Prophylactic vaccination of youngwomen aged 16 to 26 years with the 9-valent (6/11/16/18/31/33/45/52/58) human papillomavirus (HPV) virus-like particle (9vHPV) vaccine prevents infection and disease. ...We conducted a noninferiority immunogenicity study to bridge the findings in young women to girls and boys aged 9 to 15 years.
Subjects (N = 3066) received a 3-dose regimen of 9vHPV vaccine administered at day 1, month 2, and month 6. Anti-HPV serologic assays were performed at day 1 and month 7. Noninferiority required that the lower bound of 2-sided 95% confidence intervals of geometric mean titer ratios (boys:young women or girls:young women) be >0.67 for each HPV type. Systemic and injection-site adverse experiences (AEs) and serious AEs were monitored.
At 4 weeks after dose 3, >99% of girls, boys, and young women seroconverted for each vaccine HPV type. Increases in geometric mean titers to HPV types 6/11/16/18/31/33/45/52/58 were elicited in all vaccine groups. Responses in girls and boys were noninferior to those of young women. Persistence of anti-HPV responses was demonstrated through 2.5 years after dose 3. Administration of the 9vHPV vaccine was generally well tolerated. A lower proportion of girls (81.9%) and boys (72.8%) than young women (85.4%) reported injection-site AEs, most of which were mild to moderate in intensity.
These data support bridging the efficacy findings with 9vHPV vaccine in young women 16 to 26 years of age to girls and boys 9 to 15 years of age and implementing gender-neutral HPV vaccination programs in preadolescents and adolescents.
Abstract
Coccidioides immitis (and Coccidioides posadasii) are endemic fungi of the southwestern United States and northern Mexico. Uncomplicated, symptomatic Coccidioides infection most commonly ...causes a self-limited pneumonia; however, immunocompromised patients can manifest severe pneumonia with an additional risk of dissemination to bone, joints, soft tissues, and in the most severe cases, the central nervous system. In 2020, clinicians were challenged with a previously unseen volume of acute respiratory complaints as a result of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. We present a patient with respiratory failure secondary to SARS-CoV-2 who experienced prolonged hypoxia and neurologic deterioration, eventually leading to a diagnosis of occult disseminated coccidiomycosis involving meningitis, miliary-pattern pneumonia, and cutaneous lesions.
Summary Background Raltegravir (MK-0518) is an HIV-1 integrase inhibitor with potent in-vitro activity against HIV-1 strains including those resistant to currently available antiretroviral drugs. The ...aim of this study was to assess the safety and efficacy of raltegravir when added to optimised background regimens in HIV-infected patients. Methods HIV-infected patients with HIV-1 RNA viral load over 5000 copies per mL, CD4 cell counts over 50 cells per μL, and documented genotypic and phenotypic resistance to at least one nucleoside reverse transcriptase inhibitor, one non-nucleoside reverse transcriptase inhibitor, and one protease inhibitor were randomly assigned to receive raltegravir (200 mg, 400 mg, or 600 mg) or placebo orally twice daily in this multicentre, triple-blind, dose-ranging, randomised study. The primary endpoints were change in viral load from baseline at week 24 and safety. Analyses were done on a modified intention-to-treat basis. This trial is registered with ClinicalTrials.gov , with the number NCT00105157. Findings 179 patients were eligible for randomisation. 44 patients were randomly assigned to receive 200 mg raltegravir, 45 to receive 400 mg raltegravir, and 45 to receive 600 mg raltegravir; 45 patients were randomly assigned to receive placebo. One patient in the 200 mg group did not receive treatment and was therefore excluded from the analyses. For all groups, the median duration of previous antiretroviral therapy was 9·9 years (range 0·4–17·3 years) and the mean baseline viral load was 4·7 (SD 0·5) log10 copies per mL. Four patients discontinued due to adverse experiences, three (2%) of the 133 patients across all raltegravir groups and one (2%) of the 45 patients on placebo. 41 patients discontinued due to lack of efficacy: 14 (11%) of the 133 patients across all raltegravir groups and 27 (60%) of the 45 patients on placebo. At week 24, mean change in viral load from baseline was −1·80 (95% CI −2·10 to −1·50) log10 copies per mL in the 200 mg group, −1·87 (−2·16 to −1·58) log10 copies per mL in the 400 mg group, −1·84 (−2·10 to −1·58) log10 copies per mL in the 600 mg group, and −0·35 (−0·61 to −0·09) log10 copies per mL for the placebo group. Raltegravir at all doses showed a safety profile much the same as placebo; there were no dose-related toxicities. Interpretation In patients with few remaining treatment options, raltegravir at all doses studied provided better viral suppression than placebo when added to an optimised background regimen. The safety profile of raltegravir is comparable with that of placebo at all doses studied.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Purpose:
The purpose of this study was to evaluate perceived image quality, confidence in identifying key velopharyngeal landmarks, and reliability of making velopharyngeal measures between ...3-dimensional (3-D) and 2-D magnetic resonance imaging (MRI) methods and between T1-, T2-, and proton density (PD)-weighted sequences.
Methods:
Twelve healthy participants completed an MRI study. Three raters assessed overall image quality and their ability to identify key anatomic features within the images. A single rater evaluated the reliability of making measures between imaging methods and sequence types to determine if image type (2-D and 3-D) or image sequence (T1, T2, PD weighted) resulted in different values for key velopharyngeal landmarks.
Results:
An analysis of variance test revealed image quality was rated significantly different based on the scan type (P < .001) and the sequence used (P = .015). Image quality was rated higher among 2-D MR images compared to 3-D, and higher among T2 sequences compared to T1- and PD-weighted imaging methods. In contrast, raters favored 3-D sequences over 2-D sequences for identifying velopharyngeal landmarks. Measures of reliability revealed scan type significantly impacted 2 of the 6 variables but to a minimal degree; however, sequence type had no impact on measures of reliability across all variables.
