Subacute thyroiditis post-Pfizer-BioNTech mRNA vaccination for COVID-19

Summary There is emerging evidence of an association between COVID-19 vaccination and subacute thyroiditis. We present the case of a 42-year-old female healthcare worker who was diagnosed with subacute thyroiditis 4 days after receiving her second dose of Pfizer-BioNTech vaccine. Her clinical course followed the classical pattern for thyroiditis with spontaneous return to euthyroidism at 6 months post-presentation. The autoimmune/inflammatory syndrome induced by adjuvants has been implicated as a cause of autoimmune conditions post-vaccination and is a potential mechanism for subacute thyroiditis in our case. Learning points Subacute thyroiditis should be considered in all patients who receive any kind of vaccine for COVID-19 and subsequently develop symptoms or signs of hyperthyroidism or neck pain. Subacute thyroiditis is a self-limiting condition, and recognising it is important as no specific thyroid treatment (antithyroid drugs or thyroid hormone replacement) is necessary for most patients. The autoimmune/inflammatory syndrome induced by adjuvants may be an under-recognised cause of endocrinopathies and should particularly be considered post-vaccination.

A Novel “回” Pattern Branch Antenna for 3G\4G\WLAN\Bluetooth\Navigation Applications

This study proposes and designs a multiband branch antenna with a structure that imitates the Chinese classical pattern structure. The antenna radiator’s structure is a symmetrical rectangular stub fused with a Chinese classical pattern structure, and the rectangular stub is bent so that the outer and inner stubs are coupled to each other to generate multiple frequency bands. Microstrip line feeding is the feeding mode, and the grounding plate is a trapezoidal structure formed by subtracting two triangles from a rectangle. The overall size of the antenna is 60 × 60 × 1.6 mm3, and the dielectric board adopts FR4. The substrate dielectric constant εr = 4.4, the thickness h = 1.6 mm, and the dielectric loss tangent tanδ = 0.02. For antenna modeling and parameter optimization, HFSS electromagnetic simulation software is used. The antenna can cover 1.49 to 1.60 GHz, 1.87 to 2.51 GHz, and 4.63 to 5.34 GHz and generate three main frequencies: 1.57, 2.15, and 5.06 GHz, according to test result. The antenna has omnidirectional radiation characteristics and can be widely used in future mobile communication network coverage.

An Adaptive Multi-Modal Control Strategy to Attenuate the Limb Position Effect in Myoelectric Pattern Recognition

Over the last few decades, pattern recognition algorithms have shown promising results in the field of upper limb prostheses myoelectric control and are now gradually being incorporated in commercial devices. A widely used approach is based on a classifier which assigns a specific input value to a selected hand motion. While this method guarantees good performance and robustness within each class, it still shows limitations in adapting to different conditions encountered in real-world applications, such as changes in limb position or external loads. This paper proposes an adaptive method based on a pattern recognition classifier that takes advantage of an augmented dataset—i.e., representing variations in limb position or external loads—to selectively adapt to underrepresented variations. The proposed method was evaluated using a series of target achievement control tests with ten able-bodied volunteers. Results indicated a higher median completion rate >3.33% for the adapted algorithm compared to a classical pattern recognition classifier used as a baseline model. Subject-specific performance showed the potential for improved control after adaptation and a ≤13% completion rate; and in many instances, the adapted points were able to provide new information within classes. These preliminary results show the potential of the proposed method and encourage further development.

Anatomical study on variable disposition of structures in the renal hilum

Background: The hilum is a deep vertical fissure present anteromedially in the kidney, and contains renal vessels and pelvis. Due to advancements in imaging techniques; nephron sparing surgeries like laparoscopic partial nephrectomy have become more common. In these procedures, only specific branch of renal artery, and tributary of renal vein are ligated in the renal hilum. This requires adequate skill of the surgeon as the structures are crowded in the renal hilum. The knowledge of arrangement of renal hilar structures is also important for radiologists to correctly interpret renal angiograms and other radiological scans.Methods: The present study was conducted in the department of anatomy, Vardhman Mahavir medical college, New Delhi on 64 kidneys derived from embalmed human cadavers. The renal hilum was dissected and the sequence of structures from anterior to posterior direction was noted.Results: The kidneys were classified in 6 patterns, with the classical pattern (renal vein, artery and pelvis from anterior to posterior) observed in 37.5% cases only. Remaining 62.5% cases exhibited variations, of which the pattern 2 (V-A1-P-A2) was seen in maximum cases (26.5%).Conclusions: The classical pattern described in anatomical textbooks is not the only pattern of arrangement of renal hilar structures. Instead, variant patterns are commonly encountered. The present study attempts to elucidate the variant anatomy of the renal hilar region to help radiologists and surgeons in proper diagnosis and treatment.

