Initial Onset Research Articles

Characterization of electrode charges and forces in an electrohydrodynamic thruster

Corona discharge generates an electrohydrodynamic (EHD) flow and a reactive thrust between electrodes in the air. Although the theory for this thrust between two electrodes has been thoroughly developed, the mechanism responsible for the reactive forces acting on the electrode surfaces is not well understood. Here, we numerically and experimentally investigate these forces and the charges that generate them. The results show that the emitter and collector surface charges deviate from the equality of capacitive charges as the discharge initiates. As the applied voltage increases, the emitter surface charge maintains its initial onset value, while the collector surface charge and the volume charge between the electrodes linearly increase. In the same manner, the emitter and collector surface forces deviate from the equilibrium of action and reaction as the discharge initiates. As the circuit current increases, the emitter surface force maintains its initial onset value, while the collector surface force and the thrust linearly increase. In particular, we demonstrate an unconventional thrust-measuring method by installing a windshield in the rear of the thruster. The force exerted on the windshield is equal to a good approximation of the pure EHD thrust. Also, the difference between this force and the thrust measured without the windshield can be taken as the approximate drag force acting on the electrodes.

Changes in Home-Centered Religious Practices and Relational Wellbeing following the Initial Onset of the COVID-19 Pandemic

We explored associations between changes in the frequency of home-centered religious practices and family relational conflict, emotional closeness, and the perceived long-term impact of the COVID-19 pandemic on relationships. The panel survey of 1,510 adult individuals in the United States, was administered during the summer of 2020. Given our interest in understanding changes in religious practices following the COVID-19 related closures of religious institutions, the panel included an intentional oversampling of religious individuals from diverse religious affiliations. We employed a mixed methods approach (integrated quantitative and qualitative measures). Controlling for a large group of demographic variables (e.g., age, gender, race/ethnicity) and other factors (e.g., religiosity, stage of COVID-19 closures), OLS and logistic regressions found some significant associations between retrospectively reported changes in the frequency of religious practices and emotional closeness and perceived lasting impact of the pandemic on family well-being. Qualitative data from a subsample of survey participants (n = 624) suggested that family prayer, scripture study, shared sacred rituals, and home-based worship helped foster positive family interactions.

Heterogeneity of Stroke in Patients with Systemic Lupus Erythematosus.

Objective The underlying pathophysiology varies according to stroke subtype. However, stroke heterogeneity among patients with systemic lupus erythematosus (SLE) remains unstudied. We hypothesized that the contribution of SLE to stroke might vary according to its subtype and investigated the associations of SLE and various stroke subtypes. Methods Diagnostic codes and electronic medical records were used to identify 70 patients with SLE who developed acute cerebral infarction or intracerebral hemorrhaging at four tertiary referral hospitals between 2008 and 2018. Intracerebral hemorrhaging was classified as lobar or deep, while cerebral infarction was classified according to the SSS-TOAST criteria. Physician notes were used to identify SLE activity, and their prevalences were compared among stroke subtypes. Outcomes were collected from the patients' medical records. Results The most common stroke subtype in patients with SLE was that of undetermined causes (31%), followed by small artery occlusion (16%), cardioaortic embolism (13%), other causes (11%), lobar hemorrhaging (10%), deep hemorrhaging (10%), and large artery atherosclerosis (9%). Stroke onset occurred during a period of high SLE activity in 21 patients (30%). The proportion of patients with high SLE activity varied according to stroke subtype (p=0.039) and was highest for cerebral infarction with undetermined causes. Stroke recurrence or death was observed in 40% of patients within 5 years after the initial stroke onset. Conclusion The contributions of SLE to stroke varied significantly according to the stroke subtype. Given the unfavorable prognosis, close stroke subtype-specific observation by rheumatologists and stroke specialists is recommended after stroke events.

