Expression of CD25, mast cell markers and T-cell markers in eosinophilic esophagitis.

While eosinophilic esophagitis (EOE) is defined by histologic presence of eosinophils, a few studies have established the presence of mast cells in EOE and even shown their correlation with symptom persistence despite resolution of eosinophils. Expression of aberrant mast cell markers CD25 and CD2 have not been studied in EOE. This study quantifies the number of hotspot cells per high power field expressing CKIT/CD117, tryptase, CD25, CD2 and CD3 by immunohistochemical stains in endoscopic esophageal biopsies of the following three cohorts: (1) established and histologically confirmed EOE, (2) suspected EOE with biopsies negative for eosinophils, and (3) no history of or suspicion for EOE with histologically unremarkable biopsies. In this study, mast cells were highlighted by CKIT and tryptase in EOE, and not seen in other clinically mimicking cases. There were also significantly higher densities of CD25 and pan-T-cell marker staining in EOE cases. These findings suggest an inflammatory cellular milieu in EOE, beyond just eosinophils, that can be demonstrated by immunohistochemistry, and that invite further study into the role that these cells may play in EOE.

Development of a novel, highly sensitive assay for quantification of minimal residual B cells in autoimmune disease and comparison to traditional methods across B-cell-depleting agents.

Targeted B-cell depletion is a useful therapy for many diseases, including autoimmune disorders and certain cancers. We developed a sensitive blood B-cell depletion assay, MRB 1.1, compared its performance with the T-cell/B-cell/NK-cell (TBNK) assay, and assessed B-cell depletion with different therapies. The empirically defined lower limit of quantification (LLOQ) for CD19+ cells in the TBNK assay was 10 cells/µL, and 0.441 cells/µL for the MRB 1.1 assay. The TBNK LLOQ was used to compare differences between B-cell depletion in similar lupus nephritis patient populations who received rituximab (LUNAR), ocrelizumab (BELONG), or obinutuzumab (NOBILITY). After 4 weeks, 10% of patients treated with rituximab retained detectable B cells vs 1.8% with ocrelizumab and 1.7% for obinutuzumab; at 24 weeks 93% of patients who received obinutuzumab remained below LLOQ vs 63% for rituximab. More-sensitive measurements of B cells may reveal differences in potency among anti-CD20 agents, which may associate with clinical outcomes.

Defining the Full Spectrum of Pediatric Firearm Injury and Death in the United States: It is Even Worse Than We Think.

OBJECTIVE: To characterize the full spectrum of pediatric firearm injury in the United States by describing fatal and nonfatal injury data epidemiology, vulnerable populations, and temporal trends. BACKGROUND: Firearm injury is the leading cause of death in children and adolescents in the United States. Nonfatal injury is critical to fully define the problem, yet accurate data at the national level are lacking. METHODS: A cross-sectional study combining national firearm injury data from the Centers for Disease Control (fatal) and the National Trauma Data Bank (nonfatal) between 2008 and 2019 for ages 0 to 17 years. Data were analyzed using descriptive and χ 2 comparisons and linear regression. RESULTS: Approximately 5000 children and adolescents are injured or killed by firearms each year. Nonfatal injuries are twice as common as fatal injuries. Assault accounts for the majority of injuries and deaths (67%), unintentional 15%, and self-harm 14%. Black youth suffer disproportionally higher injuries overall (crude rate: 49.43/million vs White, non-Hispanic: 15.76/million), but self-harm is highest in White youth. Children <12 years are most affected by nonfatal unintentional injuries, 12 to 14 years by suicide, and 15 to 17 years by assault. Nonfatal unintentional and assault injuries, homicides, and suicides have all increased significantly ( P < 0.05). CONCLUSIONS: This study adds critical and contemporary data regarding the full spectrum and recent trends of pediatric firearm injury in the United States and identifies vulnerable populations to inform injury prevention intervention and policy. Reliable national surveillance for nonfatal pediatric firearm injury is vital to accurately define and tackle this growing public health crisis.

Content Analysis of American Network News Coverage of Prevention Strategies During the Initial Wave of the COVID-19 Pandemic.

