Unusual presentation of antisynthetase syndrome: a case series and review of the literature.

BACKGROUND: Antisynthetase syndrome is an inflammatory myopathy that is characterized by the presence of anti-aminoacyl-tRNA synthetase antibodies. Only 30% of those who suffer from the disease can be identified. We present three Hispanic cases of antisynthetase syndrome with unusual clinical pictures were extended myositis panel results enable disease diagnosis and treatment. CASE PRESENTATION: A 57-year-old Hispanic/Latino female with an erythematous scaly plaque, unresolved fever and non-immune haemolytic anaemia in whom inpatient work-up for fever of unknown origin was positive for anti-PL12 positive myositis extended panel. A 72-year-old Hispanic/Latino male with amyopathic weakness syndrome and mechanic hands in whom impatient work-up was relevant for proximal muscle uptake and anti-PM75 and AntiPL-12 myositis extended panel. And a 67-year-old Hispanic/Latino male with progressive interstitial lung disease and unresolved fever ended in myositis extended panel positive for antiPL-7. After systemic immunosuppressor treatment, patients had favourable clinical and paraclinical responses during outpatient follow-up. CONCLUSIONS: The high variability of the antisynthetase syndrome in these cases demonstrates the importance of identification through an expanded panel and highlights the probability that this is a variable disease and that we need to include emerging molecular tests to promote the timely treatment of patients.

Association Between Serum Lactate and Unsatisfactory Outcomes in Critically Ill Children in the Immediate Post-operative Period of Liver Transplantation.

OBJECTIVES: Serum lactate is a useful biomarker of tissue perfusion in critically ill patients. We evaluated the behavior of serum lactate in children in the pediatric intensive care unit (PICU) immediately after liver transplantation and its association with surgical complications, graft dysfunction and 90-day mortality. MATERIALS AND METHODS: A prospective observational study carried out between November 2009 and December 2019. Multidisciplinary PICU at the University Children's Hospital, Fundación Cardioinfantil-IC, Bogotá, Colombia. MEASUREMENTS AND MAIN RESULTS: Patients between 1 month and 18 years of age who were in the immediate post-operative period following living-donor or cadaveric liver transplantation were included. A total of 145 patients with a median age of 14 months (IQR 8-60) met the inclusion criteria. Biliary atresia was the main diagnosis in 56.5% of the cases. A serum lactate level > 3.0 mmol/L on admission to the PICU was associated with biliary complications (AUC 0.73 95% CI 0.54-0.93; p = 0.05) and mortality (AUC 0.72 95% CI 0.63-0.8; p = 0.01). A lactate level > 2 mmol/L after 6 h in the PICU was associated with mortality (AUC 0.70 95% CI 0.54-0.83; p = 0.02). Higher lactate levels and lack of clearance were associated with the presence of tardus et parvus waveforms (p = 0.001) on liver Doppler, primary dysfunction (p < 0.001), arterial thrombosis (p < 0.001) and neurological complications (p = 0.04). There was an inverse correlation between admission lactate and the volume of fluids administered during surgery (rho = 0.36; p < 0.001). A total procedure time > 350 min, along with a vasopressor score > 7 and elevated lactate, were associated with worse outcomes (p < 0.001). CONCLUSIONS: In post-operative pediatric liver transplant patients, the level of serum lactate is associated with post-operative surgical complications and mortality.

Distribution of Head Acceleration Events Varies by Position and Play Type in North American Football.

OBJECTIVE: The goal of this pilot study was to evaluate the number of head acceleration events (HAEs) based on position, play type, and starting stance. DESIGN: Prospective cohort study. SETTING: Postcollegiate skill development camp during practice sessions and 1 exhibition game. PARTICIPANTS: Seventy-eight male adult North American football athletes. INDEPENDENT VARIABLES: A position was assigned to each participant, and plays in the exhibition game were separated by play type for analysis. During the exhibition game, video data were used to determine the effects of the starting position ("up" in a 2-point stance or "down" in a 3- or 4-point stance) on the HAEs experienced by players on the offensive line. MAIN OUTCOME MEASURES: Peak linear acceleration and number of HAEs greater than 20 g (g = 9.81 m/s2) were measured using an xPatch (X2 Biosystems, Seattle, WA). RESULTS: Four hundred thirty-seven HAEs were recorded during practices and 272 recorded during the exhibition game; 98 and 52 HAEs, the greatest number of HAEs by position in the game, were experienced by the offensive and defensive linemen, respectively. Linebackers and tight ends experienced high percentages of HAEs above 60 g. Offensive line players in a down stance had a higher likelihood of sustaining a HAE than players in an up stance regardless of the type of play (run vs pass). CONCLUSIONS: Changing the stance of players on the offensive line and reducing the number of full-contact practices will lower HAEs.

