Negative History Research Articles

Higher antibody responses after mRNA-based vaccine compared to inactivated vaccine against SARS-CoV-2 in Behcet’s syndrome

There are limited data about humoral response to vaccine in Behçet’s syndrome (BS). We compared SARS-CoV-2 antibody response after two doses of inactivated (Sinovac/CoronaVac) or mRNA (Pfizer/BioNTech) vaccines in patients with BS and healthy controls (HCs). We studied 166 (92M/74F) patients with BS (mean age: 42.9 ± 9.6 years) and 165 (75M/90F) healthy controls (mean age: 42.4 ± 10.4 years), in a single-center cross-sectional design between April 2021 and October 2021. A total of 80 patients with BS and 89 HCs received two doses of CoronaVac, while 86 patients with BS and 76 HCs were vaccinated with BioNTech. All study subjects had a negative history for COVID-19. Serum samples were collected at least 21 days after the second dose of the vaccine. Anti-spike IgG antibody titers were measured quantitatively using a commercially available immunoassay method. We found that the great majority in both patient and HC groups had detectable antibodies after either CoronaVac (96.3% vs 100%) or BioNTech (98.8% vs 100%). Among those vaccinated with CoronaVac, BS patients had significantly lower median (IQR) titers compared to HCs [36.5 (12.5–128.5) vs 102 (59–180), p < 0.001]. On the other hand, antibody titers did not differ among patients with BS and HCs who were vaccinated with BioNTech [1648.5 (527.0–3693.8) vs 1516.0 (836.3–2599.5), p = 0.512). Among different treatment regimen subgroups in both vaccine groups, those who were using anti-TNF-based treatment had the lowest antibody titers. However, the difference was statistically significant only among those vaccinated with CoronaVac. Among patients vaccinated with BioNTech, there was no statistically significant difference between different treatment regimen groups. Compared to inactivated COVID-19 vaccine, mRNA-based vaccine elicited higher antibody titers among BS patients. Only in the CoronaVac group, patients especially those using anti-TNF agents were found to have low titers compared to healthy subjects. BS patients vaccinated with BioNTech were found to have similar seroconversion rates and antibody levels compared to healthy controls. Further studies should assess whether the low antibody titers are associated with diminished protection against COVID-19 in both vaccine groups.

Dynamic contact effects: Individuals' positive and negative contact history influences intergroup contact effects in a behavioral game.

Positive contact between members of different groups reduces prejudice and increases cooperation, findings known as intergroup contact effects. Yet in real-world settings not only positive, but also negative intergroup contact occurs, which have opposing effects. To date little is known about whether and how an individual's valenced history of intergroup contact influences contact effects and how this dynamic change happens during specific instances of intergroup contact. A pilot study examined the psychological impact of a novel paradigm to assess intergroup contact using a behavioral game. We then conducted two studies, which allowed us to observe a sequence of up to 23 in- and outgroup interactions and their behavioral outcomes in a continuous prisoner's dilemma behavioral game (N = 116, 2,668 interactions; N = 89, 1,513 interactions). As expected, participants showed a clear ingroup bias in expectations and cooperation. Furthermore, the quality of contact history moderated contact effects. Specifically, intergroup contact following a positive history of intergroup contact had a stronger effect on intergroup expectations than contact following a negative history thereof. Findings are discussed in view of the importance of considering the valenced history of intergroup contact, as well as new research questions on intergroup contact that can be addressed with this novel contact paradigm. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Myocardial Infarction With Nonobstructive Coronary Arteries in New-onset Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD) is a systemic pro-inflamma­tory condition with rare cardiovascular extraintestinal manifestations. Increasing evidence links gut inflammation and cardiovascular pathology, with myopericarditis encompassing approximately 70% of cases.1–3 Myocardial infarction with nonobstructive coronary arteries (MINOCA) has not been described in this population.4 A 36-year-old man with a history of gastroesophageal reflux disease and hypertension presented with a 10-day history of fever, hematochezia, and abdominal pain. Negative history included no travel, suspect foods, or drug use. Family history was negative for IBD or cardiac disease. Exam was unremarkable except for mild abdominal tenderness in bilateral lower quadrants. Labs revealed elevated white blood cell count, C-reactive protein, and erythrocyte sedimentation rate. Admission troponin and electrocardiogram (ECG) were normal. Computed tomography (CT) abdomen and pelvis revealed diffuse bowel wall thickening and associated mesenteric inflammation of the entire colon. A stool infectious panel was negative. Sigmoidoscopy demonstrated diffuse continuous ulceration, friability, and granularity up to the splenic flexure (Figure 1A). Colon biopsies demonstrated diffuse, markedly active colitis. Although pathology had no evidence of chronicity, given a negative workup for infection or ischemia, no offending medications, no response to antibiotics, a characteristic endoscopic appearance, and a worsening clinical course that ultimately responded only to steroids, it was determined to be a diagnosis of early and new-onset ulcerative colitis.