BACKGROUND: Broadcast media is a method to communicate health information to the general public and has previously been used in prior public health emergencies. Despite the current ubiquity of social media, traditional news programming retains relatively large audiences, which increased during the COVID-19 pandemic's early days. Viewership of broadcast media networks' evening news skews toward older groups (age 65 and up) which were vulnerable to health complications related to the COVID-19 pandemic. OBJECTIVES: The current study explored the trends in American broadcast network news media coverage of prevention during the initial wave of the COVID-19 pandemic. DESIGN: Quantitative content analysis using the Public Health Framework for Prevention was used to analyze three major US media networks' evening news content for thematic trends in COVID-19 coverage during the first US pandemic wave from March to May 2020. SUBJECTS: A total of 117 episodes of the evening news, 39 from each of the three major US media networks, evenly divided among the first 13 weeks of the pandemic in the US. MAIN MEASURES: Outcome variables included average seconds of coverage per episode devoted to prevention strategies, COVID-19 coverage not related to prevention, and non-COVID-19 coverage. KEY RESULTS: The proportion of coverage dedicated to COVID-19 sharply increased in the first 2 weeks of March and decreased in the last 2 weeks of May. Networks focused approximately half the COVID-19 coverage time on prevention issues (288 seconds/episode) compared to non-prevention issues (538 seconds/episode). Prevention coverage varied over time. CONCLUSIONS: Although coverage included COVID-19 prevention content, more of the coverage was on other pandemic-related issues (e.g., economic impacts). Because public network news outlets have broad reach and accessibility, they could be an effective partner for public health agencies disseminating prevention messaging for current and future disease outbreaks and threats to public health.

Regulation and Role of αE Integrin and Gut Homing Integrins in Migration and Retention of Intestinal Lymphocytes during Inflammatory Bowel Disease.

Targeting interactions between α4ß7 integrin and endothelial adhesion molecule MAdCAM-1 to inhibit lymphocyte migration to the gastrointestinal tract is an effective therapy in inflammatory bowel disease (IBD). Following lymphocyte entry into the mucosa, a subset of these cells expresses αEß7 integrin, which is expressed on proinflammatory lymphocytes, to increase cell retention. The factors governing lymphocyte migration into the intestinal mucosa and αE integrin expression in healthy subjects and IBD patients remain incompletely understood. We evaluated changes in factors involved in lymphocyte migration and differentiation within tissues. Both ileal and colonic tissue from active IBD patients showed upregulation of ICAM-1, VCAM-1, and MAdCAM-1 at the gene and protein levels compared with healthy subjects and/or inactive IBD patients. ß1 and ß7 integrin expression on circulating lymphocytes was similar across groups. TGF-ß1 treatment induced expression of αE on both ß7+ and ß7- T cells, suggesting that cells entering the mucosa independently of MAdCAM-1/α4ß7 can become αEß7+ ITGAE gene polymorphisms did not alter protein induction following TGF-ß1 stimulation. Increased phospho-SMAD3, which is directly downstream of TGF-ß, and increased TGF-ß-responsive gene expression were observed in the colonic mucosa of IBD patients. Finally, in vitro stimulation experiments showed that baseline ß7 expression had little effect on cytokine, chemokine, transcription factor, and effector molecule gene expression in αE+ and αE- T cells. These findings suggest cell migration to the gut mucosa may be altered in IBD and α4ß7-, and α4ß7+ T cells may upregulate αEß7 in response to TGF-ß once within the gut mucosa.

Validation of Self-Reported Attachment Classification Among Racially and Ethnically Diverse Parents of Young Children.

BACKGROUND: The Attachment Style Questionnaire (ASQ) was developed to measure individual differences in insecure adult attachment and was suitable for populations that may have minimal or no experience in romantic relationships. The measure was previously validated on homogenous populations. OBJECTIVES: The purpose of this study was to verify construct validity and internal consistency of the ASQ among an ethnically and racially diverse sample of caregivers of young children ages birth to 3 years. METHODS: Using a cross-sectional design, we examined the psychometric properties of the ASQ. A racially and ethnically diverse sample of caregivers of young children (birth to 3 years old) completed the 40-item measure. Factor analyses and internal consistency analyses were conducted. RESULTS: Confirmatory factor analyses showed that the previously published factor structures were not a good fit for this diverse sample. Exploratory factor analysis with promax rotation revealed a four-factor solution among 16 items, including relationship anxiety, relationships as secondary, discomfort with closeness, and relationship distrust. Adequate internal consistency was noted for the factors, and structural invariance was confirmed across Hispanic and non-Hispanic ethnicities. DISCUSSION: Nurse scientists and practitioners should take caution when using or developing indices based on previous research. There should be consideration of structural stability and replication across the intended population.

