Comparison of Risk of Recrudescent Fever in Children With Kawasaki Disease Treated With Intravenous Immunoglobulin and Low-Dose vs High-Dose Aspirin

Importance: Timely initiation of intravenous immunoglobulin plus aspirin is necessary for decreasing the risk of recrudescent fever and coronary artery abnormalities in children with Kawasaki disease (KD). The optimal dose of aspirin, however, remains unclear. Objective: To evaluate whether initial treatment with low-dose compared with high-dose aspirin in children with KD is associated with an increase in fever recrudescence. Design, Setting, and Participants: A retrospective cohort study of 260 children with KD at Riley Hospital for Children, Indianapolis, Indiana, between January 1, 2007, and December 31, 2018, was conducted. Children aged 0 to 18 years with a first episode of KD, identified by International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes treated within 10 days of symptom onset with high-dose intravenous immunoglobulin plus aspirin were eligible. Patients who received an alternative diagnosis, experienced a second episode of KD, did not receive intravenous immunoglobulin plus aspirin for initial treatment, were not treated within 10 days of symptoms, or had incomplete records were excluded. Exposures: High-dose (≥10 mg/kg/d) or low-dose (<10 mg/kg/d) aspirin therapy. Main Outcomes and Measures: The primary outcome was recrudescent fever necessitating retreatment of KD. The secondary outcomes were coronary artery abnormalities and hospital length of stay. Results: Among the 260 patients included, the median (interquartile range) age was 2.5 (1.6-4.3) years, 103 (39.6%) were girls, 166 (63.8%) were non-Hispanic white, 57 (21.9%) were African American, 22 (8.5%) were Asian, 11 (4.2%) were Hispanic, and 4 (1.5%) were of unknown race/ethnicity. One hundred-forty-two patients (54.6%) were treated with low-dose aspirin. There was no association between recrudescent fever and aspirin dose, with 39 children (27.5%) having recrudescent fever in the low-dose group compared with 26 children (22.0%) in the high-dose group (odds ratio [OR], 1.34; 95% CI, 0.76-2.37; P = .31), with similar results after adjusting for potential confounding variables (OR, 1.63; 95% CI, 0.89-2.97; P = .11). In a subset analysis of 167 children with complete KD, however, there was nearly a 2-fold difference in the odds of recrudescent fever with low-dose aspirin (OR, 1.87; 95% CI, 0.82-4.23; P = .14), although this difference did not reach statistical significance. In addition, no association was identified between treatment group and coronary artery abnormalities (low-dose, 7.4% vs high-dose, 9.4%; OR, 0.86; 95% CI, 0.48-1.55; P = .62) or median (interquartile range) length of stay (3 [3-5] days for both groups; P = .27). Conclusions and Relevance: In this study, low-dose aspirin for the initial treatment of children with KD was not associated with fever recrudescence or coronary artery abnormalities. Given the potential benefits, further study of low-dose aspirin to detect potentially clinically relevant outcome differences is warranted to inform treatment decisions and guideline development

The natural history of West Nile virus infection presenting with West Nile virus meningoencephalitis in a man with a prolonged illness: a case report

<p>Abstract</p> <p>Introduction</p> <p>Estimates indicate that West Nile virus infects approximately one and a half million people in the United States of America. Up to 1% may develop West Nile virus neuroinvasive disease, in which infected patients develop any combination of meningitis, encephalitis, or acute paralysis.</p> <p>Case presentation</p> <p>A 56-year-old African-American man presented to our hospital with headache, restlessness, fever, myalgias, decreased appetite, and progressive confusion. A cerebrospinal fluid examination showed mild leukocytosis and an elevated protein level. Testing for routine infections was negative. Brain T2-weighted magnetic resonance imaging scans showed marked enlargement of caudate nuclei and increased intensity within the basal ganglia and thalami. A West Nile virus titer was positive, and serial brain magnetic resonance imaging scans showed resolving abnormalities that paralleled his neurological examination.</p> <p>Conclusion</p> <p>This report is unusual as it portrays the natural history and long-term consequences of West Nile virus meningoencephalitis diagnosed on the basis of serial brain images.</p

