Highlights • HRV was detected in 7.5% of archived NPA specimens from ICU patients. • Pulmonary and extrapulmonary complications of HRV were common in ICU patients. • There was a high rate of seizure ...among patients with HRV infection
Abstract
This study aimed to evaluate the efficacy of 18-month 0.01% atropine in 61 myopic children (aged 7–10) and the relationship with central retinal response (by multifocal electroretinogram ...mfERG) in a double-masked randomized placebo-controlled clinical trial. Global-flash mfERG was measured at baseline, while cycloplegic spherical equivalent refraction (SER) and axial length (AL) were measured at baseline and at 6-month intervals. Annualized change in SER and AL were compared between atropine and control groups, and the relationships with baseline mfERG were evaluated. Changes in SER (−0.70 ± 0.39D vs. −0.66 ± 0.41D, p = 0.63) and AL (0.32 ± 0.16 mm vs. 0.30 ± 0.22 mm, p = 0.52) were similar in atropine and control groups. Interestingly, in the placebo group, mfERG amplitude was negatively correlated with axial elongation (R
p
= −0.44, p = 0.03) as in our previous study. However, in the atropine group, an opposite trend was observed that axial elongation was positively correlated with mfERG amplitude (R
a
= 0.37, p = 0.04). Annualized myopia progression demonstrated similar opposite effect between atropine and placebo groups but did not reach statistical significance. An ERG screening protocol may be warranted to identify suitable candidates to reduce the likelihood of an unfavorable treatment response by 0.01% atropine.
A cruise ship is a closed-off environment that simulates the basic functioning of a city in terms of living conditions and interpersonal interactions. Thus, the Diamond Princess cruise ship, which ...was quarantined because of an onboard outbreak of COVID-19 in February, 2020, provides an opportunity to define the shedding pattern of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and patient antibody responses before and after the onset of symptoms.
We recruited adult (≥18 years) passengers from Hong Kong who had been on board the Diamond Princess cruise ship docked in Yokohama, Japan in February, 2020. All participants had been found to be negative for SARS-CoV-2 by RT-PCR 4 days before disembarking and were transferred to further quarantine in a public estate in Hong Kong, where they were recruited. Participants were prospectively screened by quantitative RT-PCR (RT-qPCR) of nasopharyngeal and throat swabs, and serum IgG and IgM against internal nucleoprotein and the surface spike receptor-binding protein (RBD) of SARS-CoV-2 at baseline (upon entering quarantine) and on days 4, 8, and 12 of quarantine.
On Feb 22, 2020, 215 adults were recruited, of whom nine (4%; 95% CI 2–8) were positive for SARS-CoV-2 by RT-qPCR or serology and were hospitalised. Of these nine patients, nasopharyngeal swab RT-qPCR was positive in eight patients (89%; 57–99) at baseline. All nine patients were positive for anti-RBD IgG by day 8. Eight (89%; 57–99) were simultaneously positive for nasopharyngeal swab RT-PCR and anti-RBD IgG. One patient who was positive for anti-RBD IgG and had a negative viral load had multifocal peripheral ground-glass changes on high-resolution CT that were typical of COVID-19. Five patients (56%; 27–81) with ground-glass changes on high-resolution CT were found to have higher anti-nucleoprotein-IgG OD values on day 8 and 12 and anti-RBD IgG OD value on day 12 than patients without ground-glass changes. Six (67%; 35–88) patients remained asymptomatic throughout the 14-day quarantine period.
Patients with COVID-19 can develop asymptomatic lung infection with viral shedding and those with evidence of pneumonia on imaging tend to have an increased antibody response. Positive IgG or IgM confirmed infection of COVID-19 in both symptomatic and asymptomatic patients. A combination of RT-PCR and serology should be implemented for case finding and contact tracing to facilitate early diagnosis, prompt isolation, and treatment.
Shaw Foundation Hong Kong; Sanming-Project of Medicine (Shenzhen); High Level-Hospital Program (Guangdong Health Commission).
Myopia, the most common refractive error, is estimated to affect over two billion people worldwide, especially children from East Asian regions. Children with early onset myopia have an increased ...risk of developing sight threatening complications in later life. In addition to the contribution of genetic factors, of which expression is controversially suggested to be subject to environmental regulation, various environmental factors, such as near-work, outdoor, and living environment, have also been determined to play significant roles in the development of refractive error, especially juvenile myopia. Cues from daily visual scenes, including lighting, spatial frequency, and optical defocus over the field of visual stimuli, are suggested to influence emmetropisation, thereby affecting myopia development and progression. These risk factors in visual scenes of the everyday life may explain the relationship between urbanicity and myopia prevalence. This review first summarises the previously reported associations between myopia development and everyday-life environments, including schooling, urban settings, and outdoors. Then, there is a discussion of the mechanisms hypothesised in the literature about the cues from different visual scenes of urbanicity in relation to myopia development.
Case 291 Yip, Stefanie W Y; Lam, Sonia Hiu Yin; Lo, Christine Shing-Yen ...
