needed to further characterize the epidemiology of childhood‐onset SLE in minorities.

Multiple Sclerosis (MS), an autoimmune disorder associated with spinal cord and brain, chiefly affects the white matter. Regarding the complexity as well as heterogenic etiology of this disease, the treatment of MS has been a challenging issue up to now. Researchers are working to develop new therapeutic strategies and drugs as complementary therapies. MS diagnosis significantly depends on the findings of Magnetic Resonance Imaging (MRI) examination. In this imaging technique, gadolinium is used as a contrast agent to reveal active plaques intending to destroy the bloodbrain barrier. It also detects plaques that are not correlated with the neurological symptoms. It has been attempted to determine biomarkers related to different dimensions of MS in various organizational hierarchy levels of the human anatomy (i.e., cells, proteins, RNA, and DNA). These biomarkers are appropriate diagnostic tools for MS diagnosis. In this review, we summarized the application of MRI and biochemical biomarkers to monitor MS patients. Moreover, we highlighted the joint application of MRI and biomarkers for the diagnosis of MS subjects.

Dimpleplasty is the surgical creation of dimples on the face for aesthetic purposes. Dimples have been associated with a sign of beauty and even good fortune in some cultures and have also found themselves in Western cultures. Since the first described procedure of cheek dimple creation in 1962, there have been multiple studies on the topic. The aim of this article is to review the literature on the anatomy, creation, postoperative care, and complications associated with cheek dimpleplasty. The authors performed a literature review that focused on cheek dimpleplasty. EMBASE, Cochrane Library, Ovid Medicine, MEDLINE, Google Scholar, and PubMed databases were searched from its inception to July 2019. Peer-reviewed articles published in the English language were included. Our search in the various databases yielded multiple publications. There were different described techniques published on the determination of the ideal site for a cheek dimple. There were also multiple procedures described for the creation of cheek dimples. The basic tenet of cheek dimple creation is to create an adhesion between the dermis and buccinator muscle to create a dynamic dimple which is present on facial animation. Multiple procedures have been reported with few reported complications. Patient satisfaction is dependent on appropriate determination of the site and morphology of the dimple. Most of the complications associated with cheek dimple creation are minor, easily managed, and avoided by understanding the regional anatomy and attention to meticulous surgical technique.

Transversus abdominis plane (TAP) block is used in abdominoplasties for postoperative pain control. There has been no systematic review and meta-analysis of its use reported in the literature. The authors performed a systematic review that focused on the use of TAP block in abdominoplasties. EMBASE, Cochrane Library, Ovid Medicine, MEDLINE, Google Scholar, and PubMed databases were searched from its inception to April 2019. Peer-reviewed articles published in the English language were included. The efficacy of TAP block was determined from a review of the reported studies. The authors’ search retrieved 30 unique articles. Two independent reviewers screened texts, selecting 6 articles for inclusion. Of the included studies, 3 were randomized controlled studies, 1 was a prospective controlled study, 1 was a retrospective cohort study, and 1 was a prospective nonrandomized uncontrolled study. The level of evidence of included studies ranges from level II to level III. There were no level I studies. All of the studies concluded that TAP block was more effective in controlling pain and decreasing narcotic use compared with controls. There was significant heterogeneity in the method of administration, compositions, and dosage of the TAP block. The TAP block provides effective analgesia after abdominoplasty and reduces the use of opioids. However, its effectiveness seems to be limited to the first few postoperative hours. More studies are needed to evaluate for the optimum dosing and mode of delivery of the anesthetic.

