Better Understanding of the Metamorphosis of Pregnancy (BUMP): protocol for a digital feasibility study in women from preconception to postpartum.

The Better Understanding the Metamorphosis of Pregnancy (BUMP) study is a longitudinal feasibility study aimed to gain a deeper understanding of the pre-pregnancy and pregnancy symptom experience using digital tools. The present paper describes the protocol for the BUMP study. Over 1000 participants are being recruited through a patient provider-platform and through other channels in the United States (US). Participants in a preconception cohort (BUMP-C) are followed for 6 months, or until conception, while participants in a pregnancy cohort (BUMP) are followed into their fourth trimester. Participants are provided with a smart ring, a smartwatch (BUMP only), and a smart scale (BUMP only) alongside cohort-specific study apps. Participant centric engagement strategies are used that aim to co-design the digital approach with participants while providing knowledge and support. The BUMP study is intended to lay the foundational work for a larger study to determine whether participant co-designed digital tools can be used to detect, track and return multimodal symptoms during the perinatal window to inform individual level symptom trajectories.

Probiotic as an adjuvant therapy in chronic urticaria: a blinded randomized controlled clinical trial.

Summary: Background. Chronic spontaneous urticaria (CSU) is a common and treatment challenging disorder which may involve about 2% of normal population and in 50% do not respond properly even to the second line therapies. We aimed to evaluate the efficacy and safety of a synbiotic (prebiotic + probiotic) named as LactoCare in treatment of CSU in the RCT for the first time. Methods. This blinded RCT conducted on 42 patients (21 patients in control antihistamine group and 21 in intervention antihistamine + probiotic group) with CSU during 8 weeks. The efficacy assessed by Urticaria Activity Score (UAS7) and quality of life measured by Persian validated Dermatology Life Quality Index (DLQI). Results. Before and after UAS7 score in control group was 35.33 ± 7.81 and 16.86 ± 13.54, respectively. There was 53% score reduction in control group. Before and after UAS7 score in intervention group was 32 ± 7.84 and 11 ± 11.41, respectively. There was 66% score reduction in intervention group. Improvement of DLQI in control and intervention group was 44% and 66%, respectively. At the end, UAS7 score reduction and DLQI improvement in both groups was statistically significant. Conclusions. Probiotics are effective, safe and satisfactory adjuvant therapy for CSU. Combination of probiotic and antihistamines had no statistically significant different efficacy than the antihistamine alone, based on UAS7 score. But Patients with combination therapy may experience higher reduction rate of itch, number of urticaria and total UAS7 score that is clinically of great value and is really practical by itself. Patients with combination therapy experienced more improvement of quality of life (DLQI).

Sharing the sidewalk: A case of E-scooter related pedestrian injury.

The popularity of rideshare electric scooters is due to their availability, accessibility, and low cost. The recent increase in electric scooter use has raised concerns regarding the safety of both riders and pedestrians. Previous studies characterize the incidence and pattern of injury for riders, but there is a lack of literature concerning electric scooters' impact on pedestrians. Pedestrians injured by electric scooters face potential financial burdens from hospitalization costs, medical interventions, taking time off from work, and rehabilitation therapies. Based on prior studies, pedestrians who are most prone to injuries sustained by pedestrian transportation include individuals with vision and/or hearing impairment, young children, the elderly, and people distracted by mobile devices. We present a case involving a sixty-year-old female pedestrian who presented to the emergency department with an acute lumbar compression fracture after a collision with an electric scooter. This study highlights the safety risks and incidence of injuries for pedestrians associated with electric scooters, which can help shape public policy to ensure the safety of both riders and pedestrians.

Development of an Integrated Actuated Hand Orthosis and Virtual Reality System for Home-Based Rehabilitation.