Radiology
298, Issue:
3
Journal Article
Peer reviewed
History A 46-year-old woman with known mixed connective tissue disease with clinical features of scleroderma and polymyositis and who was not on specific medications was referred to our institution ...to assess for interstitial lung disease due to her predisposing condition. She was a nonsmoker, had no respiratory symptoms, and enjoyed good exercise tolerance. She did not have any cutaneous lesions or renal disease. There was no family history of pulmonary or systemic disease. Her routine blood test results revealed a white blood cell count of 4.6 × 10
/L (normal range, 4.4-10.1 × 10
/L), a hemoglobin level of 7.76 mmol/L (normal range, 7.26-9.18 mmol/L), a platelet count of 189 × 10
/L (normal range, 170-380 × 10
/L), a bilirubin level of 8 μmol/L (7-19 μmol/L), and a creatinine level of 63 μmol/L (45-82 μmol/L), all within normal limits. Lung function tests at presentation yielded normal results, with a diffusing capacity for carbon monoxide of 95% and a forced vital capacity of 2.29 (98% predicted value). However, this patient had an elevated serum globulin level of 47 g/L (normal range, 26-32 g/L) and an erythrocyte sedimentation rate of 36 mm/h (normal range, 0-20 mm/h), while C-reactive protein level was normal at less than 0.35 mg/dL. She was seropositive for antinuclear (titer >1/720), anti-Ro, anti-La, and anti-extractable nuclear antigen antibodies. Chest radiography and CT were performed at presentation (Figs 1, 2) and 14-year follow-up (Figs 3, 4). PET/CT was performed at 7- (Fig 5,
and
) and 13-year follow-up (Fig 5,
and
). Throughout this 14-year follow-up period, she remained completely free of respiratory symptoms and continued to go for a brisk walk every day. At 14-year follow-up, there was no substantial change in serum laboratory values, but a lung function test revealed her diffusing capacity for carbon monoxide had decreased to 52%, while her forced vital capacity remained good at 95%; these findings were suggestive of interval development of restrictive lung function.
ObjectiveFull-field electroretinogram (ffERG) is an objective test to determine the electroretinal activities in response to light stimulation for investigating retinal physiology and diagnosing ...retinal diseases. This study aimed to establish a reference data set of photopic electroretinogram (ERG) of Chinese preschool children in Hong Kong to facilitate clinical and research studies.Methods and analysisPreschool children aged 3–7 years with normal vision were recruited from local kindergartens. Eye examinations, including cycloplegic spherical equivalent refraction (SER), axial length (AL) and keratometry (K) measurements, were performed. ffERGs of the International Society for Clinical Electrophysiology of Vision (ISCEV) standard photopic flash and 30-Hz flicker protocols were measured using RETeval with Sensor Strip skin electrodes. ERG waveform characteristics were extracted, and relationships between ERG, age, SER, AL and K were evaluated.ResultsA total of 479 children completed the measurements (mean age: 5.0±0.9 years, 45.5% female). Mean, 95% CIs, 5th–95th percentile range of the ERG parameters were reported. Age was positively associated with amplitudes of b-wave and 30-Hz flicker (p<0.01), but negatively associated with implicit times of b-wave and 30-Hz flicker (p<0.01). AL was significantly associated with all amplitudes of a-wave, b-wave and 30-Hz flicker (p≤0.01) and implicit time of both a-wave and 30-Hz flicker (p<0.05). K was positively associated only with 30-Hz flicker amplitude (p=0.01), and no association between all responses and SER.ConclusionReference data set of photopic ERG of Chinese preschool children was established. Cross-sectional investigations revealed associations between ERG, age, SER and AL, which were speculated to further implicate the role of retina in refractive error development.
Outcomes in Adults With Bicuspid Aortic Valves Tzemos, Nikolaos; Therrien, Judith; Yip, James ...
