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Background Phelan-McDermid syndrome (PMS) is caused by haploinsufficiency of the SHANK3 gene and is characterized by global developmental delays and autism spectrum disorder (ASD). Based on several converging lines of preclinical and clinical evidence supporting the use of insulin-like growth factor-1 (IGF-1) in PMS, this study aims to follow-up a previous pilot study with IGF-1 to further evaluate this novel therapeutic for core symptoms of ASD in children with PMS. Methods Ten children aged 5–9 with PMS were enrolled. Participants were randomized to receive IGF-1 or placebo (saline) using a 12-week, double-blind, crossover design. Efficacy was assessed using the primary outcome of the Aberrant Behavior Checklist—Social Withdrawal (ABC-SW) subscale as well as secondary outcome measures reflecting core symptoms of ASD. To increase power and sample size, we jointly analyzed the effect of IGF-1 reported here together with results from our previous controlled trail of IGF-1 in children with PMS (combined N = 19). Results Results on the ABC-SW did not reach statistical significance, however significant improvements in sensory reactivity symptoms were observed. In our pooled analyses, IGF-1 treatment also led to significant improvements in repetitive behaviors and hyperactivity. There were no other statistically significant effects seen across other clinical outcome measures. IGF-1 was well tolerated and there were no serious adverse events. Limitations The small sample size and expectancy bias due to relying on parent reported outcome measures may contribute to limitations in interpreting results. Conclusion IGF-1 is efficacious in improving sensory reactivity symptoms, repetitive behaviors, and hyperactivity  in children with PMS. Trial registration NCT01525901.

Autism spectrum disorder (ASD) affects individuals across all racial and ethnic groups, yet rates of diagnosis are disproportionately higher for Black and Hispanic children. Caregivers of children with ASD experience significant stressors, which have been associated with parental strain, inadequate utilization of mental health services and lower quality of life. The family peer advocate (FPA) model has been utilized across service delivery systems to provide family-to-family support, facilitate engagement, and increase access to care. This study used a randomized controlled design to examine the efficacy of FPAs in a racially and ethnically diverse sample. Results demonstrate significantly increased knowledge of ASD and reduced levels of stress for caregivers who received the FPA intervention as compared to treatment as usual.

Background Phelan-McDermid syndrome (PMS) is a rare neurodevelopmental disorder caused by haploinsufficiency of the SHANK3 gene and characterized by global developmental delays, deficits in speech and motor function, and autism spectrum disorder (ASD). Monogenic causes of ASD such as PMS are well suited to investigations with novel therapeutics, as interventions can be targeted based on established genetic etiology. While preclinical studies have demonstrated that the neuropeptide oxytocin can reverse electrophysiological, attentional, and social recognition memory deficits in Shank3 -deficient rats, there have been no trials in individuals with PMS. The purpose of this study is to assess the efficacy and safety of intranasal oxytocin as a treatment for the core symptoms of ASD in a cohort of children with PMS. Methods Eighteen children aged 5–17 with PMS were enrolled. Participants were randomized to receive intranasal oxytocin or placebo (intranasal saline) and underwent treatment during a 12-week double-blind, parallel group phase, followed by a 12-week open-label extension phase during which all participants received oxytocin. Efficacy was assessed using the primary outcome of the Aberrant Behavior Checklist-Social Withdrawal (ABC-SW) subscale as well as a number of secondary outcome measures related to the core symptoms of ASD. Safety was monitored throughout the study period. Results There was no statistically significant improvement with oxytocin as compared to placebo on the ABC-SW (Mann–Whitney U  = 50, p  = 0.055), or on any secondary outcome measures, during either the double-blind or open-label phases. Oxytocin was generally well tolerated, and there were no serious adverse events. Limitations The small sample size, potential challenges with drug administration, and expectancy bias due to relying on parent reported outcome measures may all contribute to limitations in interpreting results. Conclusion Our results suggest that intranasal oxytocin is not efficacious in improving the core symptoms of ASD in children with PMS. Trial registration NCT02710084.