Stroke survivors often require a lengthy and costly rehabilitation regimen to regain some of the hand function lost due to stroke. Financial, travel, and scheduling issues can limit access to clinical therapy, thereby depriving individuals of care. Interventions are needed which can extend from the clinic into the home. Home-based rehabilitation strategies, however, must promote sensorimotor learning while maintaining user engagement. Virtual reality, in combination with actuated orthoses, has the potential to provide solutions to these issues. The orthosis can facilitate appropriate therapy while the virtual reality can provide a conduit for maintaining human interaction and engagement in the home environment. In this paper, we describe the development of such an integrated system for hand and upper extremity rehabilitation.

Maxillary advancement versus mandibular setback in class III dentofacial deformity: are there any differences in aesthetic outcomes?

A retrospective evaluation of maxillary advancement and mandibular setback in class III patients was performed and their aesthetic outcomes compared. Patients with a sella-nasion-A-point angle (SNA) of 80-84° were selected. Pre- and postoperative lateral cephalograms were obtained for 34 class III patients; these were divided into two groups according to the surgical procedure performed: mandibular setback group (n=17) and maxillary advancement group (n=17). The pre- and postoperative cervical length, lip-chin-throat angle, lower/upper lip thickness, distance from the lower/upper lip to the aesthetic line, soft tissue angle, facial contour angle, and nasolabial angle of the two groups were compared. Significant differences were observed for cervical length (P=0.0003) and sex (P=0.003) when comparing maxillary advancement with mandibular setback. Although the preoperative cervical length was similar in the two groups, it increased significantly after maxillary advancement and decreased after mandibular setback. In this study, the differences in aesthetic outcomes depending on the surgical procedure performed were considered. Some aesthetically important parameters proved to be superior after maxillary advancement when compared to mandibular setback, even with the maxilla in the normal position.

Predicting early psychiatric readmission with natural language processing of narrative discharge summaries.

The ability to predict psychiatric readmission would facilitate the development of interventions to reduce this risk, a major driver of psychiatric health-care costs. The symptoms or characteristics of illness course necessary to develop reliable predictors are not available in coded billing data, but may be present in narrative electronic health record (EHR) discharge summaries. We identified a cohort of individuals admitted to a psychiatric inpatient unit between 1994 and 2012 with a principal diagnosis of major depressive disorder, and extracted inpatient psychiatric discharge narrative notes. Using these data, we trained a 75-topic Latent Dirichlet Allocation (LDA) model, a form of natural language processing, which identifies groups of words associated with topics discussed in a document collection. The cohort was randomly split to derive a training (70%) and testing (30%) data set, and we trained separate support vector machine models for baseline clinical features alone, baseline features plus common individual words and the above plus topics identified from the 75-topic LDA model. Of 4687 patients with inpatient discharge summaries, 470 were readmitted within 30 days. The 75-topic LDA model included topics linked to psychiatric symptoms (suicide, severe depression, anxiety, trauma, eating/weight and panic) and major depressive disorder comorbidities (infection, postpartum, brain tumor, diarrhea and pulmonary disease). By including LDA topics, prediction of readmission, as measured by area under receiver-operating characteristic curves in the testing data set, was improved from baseline (area under the curve 0.618) to baseline+1000 words (0.682) to baseline+75 topics (0.784). Inclusion of topics derived from narrative notes allows more accurate discrimination of individuals at high risk for psychiatric readmission in this cohort. Topic modeling and related approaches offer the potential to improve prediction using EHRs, if generalizability can be established in other clinical cohorts.

Reconstruction of facial soft tissue: comparison between conventional procedures and the facelift technique.

We compared the result of replacement using a modified facelift technique with those of other commonly used surgical techniques for the treatment of defects of the soft tissue of the infraorbital and cheek region. We made a retrospective observational study of 86 patients who had defects of the facial soft tissue after excision of malignant tumours. Procedures used for reconstructions included non-vascularised skin grafts, local flaps, facelift technique, and microvascular free flaps, and we evaluated morbidity; duration of hospital stay; the need for, and duration of stay in the intensive care unit (ICU); and functional and aesthetic outcomes. We studied 46 men and 40 women (mean (range) age 71 (8-99) years). We found no significant difference between the methods apart from shorter duration of hospital stay and lower incidence of ectropion in the facelift group. The facelift technique also gave the best aesthetic outcome. However, in defects larger than 60cm2, microvascular free tissue transfer was the only choice. The facelift technique is reliable and safe, and gives excellent aesthetic and functional outcomes, but its use is limited to defects smaller than 60cm2.

