bluuebunny/crossref_metadata_2025 huggingface dataset:
Cutaneous Polyarteritis Nodosa: Therapy and Clinical Course in Four Cases
Authors: Misago Noriyuki , Mochizuki Yoshiko , Sekiyama‐Kodera Hanako , Shirotani Miwa , Suzuki Kumiko , Inokuchi Akira , Narisawa Yutaka
Published: November 2023

Cutaneous polyarteritis nodosa (PN) has a benign and chronic course; relapses are frequently associated with steroid dependence. We have observed four cases of cutaneous PN in the past 15 years and followed up two of the four cases long‐term for 13 and 10 years after diagnosis. There has been a marked contrast in the clinical courses of these two cases: one case has shown a complete remission for 12.5 years without treatment during the most recent 11 years; the other case had four relapses and has never experienced cessation of treatment. The only difference between the two cases was careful therapy with adequate prednisolone in the long‐term remission case. The other two cases clinically showed erythema nodosum‐like features, and they had antecedent sore throats and embedded chronic tonsillitis; one was associated with presumed streptococcal infection. These two cases may simply be an accelerated process of post‐streptococcal erythema nodosum rather than typical cutaneous PN. We performed tonsillectomies as adjuvant therapy in these two cases. No relapse of the disease has been observed in these two cases, and the tonsillectomy allowed us to taper the dose of steroids, resulting in discontinuation of the treatment in one of the two cases. The duration of the remission as well as the adjuvant therapy was variable in each of our cutaneous PN cases. Tonsillectomy can be recommended as an adjuvant to steroids for PN cases with chronic tonsillitis and/or streptococcal infection.
Prolonged Herpes Zoster in a Patient Infected with the Human Immunodeficiency Virus
Authors: Matsuo Koma , Honda Mariko , Shiraki Kimiyasu , Niimura Michihito
Published: November 2023

In 1983, varicella zoster virus (VZV) disease was first recognized in the context of infection with the human immunodeficiency virus (HIV). Since that time, there have been many reports discussing the occurrence and clinical manifestations of hepes zoster in HIV‐infected patients. We describe the development of prolonged herpes zoster in a patient with acquired immunodeficiency syndrome (AIDS) over the course of 104 days. Viral isolates at the three different clinical stages of the skin lesions were sensitive in vitro to acyclovir, and supposed to be a same strain by polymerase chain reaction (PCR) analysis. We also discuss an effective treatment for prolonged cases of zoster.
Zosteriform Pilar Leiomyoma
Authors: Sahoo Bijaylaxmi , Radotra Bishan Das , Kaur Inderjeet , Kumar Bhushan
Published: November 2023

Pilar leiomyomas are usually multiple and are commonly found on the extensor aspects of the arm, trunk, and face. They are rarely distributed in a linear fashion or seem to follow a dermatome. We report a case of painful, unilateral, zosteriform cutaneous leiomyoma in a 25‐year‐old housewife. Histopathology revealed interlacing smooth muscle bundles arising from arrector pili muscles. Nifedipine (10 mg) twice daily was remarkably effective in diminishing the pain in our patient.
Seborrheic Keratosis‐like Lesions in Patients with Epidermodysplasia Verruciformis
Authors: de Oliveira Walmar Roncalli , Neto Cyro Festa , Rady Peter L. , Tyring Stephen K.
Published: November 2023

Epidermodysplasia verruciformis (EV) is a rare genodermatosis characterized by disseminated infection by human papillomavirus (HPV) and malignant transformation of the lesions in about half of the patients. Two phenotypes of EV have been described according to their propensity to develop malignant tumors. The benign form of EV presents a singular type of lesions comprised of flat warts widely disseminated. The malignant form of EV is highly polymorphic and presents as malignant skin tumors, predominantly basal and squamous cell carcinomas, on sun‐exposed sites. The seborrheic keratosis‐like (SK) lesions in patients of EV have been reported to be associated with the malignant phenotype. In this work, we documented the behavior of SK‐like lesions in nine patients with EV, through clinical observations as well as histological and immunohistochemical findings. We suggest that the HPV infection may promote the occurrence of SK‐like lesions in EV patients. Despite the fact that we did not observe any malignant transformation of these lesions in our series of patients, this possibility was not completely excluded.
Pentoxifylline in the Treatment of Erythema Nodosum Leprosum
Authors: de Carsalade Georges‐Yves , Achirafi Aboubacar , Flageul Béatrice
Published: November 2023

Erythema nodosum leprosum (ENL) is a well‐known serious complication affecting 10% of lepromatous multibacillary leprosy patients. In the chronic form, its morbidity may be considerable. Thalidomide and systemic steroids are the two current effective drugs for the management of ENL. However, their use in endemic countries is often difficult and hazardous, and a search for new therapies is needed. We report our experience on the effects of pentoxifylline, a methylxanthine derivative, which has recently been suggested as a possible effective treatment for ENL attacks.
Open questions in the social lives of viruses
Authors: Leeks Asher , Bono Lisa M. , Ampolini Elizabeth A. , Souza Lucas S. , Höfler Thomas , Mattson Courtney L. , Dye Anna E. , Díaz-Muñoz Samuel L.
Published: November 2023