Epidemiological Study of CA Breast in Diyala

Background: Breast cancer is becoming the most common cancer among women in both developed and developing countries . Breast cancer has been the leading cause of death among Iraqi women for three decades, and it is the second leading cause of death after cerebrovascular illnesses.Objective: To investigate the epidemiological and clinic pathological behavior of breast cancer in Diyala province.Patients and Methods: A retrospective cross-sectional study conducted at the Oncology Clinic of Baquba Teaching Hospital for 24 months between April 1st and March 31st, 2021. A sample of (257) patients was selected to collect socio-demographic information (age, gender, marital status, history of breast lactation ,history of contraceptive pills, history of breast cancer in family, parity status). Results: The current study shows that more than 55% of the patients were under the age of (50) years. Two hundred fifty one patients (97.6%) were female and( 6) patients (2.4%)were male. from the 251 female patient . Right breast tumor was found in 120 patients (48%) and left breast tumor was found in (127) patients (50.4%) and bilateral breast tumor in (4) patients(1.6%). In terms of breast cancer family history, 28 patients(11%) had a positive family history, while 223 patients (89%) had a negative family history. One hundred fifty seven of patients(63%) had history of breastfeeding and( 94) of patients(37%) had no history of breastfeeding . One hundred forty six patients (58%) had positive history of oral contraceptive pill while 105 patients (42%) had negative history of oral contraceptive pill. twenty two patients (9%) had positive history of smoking while (229) patients (91%) had negative history of smoking . The histopathological result were Invasive ductal carcinoma (I.D.C) in (233) patients (93%) and Invasive lobular carcinoma (I.L.C) in (18) patients. Breast cancer patients were married in 73% of cases, widowed in 13.5 percent of cases, divorced in 2.5 percent of cases, and single in 11% of cases. Most cases belonged to differentiation stage II ( 159) patients (63%), followed by stage III ( 57) patients (23%) , stage I ( 13) patients (5%) and stage IV (22) patients(9%) . Conclusion: The current study concludes that In Iraq, the majority of breast cancer patients were in the second stage, and patients' ages at diagnosis were younger than in other communities. The development and execution of screening programs, as well as the management of risk factors, appear to be critical. Keywords: Breast, Cancer, Patients

Alteration of Inflammatory Parameters and Psychological Post-Traumatic Syndrome in Long-COVID Patients.

The aim of our study is to evaluate the correlation between the psychological status of patients recovered from SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection (long-COVID patients) and their inflammatory status. Three months after hospital discharge, ninety-three patients were recruited and categorized into two distinct populations: control and long-COVID (COrona VIrus Disease) group. Patients belonging to the control group presented with an entering diagnosis of cardiovascular, metabolic, or respiratory disease and a negative history of SARS-CoV-2 infection, whereas the long-COVID population presented with a severe SARS-CoV-2 infection treated in the sub-intensive Care Unit. Psychological evaluation was performed through the administration of the Symptom Checklist-90 (SCL90) and LDH (Lactate dehydrogenase), ferritin, CRPhs (C-high sensitivity Reactive Protein), NLR (Neutrophil-to-lymphocyte ratio), PLR (Platelet-to-lymphocyte ratio), and SII (systemic immune-inflammation index) were investigated. We highlighted that beyond the first three months after contagion, patients recovered from SARS-CoV-2 infection are characterized by the persistence of a systemic inflammatory state and are at high risk for developing somatization, depression, anxiety, and sleep disturbances. Interestingly, ferritin value was strongly correlated with sleep disorders (p < 0.05). Our study emphasizes how COVID-19 strategies for risk stratification, prognosis, and therapy management of patients should be implemented with a psychological follow-up.