AbstractBackground:Post-stroke depression (PSD) is the most frequent psychiatric complication following ischemic stroke. It affects up to 60% of all patients and is associated with increased morbidity and mortality following ischemic stroke. The pathophysiology of PSD remains elusive and appears to be multifactorial, rather than “purely” biological or psychosocial in origin. Thus, valid animal models of PSD would contribute to the study of the etiology (and treatment) of this disorder. Methods:The present study depicts a rat model for PSD, using middle cerebral artery occlusion (MCAO). The two-way shuttle avoidance task, Porsolt forced-swim test, and sucrose preference test were employed to assess any depression-like behavior. Localized brain expressions of brain-derived neurotrophic factor (BDNF) protein levels were evaluated to examine the possible involvement of the brain neuronal plasticity in the observed behavioral syndrome. The raw data were subjected to unsupervised fuzzy clustering (UFC) algorithms to assess the sensitivity of bio-behavioral measures indicative of depressive symptoms post MCAO. Results: About 56% of the rats developed significant depressive-like behavioral disruptions as a result of MCAO compared with 4% in the sham-operated control rats. A pattern of a depressive-like behavioral response was common to all affected MCAO animals, characterized by significantly more escape failures and reduced number of total avoidance shuttles, a significant elevation in immobility duration, and reduced sucrose preference. Significant downregulations of BDNF protein levels in the hippocampal sub-regions, frontal cortex, and hypothalamus were observed in all affected MCAO animals. Conclusion:The UFC analysis supports the behavioral analysis and thus, lends validity to our results.

ABSTRACTMicroRNAs are short RNA molecules that regulate function and stability of a large subset of eukaryotic mRNAs. In the main pathway of microRNA biogenesis, a short “hairpin” is excised from a primary transcript by ribonuclease DROSHA, followed by additional nucleolytic processing by DICER and inclusion of the mature microRNA into the RNA-induced silencing complex. We report that a microRNA-like molecule is encoded by human DROSHA gene within a predicted stem-loop element of the respective transcript. This putative mature microRNA is complementary to DROSHA transcript variant 1 and can attenuate expression of the corresponding protein. The findings suggest a possibility for a negative feedback loop, wherein DROSHA processes its own transcript and produces an inhibitor of its own biosynthesis.

In this paper, we consider a flight control problem subjected to actuator anomalies. We propose a shared control architecture that includes actions of both a human pilot and an adaptive autopilot that achieves bumpless performance while retaining a Capacity for Maneuver (CfM) following the anomaly. The shared controller distributes the critical tasks of anomaly perception and adaptation between a human pilot and an adaptive autopilot to best utilize their individual strengths. The human pilot’s expertise in detection and perception of anomaly is utilized to determine an initial estimate of the plant parameters. An adaptive autopilot then carries out further tuning of the controller to minimize the tracking error while retaining a certain CfM. The shared controller is evaluated in simulation study of an F-8 aircraft under actuator anomalies and shown to be advantageous compared to a fixed-gain fault tolerant controller.

India and China collectively represents an important economic polarity in the contemporary world. Together with substantial economic growth and improvement in other developmental indicators, they provide increased stability to the global economic and political order. As expected, a large part of this substantial economic growth is driven by substantial energy needs. Although there has been substantial decoupling of energy and economic growth, the nature and character of this decoupling is a matter of concern for policymakers and politicians alike. The more significant bulwark that is navigating choices for energy has been due to the concern for the environment- local and global (climate change). It would be interesting to assess these choices (energy and environmental; particularly with response to challenges posed due to climate change) between India and China in a comparative framework. Through studying recent energy and climate change and related policy documents in India and China, this paper seeks to answer the following questions: (i) Development of a comparative analytic framework and its various dimensions, to critically assess energy and climate change policies.(ii) What lessons can be learnt from the recent experiences in the two countries? (iii)What are the critical areas/dimensions of development co-operation between India and China; particularly in the domain of energy and climate change sectors? This paper aims to contextualize contemporary debate on India and China's energy and climate change policy and aims to contribute to the literature that attempts to characterize the future role in arresting incremental damages due to the contemporary climate change through increased GHG (Green House Gas) emissions.