Social interactions among viruses occur whenever multiple viral genomes infect the same cells, hosts, or populations of hosts. Viral social interactions range from cooperation to conflict, occur throughout the viral world, and affect every stage of the viral lifecycle. The ubiquity of these social interactions means that they can determine the population dynamics, evolutionary trajectory, and clinical progression of viral infections. At the same time, social interactions in viruses raise new questions for evolutionary theory, providing opportunities to test and extend existing frameworks within social evolution. Many opportunities exist at this interface: Insights into the evolution of viral social interactions have immediate implications for our understanding of the fundamental biology and clinical manifestation of viral diseases. However, these opportunities are currently limited because evolutionary biologists only rarely study social evolution in viruses. Here, we bridge this gap by (1) summarizing the ways in which viruses can interact socially, including consequences for social evolution and evolvability; (2) outlining some open questions raised by viruses that could challenge concepts within social evolution theory; and (3) providing some illustrative examples, data sources, and conceptual questions, for studying the natural history of social viruses.

Abstract

Social interactions among viruses are diverse and pervasive, with the potential to affect every stage of the viral lifecycle. Here, we explore some of the challenges and opportunities that these interactions present for evolutionary biology.
Translucent monolithic zirconia titanium‐supported FP1 full‐arch prosthesis: A novel proof of concept to address esthetic, functional, and biologic challenges
Authors: Pelekanos Stavros , Ntovas Panagiotis , Rizou Vasiliki , Pozzi Alessandro
Published: November 2023

Objective

Despite the wide clinical use of translucent zirconia for full‐arch implant prostheses, reduced flexural strength and fracture toughness compared with high‐strength opaque zirconia needs to be addressed. A novel proof of concept for FP1 full‐arch prosthesis featured by translucent monolithic zirconia and titanium framework was presented.

Clinical Considerations

Computer‐guided implant planning and surgery were executed and digitally designed FP1 temporary prosthesis prefabricated. Implant and prosthetic placement were achieved with a set of three‐dimensional (3D)‐printed templates. Implants were immediately loaded. After 4 months intraoral optical scan was taken to record implant coordinates, soft tissue anatomy, and temporary FP1 prosthesis. A novel digital workflow was used to design and mill overlaying translucent zirconia and anatomically shaped titanium framework with a scalloped soft‐tissue interface. Final FP1 prosthesis was assembled cementing zirconia jacket on titanium counterpart.

Conclusions

Translucent zirconia supported by titanium framework can address esthetic and mechanical requirements of FP1 full‐arch prosthesis, minimizing risk of fracture and providing a rigid and passive joint with supporting implants. The smooth and highly polished titanium surface with an anatomic design, tightly matching scalloped soft tissue interface, can limit food impaction, air and saliva leakage and contribute to overall biologic integration of FP1 full‐arch prosthesis.

Clinical Significance

Translucent monolithic zirconia featured with anatomically shaped titanium framework with scalloped transmucosal part, combining a pleasant esthetic outcome with increased flexural strength and fracture toughness, may be indicated to increase the clinical performance of FP1 full‐arch prosthesis.
Molecular characterization of Blastocystis spp. in Hotan Black chickens in southern Xinjiang
Authors: Feng Xinwei , Xin Luyao , Zhang Bowen , Wang Zhichao , Meng Zhu , Yu Fuchang , Qi Meng
Published: November 2023

To determine the infection status and assess the zoonotic potential of Blastocystis spp. in Hotan Black chickens in southern Xinjiang, China, fecal samples were collected from 617 chickens on 18 large‐scale farms. The presence of Blastocystis spp. was determined using polymerase chain reaction based on the small subunit rRNA (SSU rRNA) locus. The results revealed an overall infection rate of 26.3% (162/617). Samples from Farm 1 in Luopu County showed the highest infection rate (76.3%, 29/38). The highest and lowest infection rates were detected in the <30‐day (34.4%, 43/125) and > 90‐day age groups (12.4%, 11/89), respectively. The infection rate decreased with increasing age. Statistical analysis showed significant differences in the infection rates of Blastocystis spp. among the different sampling sites (p < 0.05) and age groups (p < 0.05). Four Blastocystis spp. subtypes (ST6, ST7, ST10, and ST23) were identified. The infection rates of the zoonotic subtypes, ST6 and ST7, were 3.2% (20/617) and 22.2% (137/617), respectively. The presence of Blastocystis spp. and zoonotic subtypes provided evidence for the potential transmission of this pathogen between Hotan Black chickens and humans, especially in animal handlers in this area.
Companion animals and the relationship between peer victimization and emotion regulation in youth
Authors: King Erin K. , Halbreich Eli D. , Callina Kristina , Mueller Megan K.
Published: November 2023