Reliability of Drug History to Verify Androgen Abuse in Men.

ContextClinical evaluations that require excluding androgen abuse, a secretive, illicit activity, rely on the drug history, but its veracity for androgen abuse has neither been verified nor has any objective corroborating laboratory test been validated.ObjectiveIn a high-risk population, to (a) validate the drug history of androgen abuse objectively using state-of-the-art World Anti-Doping Agency–accredited antidoping laboratory urine mass spectrometry tests and (b) to determine what biochemical tests best distinguish androgen abuse from nonuse in this population.MethodsUrine samples from current (n = 41) and past (n = 31) androgen abusers and nonusers (n = 21) were analyzed by comprehensive mass spectrometry-based detection tests for androgens and related drugs (ARD).ResultsNo prohibited ARDs were identified among nonusers. Current users had a median of 5 (range 1-13) drugs detected comprising 176 ARDs among 220 drug identifications. Past users had a median of 1 (range 0-9) drugs detected comprising 21 ARDs among 43 drugs. Negative predictive value was high (>0.8) for those denying drug usage while positive predictive value was good (>0.6) for both those reporting currently using (current) and not using (nonusers plus past users) ARD. Serum luteinizing hormone (LH) alone had high, but imperfect, discriminatory power (89%) to distinguish between current and noncurrent androgen use.ConclusionsWe demonstrates that a negative drug history in a high-risk group has high reliability and that even a single suppressed serum LH exhibits high discrimination for objectively detecting androgen abuse.

Reframing Educational Outcomes: Moving beyond Achievement Gaps.

The term “achievement gap” has a negative and racialized history, and using the term reinforces a deficit mindset that is ingrained in U.S. educational systems. In this essay, we review the literature that demonstrates why “achievement gap” reflects deficit thinking. We explain why biology education researchers should avoid using the phrase and also caution that changing vocabulary alone will not suffice. Instead, we suggest that researchers explicitly apply frameworks that are supportive, name racially systemic inequities and embrace student identity. We review four such frameworks—opportunity gaps, educational debt, community cultural wealth, and ethics of care—and reinterpret salient examples from biology education research as an example of each framework. Although not exhaustive, these descriptions form a starting place for biology education researchers to explicitly name systems-level and asset-based frameworks as they work to end educational inequities.

Diaphragmatic excursion by ultrasound: reference values for the normal population; a cross-sectional study in Egypt.

BackgroundMeasurement of diaphragmatic motion by ultrasound is being utilized in different aspects of clinical practice. Defining reference values of the diaphragmatic excursion is important to identify those with diaphragmatic motion abnormalities. This study aimed to define the normal range of diaphragmatic motion (reference values) by Mmode ultrasound for the normal population.MethodsHealthy volunteers were included in this study. Those with comorbidities, skeletal deformity, acute or chronic respiratory illness were excluded. Diaphragmatic ultrasound in the supine position was performed using a lowfrequency probe. The B-mode was applied for diaphragmatic identification, and the M-mode was employed for the recording of the amplitude of diaphragm contraction during quiet breathing, deep breathing and sniffing.ResultsThe study included 757 healthy subjects [478 men (63.14%) and 279 women (36.86%)] with normal spirometry and negative history of previous or current respiratory illness. Their mean age and BMI were 45.17 ±14.84 years and 29.36±19.68 (kg/m2). The mean right hemidiaphragmatic excursion was 2.32±0.54, 5.54±1.26 and 2.90±0.63 for quiet breathing, deep breathing and sniffing, respectively, while the left hemidiaphragmatic excursion was 2.35±0.54, 5.30±1.21 and 2.97±0.56 cm for quiet breathing, deep breathing and sniffing, respectively. There was a statistically significant difference between right and left diaphragmatic excursion among all studied subjects. The ratio of right to left diaphragmatic excursion during quiet breathing was (1.009±0.19); maximum 181% and minimum 28%. Only 19 cases showed a right to left ratio of less than 50% (5 men and 14 women). The diaphragmatic excursion was higher in males than females. There was a significant difference in diaphragmatic excursion among age groups. Age, sex and BMI significantly affected the diaphragmatic motion.ConclusionsDiaphragmatic excursion values presented in this study can be used as reference values to detect diaphragmatic dysfunction in clinical practice. Diaphragmatic motion is affected by several factors including age, sex and body mass index.