Diversity of MJO Initiation Regions and Processes

Abstract The diversity of the Madden–Julian oscillation (MJO) initiation (i.e., initial onset of active convection before moving eastward) regions was explored using a clustering method. Regions favorable for MJO initiations are grouped into four longitude zones: the Atlantic and Africa (AA), the Indian Ocean (IO), the Maritime Continent (MC), and the western Pacific (WP). The region-dependent dominant initiation mechanisms are explored using a composite procedure. The AA initiation is attributed to a circumnavigating process associated with a preceding MJO. As upper-tropospheric westerly anomalies move into the AA region, the associated descending motion leads to suppressed convection over the IO, which further triggers convection onset to its west through anomalous westward moisture advection. The IO initiation arises from the downstream forcing of a preceding suppressed phase of MJO. A delayed air–sea interaction process also plays a role. The MC initiation is triggered by a westward-propagating dry equatorial Rossby wave in the Pacific. The low-level poleward flows associated with the anticyclonic Rossby wave gyres advect high mean moisture, promoting the convection onset over the MC. The WP initiation is triggered by a preceding suppressed phase of MJO that moves eastward, in a way similar to the downstream scenario in the IO. The AA initiation is usually associated with a La Niña–like background sea surface temperature pattern, which favors the decoupling of upper-tropospheric westerly anomalies from the preceding MJO. The MC and WP initiations are more frequent during El Niño, as the relevant meridional moisture gradient is sharper and the eastern Pacific is moister.

Thyroid surgery during the COVID-19 pandemic: difficulties- how to improve.

In December 2019, the new coronavirus infection (COVID-19) was declared a pandemic by the World Health Organization after rapidly spreading over the worldin just a few months. All elective operations and nonemergency treatments have been postponed worldwide. However, some patients require surgical therapy aswell, and the time spent waiting should not have a negative impact on the surgical outcome or disease course. Following the initial onset of the COVID-19 epidemic, instructions for proper and safe surgery for healthcare staffand patients should develop. Thyroid surgeries have decreased during the COVID-19 pandemic. Most of them can be postponed for a long time. Assessment of thyroid nodules recommends clinical examination, imaging studies, fine needle aspiration (FNA) and vocal cord examination. Allthese procedures are necessary, and sometimes they cannot be postponed. To determine the best timing, athorough preoperative assessment should be undertaken, taking into account both oncological and anatomical features. Furthermore, COVID-19 status must be negative prior to any intervention, and hospital infrastructure must beready to deal with the demanding situation.

Mitigating Power and Memory Constraints on a Venusian Seismometer

Abstract The nearest term pathway to the deployment of a seismometer on Venus is an instrument that can operate under ambient surface conditions on battery power. We conduct a series of studies on combined hardware and software approaches to maximize the quality of data returned under the likely restrictions of minimal on-board data storage and only being able to transmit in real time during a small fraction of a multimonth deployment. We assess likely Venus seismicity by examining different terrestrial analog settings; we find that likely Venus analog settings all fall within about an order of magnitude of mean Earth in terms of seismicity level. We use the seismic record from a station in central Alaska as a Venus surrogate for algorithm development. We tested various transmission triggers and developed a simple low-memory algorithm that mimics the common terrestrial long-term average/short-term average trigger. If the seismometer can operate in coordination with an orbiter that can remotely turn off data transmission, then the frequency content of a few seconds of data can be used to distinguish small, nearby earthquakes from large, distal ones, and total data transmission can be tuned to favor the latter. If an orbiter can also turn on transmission for other nearby seismometers, it would further enhance the ability to distinguish small- and large-magnitude earthquakes autonomously and increase the chances of capturing the initial onset of significant events.