Accumulated deep sleep is a powerful predictor of LH pulse onset in pubertal children.

CONTEXT: During puberty, reactivation of the reproductive axis occurs during sleep, with LH pulses specifically tied to deep sleep. This association suggests that deep sleep may stimulate LH secretion, but there have been no interventional studies to determine the characteristics of deep sleep required for LH pulse initiation. OBJECTIVE: The objective of this study was to determine the effect of deep sleep fragmentation on LH secretion in pubertal children. DESIGN AND SETTING: Studies were performed in a clinical research center. SUBJECTS: Fourteen healthy pubertal children (11.3-14.1 y) participated in the study. INTERVENTIONS: Subjects were randomized to two overnight studies with polysomnography and frequent blood sampling, with or without deep sleep disruption via auditory stimuli. RESULTS: An average of 68.1 ±10.7 (± SE) auditory stimuli were delivered to interrupt deep sleep during the disruption night, limiting deep sleep to only brief episodes (average length disrupted 1.3 ± 0.2 min vs normal 7.1 ± 0.8 min, P < .001), and increasing the number of transitions between non-rapid eye movement (NREM), REM, and wake (disrupted 274.5 ± 33.4 vs normal 131.2 ± 8.1, P = .001). There were no differences in mean LH (normal: 3.2 ± 0.4 vs disrupted: 3.2 ± 0.5 IU/L), LH pulse frequency (0.6 ± 0.06 vs 0.6 ± 0.07 pulses/h), or LH pulse amplitude (2.8 ± 0.4 vs 2.8 ± 0.4 IU/L) between the two nights. Poisson process modeling demonstrated that the accumulation of deep sleep in the 20 minutes before an LH pulse, whether consolidated or fragmented, was a significant predictor of LH pulse onset (P < .001). CONCLUSION: In pubertal children, nocturnal LH augmentation and pulse patterning are resistant to deep sleep fragmentation. These data suggest that, even when fragmented, deep sleep is strongly related to activation of the GnRH pulse generator.

Long-term outcomes of minor troponin elevations in the intensive care unit.

The aim of our study is to determine the short-term and long-term outcomes of intensive care unit (ICU) patients with minor troponin elevations. The retrospective study compared ICU patients with peak troponin elevation less than 0.1 ng/ml to those with only negative tests during their hospital stay. Data were gathered from ICUs at Beth Israel Deaconess Medical Center between 2001 and 2008. A total of 4224 patients (2547 controls and 1677 positives) were analysed. The primary outcome was mortality at one year. Secondary outcomes were 30-day mortality and hospital and ICU lengths of stay. After adjusting for age, sex, Simplified Acute Physiology Score, Sequential Organ Failure Assessment and combined Elixhauser score, we found that minor troponin elevations (peak troponin elevation between 0.01 and 0.09 ng/ml) were associated with a higher one-year mortality (Hazard Ratio 1.22, P <0.001 for binary troponin presence; Hazard Ratio 1.03, P <0.001 for each 0.01 ng/ml troponin increment). This relationship held for the subgroup of seven-day post-discharge survivors (Hazard Ratio 1.26, P <0.001). Minor elevations of troponin also significantly increased the net reclassification index over traditional risk markers for mortality prediction (net reclassification score 0.12, P <0.001). Minor troponin elevation was also associated with 30-day mortality (odds ratio 1.33, P=0.003). Importantly, troponin testing did not increase the adjusted mortality odds (P=0.9). Minor elevations in troponin substantially increase one-year, all-cause mortality in a stepwise fashion; it was also independently associated with 30-day mortality. We propose that minor elevations in troponin should not be regarded as clinically unimportant, but rather be included as a prognostic element if measured. We recommend prospective ICU studies to assess prognostic value of routine troponin determination.

Jojoba in dermatology: a succinct review.