Hiroshima and Manila: Experiences and Memories of Loss in World War II

Hiroshima and Manila were both severely damaged during World War II. While Hiroshima is known around the world as a city destroyed by an atomic bomb, the damage done to Manila is less well-known internationally and also in Japan, despite the deaths of one hundred thousand civilians. The atrocities perpetrated on civilians by Japanese soldiers during the Battle of Manila cast a dark shadow over postwar views of Japan in the Philippines. But why has the battle been forgotten in today’s Japan? This article traces the history of the battle and examines Japanese perceptions of it. It also analyzes how the Japanese atrocities escalated and additionally discusses Filipino views on the atomic bombings. The article considers how to deal with memories of “negative history” through a case study.

Towards a Negative History of Science: The Unknown, Errors, Ignorance, and the “Pseudosciences”

This article outlines elements of a negative history of science. For historians wishing to get a fuller picture of scientific practice both internally and externally, there is a lot to be gained by considering the dialectical constitution of scientific knowledge. To fully comprehend this relationality, historians should, therefore, trace the negative relations science maintains. Through oppositions, such as known/unknown; success/error; consideration/ignorance; and inclusion/exclusion, scientific knowledge emerges and disappears, and the social position of scientific practice is both established and contested. To exemplify our argument, we present four areas: the unknown, errors, ignorance, and the “pseudosciences”. Taken together, this approach allows us to understand how science constitutes itself epistemically and socially across different locations and historical periods.

Clinical characteristics and outcome in muscular sarcoidosis: a retrospective cohort study and literature review

We evaluated the clinical features and treatment response of patients with muscular sarcoidosis. A retrospective cohort of 12 patients showed muscle weakness in 11 and myalgia in seven. One had focal myositis. Four had a negative medical history for sarcoidosis. Muscle imaging showed muscle edema in all and replacement of muscle tissue by fat in half of patients. Muscle biopsy showed non-caseating granulomas in six of nine patients and inflammation without granulomas in three. None of the muscle biopsies showed features of inclusion body myositis. Imaging in three patients without muscle biopsy showed focal intramuscular masses or a ‘tiger man’ appearance typical for muscular sarcoidosis. Treatment consisted of glucocorticoids in 11, additional methotrexate or azathioprine in seven and infliximab in two patients. Half of the patients had symptoms leading to substantial disability (modified Rankin scale score >1) at last follow-up. A literature review of articles describing more than one muscular sarcoidosis patient published in the last 25 years identified 153 additional patients. We found muscular sarcoidosis to be a rare and often disabling disease which may be recognized by typical muscle imaging characteristics and add focal myositis to the muscular phenotypes of sarcoidosis.

Paediatric progressive primary tuberculosis

A previously healthy 13-year-old Japanese girl with a BCG vaccination history and no tuberculosis (TB) exposure history presented to the hospital with mild dyspnea for 1 month and fever for 5 days. Computed tomography showed consolidation with a pleural effusion, obstructed left main bronchus with an air bronchogram, and traction bronchiectasis of the left upper lobe (Fig. 1A, B). No improvement was observed with ampicillin. Computed tomography on day 23 showed a new granular shadow in the right upper lobe (Fig. 1C). Despite a negative interferon-gamma release assay (IGRA) result, the sputum on day 55 was positive for acid-fast bacilli on a ZiehlNeelsen stain and Mycobacterium tuberculosis on polymerase chain reaction. A fourdrug antituberculous regimen was initiated and she recovered rapidly. TB exposure history, positive tuberculin skin test or IGRA, and typical imaging findings are the triad for primary TB diagnosis (Perez-Velez and Marais, 2012; Lewinsohn et al., 2017; Ahmed et al., 2020). In pediatric primary TB, consolidation may be present and can be misdiagnosed as bacterial pneumonia; however, massive consolidation is rare (GriffithRichards et al., 2007). Primary pulmonary TB should be considered in children with lung consolidation that is unresponsive to antibiotics, despite negative IGRA and TB exposure history.