Differences in lipid metabolism in acquired versus preexisting glucose intolerance during gestation: role of free fatty acids and sphingosine-1-phosphate

BackgroundThe prevalence of gestational diabetes mellitus (GDM) is increasing worldwide. There is increasing evidence that GDM is a heterogeneous disease with different subtypes. An important question in this context is whether impaired glucose tolerance (IGT), which is a typical feature of the disease, may already be present before pregnancy and manifestation of the disease. The latter type resembles in its clinical manifestation prediabetes that has not yet manifested as type 2 diabetes (T2DM). Altered lipid metabolism plays a crucial role in the disorder's pathophysiology. The aim was to investigate the role of lipids which are relevant in diabetes-like phenotypes in these both models with different time of initial onset of IGT.MethodsTwo rodent models reflecting different characteristics of human GDM were used to characterize changes in lipid metabolism occurring during gestation. Since the New Zealand obese (NZO)-mice already exhibit IGT before and during gestation, they served as a subtype model for GDM with preexisting IGT (preIGT) and were compared with C57BL/6 N mice with transient IGT acquired during gestation (aqIGT). While the latter model does not develop manifest diabetes even under metabolic stress conditions, the NZO mouse is prone to severe disease progression later in life. Metabolically healthy Naval Medical Research Institute (NMRI) mice served as controls.ResultsIn contrast to the aqIGT model, preIGT mice showed hyperlipidemia during gestation with elevated free fatty acids (FFA), triglycerides (TG), and increased atherogenic index. Interestingly, sphingomyelin (SM) concentrations in the liver decreased during gestation concomitantly with an increase in the sphingosine-1-phosphate (S1P) concentration in plasma. Further, preIGT mice showed impaired hepatic weight adjustment and alterations in hepatic FFA metabolism during gestation. This was accompanied by decreased expression of peroxisome proliferator-activated receptor alpha (PPARα) and lack of translocation of fatty acid translocase (FAT/CD36) to the hepatocellular plasma membrane.ConclusionThe preIGT model showed impaired lipid metabolism both in plasma and liver, as well as features of insulin resistance consistent with increased S1P concentrations, and in these characteristics, the preIGT model differs from the common GDM subtype with aqIGT. Thus, concomitantly elevated plasma FFA and S1P concentrations, in addition to general shifts in sphingolipid fractions, could be an interesting signal that the metabolic disorder existed before gestation and that future pregnancies require more intensive monitoring to avoid complications.Graphical This graphical abstract was created with BioRender.com.

Pregnancy-Related Tuberculous Meningitis and Immune Reconstitution Inflammatory Syndrome: A Case Series and Systematic Review.

BackgroundTuberculosis is a leading cause of death among women of reproductive age. However, tuberculous meningitis, the most severe form of extrapulmonary tuberculosis, is rarely discussed in pregnancy despite this being a unique period of immune modulation that may predispose women to active disease.MethodsWe identified and described cases of tuberculous meningitis among pregnant or postpartum women screened during meningitis clinical trials in Uganda from 2018 to 2022. We conducted a systematic literature review via PubMed/Medline and Embase for all English-language publications from 1970 to 10 July 2022, to identify additional cases.ResultsWe identified 8 cases of pregnancy-related tuberculous meningitis in Ugandan women living with human immunodeficiency virus (HIV) and 40 additional cases via systematic literature review (none HIV-positive). Of all combined cases, 50% (24/48) were diagnosed postpartum; 50% (24/48) had initial onset during pregnancy, of which 38% (9/24) had worsening of symptoms or disease relapse following pregnancy cessation. Diagnosis was missed or delayed in 33% (16/48) of cases. For those with known outcomes, maternal mortality was 23% (11/48) and fetal/neonatal mortality was 30% (13/44). Of maternal survivors, 30% (11/37) had residual neurologic deficits.ConclusionsThe true incidence of tuberculous meningitis in pregnancy or the postpartum period is unclear but likely underappreciated. To date, nearly all published cases have occurred in HIV-negative or otherwise immunocompetent women. Given the well-described physiological immunosuppression during pregnancy and subsequent reconstitution postpartum, physicians must be aware of tuberculous meningitis and pregnancy-related immune reconstitution inflammatory syndrome, especially in countries with a high burden of tuberculosis and in women living with HIV.