Peer victimization can negatively impact emotion regulation in youth and is associated with harmful mental health outcomes. One protective factor against the impacts of peer victimization is a strong attachment to family and positive peer relationships. Given that pets are commonly seen as family members and that youth report turning to their pet for emotional comfort, companion animals could provide an avenue of support for youth experiencing victimization. A geographically diverse sample of 5725 adolescents in the United States from the Adolescent Brain Cognitive Development (ABCD) Study® was used to explore whether the relationship between peer victimization and emotion regulation was moderated by whether a pet lives in the home. Having a pet in the home did not moderate the relationship between peer victimization and emotion regulation; however, mean‐level differences were present across types of household pet (i.e., youth with no pets, youth with at least one dog, and youth with non‐dog pets). Participants who did not live with a companion animal showed higher levels of both maladaptive emotion regulation (expressive suppression) and adaptive emotion regulation (cognitive reappraisal), suggesting that having a pet might lower overall emotion regulation pathways regardless of adaptive directionality. Relational victimization was a significant predictor of expressive suppression regardless of whether there was a pet in the home, although overt victimization was not a predictor of either kind of emotion regulation. This research demonstrates the complex nature of human–animal relationships and suggests more research is needed to understand the nuanced relationship between pets, peer victimization, and emotion regulation.
Protein turnover in pigs: A review of interacting factors
Authors: Sarri Laura , Balcells Joaquim , Seradj Ahmad Reza , de la Fuente Gabriel
Published: November 2023

Protein turnover defines the balance between two continuous and complex processes of protein metabolism, synthesis and degradation, which determine their deposition in tissues. Although the liver and intestine have been studied extensively for their important roles in protein digestion, absorption and metabolism, the study of protein metabolism has focused mainly on skeletal muscle tissue to understand the basis for its growth. Due to the high adaptability of skeletal muscle, its protein turnover is greatly affected by different internal and external factors, contributing to carcass lean‐yield and animal growth. Amino acid (AA) labelling and tracking using isotope tracer methodology, together with the study of myofiber type profiling, signal transduction pathways and gene expression, has allowed the analysis of these mechanisms from different perspectives. Positive stimuli such as increased nutrient availability in the diet (e.g., AA), physical activity, the presence of certain hormones (e.g., testosterone) or a more oxidative myofiber profile in certain muscles or pig genotypes promote increased upregulation of translation and transcription‐related genes, activation of mTORC1 signalling mechanisms and increased abundance of satellite cells, allowing for more efficient protein synthesis. However, fasting, animal aging, inactivity and stress, inflammation or sepsis produce the opposite effect. Deepening the understanding of modifying factors and their possible interaction may contribute to the design of optimal strategies to better control tissue growth and nutrient use (i.e., protein and AA), and thus advance the precision feeding strategy.
Lessons learned: Shaping the evolution of veterinary specialty education
Authors: Sykes Jane E.
Published: November 2023

In response to concerns regarding numerous complex issues facing the veterinary specialty profession, several organizations, including the American College of Veterinary Internal Medicine, have made a clarion call to the American Veterinary Medical Association to begin discussions surrounding the formation of an accrediting body for internships, residencies, and fellowships. A proposed name for such a body is the Accreditation Council on Graduate Veterinary Medical Education, in alignment with the Accreditation Council on Graduate Medical Education (ACGME); the term “graduate” refers to specialty education that occurs after the first 4 years of the MD or DVM degree. Although the structure and financing of graduate education differ between the human medical and veterinary professions, we can nevertheless learn much from the history of evolution of human medical specialization as we navigate the path ahead.
Genomic differentiation and niche divergence in the Hetaerina americana (Odonata) cryptic species complex
Authors: Vega‐Sánchez Yesenia Margarita , Oyama Ken , Mendoza‐Cuenca Luis Felipe , Gaytán‐Legaria Ricardo , González‐Rodríguez Antonio
Published: November 2023

The evolution of reproductive barriers, that is, the speciation process, implies the limitation of gene flow between populations. Different patterns of genomic differentiation throughout the speciation continuum may provide insights into the causal evolutionary forces of species divergence. In this study, we analysed a cryptic species complex of the genus Hetaerina (Odonata). This complex includes H. americana and H. calverti; however, in H. americana two highly differentiated genetic groups have been previously detected, which, we hypothesize, may correspond to different species with low morphological variation. We obtained single nucleotide polymorphism (SNP) data for 90 individuals belonging to the different taxa in the complex and carried out differentiation tests to identify genetic isolation. The results from STRUCTURE and discriminant analysis of principal components (DAPC), based on almost 5000 SNPs, confirmed the presence of three highly differentiated taxa. Also, we found FST values above 0.5 in pairwise comparisons, which indicates a considerable degree of genetic isolation among the suggested species. We also found low climatic niche overlap among all taxa, suggesting that each group occurs at specific conditions of temperature, precipitation and elevation. We propose that H. americana comprises two cryptic species, which may be reproductively isolated by ecological barriers related to niche divergence, since the morphological variation is minimal and, therefore, mechanical barriers are probably less effective compared to other related species such as H. calverti.
Plasticity in branch water relations and stem hydraulic vulnerability enhances hydraulic safety in mangroves growing along a salinity gradient
Authors: Beckett Holly A. A. , Bryant Callum , Neeman Teresa , Mencuccini Maurizio , Ball Marilyn C.
Published: November 2023

