Background: Identification of elevation in pulmonary pressures during exercise may provide prognostic and therapeutic implications in patients with connective tissue disease (CTD). Interstitial lung disease (ILD) is common in CTD patients and subtle interstitial abnormalities detected by lung ultrasound could predict exercise-induced pulmonary hypertension (PH). Methods and Results: Echocardiography and lung ultrasound were performed at rest and bicycle exercise in CTD patients (n=41) and control subjects without CTD (n=24). Ultrasound B-lines were quantified by scanning four intercostal spaces in the right hemithorax. We examined the association between total B-lines at rest and the development of exercise-induced PH during ergometry exercise. Compared to controls, the number of total B-lines at rest was higher in CTD patients (0 [0, 0] vs. 2 [0, 9], p<0.0001) and was correlated with radiological severity of ILD assessed by computed tomography (fibrosis score, r=0.70, p<0.0001). Pulmonary artery systolic pressure (PASP) was increased with ergometry exercise in CTD compared to controls (48±14 vs. 35±13 mmHg, p=0.0006). The number of total B-lines at rest was highly correlated with higher PASP (r=0.52, p<0.0001) and poor right ventricular pulmonary artery coupling (tricuspid annular plane systolic excursion/PASP ratio, r=-0.31, p=0.01) during peak exercise. The number of resting B-lines predicted the development of exercise-induced PH with an area under the curve 0.79 (p=0.0003). Conclusions: These data may suggest the value of a simple resting assessment of lung ultrasound as a potential tool for assessing the risk of exercise-induced PH in CTD patients.
The goal of CASP experiments is to monitor the progress in the protein structure prediction field. During the 14th CASP edition we aimed to test our capabilities of predicting structures of protein complexes. Our protocol for modeling protein assemblies included both template-based modeling and free docking. Structural templates were identified using sensitive sequence-based searches. If sequence-based searches failed, we performed structure-based template searches using selected CASP server models. In the absence of reliable templates we applied free docking starting from monomers generated by CASP servers. We evaluated and ranked models of protein complexes using an improved version of protein structure quality assessment method, VoroMQA, taking into account both interaction interface and global structure scores. If reliable templates could be identified, generally accurate models of protein assemblies were generated with the exception of an antibody-antigen interaction. The success of free docking mainly depended on the accuracy of initial subunit models and on the scoring of docking solutions. To put our overall results in perspective, we analyzed our performance in the context of other CASP groups. Although the subunits in our assembly models often were not of the top quality, these models had, overall, the best predicted interfaces according to several protein-protein interface accuracy measures. Since we did not use co-evolution-based prediction of inter-chain contacts, we attribute our relative success in predicting interfaces primarily to the emphasis on the interaction interface when modeling and scoring.
The bronchus-associated lymphoid tissue (BALT) lymphoma is a rare subtype of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma), affecting roughly 9% of all MALT lymphomas. The underlying pathomechanism of BALT lymphomas is not completely resolved and a standard of care treatment is so far not available.
Cerebrovascular Accidents represent a dangerous complication of cyanotic children with tetralogy of fallot with incidence of 8.6%.Tetralogy of Fallot has been associated with raised haematocrit with low arterial Saturation. Here we describe an 18 months old female child of Tetralogy of Fallot with Cyanotic spells acute onset right sided hemiplegia with Right Atrial thrombus who underwent emergency surgery with intraoperative predicament.
Reintubation in the pediatric intensive care unit (PICU) increases morbidity, mortality, and the overall cost of care. Post-extubation airway obstruction (PEAO) is a potentially predictable cause of extubation failure and may be prevented by the use of corticosteroids. Defining which patients are most at risk for the development of POAE as well as the optimal dose and timing of corticosteroids for prevention is critical. We review the current literature regarding the use of corticosteroids surrounding extubation in the PICU and discuss the implications that a clear algorithm for identification and treatment of these patients would have in the care of critically ill children.