DYSPNEIC AFTER EVERY COVID-19 SHOT: SUSPECTED BNT162B2 MRNA VACCINE-RELATED, DRUG-INDUCED PULMONARY EOSINOPHILIA

DYSPNEIC AFTER EVERY COVID-19 SHOT: SUSPECTED BNT162B2 MRNA VACCINE-RELATED, DRUG-INDUCED PULMONARY EOSINOPHILIA

S726 Fecal Transplantation Improved Patients’ Reported Outcome After Immune Checkpoint Inhibitor Colitis

Introduction: Immune checkpoint inhibitors (ICIs) have become standard treatment for cancers poorly responsive to traditional chemotherapy. The most common GI toxicity of this class of drugs is ICIs colitis (IMC) associated with difficulty to treat chronic diarrhea and risk of fatality. We have previously demonstrated that fecal microbiota transplantation (FMT) was effective in the treatment of a small number of refractory cases suggesting the gut microbiome is involved in the pathogenesis of ICIs colitis. Further large studies are needed to determine its efficacy. Methods: The present study summarizes our experience with FMT treatment of 37 patients with refractory ICIs colitis. We measured the efficacy of FMT and patients’ reported outcome (PRO) via established MD Anderson Symptom Inventory (MDASI). Among them, 9 patients had concurrent CDI as well at the time of diagnosis. (Table) Results: Thirty-seven patients included in our study, with a median age of 59 years and mostly had genitourinary cancers (35.1%) followed by melanoma (27.0%). Most patients had a peak CTCAE diarrhea grade ≥ 3 (91.9%) and colitis grade ≥ 2 (89.1%). Ulcerous (18, 48.6%) and non-ulcerous (12, 32.4%) inflammation was predominant endoscopic findings. 36 (97.3%) patients received corticosteroids, and 33 (89.1%) received add-on infliximab or vedolizumab. IMC symptom response was 83.7% after FMT with median time to response of 5 days. The rate of complications is 16.2% at 7 days and 5.4% at 30 days, and mostly were transient and mild. Response rate among 28 patients without concurrent CDI was 85.7%. Thirty-five (94.6%) patients demonstrated colitis remission at the last follow up. On the PRO analysis, we observed a favorable trend of significant patient-reported symptom reduction on diarrhea during 12 weeks after FMT, along with improved daily physical functioning on working. (Figure) Conclusion: Evidence is accumulating to suggest that efficacy and prevention of ICI related toxicities is dependent upon a healthy diverse microbiome. In the present study, we have shown that FMT achieved 83.7% success rate in patients with IMC with a favorable safety profile. FMT could become a preferred treatment option for the IMC in the future practice.Figure 1.: Patients Reported Outcome Summary Table 1. - Characteristic before FMT No. (%) (n=37) Concurrent CDI# 9 (24.3%) Highest grade of diarrhea of initial IMC onset – no. (%) 1 or 2 3 (8.1%) 3 or 4 34 (91.9%) Highest grade of colitis of initial IMC onset – no. (%) 1 4 (10.8%) 2- 4 33 (89.2%) Initial endoscopic findings – no (%), n=36 Ulcers 18 (48.6%) Non-ulcer inflammation 12 (32.4%) Normal 6 (16.2%) Hospitalizations – no. (%) 29 (78.3%) Median duration of hospitalization – days (IQR) 8 (5-13) Treatment of GI adverse events – no. (%) Steroid 36 (97.3%) Infliximab/vedolizumab added 33 (89.1%) FMT characteristic and outcome Symptom improvement after FMT, all patients – no (%) 31 (83.7%) Symptom improvement after FMT (no concurrent CDI, n=28) – no (%) 24 (85.7%) Median time from FMT to symptom improvement– days (IQR), n=37 5 (2-10) FMT-related complications within 7 days –no (%) 6 (16.2%) FMT-related complications within 30 days –no (%) 2 (5.4%) Colitis status at the end of the study period Clinical remission – no (%) 35 (94.6%) Persistent symptoms – no (%) 2 (5.4%)

Neurosurgical shunt treatment of pediatric hydrocephalus: epidemiology and influencing factors on revision surgeries: a single-center retrospective analysis of 131 patients.