Coping with water stress depends on maintaining cellular function and hydraulic conductance. Yet measurements of vulnerability to drought and salinity do not often focus on capacitance in branch organs that buffer hydraulic function during water stress. The relationships between branch water relations, stem hydraulic vulnerability and stem anatomy were investigated in two co‐occurring mangroves Aegiceras corniculatum and Rhizophora stylosa growing at low and high salinity. The dynamics of branch water release acted to conserve water content in the stem at the expense of the foliage during extended drying. Hydraulic redistribution from the foliage to the stem increased stem relative water content by up to 21%. The water potentials at which 12% and 50% loss of stem hydraulic conductivity occurred decreased by ~1.7 MPa in both species between low and high salinity sites. These coordinated tissue adjustments increased hydraulic safety despite declining turgor safety margins at higher salinity sites. Our results highlight the complex interplay of plasticity in organ‐level water relations with hydraulic vulnerability in the maintenance of stem hydraulic function in mangroves distributed along salinity gradients. These results emphasise the importance of combining water relations and hydraulic vulnerability parameters to understand vulnerability to water stress across the whole plant.
The intimate socialities of going carbon neutral
Authors: Collins Rebecca
Published: November 2023

This paper argues that the generation of social intimacy is critical to enabling acts of environmental care. By interrogating the intimate socialities of a group of young people who grew up in a village community committed to carbon reduction, I untangle the influence of everyday intimacies on everyday (un)sustainabilities, particularly in relation to the popular but uncritical positioning of young people as ‘sustainability saviours’. I problematise assumptions that young people's social intimacies are a straightforward enabler of lifestyle change aligned with sustainability by highlighting the fluidity of intimacies and associated senses of trust throughout young adulthood. I argue further that capitalising on this fluidity might in fact amplify bottom‐up environmental care if young people can move readily between networked spaces of trust and support. Drawing from scholarship on friendship, family and community intimacies and the substantial literature on households as crucibles for more sustainable living, I suggest there is considerable reconciliation work demanded at a personal level in order to live comfortably within the everyday intimacies of social life at the same time as committing to individual environmental action. These arguments advance debates around the optimal social drivers of more sustainable lifestyles, at the same time as sounding a cautionary note in relation to the too easy emplacement of responsibility for driving change at the feet of young people.
An evaluation of intracapsular lens extraction and transcorneal lens reduction for treatment of anterior lens luxation in dogs
Authors: Bowyer Ashley N. , Lassaline Mary E. , Holt Elaine
Published: November 2023

Objective

The aim of the study was to evaluate success rate, complications, and outcomes in dogs with anterior lens luxation (ALL) treated with intracapsular lens extraction (ICLE) or transcorneal lens reduction (TCLR).

Procedure

Medical records of dogs with ALL undergoing ICLE or TCLR from 2014 to 2021 were reviewed. Signalment, presenting complaint, history, ophthalmic examination findings, short‐term complications, and outcomes were analyzed.

Results

There were 20 ICLEs and 31 TCLRs; however, some cases were included in both groups. One ICLE was unsuccessful and four had undergone TCLR first, leaving 15 ICLEs. Three TCLRs were unsuccessful, four were lost to follow up, and three subsequently underwent ICLE due to recurrent ALL, leaving 21 TCLRs. Anterior uveitis was more common following ICLE than TCLR, p < .001 The frequencies of other short‐term complications (post‐operative hypertension and corneal ulceration) were not statistically different between groups. Median follow‐up was 256 and 48 days for ICLE and TCLR, respectively. Vision was retained in 7/10 (70%) eyes following ICLE and 4/9 (44%) eyes following TCLR, p = .34. Enucleation was recommended for fewer eyes following ICLE (2/15 [13%]) than TCLR (7/21 [33%], p = .47). In total, lens extraction was achieved in 19/20 (95%) ICLEs and lens reduction was achieved in 28/31 (90%) TCLRs. Anterior lens luxation recurred in 10/24 (41%) TCLRs.

Conclusions

The present study adds data to the current knowledge base regarding the treatment of ALL in dogs and highlights the need for future prospective studies containing a larger number of animals to help inform treatment decisions for dogs with ALL.
Variability Estimation in a Nonlinear Crack Growth Simulation Model With Controlled Parameters Using Designed Experiments Testing
Authors: Yeo Seungju , Funkenbusch Paul , Askari Hesam
Published: November 2023