Aim Sacroiliac joint dysfunction is an especially common cause of pain during pregnancy. Treatment options during pregnancy are very limited in order to reduce pain and increase the quality of life. We aimed to determine the efficacy of kinesiotaping (KT) in the treatment of sacroiliac joint pain in pregnant women. Methods A total of 50 pregnant women with sacroiliac joint pain were included in the study. Patients were randomized into two groups as KT and sham KT groups. Women in the KT group underwent a total of five weeks of KT once per week; the sham KT group also underwent five weeks of KT applications, but without tension in the kinesiotape. Patients were assessed before and five weeks after the treatment with a visual analogue scale (VAS) for pain and the Roland-Morris Disability Questionnaire (RMDQ) and Pelvic Girdle Questionnaire (PGQ) for disability and quality of life. Results The KT and sham KT groups were similar in terms of age, parity, gravidas, gestational week, and body mass index. At the beginning of the study, there were no statistically significant differences between the two groups in their VAS, RMDQ, or PGQ scores. Five weeks later, the KT group showed significant improvement in all parameters, but no significant differences were observed for the sham KT group in terms of VAS, RMDQ, or PGQ. Conclusions KT treatment improved the pain levels, functioning, and quality of life among pregnant women with sacroiliac joint pain. Keywords Sacroiliac joint pain; Pregnancy; Kinesiotaping
Background: Injury represents 260,000 hospitalisations and $27 billion in healthcare costs each year in Canada. Evidence suggests that there is significant variation in the prevalence of hospital admissions among ED presentations between countries and providers but we lack data specific to injury admissions. We aimed to estimate the prevalence of potentially low-value injury admissions following injury in a Canadian provincial trauma system, identify diagnostic groups contributing most to low-value admissions and assess inter-hospital variation. Methods: We conducted a retrospective multicenter cohort study based on all injury admissions in the Québec trauma system (2013-2018). Using literature and expert consultation, we developed criteria to identify potentially low-value injury admissions. We used a multilevel logistic regression model to evaluate inter-hospital variation in the prevalence of low-value injury admissions with intraclass correlation coefficients (ICC). We stratified our analyses by age (1-15; 16-64; 65-74; 75+ years). Results: The prevalence of low-value injury admissions was 16% (n=19,163) among all patients, 26% (2136) in children, 11% (4695) in young adults and 19% (12,345) in older adults. Diagnostic groups contributing most to low-value admissions were mild traumatic brain injury in children (48% of low-value pediatric injury admissions; n=922), superficial injuries (14%, n=660) or minor spinal injuries (14%, n=634) in adults aged 16-64, and superficial injuries in adults aged 65+ (22%, n=2771). We observed strong inter-hospital variation in the prevalence of low-value injury admissions (ICC=37%). Conclusion: One out of six hospital admissions following injury may be of low-value. Children with mild traumatic brain injury and adults with superficial injuries could be good targets for future research efforts seeking to reduce health care services overuse. Inter-hospital variation indicates there may be an opportunity to reduce low-value injury admissions with appropriate interventions targeting modifications in care processes.
Interpreting Complex Atrial Tachycardia Maps Using Global Atrial VectorsEditorial on: The Utility of a Novel Mapping Algorithm Utilizing Vectors and Global Pattern of Propagation for Scar-Related Atrial TachycardiasMiguel Rodrigo, PhD1-2Sanjiv M. Narayan MD, PhD11Stanford University, Stanford, CA, USA2Electronic Engineering Department, Universitat de Valencia, Spain1500 words excluding title and references12 or less references1-3 tables/figures
While many phenylpropanoid pathway-derived molecules act as physical and chemical barriers to pests and pathogens, comparatively little is known about their role in regulating plant immunity. To explore this research field, we transiently perturbed the phenylpropanoid pathway through application of the CINNAMIC ACID-4-HYDROXYLASE (C4H) inhibitor piperonylic acid (PA). Using bioassays involving diverse pests and pathogens, we show that transient C4H inhibition triggers systemic, broad-spectrum resistance in higher plant without affecting growth. PA treatment enhances tomato (Solanum lycopersicum) resistance in field and laboratory conditions, thereby illustrating the potential of phenylpropanoid pathway perturbation in crop protection. At the molecular level, transcriptome and metabolome analyses reveal that transient C4H inhibition in tomato reprograms phenylpropanoid and flavonoid metabolism, systemically induces immune signaling and pathogenesis-related genes, and locally affects reactive oxygen species metabolism. Furthermore, C4H inhibition primes cell wall modification and phenolic compound accumulation in response to root-knot nematode infection. Although PA treatment induces local accumulation of the phytohormone salicylic acid, the PA resistance phenotype is preserved in tomato plants expressing the salicylic acid-degrading NahG construct. Together, our results demonstrate that transient phenylpropanoid pathway perturbation is a conserved inducer of plant resistance and thus highlight the crucial regulatory role of this pathway in plant immunity.