Influence of Pacing Strategy on Oxygen Uptake During Treadmill Middle-Distance Running

The oxygen uptake (V·O2) attained during a constant speed 800-m pace trial on a treadmill is less than the maximal V·O2 (V·O2max) in male middle-distance runners with a high V·O2max (i.e., > 65 ml · kg-1 · min-1). We therefore investigated whether the V·O2 attained was influenced by the pacing strategy adopted. Eight male middle-distance runners (age 25.8 ± 3.3 years; height 1.78 ± 0.10 m; mass 67.8 ± 4.7 kg) with a personal best 800-m time of 112.0 ± 3.3 s volunteered to participate. Subjects undertook a speed ramped progressive test to determine V·O2max and three 800-m pace runs to exhaustion all in a randomised order. The three 800-m pace runs included constant speed, acceleration, and race simulation runs. Oxygen uptake was determined throughout each test using 15-s Douglas bag collections. Following the application of a 30-s rolling average, the highest V·O2 during the progressive test (i.e., V·O2max) and the highest V·O2 during the 800-m pace runs (i.e., V·O2peak) were compared. For the eight runners, V·O2max was 67.2 ± 4.3 ml · kg-1 · min-1. V·O2peak was 60.1 ± 5.1 ml · kg-1 · min-1, 61.1 ± 5.2 ml · kg-1 · min-1, and 62.2 ± 4.9 ml · kg-1 · min-1, yielding values of 89.3 ± 2.4 %, 90.8 ± 2.8 %, and 92.5 ± 3.1 % V·O2max for the constant speed, acceleration and race simulation runs, respectively. Across runs, repeated measures ANOVA revealed a significant effect (p = 0.048). Trend analysis identified a significant linear trend (p = 0.025) with the % V·O2max attained being higher for the acceleration run than the constant speed run, and higher still for the race simulation run. These results demonstrate that in middle-distance runners a) pacing strategy influences the V·O2 attained, with a race simulation run elevating the V·O2 attained compared with other pacing strategies, and b) regardless of pacing strategy the V·O2 attained in an 800-m pace run on a treadmill is less than V·O2max

Glycosaminoglycan profiles of repair tissue formed following autologous chondrocyte implantation differ from control cartilage

Currently, autologous chondrocyte implantation (ACI) is the most commonly used cell-based therapy for the treatment of isolated femoral condyle lesions of the knee. A small number of centres performing ACI have reported encouraging long-term clinical results, but there is currently a lack of quantitative and qualitative biochemical data regarding the nature of the repair tissue. Glycosaminoglycan (GAG) structure influences physiological function and is likely to be important in the long-term stability of the repair tissue. The objective of this study was to use fluorophore-assisted carbohydrate electrophoresis (FACE) to both quantitatively and qualitatively analyse the GAG composition of repair tissue biopsies and compare them with age-matched cadaveric controls. We used immunohistochemistry to provide a baseline reference for comparison. Biopsies were taken from eight patients (22 to 52 years old) 1 year after ACI treatment and from four cadavers (20 to 50 years old). FACE quantitatively profiled the GAGs in as little as 5 μg of cartilage. The pattern and intensity of immunostaining were generally comparable with the data obtained with FACE. In the ACI repair tissue, there was a twofold reduction in chondroitin sulphate and keratan sulphate compared with age-matched control cartilage. By contrast, there was an increase in hyaluronan with significantly shorter chondroitin sulphate chains and less chondroitin 6-sulphate in repair tissue than control cartilage. The composition of the repair tissue thus is not identical to mature articular cartilage

Optimized versus corrected peak power during friction-braked cycle ergometry in males and females