Paediatric hydrocephalus is a result of a dysfunction of cerebrospinal fluid circulation, and it has diverse pathogeneses. This study investigates the epidemiology of paediatric hydrocephalus, as well as the influences of primary aetiology and implant type on treatment complications and the development of new therapeutic approaches and strategies. Between 2013 and 2018, a retrospective analysis of 131 children, who were suffering from hydrocephalus, was conducted. Medical charts, operative reports and clinical follow-up visits were reviewed. Statistical analysis was performed using t-test/ANOVA and Kruskal-Wallis test/Mann-Whitney U test. The most common pathogeneses of hydrocephalus among our patients were meningomyelocele-associated and posthaemorrhagic. The majority of patients received a programmable differential pressure valve (PPV, 77.8%) or a fixed differential pressure valve with a gravitational unit (FPgV, 14.8%). Among 333 shunt-associated surgeries, 66% of surgeries were revision surgeries and were performed because of mechanical shunt dysfunction (61%), infection (12%), or other reasons (27%). The median rate of revisions within one year for each patient was 0.15 (IQR25-75: 0.00-0.68) and was influenced by aetiology (p = 0.045) and valve type (p = 0.029). The highest rates were seen in patients with posthaemorrhagic hydrocephalus and in those with FPgVs; the lowest rates were seen in patients with meningomyelocele-associated hydrocephalus and PPVs. The occurrence of mechanical dysfunctions was correlated with FPgV patients (p = 0.014). Furthermore, the median time interval between initial shunt surgery and onset of infection was shorter than that between initial surgery and mechanical dysfunction (p = 0.033). Based on this research, we can state several factors that influence revision surgeries in paediatric shunt patients. With the assessment of patients' risk profiles, physicians can classify paediatric shunt patients and thus avoid unnecessary examinations or invasive procedures. Furthermore, medical providers can prevent revision surgeries if they choose shunt material in accordance with a patient's associated shunt complications.

S3299 Acute Liver Injury as Initial Presentation of Adult Onset Still’s Disease

Introduction: We present a case of acute liver injury as a first presentation of Adult-Onset Still’s Disease (AOSD). Case Description/Methods: A 20-year-old man presented with fever and nausea. On admission liver function tests (LFTs) were notable for ALT 81 IU/L, AST 42 IU/L, ALP 58 IU/L and total bilirubin 6.7 mg/dL. Infectious work up was notable for positive EBV IgM that was treated appropriately. He presented again with worsening headache, fever, dark urine and petechial rash on both lower extremities. LFTs were still elevated. Patient was symptomatically managed and the elevation in LFTs was attributed to infectious etiology. Patient was discharged home with close follow up. He presented again, nine days after initial symptoms onset with worsening symptoms, jaundice and new left hip pain with lower extremity weakness. Patient had taken one pill of Metronidazole from India but denied any other drugs. LFTs were ALT 214 IU/L, AST 215 IU/L, ALP 215 IU/L and total bilirubin 6.6 mg/dL. Patient’s liver enzymes continued to rise despite discontinuing hepatotoxic medications, with ALT 186 IU/L, AST 146 IU/L, ALP 219 IU/L, total bilirubin 10.7 mg/dL and direct bilirubin 6.4 mg/dL. Therefore, a liver biopsy was ultimately performed. Histology showed a portal inflammatory process, with acute eosinophil spill over to the liver, without hepatic necrosis. Rheumatology team was consulted due to arthralgia. The patient met the Yamaguchi criteria for AOSD. He was started on prednisone 40 mg daily, with subjective and objective improvement with down trending LFTs. Outpatient follow-up with both rheumatology and hepatology continued to show significant improvement and down-trending LFTs. He continues to be on a prolonged steroid taper over 12 weeks. Discussion: In our case the patient met the Yamaguchi criteria which involves major and minor criteria with transaminitis included. In this case, the main challenge was to find a suitable diagnosis that fits all the symptoms. A previous case report suggested that Drug Induced Liver Injury (DILI) might be the inciting factor in AOSD activation, which might be proposed in our case as well. It was reported that liver involvement in AOSD can be attributed to its association with Macrophage Activation Syndrome (MAS). Treatment mainly focuses on treating AOSD itself with systemic steroid therapy. In conclusion, acute liver injury is being increasingly reported in literature and this case supports acute liver injury in association with AOSD which can be aggravated by DILI or MAS.