OBJECTIVE To determine whether a new surgical clamp reduces unfavorable postoperative outcomes. METHODS Patients with trachomatous trichiasis (TT) were randomized to surgery with standard bilamellar tarsal rotation (BLTR) instrumentation or the TT clamp and were followed up for 2 years. MAIN OUTCOME MEASURES Postoperative TT, pyogenic granuloma formation, and eyelid contour abnormalities, combined and individually. RESULTS A total of 1917 participants who had surgery (3345 eyes) were enrolled. Rates of at least 1 unfavorable outcome were similar for the participants who underwent surgery with the TT clamp and those who underwent surgery with standard BLTR (60.9% vs 63.0%, respectively; adjusted odds ratio [AOR] = 0.88; 95% CI, 0.66-1.18). Granuloma was less common in the TT clamp arm than in the standard BLTR arm (16.8% vs 22.4%, respectively; AOR = 0.67; 95% CI, 0.46-0.97). There was a trend toward increased postoperative TT in the TT clamp arm compared with the standard BLTR arm (43.2% vs 36.6%, respectively; AOR = 1.36; 95% CI, 0.96-1.93). The TT clamp decreased the risk of mild eyelid contour abnormalities compared with standard BLTR (9.1% vs 13.3%, respectively; AOR = 0.64; 95% CI, 0.42-0.97) and showed a trend for a decrease in moderate abnormalities (5.3% vs 7.8%, respectively; AOR = 0.63; 95% CI, 0.39-1.01). CONCLUSIONS Overall, rates of unfavorable outcomes were similar between groups. Although our results are similar to other programmatic settings, such high rates of unfavorable outcomes are unacceptable; future research is needed to identify ways to improve TT surgery outcomes. APPLICATION TO CLINICAL PRACTICE A new clamp for TT surgery appears to offer protection against granuloma formation and some eyelid contour abnormalities, but it does not reduce postoperative TT. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00886015

The World Health Organization has endorsed the bilamellar tarsal rotation procedure to correct blinding trachomatous trichiasis. Our field observations of bilamellar tarsal rotation have revealed some significant departures from this procedure as described in the World Health Organization manual. We designed the trachomatous trichiasis clamp to address the shortcomings of the standard instrumentation and to help nonphysicians perform the procedure more safely, reproducibly, and successfully. The trachomatous trichiasis clamp standardizes several aspects of the surgical technique that are not always performed consistently, providing guides for correct clamp and incision placement. A full-thickness eyelid incision can be made and sutures placed in a bloodless field. Two surgical technicians tested the trachomatous trichiasis clamp in 10 patients and found that it was easier to use, shortened surgery time, allowed straighter and more precisely placed incisions, and offered excellent protection for the eye.

In university hospitals, free tissue transfer has become a standard method of reconstruction for a broad spectrum of defects. Because of its complexity, free tissue transfer has not been routinely performed in a community hospital setting. This study reports the outcomes of two equal groups of free tissue transfer performed by the same surgeons, comparing the university versus the community hospital setting.

To assess the accuracy of an automated system (Morpheus I Sleep Scoring System) for analyzing and quantifying polysomnographic data from a population with sleep-disordered breathing.

In this work, we use the extrapolation methods to study the existence and the uniqueness of bounded and almost periodic, asymptotic almost periodic, pseudo almost periodic and Eberlein-weak almost periodic solutions to hyperbolic Cauchy problems for Hille-Yosida operators d/dtx(t) = Ax(t) + f(t), t ∈ R, when the inhomogeneities f take their values in the extrapolated Favard class corresponding to A.

A neural network model with dynamic thresholds, asymmetric connections, and clustered memories simulates spread activation that is hypothesized for semantic networks in the brain. By altering the parameters of the dynamic threshold a large range of disturbances can be generated in the model. These disturbances show metaphorical resemblance to certain general clinical descriptions of mental disturbances found in psychiatric patients engaged in various cognitive tasks. Even though the model is highly theoretical and metaphoric, it may help to gain certain insights into the relation between alterations of certain neural parameters, for example, thresholds and connectivity, and clinical symptoms in patients. (JINS, 2000, 6, 608–619.)