402Measles vaccine coverage: The rise of vaccine hesitancy in upper-middle income countries

Background With the rise of vaccine hesitancy, which is allegedly more frequent among rich families, we hypothesized that the classical pattern of a positive gradient in coverage with rising wealth may no longer be observable in low- and middle-income countries (LMICs). Methods We analysed DHS and MICS surveys conducted from 2010-2018 in 88 LMICs. We estimated inequality in measles vaccination coverage by wealth quintile for children aged 12-23 months using the Slope Index of Inequality (SII). Negative SII values indicate higher coverage among poor children. We correlated the SII with per capita Gross Domestic Product (GDP), using countries as the units. Results Pearson’s correlation coefficient between SII and log per capita GDP was -0.35 (p < 0.001). The percentages of countries with higher coverage among children from poor families than among those from wealthy families were 14%, 21% and 54% in low, lower-middle and upper-middle income countries (p level for trend=0.001), respectively (Figure 1). Conclusions Our results are consistent with lower vaccination coverage among the wealthy when compared to poor families in countries with higher per capita GDPs. Key messages Vaccine hesitancy was initially detected in high-income countries, but our analyses show that it is also present in upper-middle income countries.

EWSR1 rearrangement in papillary thyroid microcarcinoma is related to classic morphology and the presence of small-cell phenotype

The EWSR1 rearrangements with unknown genes were detected in a high percentage of classic variants of papillary thyroid carcinoma. The small-cell carcinoma of the thyroid with Ewing family tumor elements (CEFTE) typically presents with EWSR1-FLI1 rearrangement suggesting the possible role of EWSR-FLI1 translocation in the loss of thyroid differentiation and acquisition of a small-cell phenotype. In order to determine the frequency and association of EWSR1 rearrangements, particularly the EWSR1-FLI1 fusion with clinicopathological features of papillary thyroid microcarcinoma (m-PTC) and the presence of small cells, we analyzed a series of 99 m-PTCs using the fluorescence in situ hybridization method. Ninety cases (90.9%) of m-PTC were positive for small cells. This group of m-PTC has shown more often invasive growth, lymphatics invasion, and moderate/extended intratumoral fibrosis. Three cases out of 99 were inconclusive for EWSR1 rearrangement. Eighty-nine (92.7%) and twenty-seven (28.1%) out of 96 m-PTC cases were positive for EWSR1 rearrangement and EWSR1-FLI1 fusion, respectively. m-PTC with classical architectural pattern presented more frequently with EWSR1 rearrangement relative to m-PTC with other patterns (p = 0.005). Other clinicopathological features were not related to the presence of EWSR1 rearrangement or EWSR1-FLI1 fusion. The percentage of small cells present significantly correlated with the percentage of cells positive for EWSR1-FLI1 fusion (p = 0.05) and EWSR1 rearrangement (p <0.001). EWSR1-FLI1 fusion is not rare in m-PTC and it is associated with the acquisition of small-cell phenotype. The EWSR1 gene rearrangement is a frequent event in m-PTC and is related to the classical pattern of m-PTC.

Abdominal intussusception associated with coeliac disease: case report and literature review

In genetically susceptible individuals, gluten ingestion triggers and immune infiltration and bowel damage in the classical pattern of coeliac disease, with variable symptoms. Intussusception is a condition where one segment of intestine ‘telescopes’ inside of another portion of intestine, which may cause symptoms of abdominal pain due to obstruction. Intussusception has been associated with coeliac disease. We report a 4-year-old girl presented with recurrent abdominal pain of variable severity and found to have intussusception on two occasions, which on both occasions reduced spontaneously during ultrasound examinations. She was later diagnosed with coeliac disease. This case highlights the importance of considering coeliac screening in patients with a history of recurrent abdominal pain and intussusception.

