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Purpose: The aim of this study was to characterize antibiotic prophylaxis practices in pediatric patients who have received posterior arthrodesis for spinal deformity and understand how these practices impact 30-day postoperative infection rates. Methods: This was a retrospective cohort study using the National Surgical Quality Improvement Program Pediatric database for year 2021. Patients 18 years of age or younger who received posterior arthrodesis for scoliosis or kyphosis correction were included. The outcome of interest was 30-day postoperative infection. Fisher’s exact test and multivariable regression analysis were used to analyze the impact of intravenous antibiotic prophylaxis, intraoperative intravenous antibiotic redosing after 4 h, postoperative antibiotic prophylaxis, intraoperative topical antibiotics on 30-day postoperative infection, and various antibiotic prophylaxis regimens. Results: A total of 6974 patients were included in this study. The 30-day infection rate was 2.9%. Presurgical intravenous antibiotic (11.5% vs. 2.7%, p= 0.005), postoperative antibiotic (5.7% vs. 2.4%, p< 0.01), and intraoperative topical antibiotic (4.0% vs. 2.7%, p= 0.019) were associated with significantly reduced infection rates. There was no significant difference in infection rates between patients that received cefazolin versus vancomycin versus clindamycin. The addition of Gram-negative coverage did not result in significant differences in infection rates. Multivariable regression analysis found postoperative intravenous antibiotics and intraoperative topical antibiotics to reduce infection rates. Conclusions: We found the use of presurgical intravenous antibiotics, postoperative intravenous antibiotics, and intraoperative topical antibiotics to significantly reduce infection rates. Results from this study can be applied to future research on implementation of standardized infection prevention protocols. Level of evidence: Level II.

Based on real-world data, we developed a 10-year prediction model to estimate the burden among patients with depression from the public healthcare system payer's perspective to inform early resource planning in Hong Kong.

Transitional age youth with a history of mood disorders, such as major depressive disorder, are uniquely vulnerable to clinical destabilization and relapse in the context of life transition. Moving from a structured adolescence to a more independent and potentially more demanding young adult life can result in worsening symptoms and barriers to effective help-seeking. Transitional age youth newly diagnosed are exposed to their first course of treatment of a potentially chronic condition. This article describes the challenges inherent in navigating this life transition, and also offers strategies to promote a successful “launch” into adulthood.

Purpose: This article examines how individual, school, and social factors shape the perceptions of students in Senior Secondary Three (SS3; in some schools called Form Six [F6]) toward English private tutoring in Macao.Design/Approach/Methods: This is a comparative study of two F6 classes of an English-medium secondary school and four SS3 classes of a Chinese-medium secondary school in Macao, with a total number of 145 students. Mixed-methods approach (questionnaires and interviews) is employed in the study.Findings: The respondents’ participation in English tutoring is not very intensive. They prefer to receive government-subsidized after-school tutoring taught by their schoolteachers more than fee-paying English tutoring taught by tutors outside. Low level of social competition and high tertiary enrollment rates contribute to this phenomenon. Students’ needs and beliefs in English learning play key roles in determining their receipt of English tutoring.Originality/Value: Teachers may need better understanding of their students’ needs so as to design suitable pedagogies. Schools can consider more fully the types of tutoring that they provide for different kinds of pupils. The government-subsidized after-school tutoring could be a plausible way to reduce educational inequality.

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This article reviews the current state of diagnosis and treatment of schizophrenia, describing the recent proliferation of research in high-risk psychosis spectrum conditions, which are different from childhood-onset and early onset schizophrenia, and findings of psychotic-like experiences in the normal population. Taken from adult and childhood literature, clinical quandaries in accurate diagnosis, and treatment gaps in co-occurring, or sometimes confounding, conditions are discussed. Thoughts on the impact of schizophrenia on an emerging adulthood trajectory are offered. Recent best practices in the treatment of schizophrenia are consistent with a recovery-oriented model of mental health services for transitional age youth.