What matters most: Qualitative investigation of goals and values in a diverse sample of patients with advanced cancer.

252 Background: Goals of care conversations (GOCC) are a complex part of patient-focused care. Current understanding of GOCC content is limited to post-hoc patient satisfaction surveys and focus groups evaluating end-of-life advance care planning physician-patient interactions, and documentation. We investigated patient goals and values through standardized GOCC documentation by oncologists in patients with advanced cancer. Methods: This pilot qualitative analysis of patient goals and values included all adult patients > 18 years with advanced recurrent or stage IV cancer seen at Kaiser Permanente San Francisco with an oncologist documented GOCC between 1/1/2022 to 5/14/22. Our team developed a templated GOCC automated phrase (Smartphrase) within our electronic medical record (EMR), with a selection tab that included a listing of common patient goals and values and an option to add free text. Team members reviewed each patient’s initial GOCC content was reviewed for frequently occurring themes consistent with goals and values. Results: A total of 178 patients had EMR documented GOCC, with a mean of 1.8 GOCC per patient. These patients were 51% (n = 94) female, with a median age of 68.5 years old. The population was racially diverse with 46% identifying as White, 32% Asian/Pacific Islander, 13% Black, 8% Hispanic/Latino, and 1% Other. The most common cancer types included breast (19%, n = 34), lower GI (16%, n = 29), and thoracic (14%, n = 25). Family members were present in 35% (n = 63) of GOCC. Table summarizes thematically grouped goals and values. Conclusions: Our findings highlight the importance of GOCC in routine oncology visits. Our standardized documentation tool for GOCC prompted medical oncologists to identify what matters most to patients with advanced or recurrent cancer regarding their values and goals related to care and quality of life. Among the wide range of responses, we identified that the most important goals and values to our patients include avoiding pain and suffering, physical independence, and living as long as possible. In contrast, patients rarely identified comfort-only treatment as a priority. This tool can guide goal-concordant care at initial onset of the cancer journey and be revisited as these conversations evolve over time. Future investigation is needed to understand how GOCC goals and values identified early impact patient satisfaction, change over time, influence treatment decisions, and potentially lead to an evolution in standard for goal-concordant care.[Table: see text]

AN UNUSUAL CASE OF SUBACUTE BACTERIAL ENDOCARDITIS PRESENTING WITH CATASTROPHIC SUBARACHNOID HEMORRHAGE

AN UNUSUAL CASE OF SUBACUTE BACTERIAL ENDOCARDITIS PRESENTING WITH CATASTROPHIC SUBARACHNOID HEMORRHAGE

Comparison of Different Therapeutic Effects of T-MIST for Chronic Idiopathic Tinnitus