B-cell depletion with obinutuzumab for the treatment of proliferative lupus nephritis: a randomised, double-blind, placebo-controlled trial.

OBJECTIVE: Randomised trials of type I anti-CD20 antibodies rituximab and ocrelizumab failed to show benefit in proliferative lupus nephritis (LN). We compared obinutuzumab, a humanised type II anti-CD20 monoclonal antibody that induces potent B-cell depletion, with placebo for the treatment of LN in combination with standard therapies. METHODS: Patients with LN receiving mycophenolate and corticosteroids were randomised to obinutuzumab 1000 mg or placebo on day 1 and weeks 2, 24 and 26, and followed through week 104. The primary endpoint was complete renal response (CRR) at week 52. Exploratory analyses through week 104 were conducted. The prespecified alpha level was 0.2. RESULTS: A total of 125 patients were randomised and received blinded infusions. Achievement of CRR was greater with obinutuzumab at week 52 (primary endpoint, 22 (35%) vs 14 (23%) with placebo; percentage difference, 12% (95% CI -3.4% to 28%), p=0.115) and at week 104 (26 (41%) vs 14 (23%); percentage difference, 19% (95% CI 2.7% to 35%), p=0.026). Improvements in other renal response measures, serologies, estimated glomerular filtration rate and proteinuria were greater with obinutuzumab. Obinutuzumab was not associated with increases in serious adverse events, serious infections or deaths. Non-serious infusion-related reactions occurred more frequently with obinutuzumab. CONCLUSIONS: Improved renal responses through week 104 were observed in patients with LN who received obinutuzumab plus standard therapies compared with standard therapies alone. Obinutuzumab was well tolerated and no new safety signals were identified. TRIAL REGISTRATION NUMBER: NCT02550652.

Patterns of peripartum depression screening and detection in a large, multi-site, integrated healthcare system.

The purpose of this study was to examine peripartum depression (PD) screening patterns within and across the prenatal and postpartum periods and assess the incidence of new positive screens during standard screening protocol timepoints to inform practice, particularly when limited screenings can be conducted.This is a retrospective observational study of women screened for PD through a large, integrated health system using the Edinburgh Postnatal Depression Scale (EPDS) within their obstetrics and pediatric practices. Pregnancies with an EPDS score for at least one obstetric and one pediatric appointment between November 2016 and October 2019 were included (n = 3240). The data were analyzed using chi-squared test, Student's t-test, and binary logistic regression analyses. An EPDS score of 10 or higher was considered a positive screen.The positive screening rate for this cohort was 18.5%, with a prenatal positive rate of 9.9% and a postpartum positive rate of 8.6%. Single relationship status showed a higher rate of PD overall. Two thirds of women were not screened until their third trimester, resulting in delayed detection for an estimated 28% of women who ultimately screened positive. Few new positive screens (1.3%) were detected after 9 weeks postpartum in women who had completed all recommended prior screens.Obstetric providers should screen for PD as early in pregnancy as possible and continue to screen as often as feasible regardless of previous negative EPDS scores. Prioritizing screening more often in pregnancy and before 9 weeks postpartum is optimal to avoid delays in detection and intervention.

Reducing Secondary Traumatic Stress and Fueling Knowledge of Child Maltreatment Among Health Care Providers.