The purpose of this article is to determine the effectiveness of a hands-on continuing education program for practicing child and adolescent psychiatrists (CAPs) with a focus on best practices in transitioning psychiatric patients to college. The plan was to build on the unique knowledge and skill set of CAPs, use audience and facilitator feedback from prior programs to inform program content, structure, and format, and incorporate findings from the evolving literature. A 3-h interactive workshop was designed with an emphasis on audience participation. The workshop was divided into three main segments: didactics, whole group discussion/brainstorming, and small group discussion of illustrative case vignettes. Improvements and changes in knowledge, skills, and attitudes related to transition planning were identified by program participants. Quantitative feedback in the form of course evaluations, pre- and posttests, and a 6-month follow-up questionnaire indicate that the use of interactive teaching techniques is a productive learning experience for practicing CAPs. Qualitative feedback was that the discussion of the case vignettes was the most helpful. The use of a workshop format is an effective strategy to engage practicing CAPs in learning about and implementing best practices to support the transition of their patients to college and into young adulthood. Comprehensive and proactive transition planning, facilitated by clinicians, should promote the wellness of college-bound patients and help to reduce the potential risks in the setting of an upcoming transition.

Few studies investigated the mechanisms of treatment-resistant depression (TRD) leading to the worsened survival outcome, and economic evidence was mostly restricted to short follow-ups. We aimed to examine the association and potential mediators between TRD and all-cause mortality, and estimate a longer-term associated health resource utilisation pattern.

Objective: To evaluate the effects and side effects of both inactivated and mRNA COVID-19 vaccines in patients with systemic lupus erythematosus (SLE).Methods: This was a prospective, single-center, observational study. Patients with SLE planning to receive COVID-19 vaccines were recruited and matched 1:1 with healthy controls. The immunogenicity of the COVID-19 vaccines was assessed by a surrogate neutralization assay at 28 days after the second dose. The main outcome was the antibody response comparing SLE patients and controls. Other outcomes included reactogenicity, disease activity and predictors of antibody responses in patients with SLE.Results: Sixty-five SLE patients received 2 doses of COVID-19 vaccines (Comirnaty: 38; CoronaVac: 27) were recruited. Many of them were on systemic glucocorticoids (76%) and immunosuppressants (55%). At day 28 after the second dose of vaccines, 92% (Comirnaty: 100% vs CoronaVac: 82%, p= 0.01) of the patients had positive neutralizing antibody. However, compared to the age, gender, vaccine type matched controls, the level of neutralizing antibody was significantly lower (p< 0.001). The self-reported adverse reactions after vaccines in lupus patients were common but mild, and were more frequent in the Comirnaty group. There was no significant change in lupus disease activity up to 28 days after vaccination. The independent predictors of neutralizing antibody level included the dosage of systemic glucocorticoids, use of mycophenolate and type of vaccines.Conclusions: COVID-19 vaccines produced satisfactory but impaired humoral response in SLE patients compared to controls which was dependent on the immunosuppressive medications use and type of vaccines received. There was no new short-term safety signal noted. Booster dose is encouraged.

This study validated a Perceived Campus Caring Scale with 1,520 university students. Using factor analysis, seven factors namely, Faculty Support, Nonfaculty Support, Peer Relationship, Sense of Detachment, Sense of Belonging, Caring Attitude, and Campus Involvement, are identified with high reliability, validity, and close correlation with the Satisfaction With Life Scale.

This study validated a Perceived Campus Caring Scale with 1,520 university students. Using factor analysis, seven factors namely, Faculty Support, Nonfaculty Support, Peer Relationship, Sense of Detachment, Sense of Belonging, Caring Attitude, and Campus Involvement, are identified with high reliability, validity, and close correlation with the Satisfaction With Life Scale.

The present study estimated the population pharmacokinetics of lamotrigine in patients receiving oral lamotrigine therapy with drug concentration monitoring, and determined intersubject and intrasubject variability. A total of 129 patients were analyzed from two clinical sites. Of these, 124 patients provided sparse data (198 concentration–time points); nine patients (four from a previous group plus five from the current group) provided rich data (431 points). The population analysis was conducted using P-PHARM™ (SIMED Scientific Software, Cedex, France), a nonlinear mixed-effect modeling program. A single exponential elimination model (first-order absorption) with heteroscedastic weighting was used. Apparent clearance (CL/F) and volume of distribution (V/F) were the pharmacokinetic parameters estimated. Covariate analysis was performed to determine which factors explained any of the variability associated with lamotrigine clearance. Population estimates of CL/F and V/F for lamotrigine generated in the final model were 2.14 ± 0.81 L/h and 78.1 ± 5.1 L/kg. Intersubject and intrasubject variability for clearance was 38 and 38, respectively. The covariates of concomitant valproate and phenytoin therapy accounted for 42 of the intersubject variability of clearance. Age, gender, clinic site, and other concomitant antiepileptic drugs did not influence clearance. This study of the population pharmacokinetics of lamotrigine in patients using the drug clinically provides useful data and should lead to better dosage individualization for lamotrigine.