Variability in multiple independent input parameters makes it difficult to estimate the resultant variability in a system's overall response. The propagation of errors (PE) and Monte Carlo (MC) techniques are two major methods to predict the variability of a system. However, the formalism of PE can lead to an inaccurate estimate for systems that have parameters varying over a wide range. For the latter, the results give a direct estimate of the variance of the response, but for complex systems with many parameters, the number of trials necessary to yield an accurate estimate can be sizeable to the point the technique becomes impractical. The effectiveness of a designed experiment (orthogonal array) methodology, as employed in Taguchi tolerance design (TD) method to estimate variability in complex systems is studied. We use a linear elastic three-point bending beam model and a nonlinear extended finite elements crack growth model to test and compare the PE and MC methods with the TD method. Our focus is on assessing their effectiveness under those specific circumstances. Results from an MC estimate, using 10,000 trials, serve as a referent to evaluate the result in both cases. We find that the PE method works suboptimal for a coefficient of variation above 5% in the input variables. In addition, we find that the TD method works very well with moderately sized trials of designed experiments for both models. Our results demonstrate how the variability estimation methods perform in the deterministic domain of numerical simulations and can assist in designing physical tests by providing a guideline performance measure.
Dynamic Characteristics of Three-Body Braking System Considering Tire-Road Friction
Authors: Du Shenggang , Zhang Yuhang , Wei Daogao , Zhu Yawei , Zhang Liang , Wu Di
Published: November 2023

With the significant increase in vehicle ownership in our country, urban traffic conditions have become increasingly congested. Low-speed driving has become more prevalent, leading to more frequent instances of starting and braking. Consequently, the issue of low-speed braking flutter has become increasingly prominent. While the brake is in an open environment, the dust and particles in the air and the debris generated by the brake itself will have an impact on the braking behavior. In addition, according to the theory of modal coupling, the braking stability of the vehicle is also affected by other components. In this paper, different dynamic torsional models of braking system are established according to different braking conditions. Through numerical calculation, the influence of tire parameters, road conditions, and particles on the friction dynamics characteristics of braking system pairs is explored. The results show that the instability of the brake pair system often occurs at low speed. Different tire slip ratios, tire offset factors, and road conditions will lead to different relative motions of the braking system, but the existence of particles in the brake lining-disk interface can enhance the motion stability of the system.
Multiobjective Optimization Study on the Aerodynamic Performance and Anti-Erosion Characteristics of a Single-Stage Dusty Flue Gas Turbine
Authors: Cai Liuxi , He Yao , Yao Jiawei , Hou Yanfang , Wang Shunsen , Feng Zhenping
Published: November 2023

Solid particle erosion of dusty energy recovery turbine blades has a great impact on the operating economics and safety of the unit. To mitigate the erosion of blade and improve the aerodynamic performance of the turbine, a multi-objective optimization method for turbine cascade based on the experimental design method, genetic algorithm and CFD multiphase flow simulation was developed. The optimization results show that the number of stator and rotor blades and the trailing edge angle at 50% blade span are the main parameters affecting the efficiency and blade erosion of the dusty turbine. By reducing the number of stator blades and the circumferential bending angle of the stator trailing edge, the impingement velocity and impingement probability of particles impinging on the stator trailing edge decrease by 7.5%–16.8% and 8.9%–46.2%, respectively. Additionally, compared with the original design, the flow separation loss and secondary flow intensity of the rotor blade row are suppressed by adjusting the load distribution and inlet attack angle of the rotor; thus, the turbine efficiency effectively improves by 2.28%. Meanwhile, the optimized blade reduces the particle impingement velocity and probability on the rotor leading edge, and the erosion condition of the rotor leading edge decreases by 70%.
A Holistic Methodology to Quantify Product Competitiveness and Define Innovation Requirements for Micro Gas Turbine Systems in Hydrogen-Based Energy Storage Applications
Authors: Tilocca Giuseppe , Sánchez D. , Torres García M. , Escamilla Perejón A. , Minett S.
Published: November 2023

Microgas turbines are an on-site power and heat generation technology with a small footprint, low gaseous (NOx) and acoustic emissions, low maintenance, and high-grade heat. They entered the market at the dawn of the twentieth century; nevertheless, they achieved minimal success and a marginal role in the microgeneration market. Reciprocating internal combustion engines (ICE) raised considerable barriers hindering their market deployment, and fuel cells are also set to compete in this segment. In this scenario, this work presents an analysis of competitiveness grounded in the theory of constraints (TOC). To this end, a specific key performance indicator (KPI) has been produced, which combines technical, economic, and operational factors according to the end-user requirement. This indicator is a function of several penalty factors representing technology and market barriers, which aims to yield a unique insight into the most competitive technology for a given application, accounting for the uncertainty deriving from technical and economic elements. This novel methodology is applied to a new potential niche market: Power-to-Hydrogen-to-Power for remote applications. The methodology is applied to an independent rural community in South Wales for which a backup power system is assessed. Four technologies are considered in the analysis: reciprocating engines, fuel cells, and two different microturbines layouts. Finally, this work provides an overview of the possible R&D&I paths necessary to increase the competitiveness of microgas turbines in certain markets.
Electrohydraulic System Analysis of Variable Recruitment Fluidic Artificial Muscle Bundles With Interaction Effects
Authors: Kim Jeong Yong , Bryant Matthew
Published: November 2023

