Increased acetabular subchondral bone density is associated with cam-type femoroacetabular impingement

SummaryObjectiveFemoroacetabular impingement (FAI) has been associated with significant acetabular cartilage damage and subsequent degenerative arthritis. Subchondral bone, often neglected in osteoarthritis studies, may play an important role in the degenerative cascade. Hence the goal of this study was to assess acetabular subchondral bone mineral density (BMD) in subjects with asymptomatic or symptomatic cam deformities compared to normal control subjects. The relationship between BMD and the alpha angle, a quantitative measure of the deformity, was also analyzed.MethodsPatients diagnosed with symptomatic cam FAI were recruited (‘Surgical’) as well as subjects from the general asymptomatic population, classified from CT imaging as normal (‘Control’) or having a cam deformity (‘Bump’) based on their alpha angle measurement. There were 12 subjects in each group. All subjects underwent a CT scan with a calibration phantom. BMD was calculated in regions of interest around the acetabulum from CT image intensity and the phantom calibration. BMD was compared between groups using spine BMD as a covariate. The relationship between BMD and alpha angle was assessed by linear regression.ResultsIn the antero-superior regions bone density was 15–34% higher in the Bump group (P < 0.05) and 14–38% higher in the Surgical group (P < 0.05) compared to Controls. BMD correlated positively with the alpha angle measurements (R2 = 0.44, P < 0.001).ConclusionBMD was elevated in subjects with cam-type deformities, with the severity of the deformity more correlative than symptom status. Similarities to the symptomatic group suggest that hips with an asymptomatic deformity may already be in early stages of joint degeneration

MRI of bone marrow edema-like signal in the pathogenesis of subchondral cysts

SummaryObjectiveTo determine if a relationship exists between bone marrow edema-like signal and subchondral cysts on magnetic resonance imaging (MRI).DesignRetrospective cohort of 32 patients with two sequential knee MRI. Patients with acute trauma, infection, neoplasm, or osteonecrosis were excluded. The degree of osteoarthritis was assessed using an adaptation of the Baltimore Longitudinal Study of Aging (BLSA) scale. Initial and follow-up exams were reviewed for presence, location, size and changes of marrow edema-like signal, subarticular cysts and cartilage abnormality. All locations in the knee were aggregated for analysis with descriptive statistics.ResultsThe mean time interval between exams was 17.52 months (range 2.1–40.1 months). There were 23 cysts: 11 (47.8%) new, 6 (26.1%) increased size, 1 (4.4%) decreased size, and 5 (21.7%) no change in pre-existing lesions. Cysts always arose from regions of marrow edema-like signal. There were 68 subarticular areas of marrow edema-like signal: 16 (23.5%) new, 23 (33.8%) increased size, 17 (25%) decreased size, 11 (16.2%) resolved and 1 (1.5%) no change in pre-existing lesion. Marrow edema-like signal size always changed with cyst development: increased in 6/11 (54.5%), decreased in 2/11 (18.1%) and resolved in 3/11 (27.2%). Change in cyst size was always accompanied by a change in edema-like signal size. An MRI visible cartilage abnormality was adjacent to 87% (20/23) of cysts. The mean BLSA score changed from 2.6 to 3.6 indicating an overall progression of osteoarthritis.ConclusionSubchondral cysts develop in pre-existing regions of subchondral bone marrow edema-like signal

A 680,000-person megastudy of nudges to encourage vaccination in pharmacies

Encouraging vaccination is a pressing policy problem. To assess whether text-based reminders can encourage pharmacy vaccination and what kinds of messages work best, we conducted a megastudy. We randomly assigned 689,693 Walmart pharmacy patients to receive one of 22 different text reminders using a variety of different behavioral science principles to nudge flu vaccination or to a business-as-usual control condition that received no messages. We found that the reminder texts that we tested increased pharmacy vaccination rates by an average of 2.0 percentage points, or 6.8%, over a 3-mo follow-up period. The most-effective messages reminded patients that a flu shot was waiting for them and delivered reminders on multiple days. The top-performing intervention included two texts delivered 3 d apart and communicated to patients that a vaccine was “waiting for you.” Neither experts nor lay people anticipated that this would be the best-performing treatment, underscoring the value of simultaneously testing many different nudges in a highly powered megastudy.https://www.pnas.org/content/pnas/119/6/e2115126119.full.pd

Autoantibodies against type I IFNs in patients with life-threatening COVID-19

Interindividual clinical variability in the course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is vast. We report that at least 101 of 987 patients with life-threatening coronavirus disease 2019 (COVID-19) pneumonia had neutralizing immunoglobulin G (IgG) autoantibodies (auto-Abs) against interferon-w (IFN-w) (13 patients), against the 13 types of IFN-a (36), or against both (52) at the onset of critical disease; a few also had auto-Abs against the other three type I IFNs. The auto-Abs neutralize the ability of the corresponding type I IFNs to block SARS-CoV-2 infection in vitro. These auto-Abs were not found in 663 individuals with asymptomatic or mild SARS-CoV-2 infection and were present in only 4 of 1227 healthy individuals. Patients with auto-Abs were aged 25 to 87 years and 95 of the 101 were men. A B cell autoimmune phenocopy of inborn errors of type I IFN immunity accounts for life-threatening COVID-19 pneumonia in at least 2.6% of women and 12.5% of men

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

The CARMENES search for exoplanets around M dwarfs: Two planets on opposite sides of the radius gap transiting the nearby M dwarf LTT 3780

We present the discovery and characterisation of two transiting planets observed by the Transiting Exoplanet Survey Satellite (TESS) orbiting the nearby (d∗ ≈ 22 pc), bright (J ≈ 9 mag) M3.5 dwarf LTT 3780 (TOI-732). We confirm both planets and their association with LTT 3780 via ground-based photometry and determine their masses using precise radial velocities measured with the CARMENES spectrograph. Precise stellar parameters determined from CARMENES high-resolution spectra confirm that LTT 3780 is a mid-M dwarf with an effective temperature of Teff = 3360 ± 51 K, a surface gravity of log g∗ = 4.81 ± 0.04 (cgs), and an iron abundance of [Fe/H] = 0.09 ± 0.16 dex, with an inferred mass of M∗ = 0.379 ± 0.016M· and a radius of R∗ = 0.382 ± 0.012R·. The ultra-short-period planet LTT 3780 b (Pb = 0.77 d) with a radius of 1.35-0.06+0.06 R·, a mass of 2.34-0.23+0.24 M·, and a bulk density of 5.24-0.81+0.94 g cm-3 joins the population of Earth-size planets with rocky, terrestrial composition. The outer planet, LTT 3780 c, with an orbital period of 12.25 d, radius of 2.42-0.10+0.10 R·, mass of 6.29-0.61+0.63 M·, and mean density of 2.45-0.37+0.44 g cm-3 belongs to the population of dense sub-Neptunes. With the two planets located on opposite sides of the radius gap, this planetary system is anexcellent target for testing planetary formation, evolution, and atmospheric models. In particular, LTT 3780 c is an ideal object for atmospheric studies with the James Webb Space Telescope (JWST)