P33 SUPRAVENTRICULAR TACHYARRHYTHMIAS AND RECURRENT SYNCOPES AFTER PERCUTANEOUS CLOSURE OF PFO IN A YOUNG PATIENT WITH NO HISTORY OF THROMBOEMBOLISM. IMPORTANCE OF CURRENT GUIDELINES

Abstract The presence of a PFO (patent foramen ovale) has been associated with cryptogenic stroke in particular in the young adult, sustained by paradoxical embolism. Its percutaneous closure represents a prophylactic treatment. The procedure can involve various post–procedural complications including supraventricular tachyarrhythmias related to the mechanical action exerted by the device. The clinical case presented concerns a 49–year–old woman with a negative cardiovascular history, suffering from headache, who came to the emergency room due to the onset of relapsing episodes of symptomatic cardiopalmus due to dizziness and syncope. The ECG documented the presence of a high–frequency supraventricular tachyarrhythmia treated by external electrical cardioversion as the patient was pale and hypotensive. The laboratory tests were normal as well as the echocardiogram. The patient had undergone, three weeks earlier, percutaneous closure of PFO diagnosed following the finding of brain ischemic areas on magnetic resonance imaging (MRI) performed only to complete the diagnosis of the headache. The patient was then admitted to Cardiology where further arrhythmic relapses occurred, including a 2:1 atrial flutter treated effectively with amiodarone, a drug then introduced orally. Given the recent interventional procedure, pharmacological prophylaxis of arrhythmias was opted for, with benefit as the episodes have progressively reduced in terms of frequency and intensity. At two–months FU the patient reported only two episodes per week until complete regression, after a further 4 months. This allowed the suspension of amiodarone. Several studies and the latest guidelines indicate PFO closure in the case of stroke in patients under the age of 60 clearly correlated with paradoxical embolism; in our case, the procedure was performed after the occasional finding of ischemic micro–areas on MRI considered secondary to PFO in the absence of multidisciplinary cardiological–neurological evaluation and in a symptomatic patient only for headache. The patient had significant arrhythmic complications that had an important impact on her quality of life, also from a psychological point of view, for at least 6 months. Compared to the past, current guidelines have filled a gap that often led to “lightly” performing procedures whose complications can be really important.

Thymus CT-grading and rebound hyperplasia during COVID-19 infection: a CT volumetric study with multivariate linear regression analysis

BackgroundThe importance of thymic CT-grading and presence of thymic rebound hyperplasia during COVID-19 infection were only investigated in a few studies. This multivariate study aims to evaluate the relation between thymus CT-grading and rebound during COVID-19 infection and the following: (1) the patients' age, (2) the patients' blood lymphocytic count, (3) the CT-volumetry of the diseased lung parenchyma, (4) the patient's clinical course and prognosis, and finally (5) the final radiological diagnosis.ResultsMulticenter retrospective analyses were conducted between March and June 2021 on 325 adult COVID-19 patients with positive PCR results and negative history of malignant or autoimmune diseases. They included 186 males and 139 females (57.2%:42.8%). Their mean age was 40.42 years ± 14.531 SD. Three consulting radiologists performed CT-grading of the thymus gland (grade 0–3) and CT-severity scoring (CT-SS) of the pathological lung changes in consensus. Two consulting pulmonologists correlated the clinical severity and blood lymphocytic count. Pearson correlation coefficient (r) and linear regression analyses were statistically utilized. Sub-involuted thymus (with CT-grade 0:2) was detected in 42/325 patients (12.9%); all of them had a mild clinical course and low CT-SS (0–1). Thymic rebound hyperplasia was the only positive CT-finding in 15/325 patients (4.6%) without pathological lung changes. A weak positive significant correlation was proved between thymic grade and patient's age, clinical course, and CT-SS (r = 0.217, 0.163, and 0.352 with p ≤ 0.0001, < 0.0001, and 0.002, respectively). A weak negative significant correlation was found between thymic grade and lymphocytic count (r = − 0.343 and p ≤ 0.0001). A strong positive significant correlation was encountered between clinical severity against patients' age and CT-SS (r = 0.616 and 0.803 with p ≤ 0.0001).ConclusionsThe presence of sub-involuted thymus or thymic rebound should not be radiologically overlooked in COVID-19 patients. During COVID-19 infection, the presence of sub-involuted thymus with low CT-grading (0–2) was correlated with young age groups, low CT-severity scoring, mild clinical course, and better prognosis (good prognostic factor). It was seldom seen in old hospitalized patients. Atypically, it was also correlated with normal lymphocytic count or even lymphocytosis. The thymic rebound could be the only positive CT-finding even during the absence of lung involvement.