The aim of this study was to compare optimization and correction procedures for the determination of peak power output during friction-loaded cycle ergometry. Ten male and 10 female sports students each performed five 10- s sprints from a stationary start on a Monark 864 basket- loaded ergometer. Resistive loads of 5.0, 6.5, 8.0, 9.5, and 11.0% body weight were administered in a counterbalanced order, with a recovery period of 10 min between sprints. Peak power was greater and occurred earlier, with less work having been done before the attainment of peak power, when the data were corrected to account for the inertial and frictional characteristics of the ergometer. Corrected peak power was independent of resistive load ( P > 0.05), whereas uncorrected peak power varied as a quadratic function of load ( P > 0.001). For males and females, optimized peak power ( 971 +/- 122 and 668 +/- 37 W) was lower ( P < 0.01) than either the highest ( 1074 +/- 111 and 754 +/- 56 W respectively) or the mean ( 1007 +/- 125 and 701 +/- 45 W respectively) of the five values for corrected peak power. Optimized and mean corrected peak power were highly correlated both in males ( r = 0.97, P < 0.001) and females ( r = 0.96, P < 0.001). The difference between optimized and mean corrected peak power was 37+ 30 W in males and 33 +/- 14 W in females, of which approximately 15 W was due to the correction for frictional losses. We conclude that corrected peak power is independent of resistive load in males and females

Influence of Pacing Strategy on Oxygen Uptake During Treadmill Middle-Distance Running

The oxygen uptake (V·O2) attained during a constant speed 800-m pace trial on a treadmill is less than the maximal V·O2 (V·O2max) in male middle-distance runners with a high V·O2max (i.e., > 65 ml · kg-1 · min-1). We therefore investigated whether the V·O2 attained was influenced by the pacing strategy adopted. Eight male middle-distance runners (age 25.8 ± 3.3 years; height 1.78 ± 0.10 m; mass 67.8 ± 4.7 kg) with a personal best 800-m time of 112.0 ± 3.3 s volunteered to participate. Subjects undertook a speed ramped progressive test to determine V·O2max and three 800-m pace runs to exhaustion all in a randomised order. The three 800-m pace runs included constant speed, acceleration, and race simulation runs. Oxygen uptake was determined throughout each test using 15-s Douglas bag collections. Following the application of a 30-s rolling average, the highest V·O2 during the progressive test (i.e., V·O2max) and the highest V·O2 during the 800-m pace runs (i.e., V·O2peak) were compared. For the eight runners, V·O2max was 67.2 ± 4.3 ml · kg-1 · min-1. V·O2peak was 60.1 ± 5.1 ml · kg-1 · min-1, 61.1 ± 5.2 ml · kg-1 · min-1, and 62.2 ± 4.9 ml · kg-1 · min-1, yielding values of 89.3 ± 2.4 %, 90.8 ± 2.8 %, and 92.5 ± 3.1 % V·O2max for the constant speed, acceleration and race simulation runs, respectively. Across runs, repeated measures ANOVA revealed a significant effect (p = 0.048). Trend analysis identified a significant linear trend (p = 0.025) with the % V·O2max attained being higher for the acceleration run than the constant speed run, and higher still for the race simulation run. These results demonstrate that in middle-distance runners a) pacing strategy influences the V·O2 attained, with a race simulation run elevating the V·O2 attained compared with other pacing strategies, and b) regardless of pacing strategy the V·O2 attained in an 800-m pace run on a treadmill is less than V·O2max

Non-invasive methods of identifying and tracking wild squid

The ability to identify individual free-living animals in the field is an important method for studying their behavior. Apart from invasive external or internal tags, which may cause injury or abnormal behavior, most cephalopods cannot be tagged, as their skin is too soft and delicate for tag retention. Additionally, cephalopods remove many types of tags. However, body markings have been successfully used as a non invasive method to identify individuals of many different species of animals, including whale sharks, grey whales, seals, and zebras. We developed methods to sex and individually identify Caribbean reef squid, Sepiotheuthis sepioidea. Males showed distinct bright dots on their fins on a Basic Brown background and have a light line at the fin edge while the females had a gradual transition from Brown to Pale towards the edge of their fins without showing distinct fin-dots or lines. In the field we used four characters to distinguish individual S. sepioidea from each other – sex, relative size to each other, scars, and patterns of light-colored dots on their mantles and fins. These dot patterns are individually unique and constant in location through time. Observations in the field were backed up by an image database using illustrations and photography