Objective:After radical prostatectomy,prostate-specific antigen(PSA) value measuring ≥0.1ng/ml is defined as persistent PSA(pPSA) and in many studies,it was found to be associated with aggressive disease and poor prognosis.Our aim in this study is to point out the pathological and clinical factors affecting pPSA among the patients who underwent robot-assisted radical prostatectomy(RARP) in an experienced academic center and to make a nomogram,predicting pPSA value based on operative data,useful. Methods:We examined records of 1273 patients who underwent RARP retrospectively. Preoperative,operative,and postoperative data were collected.Based on the PSA values (ng/ml) measured after 4-to-8 weeks of RARP,patients were divided into 2 groups as pPSA group (Group1)(n=97) with PSA values ≥0.1ng/ml and undetectable PSA group (Group2)(n=778) with PSA values <0.1ng/ml.Later on,Group1 was further divided into Group1a (PSA:0.1-0.2ng/ml) and Group 1b (PSA≥0.2ng/ml) to evaluate biochemical recurrence(BCR). Results:Multivariate logistic regression analyses of the collected data revealed that PSA>20ng/ml,operation time,a postoperative international society of urological pathology (ISUP) grade of ≥4, pT 3-4, and pN were independently associated with pPSA.According to the results, a nomogram predicting pPSA was developed(Table 4).By looking at the nomogram pPSA was found in 98.9% of the cases with a PSA value of ≥20ng/ml, an operation time of 150 minutes, a postoperative ISUP grade of 4-5, a positive lymphovascular invasion (LVI) status, pT3-T4, and pN+; while pPSA was found in 25.5% of the cases with a PSA value of <20 ng/ml, an operation time of 100 minutes, a postoperative ISUP grade of <4-5, a negative LVI status, pT<3-4, and pN-.The estimated BCR-free survival time was 16.3 months in Group 1a and 57.0 months in Group2 (p<0.001).Adjuvant treatment ratio was 64.9% in Group1 and 7.1% in Group2 (p<0.001). Conclusion:For the patients who underwent RARP,factors associated with aggressive disease can predict the PSA persistence.To plan our treatment modalities accurately,an applicable nomogram in daily practice would be useful.
Abstract Objective The aim of this study is to examine the effectiveness of a single physician-led weight loss program in a primary care. Methods This is a retrospective analysis of 300 patients with a BMI >30 kg/m2 in an outpatient weight loss program. Weight loss interventions included lifestyle counseling and pharmacotherapy. Outcomes were assessed based on percentage weight change during a time period of two consecutive visits less than 90 days. Results We found that 57.7%, 43.3% and 16.1% patients who attended the clinic 5 or more times, 4-5 times, 2-3 times respectively achieved 5% weight loss (p < 0.0001). In regard to achieving 10% weight loss, 42.3%, 8.7% and 4.3% patients who attended the clinic 5 or more times, 4-5 times and 2-3 times did it respectively (p<0.0001). Moreover 60% of patients achieved 5% of weight loss in about 200 days, and 40% achieved 10% weight loss in 350 days. Patients who achieved 5% weight loss, their average A1c was reduced to 5.8 at their last visit from 6.4 at the first visit. Conclusions A single physician-led weight loss program is effective and can be created within a primary care setting to achieve 5-10% weight loss.
Unusual ovarian leukemic relapse in a girl with history of B cell lymphoblastic leukemiaACH Fung, KKY WongTo the editor:Extramedullary leukemic recurrence mostly occurs in the central nervous system and occasionally in the skin.  Here, we report an unusual case of a girl with relapsed lymphoblastic leukemia involving the ovary, presenting as a large pelvic mass.A 10-year-old girl with history of B cell lymphoblastic leukaemia treatment and in remission 1 year ago presented to oncology clinic with an enlarging pelvic mass for 2 months. Magnetic resonance imaging revealed a large lobulated solid heterogeneous pelvic mass (measuring 12cm in greatest dimension) with mass effect on pelvic organs (Figure 1a). Bone marrow aspirate at conventional site confirmed absence of lymphoblastic cells, which would have suggested leukaemia relapse. In view of the suspicion of a second primary tumour in the ovary with complication, exploratory laparotomy and left salpingo-oophorectomy were performed (Figure 1b). Histology showed diffuse infiltration of the ovary by B cell lymphoblastic leukaemia. Hematoxylin and eosin staining showed sheets of lymphoid cells with irregular nuclei. The tumour cells are positive for TdT, CD19, CD79a and CD34. (Figure 1c) She was well after operation. In view of extramedullary relapse, bone marrow aspirate was repeated after operation at anterior iliac spine which confirmed bone marrow relapse. She received treatment according to high risk protocol of CCCG Relapsed Acute Lymphoblastic Leukemia 2017 Study in Children .Acute lymphoblastic leukaemia (ALL) is responsible for one-third of childhood malignancy. Despite efforts in the treatment of ALL, 15-20% of patients developed relapse with highest risk immediately after cessation of treatment and diminishes with time.  