Basic Investigation of the Effect of Insole Shape on Leg Skeletal Muscle Mass and Pressure Changes during Walking

The COVID-19 pandemic has an impact on people's ability to exercise and walk. Decreased ex-ercise habit leads to decreased muscle mass, which may hamper social activities. The decline in exercise habit is a particular challenge among older people, as it may lead to frailty. In this paper, we report that creating arches at the cuboid boneand adductor muscles activates toe movement. We examined whether the arches could be built into shoe insole to correct left-right differences in leg skeletal muscle mass. A prototype insole with arches created at the cuboid boneand transverse head of adductor hallucis musclewas designed, and a prospec-tive cohort study was conducted to examine its effects. Plantar pressure during walking was recorded in 10 sub-jects, and a 3-month intervention study was conducted in 40 subjects. The results showed an increase in toe pressure from before to after wearing the prototype insoles. In addition, leg skeletal muscle mass increased in the group wearing the prototype insole, and a significant difference compared to the control group was detect-ed by Wilcoxon signed-rank test. The results from this study demonstrate that the prototype insole promotes toe movement and increases leg skeletal muscle mass.

Percutaneous Thrombectomy Using Angiovac System as a Diagnostic and Therapeutic Tool in Managing Right Atrial Mass in a High-Risk Patient

Background Right atrial (RA) masses often pose a dilemma in accurate diagnosis and management. We describe a challenging case of a large mobile RA mass in a febrile cancer patient. Case A 36-year-old female with newly diagnosed breast cancer on chemotherapy for 4 months via Port-A-Cath presented initially with COVID-19 pneumonia but continued to have persistent fever and dyspnea. A CT of the chest ruled out pulmonary embolism but showed an incidental RA mass. Echocardiography confirmed a large (2.7 x 1.6 cm), pedunculated mobile mass in the RA, attached to the free wall near the Eustachian valve (Fig.1). For a suspected thrombus, anticoagulation was initiated and a percutaneous thrombectomy using AngioVac was attempted. The mass was tightly attached to the atrial wall and too large to suction, resulting in only partial extraction of multiple tumor-like masses. Decision-making In addition to catheter-related thrombus and COVID-19 infection-related thrombus in transit, possibilities of myxoma, metastasis and fungal vegetation were considered due to its atypical features. A week later, pathology confirmed the diagnosis of an organized thrombus. Surgery was deferred and instead a repeat AngioVac using a larger aspiration catheter successfully aspirated the entire RA mass without complications. Conclusion Percutaneous aspiration of RA masses can prove to be of both diagnostic and therapeutic use, especially in high-risk patients. It can help avoid invasive surgical intervention in clinical dilemmas. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

Real-world treatment patterns in patients with Sézary syndrome in the United States and the impact of Covid-19

Background: Sézary syndrome (SS) is an aggressive type of cutaneous T-cell lymphomas (CTCL). Due to its low prevalence, there are limited data on real-world treatment patterns of currently available SS therapies. Furthermore, recent approvals of new agents for patients with CTCL as well as COVID-19 likely impacted real-world treatment patterns. Objective: To examine real-world treatment patterns and the impact of COVID-19 among SS patients treated in 2018-2020 in the US. Methods: Patients with public or private insurance in the 2018-2020 Symphony Health Solutions database were classified into 3 groups: ≥1 diagnosis of SS (ICD-10-CM code: C84.1x) in 2018, 2019, and 2020, respectively. Patient characteristics and treatment patterns for all therapies recommended by the National Comprehensive Cancer Network guidelines version 2.2021 were examined: systemic therapy (e.g., extracorporeal photopheresis (ECP), parenteral, or oral agents), skin-directed therapy (SDT, e.g., topical, local radiation, total skin electron beam therapy, or phototherapy) and bone marrow transplant. The impact of COVID-19 was assessed via quarterly analysis. National drug codes, current procedural terminology and healthcare common procedure coding system codes were used to identify all treatments. Results: The analyses included 869, 882, and 853 SS patients in 2018, 2019, and 2020, respectively (mean age: 66.3, 66.9 and 67.3 years;male: 54.4%, 54.8%, and 55.6%). Overall, systemic therapy increased from 2018 to 2020 (41.8% to 46.5%), with increased parenteral (20.7% to 28.7%) but decreased ECP (17.0% to 13.5%) usage. SDT increased from 2018 to 2020 (48.9% to 52.9%), with increased topical (42.3% to 48.3%) but decreased phototherapy (6.3% to 4.1%) usage. ECP, mogamulizumab, and bexarotene were the most prescribed systemic therapies in 2019-2020, with mogamulizumab being the only one with increased usage over time. Quarterly analysis showed a decreasing ECP from Q1 to Q4 within each year, with a notable drop in Q2 2020. For parental systemics, there was an increasing trend in 2019 and 2020, but utilization in Q4 2020 was lower than that of Q3 2020. For oral systemic, there was a notable drop in Q2 2020 but an increased trend in Q3-Q4 2020. Conclusions: This claims analysis indicated increased use in systemic and SDT among SS patients in 2018-2020. The quarterly analysis indicated that the drop in ECP and oral systemic usage in Q2 2020 coincided with the onset of the pandemic, but there was a stable use of parenteral systemic during 2020.