Objective Tinnitus, as a common clinical symptom, has the characteristics of high incidence and great heterogeneity among different patients. As one of the common treatment strategies for tinnitus, this study is aimed at exploring the factors influencing tinnitus sound therapy and the correlation between different tinnitus acoustic characteristics. Methods 315 patients with chronic tinnitus were enrolled and divided into three groups according to the tinnitus multielement integration sound therapy (T-MIST): (1) vanishing, (2) remission, and (3) unchanged. The general characteristics, psychoacoustic scores (tinnitus handicap inventory (THI) and visual analog scale (VAS)), residual inhibition (RI), degree of hearing loss, and tinnitus characteristics of each group were compared. Finally, we analyze the predictive significance of different features for acoustic effects. Results The frequency of tinnitus in the vanishing group was higher than that in the remission and unchanged groups (P < 0.05). There were no differences in age, initial onset time, course of the disease, and VSAD between the vanishing group and the unchanged group (P > 0.05). High-frequency tinnitus may predict the vanishing of tinnitus after treatment (P < 0.05), but the degree of hearing loss, tinnitus characteristics (loudness and frequency), and psychoacoustic score (THI and VAS) were only weakly correlated (P < 0.05). Residual inhibition test (RI) was an independent risk factor for the efficacy of acoustic therapy (P < 0.001). Conclusion The patients were divided into three groups by T-MIST treatment effect; Kruskal-Wallis test and chi-square test were used to compare the baseline information of each group. Then, we analyzed the correlation between patient characteristics and psychoacoustic scores. Finally, logistic regression was performed to explore predictors that might influence the treatment effect. High-frequency tinnitus may have a better therapeutic effect; age, disease course, and other factors can not be stable explanation factors for a poor therapeutic effect of tinnitus. The residual inhibition (RI) test was an independent factor in predicting the efficacy of T-MIST.

Biofilms possibly harbor occult SARS-CoV-2 may explain lung cavity, re-positive and long-term positive results.

During the COVID-19 pandemic, there have been an increasing number of COVID-19 patients with cavitary or cystic lung lesions, re-positive or long-term positive nucleic acid tests, but the mechanism is still unclear. Lung cavities may appear at long time interval from initial onset of coronavirus infection, generally during the absorption phase of the disease. The main histopathological characteristic is diffuse alveolar damage and may have more severe symptoms after initial recovery from COVID-19 and an increased mortality rate. There are many possible etiologies of pulmonary cavities in COVID-19 patients and we hypothesize that occult SARS-CoV-2, in the form of biofilm, is harbored in the airway lacuna with other pathogenic microorganisms, which may be the cause of pulmonary cavities and repeated and long-term positive nucleic acid tests.

37-Year-Old Man With Headache and Nasal Congestion

37-Year-Old Man With Headache and Nasal Congestion

The effectiveness of bone scintigraphy in the management of low back pain

BackgroundBack and low back pain have been reported as one of the leading causes of activity restriction. While degenerative changes in the spine are among the common causes of low back pain, zygapophyseal (facet) joint pain is seen as the most widely accepted cause of back pain. Standard imaging modalities may have low predictive value in detecting the source of back pain. Thanks to radionuclide bone scintigraphy, painful lesions can be distinguished from age-related changes, especially in patients with chronic low back pain. In this study, we aimed to retrospectively evaluate the clinical results of facet-induced low back pain, which was confirmed by bone scintigraphy, after facet injection treatment. MethodsWe completed a retrospective review of patients who underwent diagnostic radionuclide bone scintigraphy imaging for low back pain at our institution from 2019 to 2021. Scintigraphy imaging was often performed in conjunction with traditional diagnostic imaging. The patients underwent injection at the levels that were decided by the referring physician on the basis of the clinical symptoms, the physical examination findings, and findings on existing radiologic images, with performance of bone scanning. ResultsThe patients consisted of 24 (47.1 %) males and 27 (52.9 %) females with a mean age of 44.03 ± 9.26 years (range 34–67 years) at initial symptom onset. In the bone scintigraphy, increased radioactive uptake was detected in the facet joints of the lumbar region in 33 of 51 (64.7 %) patients. Statistically significant improvement was found in VAS-ODI and SF-36 scorings in 30 patients (90.1 %) after injection in patients with increased radioactive uptake. Statistically significant improvement was found in VAS-ODI and SF-36 scorings in 12 (66.6 %) patients who had no pathological findings with imaging modalities and were injected according to physical examination. When the two groups were compared with each other, the success rate in the group with increased radioactive uptake was found to be statistically significantly higher (p < 0.01) ConclusionsApplication of this technology may lead to more reliable diagnosis and treatment of painful facet arthropathy. Appropriate diagnostic tests and determination of spinal level localization will provide satisfactory results with correct patient selection

Prolonged delays in leprosy case detection in a leprosy hot spot setting in Eastern Ethiopia.