BACKGROUND: Child maltreatment is widespread, and its victims are frequently treated by trauma providers. However, providers across disciplines report feeling ill-equipped to identify and treat victims of child maltreatment and also report high levels of burnout and secondary traumatic stress. OBJECTIVE: This study aims to evaluate an intervention to improve health care provider knowledge, recognition, and reporting of child maltreatment and promote provider resilience as they care for victims of child maltreatment. METHODS: This is a single-group pre/posttest study design conducted from April to October 2019 of an educational intervention addressing child maltreatment knowledge, recognition, and self-care strategies for providers. Baseline and 6-month post-event questionnaires evaluated child maltreatment recognition and reporting, and the Professional Quality of Life instrument was used to measure compassion satisfaction, burnout, and secondary traumatic stress. Statistical analyses were conducted to evaluate the impact of the intervention on participants' self-reported knowledge, compassion, burnout, and secondary traumatic stress. RESULTS: A total of 164 health care providers participated in the study; the majority were nurses (69.5%). There was a 51.2% response rate for the 6-month post-event questionnaire (n = 84). Health care providers' knowledge of child maltreatment recognition and reporting significantly improved from pre-event (Mdn = 24.0) to post-event (Mdn = 27.0), z =-6.4, p < .001, and significantly decreased in secondary traumatic stress pre-event (Mdn = 20.0) to post-event (Mdn = 17.5), z =-2.11, p = .035. No changes were noted in compassion satisfaction or burnout. CONCLUSIONS: Educational activities can improve provider knowledge and recognition of child maltreatment and facilitate secondary traumatic stress reduction.

Appendiceal inflammation in colectomy is independently correlated with early pouchitis following ileal pouch anal anastomosis in ulcerative colitis and indeterminate colitis.

BACKGROUND: Appendiceal inflammation in colectomy is one of the histologic predictors of pouchitis in ulcerative colitis (UC) following ileal pouch anal anastomosis (IPAA). Fecal calprotectin level has been shown to increase 2 months prior to the onset of pouchitis. We evaluated whether inflammation and calprotectin expression in appendiceal specimens correlate with early-onset pouchitis in UC and indeterminate colitis (IC). MATERIALS AND METHODS: IPAA (2000-2018) cases with appendix blocks available in colectomy specimens were identified (n = 93, 90 UC, 3 IC). Histologic features thought to predict pouchitis were evaluated. The degree of appendiceal inflammation was scored. Calprotectin immunostain was performed on the appendix blocks and the extent of mucosal staining was quantified. Electronic medical records were reviewed for demographics, smoking history, clinical pouchitis, time of onset of pouchitis, and clinical and endoscopic components of the Pouchitis Disease Activity Index (PDAI) score. Follow-up pouch biopsies were reviewed and scored to generate histologic PDAI score, when available. RESULTS: Among the patients with clinical pouchitis (n = 73), moderate to severe appendiceal inflammation independently correlated with earlier pouchitis compared to no/mild inflammation (median time to pouchitis 12.0 vs. 23.8, log rank p = 0.016). Calprotectin staining correlated with inflammatory scores of the appendix (Spearman's rho, r = 0.630, p < 0.001) but not with early pouchitis (p > 0.05). CONCLUSIONS: The presence of moderate to severe appendiceal inflammation at the time of colectomy was associated with a shorter time to pouchitis following IPAA. Calprotectin immunostain may be used to demonstrate the presence of inflammation in the appendix but its role in predicting early pouchitis remains limited.

Gastrointestinal Diaphragm Disease With Retained Capsule Endoscope, Associated With Crohn's Disease: A Case Report.

Gastrointestinal diaphragm disease is a rare entity characterized by the formation of thin membranous circumferential mucosal septa, resulting in marked narrowing of the intestinal lumen. The most frequent etiology is the chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs). Idiopathic cases and other possible etiologies have been reported. We present a rare association of diaphragm disease with Crohn's disease in a boy without a history of significant NSAID usage.

Development and Validation of a PACER Prediction Equation for VO2peak in 10- to 15-Year-Old Youth.

Previous progressive aerobic cardiovascular endurance run (PACER) equations were developed to estimate peak oxygen consumption (VO2peak) from data collected during treadmill running. No equation has been developed using VO2peak assessed during the PACER. Purpose: To develop and validate a prediction equation to estimate VO2peak from the PACER in 10- to 15-year-olds. Methods: A sample of 163 youth were recruited to develop (n = 101) and validate (n = 62) a prediction equation. VO2peak was measured using a portable metabolic unit. Regression analysis yielded a prediction equation that included laps, body mass index, and interaction between sex and age. Correlations and repeated-measures analysis of variances were used to compare the measured and estimated VO2peak from the new Scott et al equation and 2 commonly used FitnessGram™ (Mahar et al 2011 and Mahar et al 2018) equations, and the impact of sex on predicted VO2peak. Results: Predicted VO2peak from the Mahar et al 2011 and 2018 equations was significantly lower compared with measured values, and the Scott et al prediction was not different. The Mahar et al 2018 equation tended to overestimate VO2peak in males but worked well for females. The Mahar et al 2011 and Scott et al equations revealed no sex differences. Conclusions: The Scott et al equation resulted in a more accurate estimate of VO2peak, performing equally well for both sexes.