Extramedullary involvement constitutes 2-5% of all relapses with the majority in the central nervous system. It seldom involves other sites, such as the eye, kidney, and omentum. Ovarian leukemic relapse is rarely reported in children with scarce case reports in the literature [4, 5] It is insidious and not usually detected until symptoms arise. Patient most commonly presents with lower abdominal pain or a palpable large abdominal mass.  Timely detection is important as it often coincides with marrow recurrence. Routine surveillance pelvic sonography is recommended for timely detection of pelvic extramedullary relapse. In patients with background of leukaemia presenting with an ovarian mass, a higher level of suspicion needs to be kept. In the absence of evidence in bone marrow relapse at conventional site, repeat marrow aspirate at another site would be warranted since this affect the choice of management. Previous reports shown that mainly chemotherapy had a beneficial effect, while neither local radiation nor extensive surgical resection of the leukaemic mass had any obvious effect on overall outcome . Operation could have been avoided if marrow relapse is confirmed at the time of ovarian mass detection. However, surgical excision was reported to have role in situation when bone marrow had good response but no signs of regression of ovarian mass. Reference1. Kim, J.W., et al., Ovarian and multiple lymph nodes recurrence of acute lymphoblastic leukemia: a case report and review of literature. Pediatr Surg Int, 2008. 24 (11): p. 1269-73.2. CCCG Relapsed Acute Lymphoblastic Leukemia 2017 Study in Children .https://ClinicalTrials.gov/show/NCT04224571.3. Berretta, R., et al., Isolated ovarian relapse of pre-B acute lymphoblastic leukemia: a case report. J Pediatr Adolesc Gynecol, 2009.22 (4): p. e65-8.4. Kantekure, K., et al., A unique case of relapsed B-acute lymphoblastic leukemia/lymphoma as an isolated omental mass. Case Rep Hematol, 2014. 2014 : p. 425163.5. Sava, C.N., et al., Unusual extramedullary relapses in a case of common B-cell acute lymphoblastic leukemia. Case report and review of literature. Rom J Morphol Embryol, 2019. 60 (1): p. 249-254.6. Turial, S., et al., Ovarian tumours: late extramedullary recurrence of acute leukaemia. Eur J Pediatr Surg, 2009.19 (3): p. 184-6.7. Lane, D.M. and R.L. Birdwell, Ovarian leukemia detected by pelvic sonography. A case report. Cancer, 1986. 58 (10): p. 2338-42.8. Pais, R.C., et al., Ovarian tumors in relapsing acute lymphoblastic leukemia: a review of 23 cases. J Pediatr Surg, 1991.26 (1): p. 70-4.9. Till, H., O. Muensterer, and U. Graubner, Laparoscopic adnexectomy of a persistent ovarian tumor in a girl with acute lymphoblastic leukemia relapse. Pediatr Hematol Oncol, 2003.20 (5): p. 417-20.
Introduction. Atrial Fibrillation and Atrial Flutter (AF/AFL), the most common atrial arrhythmias, have never been examined in combat casualties. In this study, we investigated the impact of traumatic injury on AF/AFL among service members with deployment history. Methods. Sampled from the Department of Defense (DoD) Trauma Registry (n=10,000), each injured patient in this retrospective cohort study was matched with a non-injured service member drawn from the Veterans Affairs/DoD Identity Repository. The primary outcome was AF/AFL diagnosis identified using ICD-9-CM and ICD-10-CM codes. Competing risk regressions based on Fine and Gray subdistribution hazards model with were utilized to assess the association between injury and AF/AFL. Results. There were 130 reported AF/AFL cases, 90 of whom were injured and 40 were non-injured. The estimated cumulative incidence rates of AF/AFL for injured was higher compared to non-injured patients (HR = 2.04; 95% CI = 1.44, 2.87). After adjustment demographics and tobacco use, the association did not appreciably decrease (HR = 1.90; 95% CI = 1.23, 2.93). Additional adjustment for obesity, hypertension, diabetes, and vascular disorders, the association between injury and AF/AFL was no longer statistically significant (HR: 1.51; 95% CI = 0.99, 2.52). Conclusion. Higher AF/AFL incidence rate was observed among deployed service members with combat injury compared to servicemembers without injury. The association did not remain significant after adjustment for cardiovascular-related covariates. These findings highlight the need for combat casualties surveillance to further understand the AF/AFL risk within the military population and to elucidate the potential underlying pathophysiologic mechanisms.