Dendritic cells (DC) take up antigen from the periphery and migrate to the lymphoid organs where they present the processed antigens to T cells. The propensity of DC to migrate changes during DC maturation and is probably dependent on alterations in the expression of chemokine receptors on the surface of DC. Secondary lymphoid tissue chemokine (SLC), a recently discovered chemokine for nai¨ve T cells, is primarily expressed in secondary lymphoid organs and may be important for colocalizing T cells with other cell types important for T-cell activation. We show here that SLC is a potent chemokine for mature DC but does not act on immature DC. SLC also induced calcium mobilization specifically in mature DC. SLC and Epstein-Barr virus–induced molecule 1 ligand chemokine completely cross-desensitized the calcium response of each other, indicating that they share similar signaling pathways in DC. The finding that SLC is a potent chemokine for DC as well as nai¨ve T cells suggests that it plays a role in colocalizing these two cell types leading to cognate T-cell activation.

Dendritic cells (DC) take up antigen from the periphery and migrate to the lymphoid organs where they present the processed antigens to T cells. The propensity of DC to migrate changes during DC maturation and is probably dependent on alterations in the expression of chemokine receptors on the surface of DC. Secondary lymphoid tissue chemokine (SLC), a recently discovered chemokine for naïve T cells, is primarily expressed in secondary lymphoid organs and may be important for colocalizing T cells with other cell types important for T-cell activation. We show here that SLC is a potent chemokine for mature DC but does not act on immature DC. SLC also induced calcium mobilization specifically in mature DC. SLC and Epstein-Barr virus–induced molecule 1 ligand chemokine completely cross-desensitized the calcium response of each other, indicating that they share similar signaling pathways in DC. The finding that SLC is a potent chemokine for DC as well as naïve T cells suggests that it plays a role in colocalizing these two cell types leading to cognate T-cell activation.

AbstractThe TNF family is involved in the regulation of the immune system, and its members have been implicated in a variety of biological events such as apoptosis, cell proliferation, differentiation and survival. Here we present a new member of the TNF family, tumor necrosis factor super family member 20 (TNFSF20) that we have identified from the expressed sequence tag (EST) database and characterized. The human protein is a 285 amino acid long type II transmembrane protein and is 19% homologous to TNF in its extra-cellular domain. TNFSF20 is expressed at the surface of antigen presenting cells such as cells of the macrophagemonocyte lineage and dendritic cells. After treatment with bacterial lipopolysaccharide (LPS), TNFSF20 expression is downregulated at the surface of the expresssing cells, suggesting that the membrane-bound protein gets cleaved, and that a soluble factor is released in the extra-cellular compartment. The soluble form of the recombinant TNFSF20 induces proliferation of resting peripheral blood monocytes (PBMC) and cell death of activated lymphocytes. TNFSF20 might therefore play a critical role in the regulation of cell-mediated immune responses.

The function of Lyn in B cell activation has been studied recently by examining the properties of B cells from mice in which thelyngene has been inactivated by gene targeting. These mice show evidence of B cell hyperreactivityin vivo,as the number of B lymphoblastoid cells greatly increase with age, IgM levels increase by 10-fold or more, and auto- antibodies to double-stranded DNA and other nuclear antigens become apparent. B cells fromlyn−/−mice also exhibit enhanced BCR-induced activation of MAP kinases, intracellular calcium elevation and proliferative responsesin vitro.Thes e phenomena may relate to participation of Lyn in events that serve to decrease B cell responses to antigen. Among the leading candidates for these suppressive events are the inhibition of B cell antigen receptor function by FcγRIIb1 and by CD22. Although Lyn also participates positively in the initial events of B cell antigen receptor signal transduction, this function can also be supplied by other tyrosine kinases, presumably other Src-family kinases. In contrast, some aspects of inhibition by CD22 appear to be almost completely dependent upon Lyn and FcγRIIb1 inhibition is also diminished in the absence of Lyn. Thus, the net effect of Lyn action is negative rather than positive for B cell activation.

