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We conducted an observational study to determine whether patients with syphilis who do not demonstrate serological cure or lack of seroreversion in nontreponemal (NT) antibody titers after initial therapy benefit from re-treatment and cerebrospinal fluid (CSF) analysis.We enrolled patients with syphilis from sexually transmitted disease clinics in Guangzhou, China, who had persistent NT titers after therapy. Serological nonresponse was defined as a4-fold decline in baseline NT titers after therapy. Lack of seroreversion was defined as demonstrating a ≥4-fold NT titer decline but without seroreversion to negative, or having persistent low-level titers (i.e., 1:1-1:2) after therapy. After consent, we abstracted medical record data regarding syphilis diagnoses, initial and re-treatment regimens, and serological outcomes. Nontreponemal titers were obtained from participants at enrollment and follow-up. We evaluated CSF findings among a subgroup of participants relative to re-treatment.From March 2012 to February 2016, we enrolled 135 HIV-negative patients with syphilis with persistent NT titers after initial therapy. Among 116 participants with ≥12 months of follow-up, 60 (52%) received re-treatment of syphilis. Overall, there were no significant differences in serological response between those who were re-treated and those who were not among serological nonresponders (29% vs. 27%; P = 1.0) or among participants without seroconversion (41% vs. 37%; P = 0.8). Of 60 participants who underwent CSF analyses, 8 (13%) had CSF abnormalities, but only 2 (3%) met the neurosyphilis criteria after re-treatment.Most HIV-negative patients with syphilis who have serological nonresponse or lack of seroreversion after therapy do not benefit from re-treatment in the short term, and neurosyphilis is uncommon.

The objective of this study is to investigate the response of an Euler-Bernoulli beam under a force or mass traversing with constant velocity. Simply-supported and clamped-clamped boundary conditions are considered. The linear strain-displacement scenario is applied to both boundary conditions, while the von Kármán nonlinear scenario is applied only to the former boundary condition. The governing equation of motion is derived via the extended Hamilton's principle. Simulations are performed with the fourth-order Runge-Kutta method via Matlab software. The equation of motion is first validated and then used to investigate the effects of the beam second moment of area, the magnitude of the traversing velocity, and centrifugal and gyroscopic forces.

Diamond-Blackfan anemia (DBA) is a congenital erythroblastopenia that is characterized by a blockade in erythroid differentiation related to impaired ribosome biogenesis. DBA phenotype and genotype are highly heterogeneous. We have previously identified 2 in vitro erythroid cell growth phenotypes for primary CD34+ cells from DBA patients and following short hairpin RNA knockdown of RPS19, RPL5, and RPL11 expression in normal human CD34+ cells. The haploinsufficient RPS19 in vitro phenotype is less severe than that of 2 other ribosomal protein (RP) mutant genes. We further documented that proteasomal degradation of HSP70, the chaperone of GATA1, is a major contributor to the defect in erythroid proliferation, delayed erythroid differentiation, increased apoptosis, and decreased globin expression, which are all features of the RPL5 or RPL11 DBA phenotype. In the present study, we explored the hypothesis that an imbalance between globin and heme synthesis may be involved in pure red cell aplasia of DBA. We identified disequilibrium between the globin chain and the heme synthesis in erythroid cells of DBA patients. This imbalance led to accumulation of excess free heme and increased reactive oxygen species production that was more pronounced in cells of the RPL5 or RPL11 phenotype. Strikingly, rescue experiments with wild-type HSP70 restored GATA1 expression levels, increased globin synthesis thereby reducing free heme excess and resulting in decreased apoptosis of DBA erythroid cells. These results demonstrate the involvement of heme in DBA pathophysiology and a major role of HSP70 in the control of balanced heme/globin synthesis.