This study investigates the system-level performance of variable recruitment (VR) fluidic artificial muscle (FAM) actuator bundles using a model that incorporates FAM interaction effects. A VR bundle combines multiple FAMs to act as one actuator in which the FAMs are sequentially recruited to increase overall efficiency. In a VR bundle, inactive/low-pressure FAMs are compressed beyond their free strains, exerting resistive forces opposing that of active FAMs. A recent model that captures this behavior is used to simulate sinusoidal contraction of a VR bundle with a hanging mass load. The implications of inter-FAM effects on the force–strain space of a VR bundle are discussed and a method of recruitment state transition required to track a sinusoid is proposed. The dynamics of the electrohydraulic subsystems are presented and used to evaluate its system efficiency and bandwidth limits. Three different electrohydraulic configurations are considered: (1) continuous motor operation with constant pump displacement, (2) intermittent motor operation with constant pump displacement, and (3) continuous motor operation with variable pump displacement. Simulation results show the superior bandwidth capabilities of VR bundles by demonstrating its ability to track sinusoids with amplitudes up to 16% strain at frequencies greater than 0.5 Hz, compared to that of a single equivalent cross section area motor unit (SEMU). In addition to increased bandwidth limit, system efficiencies averaged over a range of amplitudes show up to 170% increase when comparing a VR bundle using variable pump displacement to a SEMU using constant pump displacement.
Sports Reforms and Coaches’ Spoiled Identities: An Analysis of Structural Stigma
Authors: Kim Yoon Jin , Dawson Marcelle C.
Published: November 2023

This article explores how sports coaches’ identity and social relations are shaped within the context of new policy initiatives in sport. It focuses particularly on South Korea’s ongoing sports reforms wherein sports coaches feel stigmatized and disgraced. Informed by classic and contemporary sociological understandings of stigma and relying both on documents and narratives from 29 individuals, our qualitative analysis reveals that Korean coaches’ stigma is discrediting, prior-known, and power-laden. By viewing stigmatization as a social process constructed both “symbolically” and “structurally,” this article extends Goffman’s analysis to argue that coaches’ stigmatization is rooted in the social, institutional, and political power around sports reforms that forge stigmatizing attitudes and beliefs across society by offering ready-made scripts for both the stigmatized and the “normals.”
Socioeconomic circumstances, health-related behaviours and paediatric infections: a mediation analysis
Authors: Videholm Samuel , Silfverdal Sven Arne , Gustafsson Per E
Published: November 2023

Objective

To examine how the effect of disadvantaged socioeconomic circumstances on the risk of paediatric infections is mediated by pregnancy smoking, excess weight during pregnancy and breast feeding in children under 5 years of age.

Design

A population-level, retrospective cohort study. The Swedish Medical Birth Register was combined with the National Patient Register, the longitudinal integration database for health insurance and labour market studies, the Cause of Death Register and a local register held by the Child Health Care Unit in Uppsala Region.

Setting

Uppsala Region, Sweden.

Patients

63 216 term and post-term singletons born to women who resided in Uppsala Region, Sweden between 1997 and 2015.

Main outcome measures

Number of hospital admissions for infectious diseases. Secondary outcomes were the number of hospitalisations for respiratory and enteric infections, respectively.

Results

The effect of disadvantaged socioeconomic circumstances, that is, low maternal education on the overall risk of paediatric infections was mediated to a considerable (33%–64%) proportion by pregnancy smoking, excess weight during pregnancy and breast feeding.

Conclusions

Pregnancy smoking, excess weight during pregnancy and breast feeding mediate a considerable proportion of the association between deprived socioeconomic circumstances and paediatric infectious diseases. Therefore, inequalities in paediatric infectious diseases may be reduced by public health policies addressing these health-related behaviours.
Pulmonary function outcomes after tuberculosis treatment in children: a systematic review and meta-analysis
Authors: Lew Yao Long , Tan Angelica Fiona , Yerkovich Stephanie T. , Yeo Tsin Wen , Chang Anne B. , Lowbridge Christopher P.
Published: November 2023

Background

Despite tuberculosis (TB) being a curable disease, current guidelines fail to account for the long-term outcomes of post-tuberculosis lung disease—a cause of global morbidity despite successful completion of effective treatment. Our systematic review aimed to synthesise the available evidence on the lung function outcomes of childhood pulmonary tuberculosis (PTB).

Methods

PubMed, ISI Web of Science, Cochrane Library and ProQuest databases were searched for English-only studies without time restriction (latest search date 22 March 2023). Inclusion criteria were (1) patients who had TB with pulmonary involvement at age ≤18 years; (2) pulmonary function tests (PFTs) performed on patients after treatment completion; and (3) observational studies, including cohort and cross-sectional studies. We adhered to the recommendations of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Results

From 8040 records, 5 studies were included (involving n=567 children), with spirometry measures from 4 studies included in the meta-analyses. The effect sizes of childhood TB on forced expiratory volume in the first second and forced vital capacity z-scores were estimated to be −1.53 (95% CI −2.65, –0.41; p=0.007) and −1.93 (95% CI −3.35, –0.50; p=0.008), respectively.