Human thrombin is inactivated by 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (EDC) or 1-ethyl-3-(4-azonia-4,4-dimethylpentyl)carbodiimide (EAC) by a second order process. A plot of the pseudo-first order rate constant for inactivation by 20 mM EDC at different pH values from 4.2 to 7.7 at 25°C shows that this inactivation is due to the modification of a protonated carboxyl with a p Kaof 5.6. The rate of inactivation by EDC at pH 6.0 is reduced, but not eliminated by saturating levels of the competitive inhibitor dansyl-L-arginine N-(3-ethyl-1,5-pentanediyl)amide, suggesting that the essential carboxyl modified is one other than Asp-189 in the substrate specificity pocket of thrombin. Complete inactivation by 14C-EAC correlates with the incorporation of approximately 2.5–3 EACs per thrombin.

Human thrombin is inactivated by 1‐ethyl‐3‐(3‐dimethylaminopropyl)carbodiimide (EDC) or 1‐ethyl‐3‐(4‐azonia‐4,4‐dimethylpentyl)carbodiimide (EAC) by a second order process. A plot of the pseudo‐first order rate constant for inactivation by 20 mM EDC at different pH values from 4.2 to 7.7 at 25°C shows that this inactivation is due to the modification of a protonated carboxyl with a pKaof 5.6. The rate of inactivation by EDC at pH 6.0 is reduced, but not eliminated by saturating levels of the competitive inhibitor dansyl‐L‐arginine N‐(3‐ethyl‐1,5‐pentanediyl)amide, suggesting that the essential carboxyl modified is one other than Asp‐189 in the substrate specificity pocket of thrombin. Complete inactivation by 14C‐EAC correlates with the incorporation of approximately 2.5–3 EACs per thrombin.

The B cell–specific transmembrane protein RP-105 belongs to the family of Drosophila toll-like proteins which are likely to trigger innate immune responses in mice and man. Here we demonstrate that the Src-family protein tyrosine kinase Lyn, protein kinase C β I/II (PKCβI/II), and Erk2-specific mitogen-activated protein (MAP) kinase kinase (MEK) are essential and probably functionally connected elements of the RP-105–mediated signaling cascade in B cells. We also find that negative regulation of RP-105–mediated activation of MAP kinases by membrane immunoglobulin may account for the phenomenon of antigen receptor–mediated arrest of RP-105–mediated B cell proliferation.

Orphaned because of low prevalence and barely recoverable medical costs, patients with rare diseases are disproportionately deprived of life-saving treatment. In China, an estimated 16·8 million patients suffer from rare diseases. This substantial burden could potentially be addressed through policies that optimise research and development, licensing, pricing, and reimbursement of orphan drugs. We aimed to review existing international orphan drug frameworks to inform policy formulation in China.

During patient triggered ventilation (PTV) each of the infant's respiratory efforts will trigger a positive pressure inflation, providing that the respiratory effort is of sufficient magnitude to exceed the critical trigger level. It is likely therefore that the nature of the infant's lung function and respiratory reflex activity will influence the success of PTV. The aim of this study was to test that hypothesis. 20 premature infants (median gestational age 29 weeks) in the recovery stage of respiratory distress were studied at a median postnatal age of 2.5 days. Lung function was assessed by measurement of compliance using a single breath technique. Reflex activity was assessed by measurement of the strength of the Hering Breuer reflex, indicated by the degree of prolongation of expiration following end inspiratory occlusion. PTV was considered to have failed if the infant became apnoeic or required an increased level of respiratory support. PTV failed ultimately in 6 infants, compliance of the respiratory system of those 6 infants did not differ significantly from the rest of the cohon, but the Hering Breuer reflex was significantly weaker (p<0.01). Although the infants in whom PTV failed compared to those in whom it succeeded were significantly more immature and of lower birthweight (p < 0.01), multiple regression analysis demonstrated that reflex activity was independently associated with PTV failure after accounting for gestational age. birthweight and compliance. We conclude that failure of PTV is more likely in immature infants who have a weak Hering Breuer reflex.