Arc plasma torches are the primary components of various industrial thermal plasma processes involving plasma spraying, metal cutting and welding, thermal plasma CVD, metal melting and remelting, waste treatment, and gas production. They are relatively simple devices whose operation implies intricate thermal, chemical, electrical, and fluid dynamics phenomena. Modeling may be used as a means to better understand the physical processes involved in their operation. This article presents an overview of the main aspects involved in the modeling of DC arc plasma torches: the mathematical models including thermodynamic and chemical nonequilibrium models, turbulent and radiative transport, thermodynamic and transport property calculation, boundary conditions, and arc reattachment models. It focuses on the conventional plasma torches used for plasma spraying that include a hot cathode and a nozzle anode.

Background Viral pneumonia is an important cause of respiratory morbidity and mortality. Cases of viral pneumonia are becoming increasingly more common as at-risk populations increase globally. We sought to highlight the racial distribution of hospitalized patients with viral pneumonia and compare their outcomes. Materials and methods Data were obtained from the Nationwide Inpatient Sample (NIS) for 2016 and 2017. The study involved adults who had a principal discharge diagnosis of viral pneumonia. The primary outcome analyzed was inpatient mortality. Secondary outcomes included the development of sepsis, septic shock, acute respiratory failure, acute respiratory distress syndrome, non-ST segment elevation myocardial infarction (NSTEMI), acute kidney failure, deep vein thrombosis, pulmonary embolism, cerebrovascular accident, need for mechanical ventilation, and use of vasopressors as well as mean length of hospitalization and mean total hospital charges. Results Blacks and Hispanics had lower inpatient mortality adjusted odds (aOR: 0.39, 95% CI = 0.229 - 0.662, p<0.001 and aOR: 0.55, 95% CI = 0.347 - 0.858, p=0.009, respectively) compared to Whites. Black and Hispanic patients were also found to have lower adjusted odds ratio of having acute respiratory failure (aOR: 0.54, 95% CI = 0.471 - 0.614, p<0.001, and 0.66, 95% CI = 0.576 - 0.753, p<0.001, respectively). Conclusion Black and Hispanic patients are at lower risk of adverse outcomes when compared to White patients with viral pneumonia.

BackgroundCommunity-acquired pneumonia due to viral pathogens is an under-recognized cause of healthcare-associated mortality and morbidity worldwide. We aimed to compare mortality rates and outcome measures of disease severity in obese vs non-obese patients admitted with viral pneumonia.MethodsAdult patients admitted with viral pneumonia were selected from the Nationwide Inpatient Sample of 2016 and 2017. The arms were stratified based on the presence of a secondary discharge diagnosis of obesity. The primary outcome was inpatient mortality. Secondary outcomes included sepsis, acute respiratory failure, acute respiratory distress syndrome, acute kidney injury, and pulmonary embolism.Results and interpretationIn total, 89,650 patients admitted with viral pneumonia were analyzed, and 17% had obesity. There was no significant difference in mortality between obese and non-obese patients (aOR: 0.98, 95% CI: 0.705 - 1.362, p < 0.001). Compared to non-obese patients, obese patients had higher adjusted odds of developing acute hypoxic respiratory failure (aOR: 1.37, 95% CI: 1.255 - 1.513, p < 0.001), acute respiratory distress syndrome (aOR: 2.29, 95% CI: 1.554 - 3.381, p < 0.001), need for mechanical ventilation (aOR: 1.50, 95% CI: 1.236 - 1.819, p < 0.001), and pulmonary embolism (aOR: 1.69, 95% CI: 1.024 - 2.788, p = 0.040).ConclusionsObesity was not found to be an independent predictor of inpatient mortality in patients admitted with viral pneumonia. However, obesity is associated with worse clinical outcomes and disease severity as defined by the presence of complications, greater incidence of acute respiratory failure (ARF), acute respiratory distress syndrome (ARDS), need for mechanical ventilation, acute kidney injury (AKI), pulmonary embolism (PE), stroke, and sepsis.

Three-dimensional, transient simulations of the plasma flow inside different plasma spray torches have been performed using a local thermodynamic equilibrium model solved by a multiscale finite-element method. The model describes the dynamics of the arc without any further assumption on the reattachment process except for the use of an artificially high electrical conductivity near the electrodes. Simulations of an F4-MB torch from Sulzer-Metco and two configurations of the SG-100 torch from Praxair are presented. The simulations show that, when straight or swirl injection is used, the arc is dragged by the flow and then jumps to form a new attachment, preferably at the opposite side of the original attachment, as has been observed experimentally. Although the predicted reattachment frequencies are at present higher than the experimental ones, the model is suitable as a design tool.