One of the most fascinating aspects of brain research is the subject of language. As in many other cases, the malfunctions that occur in different persons for various reasons give us insight on the mechanisms that support our ability to talk, read and listen. Following the work of Plaut and associates, we deal with the dyslexia disorder, which is the overall name for a large number of reading disorders. A Boltzmann machine neural network scheme was trained to implement the nonlinear mapping task of graphic representation into semantic representation, which may model the brain sections responsible for the translation of a written word into meanings and syllables. After training, various types of lesions were applied and the performance of the network was tested in order to measure the effect of each lesion on the error rate and type distribution that were detected. The system's errors were classified into several categories and the distribution of errors between the categories was studied. Using the simulations, it is demonstrated that a finite scheduling process in the Boltzmann machine causes the distribution of the network's errors to be unique and different from its expected error distribution. The phenomenon is given a mathematical explanation rooted in the statistical mechanics basics of the Boltzmann machine. Test results suggest the localization of certain reading functions within the network. Comparison is made to relevant types of dyslexia and shows resemblance in major symptoms as well as in certain known side effects. (JINS, 2000, 6, 620–626.)

Purpose: Postoperative nausea and vomiting (PONV) is a distressing adverse effect of general anaesthesia. The aim of the current study was to compare the antiemetic activity of different 5-hydroxytryptamine3receptor antagonists with that of metoclopramide and placebo. Methods: In a prospective, randomized, double-blind study we have compared the antiemetic activity of the prophylactic administration of ondansetron 4 mg, tropisetron 5 mg and granisetron 3 mg with that of metoclopramide 10 mg and placebo in 132 patients undergoing laparoscopic cholecystectomy. All study drugs and placebo were given as a short iv infusion ten minutes before the induction of anaesthesia. Perioperative anaesthetic care was standardized in all patients. Nausea and vomiting were assessed by direct questioning of the patient at 1, 4, 9, 12, 18 and 24 hr after recovery from anaesthesia. If patients experienced nausea and/or vomiting, rescue antiemetic treatment (metoclopramide 10 mg iv) was administered. Results: For the 24-hr recovery period after surgery, the percentages of emesis-free patients were 65.5%, 52%, 48%, 29.2% and 27.6% in the ondansetron, granisetron, tropisetron, metoclopramide and placebo groups, respectively. Prophylactic antiemetic treatment with ondansetron resulted in a lower incidence (P = 0.02) of PONV than with metoclopramide or placebo. The times at which rescue antiemetic was first received were longer (P < 0.01) in ondansetron group than in the placebo and metoclopramide groups. There were no statistical differences between ondansetron, tropisetron and granisetron groups. Conclusions: Ondansetron, when given prophylactically resulted in a significantly lower incidence of PONV than metoclopramide and placebo. Metoclopramide was ineffective.

The approximate theory of ELF propagation in the Earth-ionosphere transmission line described by Booker (1980) is applied to a simplified worldwide model of the D and E regions, and of the Earth's magnetic field. At 1000 Hz by day, reflection is primarily from the gradient on the underside of the D region. At 300 Hz by day, reflection is primarily from the D region at low latitudes, but it is from the E region at high latitudes. Below 100 Hz by day, reflection is primarily from the gradient on the underside of the E region at all latitudes. By night, reflection from the gradient on the topside of the E region is important. There is then a resonant frequency (~ 300 Hz) at which the optical thickness of the E region for the whistler mode is half a wavelength. At the Schumann resonant frequency in the Earth-ionosphere cavity (~ 8 Hz) the nocturnal E region is almost completely transparent for the whistler mode and is semi-transparent for the Alfvén mode. Reflection then takes place from the F region. ELF propagation in the Earth-ionosphere transmission line by night is quite dependent on the magnitude of the drop in ionization density between the E and F regions. Nocturnal propagation at ELF therefore depends significantly on an ionospheric feature whose magnitude and variability are not well understood. A comparison is made with results based on the computer program of the United States Naval Ocean Systems Center.

A 31-year-old woman at 32 weeks' gestation presented with an ST segment elevation myocardial infarction with subsequent bare metal stent placement. A multidisciplinary team coordinated the delivery plan, including anticoagulation and delivery mode. Because the patient was at high risk for stent thrombosis, clopidogrel was discontinued after 4 weeks and bridged with eptifibatide for 7 days. Eptifibatide was stopped for induction of labor. Twelve hours after eptifibatide was discontinued, hemostatic function was assessed with thromboelastography before initiating neuraxial analgesia. A successful operative vaginal delivery was performed, followed by an uncomplicated recovery. Clopidogrel was resumed 24 hours postpartum.