Safety and immunogenicity of an egg-based inactivated Newcastle disease virus vaccine expressing SARS-CoV-2 spike: Interim results of a randomized, placebo-controlled, phase 1/2 trial in Vietnam

Production of affordable coronavirus disease 2019 (COVID-19) vaccines in low- and middle-income countries is needed. NDV-HXP-S is an inactivated egg-based Newcastle disease virus (NDV) vaccine expressing the spike protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Wuhan-Hu-1. The spike protein was stabilized and incorporated into NDV virions by removing the polybasic furin cleavage site, introducing the transmembrane domain and cytoplasmic tail of the fusion protein of NDV, and introducing six prolines for stabilization in the prefusion state. Vaccine production and clinical development was initiated in Vietnam, Thailand, and Brazil. Here the interim results from the first stage of the randomized, dose-escalation, observer-blind, placebo-controlled, phase 1/2 trial conducted at the Hanoi Medical University (Vietnam) are presented. Healthy adults aged 18–59 years, non-pregnant, and with self-reported negative history for SARS-CoV-2 infection were eligible. Participants were randomized to receive one of five treatments by intramuscular injection twice, 28 days apart: 1 μg +/- CpG1018 (a toll-like receptor 9 agonist), 3 μg alone, 10 μg alone, or placebo. Participants and personnel assessing outcomes were masked to treatment. The primary outcomes were solicited adverse events (AEs) during 7 days and subject-reported AEs during 28 days after each vaccination. Investigators further reviewed subject-reported AEs. Secondary outcomes were immunogenicity measures (anti-spike immunoglobulin G [IgG] and pseudotyped virus neutralization). This interim analysis assessed safety 56 days after first vaccination (day 57) in treatment-exposed individuals and immunogenicity through 14 days after second vaccination (day 43) per protocol. Between March 15 and April 23, 2021, 224 individuals were screened and 120 were enrolled (25 per group for active vaccination and 20 for placebo). All subjects received two doses. The most common solicited AEs among those receiving active vaccine or placebo were all predominantly mild and included injection site pain or tenderness (<58%), fatigue or malaise (<22%), headache (<21%), and myalgia (<14%). No higher proportion of the solicited AEs were observed for any group of active vaccine. The proportion reporting vaccine-related AEs during the 28 days after either vaccination ranged from 4% to 8% among vaccine groups and was 5% in controls. No vaccine-related serious adverse event occurred. The immune response in the 10 μg formulation group was highest, followed by 1 μg + CpG1018, 3 μg, and 1 μg formulations. Fourteen days after the second vaccination, the geometric mean concentrations (GMC) of 50% neutralizing antibody against the homologous Wuhan-Hu-1 pseudovirus ranged from 56.07 IU/mL (1 μg, 95% CI 37.01, 84.94) to 246.19 IU/mL (10 μg, 95% CI 151.97, 398.82), with 84% to 96% of vaccine groups attaining a ≥ 4-fold increase over baseline. This was compared to a panel of human convalescent sera (N = 29, 72.93 95% CI 33.00–161.14). Live virus neutralization to the B.1.617.2 (Delta) variant of concern was reduced but in line with observations for vaccines currently in use. Since the adjuvant has shown modest benefit, GMC ratio of 2.56 (95% CI, 1.4–4.6) for 1 μg +/- CpG1018, a decision was made not to continue studying it with this vaccine. NDV-HXP-S had an acceptable safety profile and potent immunogenicity. The 3 μg dose was advanced to phase 2 along with a 6 μg dose. The 10 μg dose was not selected for evaluation in phase 2 due to potential impact on manufacturing capacity. ClinicalTrials.gov NCT04830800.