Discussion

The small number of included studies reflects this under-researched area, relative to the global burden of TB. Nevertheless, as childhood PTB impacts future lung function, PFTs (such as spirometry) should be considered a routine test when evaluating the long-term lung health of children beyond their completion of TB treatment.

PROSPERO registration numberCRD42021250172.
IgG4-related disease of the mastoid: a rare presentation of a novel diagnosis
Authors: Achanta Mohit , Jaber Hisham , Onovo Adaku , Stew Ben
Published: November 2023

IgG4-related disease (IgG4-RD) is an inflammatory condition characterised by infiltration of tissue by IgG4-positive plasma cells. This is the seventh reported case of IgG4-RD affecting the mastoid and informs clinicians in diagnosing patients affected by this rare condition.

A woman in her 20s presented with unilateral otalgia, hearing loss and vertigo. She deteriorated despite antibiotic therapy and cross-sectional imaging revealed a destructive extra-axial lesion of the mastoid cells. Biopsy confirmed a diagnosis of IgG4-RD. She was successfully treated with prednisolone and azathioprine.

Inflammatory conditions should be considered in patients with persistent middle ear symptoms after infection and malignancy are excluded. Delays in diagnosis can lead to irreversible mass effects and may occur as current diagnostic criteria exclude mastoid-specific features.

IgG4-RD remains a rare diagnosis. To avoid significant effects on a patients’ quality of life, prompt multidisciplinary treatment is vital alongside development of diagnostic criteria specific to otolaryngology.
Tracheobronchomalacia: an unusual cause of debilitating dyspnoea and its surgical management
Authors: Mulryan Kathryn , O'Connor James , Egan Michael , Redmond Karen
Published: November 2023

Tracheobronchomalacia (TBM) is a progressive weakening of the airways, leading to collapse and dyspnoea. TBM can be misdiagnosed when multiple chronic conditions accompany it. Tracheobronchoplasty (TBP) is indicated for severe symptomatic TBM, diagnosed by bronchoscopy and CT thorax. We report the case of a patient who underwent tracheal resection and reconstruction for continuing dyspnoea post argon therapy, TBP and a failure to tolerate extracorporeal membrane oxygenation-assisted Y-stent insertion. Relevant background history includes asthma, sleep apnoea, reflux, cardiomyopathy and a high body mass index. Bronchoscopy postreconstruction showed patent airways. Airway reconstruction was a viable management option for this patient’s TBM. TBP is a treatment option for TBM. In this case, tracheal resection was required to sustain benefit. In addition, surveillance bronchoscopies will be carried out every year.
Improved survival for stage IV sinonasal small cell neuroendocrine carcinoma treated with chemotherapy and anti-PD-L1 therapy
Authors: Selesky Margaret , Elghawy Omar , Kaur Varinder
Published: November 2023

Small cell carcinoma neuroendocrine type (SCCNET) is a rare tumour of the head and neck. Due to its infrequency, a paucity of data exists on optimal treatment, and the current paradigm for advanced SCCNET mirrors that of extensive small cell lung cancer. Increasingly, the treatment for extrapulmonary small cell carcinomas like SCCNET has incorporated immune checkpoint inhibitors (ICIs), although the utility of ICIs is not fully understood. We present a case of stage IVC sinonasal SCCNET in a woman in her 90s, who experienced eyelid swelling and unintentional weight loss. After diagnostic work-up, she was treated with etoposide, carboplatin and atezolizumab with a complete response to therapy. The patient had one episode of inflammatory polyarthropathy which resolved with steroids but otherwise tolerated treatment well and is now living with an overall survival of greater than 27 months. This case highlights the long-term efficacy of combination ICIs and chemotherapy in the treatment of SCCNET.
Challenging management of an enlarged tracheoesophageal fistula in an irradiated patient
Authors: Bramati Chiara , Galli Andrea , Salerno Emilio , Giordano Leone
Published: November 2023

Speech restoration after total laryngectomy may be achieved in different ways, the gold standard being tracheoesophageal puncture (TPE) with the positioning of a speech prosthesis. TPE is not immune to complications, the most common of which being leakage through or around the prosthesis. When dealing with an enlarged tracheoesophageal fistula, the management can be either conservative or surgical. In the following case report, we present a particularly challenging case, in which every conservative strategies failed and a major surgery was required to close the fistula.
Recurrent multinodular goitre and primary hyperparathyroidism due to adenoma arising in a parathyroid autotransplant more than 20 years after near-total thyroidectomy
Authors: Boggiano Victoria , Barnhouse Kathleen , Rodriguez Tahereh Ghorbani , Kim Lawrence
Published: November 2023