IMPORTANCE: Early intervention using cone-beam computed tomography (CBCT) and adenotonsillectomy for children with obstructive sleep apnea (OSA) may prevent impaired growth, adverse cardiovascular consequences, learning deficits, and poor quality of life. OBJECTIVE: To assess changes in CBCT airway measurements and polysomnography (PSG) parameters that occur after adenotonsillectomy in children with OSA and to determine whether CBCT changes are correlated with apnea-hypopnea index (AHI) reduction. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study was conducted at a tertiary medical center from 2013 to 2016. Children aged 7 to 13 years with PSG-confirmed OSA (ie, AHI ≥1) were recruited. Data analysis was performed from March to July 2021. EXPOSURES: All participants underwent CBCT and PSG before and after adenotonsillectomy. MAIN OUTCOMES AND MEASURES: Changes in PSG and CBCT parameters after adenotonsillectomy were analyzed. RESULTS: A total of 49 children (mean [SD] age, 9.5 [1.8] years; 34 boys [69.4%]) were recruited. Eighteen participants (36.7%) had obesity. After adenotonsillectomy, AHI significantly decreased from 11.4 to 1.2 events per hour (mean difference, −10.24 events per hour; 95% CI, −13.84 to −6.64 events per hour). The following CBCT parameters significantly increased: total airway volume (from 11 265 to 15 161 mm(3); mean difference, 3896.6 mm(3); 95% CI, 2788.0 to 5005.2 mm(3)), nasopharyngeal volume (from 2366 to 3826 mm(3); mean difference, 1459.7 mm(3); 95% CI, 1122.9 to 1796.5 mm(3)), minimal nasopharyngeal airway area (from 128 to 191 mm(2); mean difference, 63.1 mm(2); 95% CI, 47.4 to 78.8 mm(2)), mean nasopharyngeal airway area (from 144 to 231 mm(2); mean difference, 86.8 mm(2); 95% CI, 67.0 to 106.5 mm(2)), oropharyngeal volume (from 8898 to 11 335 mm(3); mean difference, 2436.9 mm(3); 95% CI, 1477.0 to 3396.8 mm(3)), minimal oropharyngeal airway area (from 82 to 158 mm(2); mean difference, 76.2 mm(2); 95% CI, 57.0 to 95.4 mm(2)), and mean oropharyngeal airway area (from 182 to 234 mm(2); mean difference, 52.5 mm(2); 95% CI, 33.6 to 71.4 mm(2)). Among all parameters, only body mass index percentile showed large effect size between the group with residual OSA (postoperative AHI ≥1) and the group with resolved disease, with the residual OSA group having a higher body mass index percentile (87.8 vs 61.4; mean difference, 26.33; 95% CI, 10.00 to 42.66). A quantile regression model revealed that total airway volume and minimal oropharyngeal airway area were significantly correlated with reductions in AHI. CONCLUSIONS AND RELEVANCE: These findings suggest that in children undergoing adenotonsillectomy, improvements in total airway volume and oropharyngeal minimal airway area were correlated with reduction of AHI. Future studies are needed to assess whether CBCT has a role in the evaluation of children with OSA who are being considered for adenotonsillectomy.

Additional file 1: Supplementary Table 1. Primer sequences for RT-qPCR analysis. Supplementary Figure 1. Evaluation of collagen-induced arthritis (CIA) rats. a and b The change of right (a) and left (b) paw volume of control and CIA rats within 17 days following the first immunization (n=10). c The body weight change of control and CIA rats within 17 days following the first immunization (n=10). The data are the mean ± SEM. The asterisk indicates P value < 0.05 compared to the saline injected control group.

This study aimed to investigate alveolar bone change around mandibular anterior teeth during orthodontic decompensation in patients with skeletal Class III malocclusion and different vertical facial patterns. The records of 29 consecutive Class III patients selected from those pending two-jaw orthognathic surgery were divided into low (≤ 28°), average (30°–37°), and high (≥ 39°) mandibular plane angle (MPA) groups. The DICOM files of CBCT scans and STL files of digital dental models, taken before (T1) and after (T2) presurgical orthodontic treatment, were imported into Dolphin imaging software to reconstruct dentoskeletal images. T1 and T2 images were superimposed and analyzed for bone thickness and height at the level of root apex on each mid-sagittal slice of six mandibular anterior teeth. Differences between T1 and T2 were analyzed by non-parametric tests and mixed-effect model analysis. The results showed that the measurements of alveolar bone height generally decreased after treatment, regardless of MPA. The facial divergence, incisor irregularity, tooth site, treatment time, and change in proclination were identified as the significant factors affecting alveolar bone thickness and height during treatment. The presurgical orthodontic treatment to decompensate mandibular anterior teeth should be very careful in all MPA groups.

OBJECTIVE Cone-beam computed tomography (CBCT) offers three-dimensional structures in assessing upper airway of patients. This study aims to compare the cone-beam computerized tomography scan measurements between children with obstructive sleep apnea (OSA) and primary snoring. STUDY DESIGN Case-control study. METHODS This prospective study was conducted in a tertiary referral center. Thirty-six children with moderate-to-severe OSA (with apnea-hypopnea index [AHI] > 5 events/hour) and 36 age-, gender-, and obesity-matched children with primary snoring (AHI