Effects of Age and Middle Ear on the Frequency Tuning of the cVEMP and oVEMP.

Upward shift in the air conducted (AC) frequency tuning of vestibular evoked myogenic potentials (VEMPs) as an effect of aging is hypothesized to be due to the microstructural stiffening changes in the inner ear. However, with an AC stimulus, it may be possible that the shift in the frequency tuning of VEMPs as an effect of aging may also be due to contributions from the middle ear. The main aim of this study was to examine the effects of age on the frequency tuning of the cervical VEMP (cVEMP) and ocular VEMP (oVEMP) and determine the role of middle ear transmission characteristics in shaping these effects. Standard group comparison. One-hundred seven participants divided in three groups: young adult, middle-age, and older adults with "normal" middle ear and negative history of neurological or vestibular complaints. Middle ear measures included static admittance and middle ear resonant frequency. cVEMP and oVEMPs were elicited with AC tone bursts at 500, 750, and 1,000 Hz. No significant effect of age was observed on any of the middle ear measures. There was a significant effect of age on the amplitude of the cVEMP, but this effect was frequency specific. The age-related reduction in cVEMP corrected amplitude was only observed when the eliciting stimulus was 500 or 750 Hz, with no significant effect observed with a 1,000 Hz stimulus. For the oVEMP, the effects of age were apparent at all stimulus frequencies. We also observed a general upward shift in the frequency tuning of both the cVEMP and oVEMP for middle-age and older adults, with 750 and 1,000 Hz yielding higher response rates and larger amplitudes among middle-aged and older adults. Measurements of middle ear did not significantly contribute to the observed findings. The upward shift in frequency tuning of VEMPs among middle age and older adults could be due to the changes in the vestibular system and not from the middle ear. These results support the use of different frequency stimuli (i.e., 750 or 1,000 Hz) to elicit a VEMP if a response is absent using a 500 Hz stimulus, especially in patients over the age of 40.

Evaluating the Response and Safety of Inactivated COVID-19 Vaccines in Liver Transplant Recipients.

PurposeTo evaluate the response and safety of an inactivated vaccine (Sinovac Life Sciences Co., Ltd., Beijing, China) for coronavirus disease 2019 (COVID-19) in liver transplant (LTx) recipients from China.Patients and MethodsThirty-five recipients post LTx from the First Affiliated Hospital of Zhejiang University School of Medicine who received inactivated vaccine from June to October 2021 were screened. Information regarding vaccine side effects and clinical data were collected.ResultsThirty-five LTx recipients were enrolled, with a mean age of 46 years, and most patients were male (30, 85.71%). All the participants had a negative history of COVID-19 infection. Predictors for negative response in the recipients were interleukin-2 receptor (IL-2R) induction during LTx, shorter time post LTx and application of a derivative from mycophenolate acid (MPA). No serious adverse events were observed during the progress of vaccination or after the vaccination.ConclusionLTx recipients have a substantially partial immunological response to the inactivated vaccine for COVID-19. IL-2R induction during LTx, a shorter time post LTx and the application of a derivative from MPA seem to be predictors for a negative serological immunoglobulin G (IgG) antibody response in recipients. The findings require booster vaccination in these LTx recipients.