Real-world use of mogamulizumab among patients with mycosis fungoides and Sézary syndrome before and during COVID-19 in the United States

Background: Per label, mogamulizumab (Moga) is administered on days 1, 8, 15, and 22 of the first 28-day cycle (loading) and on days 1 and 15 of each subsequent cycle (maintenance) for adult patients with relapsed or refractory mycosis fungoides (MF) or Sézary syndrome (SS) after ≥1 prior systemic therapy. During the COVID-19 pandemic, professional organizations suggested dosing intervals for systemic cancer therapies be extended to limit in-person visits. This study examined the real-world use of Moga before and during the COVID-19 pandemic in the United States. Methods: Using the Symphony Health Solutions database, adults with ≥1 diagnosis (dx) of MF or SS (ICD-10 CM: C84.0x or C84.1x) and ≥1 Moga claim during 10/1/2018-5/6/2021 were identified. Within the MF (no SS dx) and SS (any SS dx) cohorts, patients were divided into 2 subgroups based on their Moga initiation date: 10/1/2018-3/31/2020 (pre COVID-19) and 4/1/2020-5/6/2021 (COVID-19). Patient characteristics and dosing intervals between Moga doses 1-4 (loading) and between subsequent doses (maintenance) were examined. Results: Overall, 154 MF and 204 SS patients initiated Moga during the study period (mean age: 66.8 and 69.2 years;male: 64% and 55%, respectively). In the MF cohort, 98 and 56 patients were in the “pre COVID-19” and “COVID-19” subgroups. The mean dosing interval was shorter among patients in the “COVID-19” subgroup for both the loading (9.1 vs. 13.2 days) and maintenance doses (15.2 vs. 16.1 days) (Table). In the SS cohort, 121 and 83 patients were in the “pre COVID-19” and “COVID-19” subgroups. Mean loading (9.0 vs. 11.1 days) and maintenance (15.0 vs. 16.8 days) dosing intervals were shorter for patients included in the “COVID-19” subgroup. Conclusions: Among MF and SS patients, dosing intervals for Moga in loading and maintenance were not extended during the 1st year of the COVID-19 compared to pre COVID-19. There was a trend towards closer concordance with the label during COVID-19.

Design of a n+1 feeder aircraft for regional cargo airlines

This paper study suggests the specifications for high-efficiency, short-haul utility aircraft. This class of aircraft is used extensively in the multinational express package delivery service. Concurrent with the COVID 19 pandemic upending passenger travel, there has been a broad increase in the demand for air cargo. We forecast a need for more efficient short and medium range aircraft that offer route time savings and lower operating costs. Using current market planes designed with similar mission requirements, payloads, and engines – a general plane was created and optimized around the operating model of the present-day FedEx package delivery feeder fleet. The modification and optimization process was completed using a Model-Based-Systems-Engineering (MBSE) approach utilizing Phoenix Integration’s ModelCenter, Excel, MATLAB, and SOLIDWORKS. The final design achieved 40% improvement in fuel efficiency over the current fleet, and improvements in speed, payload, and range while in compliance with FAA regulations as a class E cargo aircraft certified under 14 CFR Part 25. © 2022, American Institute of Aeronautics and Astronautics Inc, AIAA. All rights reserved.