Background Community-acquired pneumonia (CAP) is associated with significant morbidity and mortality. Viral organisms have been identified as the causal pathogen in approximately 20% of CAP. Nutritional status plays an important role in the response to pneumonia. This study aims to identify whether protein energy malnutrition (PEM) is an independent risk factor for mortality and morbidity in viral CAP. Materials and methods This was a retrospective cohort study involving adult hospitalizations for viral CAP in the United States using the Nationwide Inpatient Sample (NIS) database. This cohort was further divided based on the presence or absence of a secondary discharge diagnosis of PEM. The primary outcome was inpatient mortality. Secondary outcomes included the rate of mechanical ventilation among other complications. Results The in-hospital mortality for viral CAP was 2.22%. Patients with PEM had over two-fold high adjusted odds of inpatient mortality (aOR: 2.42, 95% CI: 1.746-3.351, p < 0.001) compared with patients without PEM. Patients with PEM had higher adjusted odds of having septic shock (aOR: 3.34, 95% CI: 2.158-5.160, p < 0.001). NSTEMI (aOR: 1.75, 95% CI: 1.163-2.621, p = 0.007), need for mechanical ventilation (aOR: 3.13, 95% CI: 2.448-4.006, p < 0.001), CVA (aOR: 3.49, 95% CI: 1.687-7.220, p = 0.001), DVT (aOR: 2.19, 95% CI: 1.453-3.295, p < 0.001), and PE (aOR: 2.24, 95% CI: 1.152-4.357, p = 0.017) relative to patients without PEM. Conclusion In conclusion, coexisting PEM is associated with a higher rate of in-hospital morbidity and mortality in patients with viral CAP. Early identification and treatment of nutritional deficiencies can lead to improved outcomes and reduced costs.

A two-temperature thermal non-equilibrium model is developed and applied to the three-dimensional and time-dependent simulation of the flow inside a DC arc plasma torch. A detailed comparison of the results of the non-equilibrium model with those of an equilibrium model is presented. The fluid and electromagnetic equations in both models are approximated numerically in a fully-coupled approach by a variational multi-scale finite element method. In contrast to the equilibrium model, the non-equilibrium model did not need a separate reattachment model to produce an arc reattachment process and to limit the magnitude of the total voltage drop and arc length. The non-equilibrium results show large non-equilibrium regions in the plasma - cold-flow interaction region and close to the anode surface. Marked differences in the arc dynamics, especially in the arc reattachment process, and in the magnitudes of the total voltage drop and outlet temperatures and velocities between the models are observed. The non-equilibrium results show improved agreement with experimental observations.

PurposeWhite light (WL) is the traditional imaging modality for transurethral resection of bladder tumour (TURBT). IMAGE1S is a likely addition. We compare 18-mo recurrence rates following TURBT using IMAGE1S versus WL guidance.MethodsTwelve international centers conducted a single-blinded randomized controlled trial. Patients with primary and recurrent non-muscle-invasive bladder cancer (NMIBC) were randomly assigned 1:1 to TURBT guided by IMAGE1S or WL. Eighteen-month recurrence rates and subanalysis for primary/recurrent and risk groups were planned and compared by chi-square tests and survival analyses.Results689 patients were randomized for WL-assisted (n = 354) or IMAGE1S-assisted (n = 335) TURBT. Of these, 64.7% had a primary tumor, 35.3% a recurrent tumor, and 4.8%, 69.2% and 26.0% a low-, intermediate-, and high-risk tumor, respectively. Overall, 60 and 65 patients, respectively, completed 18-mo follow-up, with recurrence rates of 31.0% and 25.4%, respectively (p = 0.199). In patients with primary, low-/intermediate-risk tumors, recurrence rates at 18-mo were significantly higher in the WL group compared with the IMAGE1S group (31.9% and 22.3%, respectively: p 0.035). Frequency and severity of adverse events were comparable in both treatment groups. Immediate and adjuvant intravesical instillation therapy did not differ between the groups. Potential limitations included lack of uniformity of surgical resection, central pathology review, and missing data.ConclusionThere was not difference in the overall recurrence rates between IMAGE1S and WL assistance 18-mo after TURBT in patients with NMIBC. However, IMAGE1S-assisted TURBT considerably reduced the likelihood of disease recurrence in primary, low/intermediate risk patients.RegistrationClinicalTrials.gov Identifier NCT02252549 (30-09-2014).