Administration of certain sedative drugs is associated with variation in sonographic and radiographic splenic size in healthy cats.

Ultrasonography and radiography are standard diagnostic tests for cats with suspected splenic disease, however published information on outside sources of variation are currently lacking. The purpose of this prospective, randomized, crossover group study was to evaluate effects of common sedative drugs on the sonographic and radiographic characteristics of the spleen in healthy cats. Fifteen healthy adult research cats were randomly assigned into one of three groups corresponding to different sequences of administration of five sedative drugs/drug combinations (acepromazine; butorphanol; dexmedetomidine; midazolam and butorphanol (MB); and dexmedetomidine, butorphanol, and ketamine (DBK)), administered at 1-week intervals. At each visit, three-view abdominal radiographic and ultrasonographic examinations were performed prior to sedation and repeated 15-30 min and 2-3 h post sedation. Two board-certified radiologists (one ACVR and one ACVR/ECVDI) evaluated the anonymized and randomized images. Acepromazine resulted in significantly increased sonographic and radiographic splenic measurements from baseline, which remained significantly increased 2-3 h post sedation. The mean magnitude of this change ranged from 0.9 mm (tail height, SD 1.4 mm) to 1.8 mm (body height, SD 1.7 mm) for ultrasound, and was 2.2 mm (ventrodorsal width, SD 2.3 mm) for radiographs. With butorphanol, there was no significant change in splenic size. For dexmedetomidine, MB, and DBK, there was a trend toward increased splenic size from baseline to the first post-sedation timepoint, which was statistically significant for radiographic measurements, although not for ultrasound. Findings indicated that acepromazine should be avoided prior to imaging while butorphanol may be used when sedation is needed in cats presenting for potential splenic disease.

Socioeconomic disparities based on shooting intent in pediatric firearm injury.

BACKGROUND: Pediatric firearm injury is often associated with socioeconomically disadvantaged neighborhoods. Most studies only include fatal injuries and do not differentiate by shooting intent. We hypothesized that differences in neighborhood socioeconomic disadvantage would be observed among shooting intents of fatal and nonfatal cases. METHODS: A linked integrated database of pediatric fatal and nonfatal firearm injuries was developed from trauma center and medical examiner records in Harris County, Texas (2018-2020). Geospatial analysis was utilized to map victim residence locations, stratified by shooting intent. Area Deprivation Index (ADI), a composite measure of neighborhood socioeconomic disadvantage at the census tract level was linked to shooting intent. Differences in high ADI (more deprived) versus low ADI among the shooting intents were assessed. Unadjusted and adjusted regression models assessed differences in ADI scores across shooting intent, adjusted models controlled for age, gender, and race/ethnicity. RESULTS: Of 324 pediatric firearm injuries, 28% were fatal; 77% were classified as interpersonal violence, 15% unintentional, and 8% self-harm. Differences were noted among shooting intent across the ADI quartiles; with increases in ADI score, the odds of interpersonal violence injuries compared to self-harm injuries significantly increased by 5%; however, when adjusting for individual-level variables of age, gender, and race and ethnicity, no significant differences in ADI were noted. CONCLUSIONS: Our results suggest that children living in disadvantaged neighborhoods are more likely to be affected by interpersonal firearm violence compared to self-harm; however, when differences in race/ethnicity are considered, the differences attributable to neighborhood-level disadvantage disappeared. Resources should be dedicated to improving structural aspects of neighborhood disadvantage, which disproportionately impact racial/ethnic minoritized populations. Furthermore, firearm self-harm injuries occurred among children living in the less disadvantaged neighborhoods. Understanding the associations among individual and neighborhood-level factors are important for developing streamlined injury prevention interventions by shooting intent. LEVEL OF EVIDENCE: Level IVStudy TypePrognostic/Epidemiological.

A randomized, rater-blinded, parallel trial of intensive speech therapy in sub-acute post-stroke aphasia: the SP-I-R-IT study.