Conclusion:
Results of the study suggest the scan type and sequence used are factors that likely do not impact the reliability of measures. Based on image quality, the recommended technique for velopharyngeal imaging would be using a 2-D T2-weighted technique. However, based on the ability to identify key landmarks, a 3-D T1- or PD-weighted technique was favored.
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CMK, NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Background
Fused deposition modeling 3D printing is used in medicine for diverse purposes such as creating patient-specific anatomical models and surgical instruments. For use in the sterile surgical ...field, it is necessary to understand the mechanical behavior of these prints across 3D printing materials and after autoclaving. It has been previously understood that steam sterilization weakens polylactic acid, however, annealing heat treatment of polylactic acid increases its crystallinity and mechanical strength. We aim to identify an optimal and commercially available 3D printing process that minimizes distortion after annealing and autoclaving and to quantify mechanical strength after these interventions.
Methods
Thirty millimeters cubes with four different infill geometries were 3D printed and subjected to hot water-bath annealing then immediate autoclaving. Seven commercially available 3D printing materials were tested to understand their mechanical behavior after intervention. The dimensions in the X, Y, and Z axes were measured before and after annealing, and again after subsequent autoclaving. Standard and strength-optimized Army-Navy retractor designs were printed using the 3D printing material and infill geometry that deformed the least. These retractors were subjected to annealing and autoclaving interventions and tested for differences in mechanical strength.
Results
For both the annealing and subsequent autoclaving intervention, the material and infill geometry that deformed the least, respectively, was Essentium PLA Gray and “grid”. Standard retractors without intervention failed at 95 N +/− 2.4 N. Annealed retractors failed at 127.3 N +/− 10 N. Autoclave only retractors failed at 15.7 N +/− 1.4 N. Annealed then autoclaved retractors failed at 19.8 N +/− 3.1 N. Strength-optimized retractors, after the annealing then autoclaving intervention, failed at 164.8 N +/− 12.5 N.
Conclusion
For 30 mm cubes, the 3D printing material and infill geometry that deformed the least, respectively, was Essentium PLA and “grid”. Hot water-bath annealing results in increased 3D printed model strength, however autoclaving 3D prints markedly diminishes strength. Strength-optimized 3D printed PLA Army-Navy retractors overcome the strength limitation due to autoclaving.
This study analyzed the association between Asian dust storms events and diabetes hospital admissions during 2000–2009 in Taiwan using time-series autoregressive model with explanatory variables. ...Data came from National Health Insurance Research Database, Taiwan Environmental Protection Agency, and Central Weather Bureau. There were 1,283,509 diabetes hospital admissions and 55 ADS events. Our study showed that Asian dust storms were positively associated with diabetes hospital admissions for women, but the connection was delayed rather than immediate. The females who were aged above 74 and who were active in the labor market were more vulnerable to Asian dust storms.
Objective
This study was the first to explore the relationship between Asian dust storm events (ADS) and acute myocardial infarction (AMI) hospital admissions by applying time series models.
Design ...and Sample
Nationwide population‐based hospitalization claims data in Taiwan were used. There were 143,063 AMI admissions during 2000–2009.
Measures
An autoregressive with exogenous variables (ARX) time series model was used to investigate the dynamic connection between AMI hospital admissions and ADS events.
Results
AMI hospitalizations significantly spiked on post‐ADS day three. Among the total population, 3.2 more cases of AMI admissions occurred on post‐ADS day three. When the data were stratified by age and gender, the same delayed effect was present in the male population, especially those aged 45–64 and over 74.
Conclusions
Our study shows that although an ADS event does not cause an immediate incidence of AMI, storms may increase AMI incidence through a delayed effect. Hence, AMI prevention is not only important during a dust storm, but particularly so in subsequent days. During the days after an ADS, exposure to dust should be minimized by staying indoors as much as possible and by wearing a mask when exposure to dust is unavoidable. This is especially true for working and older adults. Nurses at local public health centers can increase awareness and promote public safety by providing health information to local communities regarding the link between dust storms and AMI.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Previous animal study revealed that post-implantation electrical detection levels significantly declined within days. The impact of cochlear implant (CI) insertion on human auditory pathway in terms ...of impedance and electrically evoked compound action potential (ECAP) variation within hours after surgery remains unclear, since at this time frequency mapping can only commence weeks after implantation due to factors associated with wound conditions. The study presented our experiences with regards to initial switch-on within 24 hours, and thus the findings about the milieus inside cochlea within the first few hours after cochlear implantation in terms of impedance/ECAP fluctuations. The charts of fifty-four subjects with profound hearing impairment were studied. A minimal invasive approach was used for cochlear implantation, characterized by a small skin incision (≈ 2.5 cm) and soft techniques for cochleostomy. Impedance/ECAP was measured intro-operatively and within 24 hours post-operatively. Initial mapping within 24 hours post-operatively was performed in all patients without major complications. Impedance/ECAP became significantly lower measured within 24 hours post-operatively as compared with intra-operatively (p<0.001). There were no differences between pre-operative and post-operative threshold for air-conduction hearing. A significant drop of impedance/ECAP in one day after cochlear implantation was revealed for the first time in human beings. Mechanisms could be related to the restoration of neuronal sensitivity to the electrical stimulation, and/or the interaction between the matrix enveloping the electrodes and the electrical stimulation of the initial switch-on. Less wound pain/swelling and soft techniques both contributed to the success of immediate initial mapping, which implied a stable micro-environment inside the cochlea despite electrodes insertion. Our research invites further studies to correlate initial impedance/ECAP changes with long-term hearing/speech performance.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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