HIV diagnosis is the essential first step for persons living with HIV (PLWH) to access HIV care, which can improve health outcomes and prevent onward transmission. Synergy between HIV and other sexually transmitted infections (STI) makes STI clinics effective settings to reach PLWH and to find persons unaware of their HIV infection. We assessed the efficacy of an intervention incorporating acute HIV infection (AHI) screening, contract partner notification, and social contact referral on HIV detection among the sociosexual networks of PLWH seeking STI care in Lilongwe, Malawi.We conducted a randomized controlled trial to evaluate the combination intervention relative to the Malawian standard of care of rapid serological HIV tests and passive partner notification. Enrollment occurred in two STI clinics between 2015 and 2019. We also standardized the intervention and standard-of-care outcomes to six months of patient visits at Bwaila District Hospital’s STI Clinic to assess potential real-world clinical impacts. We used the SEDIA LAg avidity assay to assess the stage of HIV infection among participants.During study enrollment, 1230 HIV-seropositive persons received control arm procedures and 655 received intervention arm procedures, including 94 persons with AHI. The intervention was efficacious in increasing the total number of new HIV diagnoses made per index participant (ratio: 1.9 (95% confidence interval (CI): 1.2, 3.1)) versus the standard of care. When we standardized the trial outcomes to 4730 patient visits at Bwaila STI Clinic, we found estimated that the intervention would yield 6.7 times the number of new HIV diagnoses relative to the standard of care, including index participants diagnosed with AHI. Among STI patients seeking care, we found that only 6% of patients newly diagnosed with HIV had a recent HIV infection, with a mean duration of infection of 130 days.The combination intervention was efficacious in increasing HIV detection among the sociosexual networks of PLWH seeking STI care. Furthermore, when the acute HIV diagnoses among index participants were considered, the intervention greatly improved HIV detection beyond the standard of care. Integrating novel referral and HIV testing strategies can improve HIV detection, which is the first step to ending the HIV epidemic.

Objective During orthodontic tooth movement (OTM), the speed of movement depends on the rate of bone turnover. In this study, we used a rat model to investigate the effect of 970 nm low-level laser therapy (LLLT) on OTM under different dose and frequency protocols. Methods We first compared the OTM rates between the OTM only control and the OTM + LLLT group (1250 J/cm2) in Experiment 1 and showed that LLLT significantly increased OTM. In Experiment 2, we employed 3 different LLLT protocols: the low-dose group and the high-dose group receiving 5 doses of 750 J/cm2 and 15,000 J/cm2 of LLLT every 3 days, respectively, and the early high-dose group which received 5 daily doses at 15,000 J/cm2 at the beginning of the experiments. The OTM-only control group received no LLLT. Tooth movement rate was measured through sequential silicone impressions. MicroCT was also performed to evaluate bone de-mineralization rate. Bone histmorphometry was used to compare the bone turnover rate between LLLT group and control group. Finally, TRAP, Osteocalcin, and VEGF expression is evaluated by immunohistochemistry (IHC) in tissue sections. Results When LLLT treatment was given every three days, both the 1250 J/cm2 and 15,000 J/cm2 groups showed significantly increased OTM compared to the control group. No significant difference was observed in the 750 J/cm2 group, or in the early irradiation group, when compared with controls, although 750 J/cm2 showed the same trend of accelerating OTM. The MicroCT result of rat maxilla demonstrated that LLLT increased bone remodeling and showed decreased bone mineral density and bone volume/total volume in the furcation areas of the maxillary first molars at the end of experiment. LLLT without OTM increased bone turnover as evidenced by fluorochrome incorporation. Immunohistochemistry analyses revealed high osteocalcin expression at later stages of OTM in the LLLT group, while VEGF expression was highly induced in the LLLT + OTM group at an early stage. Conclusion Our results suggest that the 970 nm LLLT increases the rate of OTM in a dose-sensitive and frequency-dependent manner. Further animal and human studies are needed to determine the optimal timing and dosage of LLLT for OTM acceleration.

Individuals with autism spectrum disorder (ASD) have atypical cognitive behaviors, including impairment of social interaction, communication, and intellectual deficit; effective intervention from behavioral and educational approaches have demonstrated effective and adopted at home and schools. s. A number of tablet applications are available to children with autism for practicing mathematical and cognitive skills, yet few of them provide behavioral data of users for health professionals to monitor their progress for personalized training accordingly which motivated our design. Specifically, we developed a tablet-based math game to strengthen the capabilities of mathematics and cognition for children with autism. It provides several basic math practices on counting, recognition, and measurements in the form of a game which increas-es children's acceptance and encourages their engagement. It lessens the bur-den of special education teachers from repeatedly teaching mathematical and cognitive knowledge, which we observed during our multiple field visits. The application can record all user interaction and stored as the behavioral data on which intelligent behavioral modeling can be performed for health professionals. In addition, application use is not restricted in schools which thus offers children continuous opportunities to practice these skills after class.