BACKGROUND: There is conflicting evidence regarding the benefits of intensive speech and language therapy (SLT), particularly because intensity is often confounded with total SLT provided. AIMS: A two-centre, randomized, rater-blinded, parallel study was conducted to compare the efficacy of 100 h of SLT in a regular (RT) versus intensive (IT) treatment in sub-acute post-stroke aphasia. METHODS & PROCEDURES: Consecutive patients with aphasia, within 3 months of a left hemisphere ischemic stroke, were randomized to IT (2 h per day × 5 days per week, 10 weeks) or RT (2 h per week × 50 weeks). Evaluations took place at 10, 50 and 62 weeks. Primary outcome was the frequency of responders, defined by 15% increase of Aphasia Quotient (AQ) from the baseline to 50 weeks. Secondary outcomes were changes from the baseline in AQ and functional communication profile (FCP) at 50 and 62 weeks and improvement stability between 50 and 62 weeks. OUTCOMES & RESULTS: Thirty patients were randomized and 18 completed the study. No significant differences were found between groups in primary or secondary outcomes, although IT patients (N = 9) obtained higher scores in language measures between 10 and 62 weeks in per protocol analysis. The number of non-completions was identical between groups. CONCLUSIONS & IMPLICATIONS: This study suggests that, in the sub-acute period following stroke and controlling for the number of hours of SLT provided, there is a trend for a greater improvement in language and functional communication measures with IT compared with RT. The lack of statistical significance in results was probably due to the small sample size.

Radiographic lung congestion scores in dogs with acute congestive heart failure caused by myxomatous mitral valve disease.

BACKGROUND: In humans, lung congestion scores are predictive of recurrence of acute congestive heart failure (CHF) and are superior to cardiac biomarkers in predicting survival. OBJECTIVES: The primary aim of this retrospective study was to determine if a modified lung congestion score (LCS) in dogs diagnosed with acute CHF because of myxomatous mitral valve disease was associated with time until recurrence or death. ANIMALS: Complete medical records were available for a total of 94 dogs between 2010 and 2019, but only 35 dogs fulfilled the criteria for inclusion. METHODS: This retrospective study used descriptive statistics to describe the cumulative and corrected LCS. Correlations were used to examine the association of the corrected LCS and time until recurrence or death, selected echocardiographic variables, and timing of furosemide administration. RESULTS: The mean LCS was 8.4 (SD 3.3) and corrected LCS was 0.48 (SD 0.19). The pattern was predominantly symmetric (40% of dogs) and focal (caudal) but more commonly right-sided when asymmetric (40% vs 20%). The median number of days after initial diagnosis of acute CHF to readmission and death was 150 days (range 4-572), and 266 days (range 5-965), respectively. No significant association between the dog's corrected LCS and number of days until readmission (r = .173, P = .42) nor survival (r = .109, P = .56) was found. There was a negative significant correlation (r = -.71, P < .001) between the time interval of furosemide administration and corrected LCS.

Nurses' Short-Term Sickness Absences Before and After the Implementation of a Brief Napping Opportunity During Night Shifts.

BACKGROUND: Nurses who work at night have used naps to alleviate their sleepiness and fatigue. Research has shown night shifts, sleepiness, and fatigue predict nurses' missed workdays. Thus, nighttime napping may have a beneficial consequence of reducing nurses' sickness absences. The purpose of this brief report was to describe the difference in rates of short-term sickness absence before and after implementation of a 30-min nap opportunity in one U.S. hospital for 12-hr shift nurses. METHODS: The study was a retrospective pre-post evaluation design. Eight units provided nap opportunities for the nurses. Full-time nurses were classified into night and rotating shifts based on their 2 years of scheduling patterns. Absence data were extracted from the hospital's timekeeping system and annual absence rates were computed. A single linear mixed model with rank transformed data was conducted for each group. Median estimates, minimum and maximum, and p-values were reported. FINDINGS: The median absence rates for night shift nurses were 4.3% and 4.0% for the pre-napping and post-napping implementation periods, respectively; however, this difference was not statistically significant (p = .241). The median absence rates for rotating shift nurses were 2.0% and 3.9% for the pre-napping and post-napping implementation periods, respectively; and the difference increase was statistically significant (p < .001). CONCLUSION/APPLICATION TO PRACTICE: A nap policy which provides nurses with the opportunity to take nighttime naps did not benefit their sickness absence rates. Future research needs to examine the actual napping process on sickness absences, as well as explore other sickness management avenues.

