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We aimed to describe the SARS-CoV-2 lineages circulating early pandemic among samples with S gene dropout and characterize the receptor-binding domain (RBD) of viral spike protein. Adults and children older than 2 months with signs and symptoms of COVID-19 were prospectively enrolled from May to October in Porto Alegre, Brazil. All participants performed RT-PCR assay, and samples with S gene dropout and cycle threshold less then 30 were submitted to high-throughput sequencing (HTS). 484 out of 1,557 participants tested positive for SARS-CoV-2. The S gene dropout was detected in 7.4% (36/484) and a peak was observed in August. The B.1.1.28, B.1.91 and B.1.1.33 lineages were circulating in early pandemic. The RBD novel mutation (Y380Q) was found in one sample occurring simultaneously with C379W and V395A, and the B.1.91 lineage in the spike protein. [https://www.selleckchem.com/products/conteltinib-ct-707.html selleck] The Y380Q and C379W may interfere with the binding of neutralizing antibodies (CR3022, EY6A, H014, S304).<br /><br /> The plaques with higher grade of yellow color by angioscopy are reported to be associated with vulnerability leading to adverse outcomes in coronary artery diseases. However, no studies have been performed for peripheral artery disease (PAD). We aimed to evaluate the relationship of angioscopic findings of peripheral arteries with the long-term prognosis.<br /><br /> Angioscopy of iliac or femoropopliteal artery was performed before endovascular therapy in patients with PAD. The local plaque color and presence of thrombus were evaluated. Multivariable Cox regression models were used to estimate hazard ratio (HR) for all-cause mortality or major adverse cardiovascular event (MACE) related to the plaque colors as well as presence of thrombus.<br /><br /> Among 67 patients, 49.3% had intensive yellow plaques (group H) and the rest had light yellow to yellow ones (group L). Thrombus was detected in 74.6% of the patients and the presence was not different between the two groups. In Kaplan-Meier analysis during a median follow-up of 976 days and 757 days, group H showed increased mortality and MACE compared with group L (p &lt;0.01 for both). Multivariable analysis demonstrated that the intensive yellow color of plaque was independently associated with mortality and MACE [HR 11.48, 95% confidence interval (CI) 2.19-211.1 and HR 3.81, 95% CI 1.36-13.48, respectively] after adjusting for the presence of thrombus.<br /><br /> The yellow color intensity in local plaques by angioscopy may be a novel predictor of long-term prognosis in patients with PAD, regardless of the presence of thrombus.<br /><br />The yellow color intensity in local plaques by angioscopy may be a novel predictor of long-term prognosis in patients with PAD, regardless of the presence of thrombus.<br /><br /> Human trafficking (HT) is a global problem that may affect children's health. In the United States, victims and children are at risk in most communities. History of abuse is a risk factor for HT. This study explored associations between pediatric patients with positive universal abuse screens and indicators from the commercial sexual exploitation of children/child sex trafficking (CSEC/CST) screening tool.<br /><br /> A retrospective chart review was conducted on random patients, aged 11-17 years, with positive universal abuse screens at emergency/urgent care departments in a large Midwest pediatric medical center in 2018. Documentation identifying at least two CSEC/CST screening tool indicators was abstracted from these records. Data analysis included descriptive statistics, univariate analyses, and correlations.<br /><br /> Two or more indicators from the CSEC/CST screening tool were identified in 43% (n=121). Age and history of running away were significant predictors for a patient having two or more CSEC/CST positive indicators.<br /><br /> Targeted screening and interventions are needed to identify and help these vulnerable youth.<br /><br />Targeted screening and interventions are needed to identify and help these vulnerable youth.<br /><br /> Up to 30% of patients undergoing lumpectomy for breast cancer are in need for re-excision due to either close or involved margins. We evaluated the yield of Margin Probe© (MP; Dilon Technologies, USA) in a cohort of patients undergoing lumpectomy for both palpable and non-palpable tumors.<br /><br /> Following lumpectomy, margins were evaluated with MP and readings were compared to the lumpectomies' pathological evaluation irrespective of whether additional margins were removed during surgery. Involved margins or the presence of DCIS within 1mm of the resection margins were considered as positive margins.<br /><br /> 48 patients with 51 tumors underwent lumpectomy. Thirteen of the 51 lumpectomies had pathological close or involved margins. MP identified 3 out of the 13 positive margins. False-positive readings were recorded in 97 out of 287 margins. The sensitivity, specificity, positive predictive value and negative predictive value were 23.1% (95%CI 5.0% 53.8%), 66.4% (95%CI 60.7%-71.9%), 3% (95%CI 0.6%-8.5%), and 95.1% (95%CI 91.1%-97.6%) respectively.<br /><br /> MP cancer detection rate is relatively low while high false-positive rate leads to unnecessary shavings in almost all patients. Evaluation of MP performance should be based on comparing MP read to pathology report.