BackgroundLeprosy or Hansen’s disease is known to cause disability and disfigurement. A delay in case detection of leprosy patients can lead to severe outcomes. In Ethiopia, the disability rates caused by leprosy among new cases are relatively high compared to other endemic countries. This suggests the existence of hidden leprosy cases in the community and a delay in timely detection. To reduce disability rates, it is crucial to identify the factors associated with this delay. This study aimed to determine the extent of delay in case detection among leprosy cases in Eastern Ethiopia.MethodsThis cross-sectional explorative study was conducted in January and February 2019 among 100 leprosy patients diagnosed ≤6 months prior to inclusion. A structured questionnaire was used to collect data, including the initial onset of symptoms, and the reasons for delayed diagnosis. Descriptive statistics, including percentages and medians, were used to describe the case detection delay. Logistic regression analysis was carried out to evaluate the predictors of delay in case detection of >12 months.FindingsThe median age of patients was 35 years, with a range of 7 to 72 years. The majority were male (80%) and rural residents (90%). The median delay in case detection was 12 months (interquartile range 10–36 months) among the included patients. The mean delay in case detection was 22 months, with a maximum delay of 96 months. The overall prevalence of disability among the study population was 42% (12% grade I and 30% grade II). Fear of stigma (p = 0.018) and experiencing painless symptoms (p = 0.018) were highly associated with a delay in case detection of >12 months.ConclusionsBeing afraid of stigma and having painless symptoms, which are often misinterpreted as non-alarming at the onset of the disease, were associated with a delay in case detection. This study showed the need to increase knowledge on early symptoms of leprosy among affected communities. Furthermore, it is important to support initiatives that reduce leprosy related stigma and promote health worker training in leprosy control activities.

High-throughput sequencing unravels the cell heterogeneity of cerebrospinal fluid in the bacterial meningitis of children

Bacterial meningitis (BM) is a common life-threatening infection in children that occurs in the central nervous system (CNS). The cytologic examination of cerebrospinal fluid (CSF) is a key parameter in the diagnosis of BM, but the heterogeneity of cells in the CSF has not been elucidated, which limits the current understanding of BM neuroinflammation. In this study, CSF samples were collected from a number of BM patients who were in different stages of disease progression. Single-cell RNA-sequencing (scRNA-seq), with additional bulk transcriptome sequencing, was conducted to decipher the characteristics of CSF cells in BM progression. A total of 18 immune cell clusters in CSF were identified, including two neutrophils, two monocytes, one macrophage, four myeloid dendritic cells, five T cells, one natural killer cell, one B cell, one plasmacytoid dendritic cell, and one plasma cell subtype. Their population profiles and dynamics in the initial onset, remission, and recovery stages during BM progression were also characterized, which showed decreased proportions of myeloid cells and increased proportions of lymphoid cells with disease progression. One novel neutrophil subtype, FFAR2+TNFAIP6+ neutrophils, and one novel monocyte subtype, THBS1+IL1B+ monocytes, were discovered, and their quantity changes positively correlated with the intensity of the inflammatory response in the CSF during BM. In addition, the CSF of BM patients with unsatisfactory therapeutic responses presented with different cell heterogeneity compared to the CSF of BM patients with satisfactory therapeutic responses, and their CSF featured altered intercellular communications and increased proportions of type II myeloid dendritic cells and plasmacytoid dendritic cells. Moreover, the bulk transcriptome profiles of autologous CSF cells and peripheral blood leukocytes of BM patients showed that the immune cells in these two physiological compartments exhibited distinct immune responses under different onset conditions. In particular, the CSF cells showed a high expression of macrophage characteristic genes and a low expression of platelet characteristic genes compared with peripheral blood leukocytes. Our study conducted an in-depth exploration of the characteristics of CSF cells in BM progression, which provided novel insights into immune cell engagement in acute CNS infection.