A Descriptive Methodology for Studying the Ontogeny of Object Play and Breed Differences in Dogs (Canis lupus familiaris).

Play behavior is a prominent aspect of juvenile behavior for many animals, yet early development, especially play with objects, has received little attention. Our previous study on object play introduced our general methods, focusing on litter differences in the developmental trajectory of object play and toy preferences. Here, we present a detailed ethogram of more than 30 observed object play behaviors. We focus on breed differences in the development of play in the three following breeds: Welsh Terriers, Vizslas, and standard Poodles. Puppies were video recorded from 3 to 7 weeks of age at half-week intervals upon the introduction of a standard set of five toys into their home environments. Ten minutes of video from each session for each puppy were analyzed using the Noldus Observer XT program. Aside from analyzing individual behaviors, they were also grouped into three behavioral categories. These were behaviors that occurred only in a solitary context, only in a social context, or in both contexts. Solitary object play developed first, and social object play developed later across breeds. There was a significant three-way interaction between breed, developmental age, and the context in which play occurred. Pairwise comparisons within each breed, age, and context are discussed, but a prominent result is that the onset of many behaviors occurred later in Welsh Terriers compared to the other breeds.

Distal biceps reconstruction: a long-term follow-up of the complications and durability of the single-incision power optimizing cost-effective (SPOC) repair.

Background: The Single-Incision Power Optimizing Cost-Effective Repair (SPOC) method reattaches the distal biceps tendon to its original posterior anatomic footprint and utilizes the anterior cortex of the supinated radius for fixation. The purpose of the study was to define the long-term complications and durability of the SPOC method. Methods: Two hundred and eighteen patients underwent the SPOC repair of distal biceps ruptures from 2008 to 2020, with 185 having at least 1-year follow-up data. The average follow-up was 50.1 months. Information regarding smoking, body mass index, interval between injury and surgery, peripheral nerve injury, heterotopic ossification, vascular injury, re-rupture, chronic regional pain syndrome, fracture of the radius, loss of motion, pain with use, and deformity were acquired. Results: No complication occurred beyond the third postoperative month. No patient complained of severe lateral antebrachial cutaneous nerve-related symptoms. Major complications exclusive of re-rupture occurred include 1 case of heterotopic ossification and 1 deep infection. Major complications with re-ruptures occurred in 9 patients (4.8%). Seven of the re-ruptures (78%) were associated with an unexpected forceful contraction within the first 4 weeks postop. All complications aside from 1 minor complication occurred in the chronic group. Long term follow-up revealed no re-ruptures and high satisfaction rate with return of strength, motion, and biceps profile. Conclusion: The safety profile of the SPOC repair is consistent with those of other published repairs. Major complications were associated with prolonged intervals between injury and reconstruction. Re-ruptures were associated with worker's compensation status and patient noncompliance with postoperative protocols.

Expanding the MAPPs Assay to Accommodate MHC-II Pan Receptors for Improved Predictability of Potential T Cell Epitopes.

A critical step in the immunogenicity cascade is attributed to human leukocyte antigen (HLA) II presentation triggering T cell immune responses. The liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based major histocompatibility complex (MHC) II-associated peptide proteomics (MAPPs) assay is implemented during preclinical risk assessments to identify biotherapeutic-derived T cell epitopes. Although studies indicate that HLA-DP and HLA-DQ alleles are linked to immunogenicity, most MAPPs studies are restricted to using HLA-DR as the dominant HLA II genotype due to the lack of well-characterized immunoprecipitating antibodies. Here, we address this issue by testing various commercially available clones of MHC-II pan (CR3/43, WR18, and Tü39), HLA-DP (B7/21), and HLA-DQ (SPV-L3 and 1a3) antibodies in the MAPPs assay, and characterizing identified peptides according to binding specificity. Our results reveal that HLA II receptor-precipitating reagents with similar reported specificities differ based on clonality and that MHC-II pan antibodies do not entirely exhibit pan-specific tendencies. Since no individual antibody clone is able to recover the complete HLA II peptide repertoire, we recommend a mixed strategy of clones L243, WR18, and SPV-L3 in a single immunoprecipitation step for more robust compound-specific peptide detection. Ultimately, our optimized MAPPs strategy improves the predictability and additional identification of T cell epitopes in immunogenicity risk assessments.