The patient is a female in her 60s with a remote history of a near-total thyroidectomy in 1997 for multinodular goitre. At the initial operation, she sustained a left recurrent laryngeal nerve injury. A devascularised parathyroid gland was autotransplanted into the right sternocleidomastoid muscle. She had been off of thyroid hormone for long periods, and her most recent levothyroxine requirement had fallen to only 25 mcg daily. The patient presented more than 20 years after her thyroidectomy with hoarseness, fatigue and dyspnoea. Laboratory studies suggested primary hyperparathyroidism. Imaging demonstrated bilateral pulmonary emboli and bulky thyroid tissue extending into her mediastinum. She underwent a completion thyroidectomy with the removal of a parathyroid adenoma arising in the autotransplanted parathyroid. This case illustrates the possibility of regrowth of benign thyroid tissue after thyroidectomy. In addition, to our knowledge, this is the first case report of a parathyroid adenoma arising from autotransplantation of a normal parathyroid.
Pulmonary sclerosing pneumocytoma – approaching a solitary pulmonary nodule and the limitations of risk prediction models
Authors: Saripalli Kundan Reddy , Wang Mark Qi Wei , Chow Chun Yuen , Chew Si Yuan
Published: November 2023

Our case is an asymptomatic, non-smoking, East Asian woman in her 40s presenting with a solitary pulmonary nodule (SPN). On imaging, the 1.7 cm solid SPN located in the left upper lobe, was rounded in morphology and moderately fluorodeoxyglucose avid. The clinical pretest probability of malignancy assessed by risk prediction models such as Brock (19.1%), Mayo Clinic (56.2%) and Herder (51.4%) was discordant. She underwent a percutaneous CT-guided needle biopsy, establishing a diagnosis of pulmonary sclerosing pneumocytoma (PSP). PSP is a rare benign lung neoplasm with indolent growth characteristics that has been described predominantly in non-smoking women. Our case illustrates the limitations of applying existing risk prediction models in Asia where the epidemiology and biology of lung cancer differ significantly from the Caucasian derivation cohorts. Additionally, the risk models do not account for tuberculosis, which is endemic in Asia and can mimic malignancy. Non-surgical lung biopsy remains useful in minimising unnecessary thoracotomy.
Pulmonary tuberculosis presenting with cluster sign and galaxy sign
Authors: Nakamura Tomoaki , Nishimura Naoki
Published: November 2023

In a routine medical check-up, a healthy man in his 20s was found to have an upper left lung abnormality. Subsequent chest CT revealed the cluster sign (CS) and galaxy sign (GS). Although tests such as sputum analysis and interferon-gamma assays reduced the likelihood of tuberculosis, these abnormalities remained unchanged. A lung biopsy indicated non-caseating granuloma unrelated to tuberculosis. Initially suspected of sarcoidosis, the patient later developed fever and malaise. Follow-up CT showed CS progressing to a cavitatory shadow and GS intensification. The detection ofMycobacterium tuberculosis (M. tuberculosis) in a subsequent sputum analysis prompted treatment with antitubercular drugs, leading to symptom relief.

CS and GS are usually associated with sarcoidosis but can also occur in tuberculosis, connected to slower pathogen growth and lower isolation rates. Furthermore, pulmonary tuberculosis may ultimately be present even when biopsies show non-caseating granulomas that are not typical ofM. tuberculosisand sputum culture results are negative forM. tuberculosis. Tuberculosis should not be ruled out lightly, and patients should be carefully followed-up.
Organisation of care for people receiving drug-resistant tuberculosis treatment in South Africa: a mixed methods study
Authors: Dickson Lindy , Le Roux Sacha Roxanne , Mitrani Leila , Hill Jeremy , Jassat Waasila , Cox Helen , Mlisana Koleka , Black John , Loveday Marian , Grant Alison , Kielmann Karina , Ndjeka Norbert , Moshabela Mosa , Nicol Mark
Published: November 2023

Objectives

Treatment for multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) is increasingly transitioning from hospital-centred to community-based care. A national policy for decentralised programmatic MDR/RR-TB care was adopted in South Africa in 2011. We explored variations in the implementation of care models in response to this change in policy, and the implications of these variations for people affected by MDR/RR-TB.

Design

A mixed methods study was done of patient movements between healthcare facilities, reconstructed from laboratory records. Facility visits and staff interviews were used to determine reasons for movements.

Participants and setting

People identified with MDR/RR-TB from 13 high-burden districts within South Africa.

Outcome measures

Geospatial movement patterns were used to identify organisational models. Reasons for patient movement and implications of different organisational models for people affected by MDR/RR-TB and the health system were determined.

Results

Among 191 participants, six dominant geospatial movement patterns were identified, which varied in average hospital stay (0–281 days), average patient distance travelled (12–198 km) and number of health facilities involved in care (1–5 facilities). More centralised models were associated with longer delays to treatment initiation and lengthy hospitalisation. Decentralised models facilitated family-centred care and were associated with reduced time to treatment and hospitalisation duration. Responsiveness to the needs of people affected by MDR/RR-TB and health system constraints was achieved through implementation of flexible models, or the implementation of multiple models in a district.

Conclusions

Understanding how models for organising care have evolved may assist policy implementers to tailor implementation to promote particular patterns of care organisation or encourage flexibility, based on patient needs and local health system resources. Our approach can contribute towards the development of a health systems typology for understanding how policy-driven models of service delivery are implemented in the context of variable resources.