Community-acquired group B streptococcal meningitis in adults

IntroductionStreptococcus agalactiae (group B streptococci; GBS) is an uncommon cause of bacterial meningitis in adults.MethodsWe reviewed literature published between 1975 and 2018. Studies were included if they reported age, sex and outcome of patients above 16 years of age with cerebrospinal fluid culture (CSF) positive for GBS.ResultsSixty-seven articles describing 141 patients were included. Median age was 56 years (IQR 41–66); 52% were male. Fifty-three patients (38%) were immunocompromised and CSF leakage was reported in 9 (10%) of 88 immunocompetent patients. Sixty-two patients (44%) had extra-meningeal foci of infection, most commonly endocarditis, which occurred in 14 patients (12%). Twenty-eight patients (23%) were described as previously healthy. Forty-four (31%) of the 141 patients died, after a median duration of 5 days after admission. Death was associated with advanced age and an immunocompromised state.ConclusionGBS meningitis in adults mainly occurs in those with underlying conditions such as immunocompromised state, CSF leakage, and endocarditis. These conditions should be actively sought for in adults with GBS meningitis.     

Acute effect of engineered thermoplastic polyurethane elastomer knockoff running footwear on foot loading and comfort during heel-to-toe running

BackgroundBetter midsole materials and comfort have been incorporated into more expensive shoes and are popular with runners. Consequently, knockoff running shoes are currently widely distributed in the Chinese market and and cost only 30%–50% of the total price of genuine branded products.Research questionUncertainty exists concerning the beneficial effects of advanced shoe material application in decreasing foot loading or impact force during running. Additionally, using comfort as a criterion to identify genuine branded running shoes may exclude brand factor.MethodsFifteen healthy male volunteers were asked to perform two different tests, including running and a comfort evaluation. Each participant was asked to identify which footwear was the Adidas brand shoe based on their perception of comfort.ResultsTime to the first peak of the vertical ground reaction force occurred significantly later when subjects wore the genuine branded shoe compared to knockoff shoe 1 (p = 0.003) and knockoff shoe 2 (p = 0.015) footwea. The genuine branded shoe (p = 0.005) and knockoff shoe 1 (p = 0.029) were significantly more comfortable compared to the knockoff shoe 2. Only four subjects selected the genuine branded shoe, whereas six subjects selected both the genuine branded shoe and knockoff shoe 1.SignificanceKnockoff running footwear significantly increases impact loading compared to the genuine branded product, thereby posing greater risk of running injury.     

Optimal needle design for minimal insertion force and bevel length

This research presents a methodology for optimal design of the needle geometry to minimize the insertion force and bevel length based on mathematical models of cutting edge inclination and rake angles and the insertion force. In brachytherapy, the needle with lower insertion force typically is easier for guidance and has less deflection. In this study, the needle with lancet point (denoted as lancet needle) is applied to demonstrate the model-based optimization for needle design. Mathematical models to calculate the bevel length and inclination and rake angles for lancet needle are presented. A needle insertion force model is developed to predict the insertion force for lancet needle. The genetic algorithm is utilized to optimize the needle geometry for two cases. One is to minimize the needle insertion force. Using the geometry of a commercial lancet needle as the baseline, the optimized needle has 11% lower insertion force with the same bevel length. The other case is to minimize the bevel length under the same needle insertion force. The optimized design can reduce the bevel length by 46%. Both optimized needle designs were validated experimentally in ex vivo porcine liver needle insertion tests and demonstrated the methodology of the model-based optimal needle design.     

Clinical presentation of young people (10–24 years old) with brain tumors: results from the international MOBI-Kids study

Journal of Neuro-Oncology - We used data from MOBI-Kids, a 14-country international collaborative case–control study of brain tumors (BTs), to study clinical characteristics of the tumors in...     

Hospital utilization 4 years after bariatric surgery: sleeve gastrectomy versus Roux-en-Y gastric bypass

BackgroundWhile sleeve gastrectomy (SG) has lower perioperative risk compared with Roux-en-Y gastric bypass (RYGB), long-term data about their differential impact on overall health are unclear. Hospital use after bariatric surgery is an important parameter for improving peri- and postoperative care.ObjectiveThis present study was aimed to compare SG and RYGB in terms of their effect on long-term hospital-based healthcare utilization.SettingMulticenter, statewide database.MethodsA retrospective cohort study of adult patients who underwent SG and RYGB between 2009 and 2011, with follow-up until 2015 and 2-year presurgery information. Propensity score–matched SG and RYGB groups were created using preoperative demographic characteristics, co-morbidities, and presurgery hospital use, measured by cumulative length of stay (LOS) and frequency of emergency department visits. Postsurgery yearly LOS, incidence of hospital visits, and the reason for the visit were compared. Primary outcomes included postoperative hospital visits during years 1 to 4 after bariatric surgery and cumulative LOS. Secondary outcomes included specific reasons for hospital use.ResultsThere were 3540 SG and 13,587 RYGB patients, whose mean (95% confidence interval [CI]) LOS was 1.3 (1.3–1.4), .9 (.8–1), 1 (.9–1.1), and 1.2 (1–1.3) days at years 1 through 4, respectively. Postoperative yearly LOS was similar between the 2 propensity-matched groups. The risk of hospitalizations (odd ratio .73, 95% CI .64–.84, P < .0001) and emergency department visits (odds ratio .84, 95% CI .75–.95, P = .005) was significantly lower for SG, during the first postoperative year. The reverse was seen at the fourth postoperative year, with higher risk of emergency department use after SG (odds ratio 1.16, 95% CI 1.01–1.33, P = .035).ConclusionPostoperative 4-year hospital utilization remains low for both SG and RYGB. The previously established lower early perioperative risk of SG was not appreciated for longer-term hospital use compared with RYGB.