JAMA : the journal of the American Medical Association,
09/2008, Volume:
300, Issue:
11
Journal Article
Peer reviewed
CONTEXT Bicuspid aortic valve is the most common congenital cardiac anomaly in the adult population. Cardiac outcomes in a contemporary population of adults with bicuspid aortic valve have not been ...systematically determined. OBJECTIVE To determine the frequency and predictors of cardiac outcomes in a large consecutive series of adults with bicuspid aortic valve. DESIGN, SETTING, AND PARTICIPANTS Cohort study examining cardiac outcomes in 642 consecutive ambulatory adults (mean SD age, 35 16 years; 68% male) with bicuspid aortic valve presenting to a Canadian congenital cardiac center from 1994 through 2001 and followed up for a mean (SD) period of 9 (5) years. Frequency and predictors of major cardiac events were determined by multivariate analysis. Mortality rate in the study group was compared with age- and sex-matched population estimates. MAIN OUTCOME MEASURES Mortality and cause of death were determined. Primary cardiac events were defined as the occurrence of any of the following complications: cardiac death, intervention on the aortic valve or ascending aorta, aortic dissection or aneurysm, or congestive heart failure requiring hospital admission during the follow-up period. RESULTS During the follow-up period, there were 28 deaths (mean SD, 4% 1%). One or more primary cardiac events occurred in 161 patients (mean SD, 25% 2%), which included cardiac death in 17 patients (mean SD, 3% 1%), intervention on aortic valve or ascending aorta in 142 patients (mean SD, 22% 2%), aortic dissection or aneurysm in 11 patients (mean SD, 2% 1%), or congestive heart failure requiring hospital admission in 16 patients (mean SD, 2% 1%). Independent predictors of primary cardiac events were age older than 30 years (hazard ratio HR, 3.01; 95% confidence interval CI, 2.15-4.19; P<.001), moderate or severe aortic stenosis (HR, 5.67; 95% CI, 4.16-7.80; P<.001), and moderate or severe aortic regurgitation (HR, 2.68; 95% CI, 1.93-3.76; P<.001). The 10-year survival rate of the study group (mean SD, 96% 1%) was not significantly different from population estimates (mean SD, 97% 1%; P = .71). At last follow-up, 280 patients (mean SD, 45% 2%) had dilated aortic sinus and/or ascending aorta. CONCLUSIONS In this study population of young adults with bicuspid aortic valve, age, severity of aortic stenosis, and severity of aortic regurgitation were independently associated with primary cardiac events. Over the mean follow-up duration of 9 years, survival rates were not lower than for the general population.
Myopia control efficacy and long-term safety of the Breath-O-Correct orthokeratology (OK) lens was evaluated in a 2-year randomized, single vision (SV) spectacle lens-controlled, single-blind ...clinical trial combining clinical and tear proteomics data. A total of 71 children (43 OK, 9.8 ± 1.3 years; 28 SV, 9.5 ± 1.4 years) completed the 2-year study. Axial length (AL), cycloplegic refraction, clinical safety parameters (best-corrected visual acuity, central cornea thickness, corneal endothelial health, ocular surface disease index), and quantitative tear proteomics were evaluated by masked examiners. Mean 2-year-normalized AL elongations in the OK and SV groups differed significantly (
= 0.03) and were 0.37 ± 0.37 mm and 0.60 ± 0.41 mm, respectively. OK-mediated myopia control efficacy was 37.1%. No significant difference was found in clinical safety parameters of both groups (
> 0.10), except for a thinner central corneal thickness in the OK group (
= 0.01). Proteomics revealed modest OK lens-mediated effects on immune response proteins, including an increased abundance of haptoglobin at 6 and 12 months and a decreased abundance of two proteins (neutrophil defensin 3 and histone 4) at 6 months. The changes were further validated using a high-resolution multiple-reaction monitoring (MRM
) mass spectrometry. In summary, the Breath-O-Correct OK lens significantly reduced AL elongation in schoolchildren without adverse clinical effects or subclinical inflammatory responses.
Context:
Individualized management, incorporating papillary thyroid cancer (PTC) variant-specific risk, is conceivably a useful treatment strategy for PTC, which awaits comprehensive data ...demonstrating differential risks of PTC variants to support.
Objective:
This study sought to establish the differential clinicopathological risk of major PTC variants: conventional PTC (CPTC), follicular-variant PTC (FVPTC), and tall-cell PTC (TCPTC).
Methods:
This was a retrospective study of clinicopathological outcomes of 6282 PTC patients (4799 females and 1483 males) from 26 centers and The Cancer Genome Atlas in 14 countries with a median age of 44 years (interquartile range, 33–56 y) and median follow-up time of 37 months (interquartile range, 15–82 mo).
Results:
The cohort consisted of 4702 (74.8%) patients with CPTC, 1126 (17.9%) with FVPTC, and 239 (3.8%) with TCPTC. The prevalence of high-risk parameters was significantly different among the three variants, including extrathyroidal invasion, lymph node metastasis, stages III/IV, disease recurrence, mortality, and the use (need) of radioiodine treatment (all P < .001), being highest in TCPTC, lowest in FVPTC, and intermediate in CPTC, following an order of TCPTC > CPTC ≫ FVPTC. Recurrence and mortality in TCPTC, CPTC, and FVPTC were 27.3 and 6.7%, 16.1 and 2.5%, and 9.1 and 0.6%, corresponding to events per 1000 person-years (95% confidence interval CI) of 92.47 (64.66–132.26) and 24.61 (12.31–49.21), 34.46 (30.71–38.66), and 5.87 (4.37–7.88), and 24.73 (18.34–33.35) and 1.68 (0.54–5.21), respectively. Mortality hazard ratios of CPTC and TCPTC over FVPTC were 3.44 (95% CI, 1.07–11.11) and 14.96 (95% CI, 3.93–56.89), respectively. Kaplan-Meier survival analyses showed the best prognosis in FVPTC, worst in TCPTC, and intermediate in CPTC in disease recurrence-free probability and disease-specific patient survival. This was particularly the case in patients at least 45 years old.
Conclusion:
This large multicenter study demonstrates differential prognostic risks of the three major PTC variants and establishes a unique risk order of TCPTC > CPTC ≫ FVPTC, providing important clinical implications for specific variant-based management of PTC.
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