Phytomedicine has been successfully used in dermatology horizon for thousands of years. Jojoba (Simmondsia chinensis) is a long-lived, drought resistant, perennial plant with interesting economic value as it is processed for liquid wax production. The jojoba plant produces esters of long-chain alcohols and fatty acids (waxes) as a seed lipid energy reserve. The liquid wax is an important substrate for a variety of industrial applications and is used in skin treatment preparations. The oil from the jojoba plant is the main biological source of wax esters and has a multitude of potential applications. The review of literatures suggest that jojoba has anti-inflammatory effect and it can be used on a variety of skin conditions including skin infections, skin aging, as well as wound healing. Moreover, jojoba has been shown to play a role in cosmetics formulas such as sunscreens and moisturizers and also enhances the absorption of topical drugs. The intention of the review is to summarize the data regarding the uses of jojoba in dermatology for readers and researchers.

Occupational lead poisoning in workers of traditional tile factories in Mashhad, Northeast of Iran.

BACKGROUND: Occupational lead poisoning is a health problem in Iran. It has not previously been studied in traditional tile makers. OBJECTIVE: To determine the prevalence of lead poisoning and its complications in traditional tile workers in Mashhad, Northwest of Iran. METHODS: We visited workers in two traditional tile factories and collected data by direct history taking and physical examination. Blood and urine lead concentrations were measured by heated graphite atomization technique. RESULTS: Overall, 108 men with mean±SD age of 37±7.8 years were studied. The mean±SD length of daily lead exposure was 9.8±6 years. The mean±SD blood lead concentration was 520.5±323.2 µg/L. The main objective clinical findings were the presence of lead line (64.8%), peripheral neuropathy of the upper extremities (37%), depressed deep tendon reflexes in the upper extremities (25.7%), tremor (23.3%), peripheral neuropathy of the lower extremities (17%) and abdominal tenderness (15.1%). The subjective findings were mainly attributed to the central nervous system and included loss of memory (57%), moodiness (56.1%), agitation (47.7%), drowsiness (36.4%) and headache (29.9%). There was no statistically significant correlation between the blood lead concentration and glomerular filtration rate. However, there were significant correlations between the blood lead concentration and each of the urine lead concentration (p<0.001), diastolic blood pressure (p = 0.04), serum triglyceride level (p = 0.043), high density lipoprotein level (p = 0.012), and basophilic stippling (p = 0.048). Blood lead level, however, did not have any significant correlation with the presence of lead line. CONCLUSION: In traditional tile workers, lead toxicity is not uncommon and the toxic effects of lead were found more often on the teeth (bone), central and peripheral nervous system, hematological and lipid profiles than on the renal function.

Cochlear implantation in children with Jervell, Lange-Nielsen syndrome.

Jervell, Lange-Nielsen syndrome is a condition that causes profound hearing loss and disruption of the normal cardiac rhythm. This disorder is a form of long QT syndrome, a cardiac disorder that causes the cardiac muscle to take longer than usual to recharge between beats. A retrospective case study was performed to document cochlear implantation in three profoundly deaf children (two of them siblings) with Jervell, Lange-Nielsen syndrome. We discuss diagnosis and management of this syndrome and also the long-term performance of cochlear implantation in these Iranian patients, referring especially to the role of the ENT specialist in diagnosis and treatment. The collected data show that cochlear implantation can be relatively safely performed in patients with Jervell, Lange-Nielsen syndrome and that these children received significant benefit from cochlear implantation.

Lymphoproliferative responses to mitogens and prepared antigens of M. avium complex in patients with HIV infection.

Published reports have demonstrated that antigens of Mycobacterium avium complex (MAC) can suppress the normal response to mitogens in lymphoproliferation assays. We therefore studied the lymphoproliferative (LP) function of PBMC from 55 HIV-infected patients and 16 controls in response to mitogens with and without MAC antigen. As expected, LP responses decline with progressive decline in CD4 count; MAC antigen in combination with PHA further suppresses that response in a dose-dependent manner. More relevant were the LP responses in those with CD4 counts less than 100. All patients with MAC disease had poor responses (stimulation index, SI < 10) to PHA or anti-CD3 with or without MAC antigen. Those who did not have nor subsequently developed MAC were both good (SI > 10) or poor responders (SI < 10). The suppressive effect of MAC on lymphocyte function may serve as a weak virulence factor which is only relevant in severely immunocompromised HIV patients.