<br /><br />MP cancer detection rate is relatively low while high false-positive rate leads to unnecessary shavings in almost all patients. Evaluation of MP performance should be based on comparing MP read to pathology report.Breast cancer represents an urgent global priority. While this is a universal issue, and as the burden of the disease is increasing globally, current estimates indicate that in the next couple of decades, much of the incidence and mortality related to breast cancer will be seen in underserved populations. The fragile and ill-prepared healthcare systems in low- and middle-income countries (LMIC) need to address this challenge and find solutions with their limited resources. Significant disparities can be identified in stage at presentation as the ability to detect the disease in earlier stages is compromised in these scenarios leading to worse outcomes associated to late diagnoses. Furthermore, access to healthcare in general and to basic surgical, radiotherapy and systemic care is suboptimal additionally limiting treatment results. With a small portion of their budget allocated to healthcare, LMIC need to make the most of their resources prioritizing cost-effective strategies that could offer the best possible results. Countries that invest in women's health do develop into healthier, more educated, and importantly, more productive societies with benefits seen across generations. Finally, recognition of inequities should stimulate a concerted effort engaging all involved stakeholders to find context-adapted solutions to improve healthcare outcomes.<br /><br /> Early glycemic variability (GV) in diabetic patients is a poor prognosis factor following cardiovascular events. However, its influence on the course of acute ischemic stroke (AIS) with large vessel occlusion remains unclear. We investigated the relationship between high GV during acute stroke and three-month functional outcome among patients treated with combined intravenous thrombolysis and endovascular therapy for large vessel occlusion.<br /><br /> A single-center retrospective analysis of AIS patients with proximal intracranial occlusion who underwent thrombolysis and mechanical thrombectomy between January 2015 and May 2017. Early GV was assessed using standard deviation (SD) of blood glucose levels for the first 24hours. The main outcome was functional status at three months as defined by the modified Rankin scale (mRS). Secondary outcomes were change in NIHSS score from baseline to 24hours and occurrence of severe hemorrhagic transformation. Multivariate logistic regression analyses including GV, admission glycemia and mean glycemia were performed.<br /><br /> Among the 93 patients evaluated, 26 had early high GV (≥20.9mg/dl). High GV was associated with poor functional outcome (OR=8.00; 95%CI [1.34-47.89]; P=0.02) unlike admission glycemia and mean glycemia (OR=2.92; 95%CI [0.51-16.60]; P=0.23 and OR=0.36; 95%CI [0.05-2.6]; p=0.31, respectively). High GV was not associated with NIHSS at 24hours or hemorrhagic transformation.<br /><br /> Acute high GV contributes to poorer functional outcome following AIS related to large vessel occlusion and should be considered as a new target in acute stroke management.<br /><br />Acute high GV contributes to poorer functional outcome following AIS related to large vessel occlusion and should be considered as a new target in acute stroke management.Since its identification as a unique species in 1982, Escherichia hermannii has only recently been implicated as a pathogenic organism in human diseases. Literature search indicates removal of hemodialysis catheter as being essential to the success of treatment for bacteremia with this organism. However, having no alternative access for hemodialysis led to the attempt to salvage the catheter with the use of Antibiotic lock therapy. This case highlights Antibiotic lock therapy as an indication in Escherichia hermanii Catheter related Bloodstream infection.<br /><br /> In this study, we evaluated the biomechanical characteristics of different locations of medial fixation strategies in double-plate osteosynthesis for fixing AO/ASIF type 33-C2 fractures by means of finite element analysis.<br /><br /> We used 3-matic software and UG-NX software to construct AO/ASIF type 33-C2 fractures and lateral less invasive stabilization system (LISS) plates, medial plates (MPs), and medial support pads (MSPs), respectively. Then, the LISS, MP and MSP were assembled into the fracture model separately to form three fixation models MSP+LISS, anteromedial plate (AMP+LISS), and MP+LISS. In the next procedure, we performed finite element analysis using ANSYS software after meshing the elements of the models in HyperMesh 11.0 software. Loading conditions including lateral-medial four-point bending, anterior-posterior four-point bending, axial loading, and torsional loading were applied to evaluate the biomechanical advantages among the three fixation types. We observed the peak Von Mises Stress (VMS) vLISS preceded those of the other two models. However, under axial loading, the peak VMS (76.376MPa) and the maximum displacement (3.1798mm) of MSP+LISS were slightly higher than those of MP+LISS.<br /><br /> The MSP+LISS model showed better biomechanical performance than the double-plate models, which might be an effective solution for the treatment of comminuted distal femur fractures.<br /><br />The MSP+LISS model showed better biomechanical performance than the double-plate models, which might be an effective solution for the treatment of comminuted distal femur fractures.<br /><br /> The ankle syndesmosis is frequently disrupted in ankle injuries, with higher incidence in concomitant ankle fractures. There is debate regarding the most appropriate surgical management of these injuries, with the development of suture-button devices challenging the conventional approach of surgical stabilisation with syndesmotic screws. The primary aim of this study was to assess current practice variation at a national level, enabling a comparison with reported practice around the world. The secondary aims were to assess practice variation between operative indications and inconsistencies between surgeon device usage and personal preference should they be injured themselves.<br /><br /> A 20-item survey detailing surgical experience, diagnosis, surgical management preference and a series of case studies was conducted. The survey was endorsed and promoted by the Australian Orthopaedic Association (AOA).<br /><br /> 125 responses were received during the three-month study period. The most commonly used method to stabilise a syndesmotic injury by Australian orthopaedic surgeons was two 3.