Ways of interpretation of legislative provisions setting forth administrative fines for customs violatios for aligning them with the rule of law

The article argues that there is an urgent need to interpret the provisions of the customs legislation on administrative fines in a way that ensures correspondence of its amount to circumstances of the case relating to the gravity of the offense, the degree of guilt of the offender and his situation, as opposed to the mechanical imposition of this administrative penalty by customs authorities and courts in single unchangeable amount prescribed by law. Applying normative-dogmatic, systemic, comparative-legal and other methods of scientific research, the author maintains that, despite the literal content of the provisions of customs legislation on the application of fines for violations of customs rules, they should be interpreted taking into account the principle of proportionality, which requires limiting punishments to the mildest possible measures suitable enough to respond to particular offenses. Given the priority of the rule of law over the provisions of positive law, a definite amount of fines for violation of customs legislation cannot relieve governmental authorities of the obligation, to weigh the intensity of state repressive measures in light of special circumstances. As the experience of the most developed countries shows, aggravating circumstances can be considered which are, in particular, the negative history of cooperation with customs authorities, intentional obstruction of the investigation of customs authorities by withholding evidence or misleading customs officials. Instead, in determination of appropriate amount of fine for violating customs regulations one should consider mitigating circumstances such as commitment of an offense for the first time with a negligent form of guilt or without significant consequences for the state budget due to lack of revenue; severe events of a personal nature in life of a person who independently conducts business activities or has a decisive influence on business decisions; taking all possible steps to avoid the offense, including requesting advice or other assistance from the customs authorities; bona fide error in complex issues of customs administration due to inexperience; connection of the offense with a complementary error of the customs authorities, cooperation during the investigation of the customs authorities; immediate correction of the violation; positive history of interaction with customs authorities.

Gingival Squamous Cell Carcinoma Masquerading as Localized Periodontal Disease in the Maxilla: A Case Report

Objectives: Squamous cell carcinoma is a malignant neoplasm of epithelium. In the U.S., carcinoma of the gingiva constitutes 4% to 16% of all oral carcinomas. This case report highlights such a case in maxillary gingiva and emphasizes the vital role of dental professionals, especially periodontists and endodontists, in being cognizant that an inflammatory lesion can mimic a serious condition like squamous cell carcinoma. Case Presentation: A patient who visited the screening clinic for an ulcerated lesion in the gingiva was otherwise healthy with no associated history of tobacco or any traumatic/persistent traumatic events. The patient was treated for pseudoepitheliomatous hyperplasia based on the current condition and negative history of malignancy. On three months of follow-up, computed tomography radiographic evaluation and a biopsy were done, which were positive for the malignancy. Follow-up after six months includes PET, Head MRI, and chest X-ray examinations to rule out any metastatic entity. Results: A six-month follow-up radiographic examination revealed metastasis of the entity. Additional findings include pleural effusion and underlying infections. Conclusion: Early diagnosis is the key to the treatment plan. It further highlights the role of advanced imaging as a vital tool in determining the extent of the disease. Therefore, any persistent lesion exhibiting features that are not responding to conventional gingival and periodontal treatment options for more than two weeks should be referred for further evaluation to rule out cancer.

A survey of physicians’ opinions about the treatment of subsegmental pulmonary embolism

IntroductionThe aim of this study was to survey the attitudes of internists, cardiologists, and pulmonologists regarding treatment or no treatment of isolated subsegmental pulmonary embolism (ISSPE) with anticoagulant drugs.MethodsQualified physicians were asked to select their management options from a questionnaire that included a patient scenario with subsegmental pulmonary embolism (SSPE) and negative past medical history of thromboembolism.ResultsA total of 113 physicians responded to the survey. Of these, 8.8% preferred not to treat patients without further evaluation; 15% decided not to treat, but follow-up the patient with a serial lower-limb colour Doppler ultrasonography; 1.7% preferred anticoagulant treatment only during hospitalization and follow-up without medication; 5% preferred anticoagulant treatment for less than 3 months; and 34.5% chose a 3–6-month treatment with anticoagulation. Furthermore, 24% of physicians opted for anticoagulant treatment for more than 6 months, and 9.7% left the decision up to the patient. Opting not to treat was an option selected by more board-certified faculty members specialized in cardiology, internal medicine, and pulmonology compared with residents (p = 0.038). Willingness to provide anticoagulant therapy in the internal medicine, cardiology and pulmonology groups was 56.6%, 37.3% and 6%, respectively (p = 0.007).ConclusionThe majority of physicians surveyed prefer anticoagulant therapy in patients with SSPE.