Induction of human immunodeficiency virus type 1 expression by anaerobes associated with bacterial vaginosis.

Bacterial vaginosis (BV) is a common disorder characterized by increased levels of anaerobic bacteria in the genital tract. BV has been associated with an increased rate of sexual transmission of human immunodeficiency virus (HIV). The effects of BV-associated anaerobic bacteria on HIV expression in monocytoid cells and T cells were examined. Peptostreptococcus asaccharolyticus and Prevotella bivia stimulated HIV expression in monocytoid cells, whereas Bacteroides ureolyticus, Peptostreptococcus anaerobius, and Lactobacillus acidophilus did not enhance HIV expression. P. asaccharolyticus also enhanced HIV expression in T cells and activated HIV long-terminal-repeat transcription in U38 cells. This report suggests a mechanism by which disturbances in vaginal flora could lead to a higher rate of sexual transmission of HIV. Furthermore, this study supports the idea that treatment of BV might serve as a preventive measure to reduce the risk of HIV transmission.

Mycobacterium avium induces HIV upregulation through mechanisms independent of cytokine induction.

Mycobacterium avium complex (MAC) can induce upregulation of HIV. To investigate the underlying mechanisms, the effect of MAC-induced cytokines on HIV replication was first studied. Semiquantitative RT-PCR, followed by Northern blot analysis, revealed that mRNA encoding IL-6 and TNF-alpha was induced by MAC. However, production of these cytokines was undetectable and the addition of anti-cytokine antibodies to coinfected cells could only minimally block the MAC effect on HIV. Infection of U38 cells with MAC resulted in enhancement of HIV-1 LTR-CAT transcription. In addition, transient transfection of U937 cells with full-length wild-type as well as NF-kappaB-binding site-deleted mutant HIV-1 LTR-CAT constructs revealed that MAC-induced HIV-LTR CAT is NF-kappaB dependent. These findings, together with our previous work, indicate that MAC-induced cytokine expression increases the formation of NF-kappaB, which in turn enhances HIV-1 LTR-CAT transcription. However, additional factor(s) yet to be elucidated may play a more significant role in MAC-mediated HIV-upregulation.

Chronic sternal wound infection and endocarditis with Coxiella burnetii.

Chronic Q fever is most commonly associated with culture-negative endocarditis and less frequently with infection of vascular grafts, infection of aneurysms, hepatitis, pulmonary disease, osteomyelitis, and neurological abnormalities. We report a case of chronic sternal wound infection, polyclonal gammopathy, and mixed cryoglobulinemia in which Q fever endocarditis was subsequently diagnosed. Polymerase chain reaction analysis of the wound tissue was positive for Coxiella burnetii DNA, and treatment of the endocarditis resulted in prompt healing of the wound. Chronic Q fever can occur without epidemiological risk factors for C. burnetii exposure and can produce multisystem inflammatory dysfunction, aberrations of the immune system, and persistent wound infections.

Activation of human immunodeficiency virus type 1 expression by Gardnerella vaginalis.

Bacterial vaginosis (BV) is associated with an increased rate of sexual transmission of human immunodeficiency virus (HIV) type 1, and Gardnerella vaginalis is frequently isolated from the genital tracts of women with BV. G. vaginalis lysates were found to significantly stimulate HIV expression in monocytoid cells. Stimulation was significantly higher when lysates were heated at 100 degrees C for 5 min but was reduced by treatment with lysozyme or protease. G. vaginalis lysates also activated HIV expression in certain T cell lines. G. vaginalis lysates activated HIV long-terminal repeat transcription in HIV-infected cells and increased NF-kappaB binding activity, indicating an effect by G. vaginalis on HIV transcription. The activation of HIV production by G. vaginalis suggests that genital tract infection with G. vaginalis increases the risk of HIV transmission by increasing HIV expression in the genital tract. This may explain, at least in part, the increased rate of HIV transmission in women with BV.