Factors affecting peak impact force during soccer headers and implications for the mitigation of head injuries.

It has been documented that up to 22% of all soccer injuries are concussions. This is in part due to players purposely using their head to direct the ball during play. To provide a more complete understanding of head trauma in soccer athletes, this study characterized the effects of four soccer ball characteristics (size, inflation pressure, mass, velocity) on the resulting peak impact force as it relates to the potential for incurring neurophysiological changes. A total of six hundred trials were performed on size 4 and 5 soccer balls as well as a novel lightweight soccer ball. Impact force was measured with a force plate and ball velocity was determined using motion capture. These data were used, in conjunction with dimensional analysis to relate impact force to ball size, mass, velocity, and pressure. Reasonable reductions in allowable ball parameters resulted in a 19.7% decrease in peak impact force. Adjustments to ball parameters could reduce a high cumulative peak translational acceleration soccer athlete down into a previously defined safer low loading range. In addition, it was noted that water absorption by soccer balls can result in masses that substantially increase impact force and quickly surpass the NCAA weight limit for game play. Additional research is required to determine whether varying soccer ball characteristics will enable soccer players to avoid persistent neurophysiological deficits or what additional interventions may be necessary and the legal implications of these data are discussed.

Evaluation of Impulse Attenuation by Football Helmets in the Frequency Domain.

Design of helmets used in contact sports has been driven by the necessity of preventing severe head injuries. Manufacturing standards and pass or fail grading systems ensure protective headgear built to withstand large impacts, but design standards do no account for impacts resulting in subconcussive episodes and the effects of cumulative impacts on its user. Thus, it is important to explore new design parameters, such as the frequency-domain measures of transmissibility and mechanical impedance that are based on energy absorption from a range of impact loads. Within the experimentally determined frequency range of interest (FROI), transmissibilities above unity were found in the 0-40 Hz range with the magnitude characteristics varying considerably with impact location. A similar variability with location was observed for the mechanical impedance, which ranged from 9 N/m to 50 N/m. Additional research is required to further understand how changes in the components or materials of the components will affect the performance of helmets, and how they may be used to reduce both transmissibility and dynamic impedance.

Vertical root fractures in endodontically-treated teeth: A retrospective analysis of possible risk factors.

AIM: The prevalence of vertical root fractures (VRF) ranges from 2% to 20%, and is associated with endodontically-treated teeth (ETT). The aim of the present study was to analyze clinically and radiographically, at different intervals of time, some of the risk factors present in ETT that developed VRF. METHODS: A classification model according to time measured the follow-up period of three groups. A match was made for times of occurrence (cases) and follow up (controls). An odds ratio (OR) test and a logistic regression model set at 95% confidence interval (CI) established the VRF probability when different clinical factors (patient, tooth, and endodontic or restorative treatment) were present. RESULTS: The sample was composed of 197 ETT (41 cases and 156 controls). A classification model set the trend, thus defining three groups: group 1 (1-4 years of follow up): endodontic retreatment (OR: 8.01, 95% CI: 1.85-37.90, P=.0014), indirect restoration (OR: .202, 95% CI: .036-.979, P=.05); group 2 (5-8 years of follow up): primary treatment (OR: .052, 95% CI: .002-.680, P=.044) and the 'single tooth' category (OR: .042, 95% CI: .002-.453, P=.02) demonstrated a significant association with VRF; and group 3 (>9 years of follow up): no association. CONCLUSION: Endodontic retreatment had the highest risk association for VRF after 1-8 years of follow up. Indirect and individual restorations were not significantly associated with VRF.

Using multivariate methods to infer knowledge from genomic data.

Since the introduction of genome sequencing techniques several methods for genomic data preprocessing and analysis have been published and applied to answer different biological questions. Rarely, multivariate methods have been used to extract knowledge about protein roles. Two of the most informative types of data are gene expression data (microarrays) and phylogenetic profiles indicating presence of genes in other organisms and therefore providing information about their co-evolution. Here we show that these two types of data, analyzed by means of principal component analysis and non parametric discriminant analysis, provide useful information about protein function and their participation in virulence processes.