Multi-spike solutions of a hybrid reaction–transport model

Simulations of classical pattern-forming reaction–diffusion systems indicate that they often operate in the strongly nonlinear regime, with the final steady state consisting of a spatially repeating pattern of localized spikes. In activator–inhibitor systems such as the two-component Gierer–Meinhardt (GM) model, one can consider the singular limit D a ≪ D h , where D a and D h are the diffusivities of the activator and inhibitor, respectively. Asymptotic analysis can then be used to analyse the existence and linear stability of multi-spike solutions. In this paper, we analyse multi-spike solutions in a hybrid reaction–transport model, consisting of a slowly diffusing activator and an actively transported inhibitor that switches at a rate α between right-moving and left-moving velocity states. Such a model was recently introduced to account for the formation and homeostatic regulation of synaptic puncta during larval development in Caenorhabditis elegans . We exploit the fact that the hybrid model can be mapped onto the classical GM model in the fast switching limit α → ∞, which establishes the existence of multi-spike solutions. Linearization about the multi-spike solution yields a non-local eigenvalue problem that is used to investigate stability of the multi-spike solution by combining analytical results for α → ∞ with a graphical construction for finite α .

Bilateral asymmetric tonic seizure in insulo-opercular epilepsy: an anatomo-electro-clinical study

Background Insulo-opercular seizures are highly heterogeneous in seizure semiology and electrical features. Bilateral asymmetric limb posturing, as a classical pattern of supplementary sensorimotor area (SMA) seizure, also occurs in insulo-opercular epilepsy. This study was aimed to study the anatomo-electro-clinical correlations in bilateral asymmetric tonic seizures (BATS), in order to advance the understanding of insulo-opercular epilepsy. Methods Eight patients with insulo-opercular epilepsy as confirmed by stereoelectroencephalography (SEEG) and manifesting BATS as the major ictal motor sign, in Guangdong Sanjiu Brain Hospital Epilepsy Center from 2014 to 2018, were employed in this study. The BATS of the patients were evaluated, and the semiologic features and concomitant intracerebral EEG changes were quantified. Then the variables were examined with Cluster Analysis, and the semiologic features were correlated with anatomic localization using the Kendall correlation test. Results Of the 8 patients, the most frequent initial motor sign was bilateral asymmetric tonic posturing (62.5%). Facial tonic-clonic sign also had a high prevalence in the evolution of seizures (87.5%). The results of Cluster Analysis showed that the semiologic features were subdivided into two main groups, one group comprising exclusively BATS and the other including signs of focal tonic seizure, aura, focal limb tonic-clonic seizure (TCS), facial TCS, hypermotor behavior, eye movement, autonomic changes and generalized TCS. The BATS was strongly associated with the posterior long gyrus (PLG) of insula (t = 0.732) and parietal operculum (t = 1.000); the hypermotor behaviors were associated with the anterior long gyrus (ALG) (t = 0.770); and the autonomic changes were associated with the anterior limiting sulcus (ALS) (t = 0.734) and middle short gyrus (MSG) (t = 0.700). Conclusions The seizure semiology of insulo-opercular epilepsy is characterized, in temporal order, by BATS, with or without simultaneous hypermotor behaviors, and frequently ends up with facial tonic-clonic signs, which is different from that of the SMA seizure. The early spread network involving the posterior insular lobe and parietal operculum may contribute to this pattern of manifestation.

Role of Human Leukocyte Antigens at the Feto-Maternal Interface in Normal and Pathological Pregnancy: An Update

The successful maternal tolerance of the semi-allogeneic fetus provides an apparent immunologic paradox. Indeed, deep invasion of placental trophoblast cells into maternal uterine tissue and the following growth of the fetus have to be tolerated by a pregnant woman’s immune system. Among the various possible protective mechanisms that may be involved in human pregnancy, the expression of a non-classical pattern of human leukocyte antigen (HLA) class I molecules and the complete lack of expression of HLA class II molecules in placental tissues seem to be the most relevant mechanisms of fetal escape from maternal immune recognition. The importance of HLA molecules in fetal toleration by the maternal immune system is highlighted by pregnancy complications occurring in cases of abnormal HLA molecule expression at the maternal–fetal interface. In this review, we summarize evidences about the role of placental HLA molecules in normal and pathological pregnancies.