Mycobacterium avium complex activates nuclear factor kappaB via induction of inflammatory cytokines.

A variety of microorganisms has been reported to directly induce NF-kappaB, a critical step in the regulation of genes involved in the cellular immune response. In this study, we demonstrate that proinflammatory cytokines such as tumor necrosis factor alpha (TNFalpha) produced upon activation by the Mycobacterium avium complex (MAC) preceed NF-kappaB activity in U937, a human monocytoid cell line. MAC induction of TNFalpha mRNA expression was detected within 15 min after MAC infection, whereas enhanced NF-kappaB binding activity was not detected until 90 to 120 min postinfection. Supershift analysis revealed increased p50 in the MAC-induced NF-kappaB binding complexes. Consistent with an autocrine mechanism, anti-TNFalpha antibody and dexamethasone, a known cytokine inhibitor, both completely suppressed the effect of MAC on the induction of NF-kappaB. Taken together, these findings suggest that exposure of monocyte cell membranes to MAC induces endogenous TNFalpha, which in turn enhances NF-kappaB binding activity. The rapid induction of TNFalpha may be important in the initial host response to MAC infection.

Coinfection with Babesia microti and Borrelia burgdorferi in a western Wisconsin resident.

A 68-year-old woman, who had not traveled outside of western Wisconsin, was hospitalized after 4 weeks of chills, fevers, myalgias, neuralgias in her right arm, and pain in the right upper quadrant of her abdomen. Physical examination revealed hepatosplenomegaly, and laboratory studies showed anemia, thrombocytopenia, increased aspartate transaminase level, and microscopic hematuria. Wright's stain of a blood smear revealed intraerythrocytic organisms consistent with Babesia species. A polymerase chain reaction of whole blood specimens along with an increased serologic titer confirmed the diagnosis of Babesia microti. Indirect immunofluorescent antibody serology and Western blot analysis revealed a simultaneous infection with Borrelia burgdorferi. Coinfection with B. microti and B. burgdorferi may occur in endemic areas where both organisms are carried by the same tick vector, Ixodes scapularis. The intensity and duration of illness seem to be greatest in patients with concurrent infection.

Host cell-derived complement control proteins CD55 and CD59 are incorporated into the virions of two unrelated enveloped viruses. Human T cell leukemia/lymphoma virus type I (HTLV-I) and human cytomegalovirus (HCMV).

The current study was undertaken to determine whether the human T cell leukemia/lymphoma oncovirus type I (HTLV-I) and the herpesvirus human cytomegalovirus (HCM) incorporate host cell-derived C regulatory proteins. Our experiments showed that both CD59 and CD55 were associated with the external membrane of HTLV-I derived from MT2 cells, since virus could be captured by mAbs to these proteins, and antisera to CD55 and CD59 induced C-mediated lysis of HTLV-I virions. Additionally, both CD55 and CD59 were detected by immunoblot analysis of purified HTLV-I. Purified HCMV produced in human foreskin fibroblasts (HFF) also contained both CD55 and CD59, as detected by immunoblot analysis. However, treatment with anti-CD55, but not anti-CD59, reduced the HCMV infectious titer in the presence of C. Additional studies determined whether HTLV-I-associated CD55 and CD59 participated in the resistance of the virus to C-mediated lysis. Treatment of virus with phosphatidylinositol-specific phospholipase C (PI-PLC), which removes glycosylphosphatidylinositol-anchored CD55 and CD59, increased the sensitivity of HTLV-I to C-mediated destruction in the presence of anti-HTLV-I Abs. Reconstitution of PI-PLC-treated virus with purified CD55 and CD59 restored resistance to C. These experiments show that HTLV-I and HCMV acquire C control proteins from host cells. Together with our previous experiments showing that both CD55 and CD59 are present on HIV-1, these studies demonstrate a mechanism by which a variety of enveloped viruses may acquire resistance to C-mediated destruction.