Real-World Treatment Patterns Among Patients with Mycosis Fungoides and Sézary Syndrome in the United States between 2018 and 2020

Objectives: Mycosis Fungoides (MF) and Sézary syndrome (SS) are the two most common subtypes of cutaneous T cell lymphomas. Given their low prevalence, real-world treatment patterns of existing and newly approved therapies for MF and SS remain unknown, especially during the COVID pandemic. This study examined treatment patterns among patients with MF or SS between 2018-2020 in the United States. Methods: Patients in the Symphony Health Solutions database were classified into 6 groups: ≥1 MF diagnosis (no SS diagnosis) in 2018, 2019, and 2020, and ≥1 SS diagnosis in 2018, 2019, 2020, respectively. Utilization of treatments recommended by the current National Comprehensive Cancer Network guidelines was examined: skin-directed therapy (SDT;topical, local radiation, total skin electron beam therapy, or phototherapy), systemic therapy (extracorporeal photopheresis [ECP], parenteral, or oral), and bone marrow transplant (BMT). Results: Overall(mean age;male), 10,527(62.9 years;54.6%), 10,078(63.2 years;54.3%) and 9,414(63.2 years;53.9%) patients had ≥1 MF diagnosis and 869(66.3 years;54.4%), 882(66.9 years;54.8%) and 853(67.3 years;55.6%) patients had ≥1 SS diagnosis in 2018, 2019 and 2020, respectively. From 2018-2020, 56.1-56.6% of MF (SDT 52.1-52.5%;systemics 12.1-13.5%;BMT 0.1-0.2%) and 64.6-68.8% of SS patients (SDT 48.9-52.9%;systemics 41.8-46.5%;BMT 0.8-1.5%) had ≥1 treatment claims. Among MF patients with any systemic therapies, bexarotene was the most common in 2018 (28.1%) and 2019 (27.5%), methotrexate in 2020 (27.2%), and mogamulizumab (2018 MF/SS approval) the 6th most common in 2019 (6.8%) and 2020 (6.6%). Among SS patients with any systemic therapies, ECP was the most common in 2018 (40.8%) and 2019 (33.3%), and mogamulizumab in 2020 (29.2%). Conclusions: Using claims from 2018-2020, approximately half of MF and SS patients had SDT each year, without major change during the COVID pandemic. Since 2018 in SS, there was an increasing systemic usage, with increasing mogamulizumab but decreasing ECP usage.

Diet and Lifestyle Guidelines for Immunomodulation with Reference to Corona Virus Pandemic: A Scientific Statement of the International College of Nutrition

The immune system is comprised of lymph glands, lymph nodes, thymus gland, spleen, bone marrow, lymphocytes, and molecules such as antibodies and cytokines. It has a vast array of functionally different cells such as T and B lymphocytes, macrophages, neutrophils and mast cells. The ontogenesis of the immune system is comprised of the innate immune cells and the adaptive immune cells, where innate immune cells are the first defense mechanisms to respond to pathogenic environmental factors. There are multiple components of the adaptive immune cells, including immunoglobulins (Igs), T-cell receptors (TCR), and major histocompatibility complex (MHC) responsible for adaptive immunity. However, many elements of both the innate and adaptive immune systems are conserved in our bodies. The adaptive immunity is a type of immunity that develops when a person’s immune cells respond to a pathogen such as microorganism or vaccination. Environmental factors such as pathogenic bacteria or viruses, solar exposure, age, exercise, stress, diet, sleep quality and air pollutants can influence the immune system. There may be marked decline in the immune function due to attack of COVID-19. Most patients with mild COVID-19 develop an appropriate immune response that culminates with viral clearance. However, severe disease manifestations have been linked to lymphopenia and immune hyper-responsiveness leading to cytokine storm. It has been observed that in COVID-19, alveolar macrophages are epigenetically altered after inflammation, leading to long-term lung immune-paralysis. Western diets are known to have adverse effects on the immune function. However, Mediterranean-type diets rich in short-and long-chain polyunsaturated fatty acids (PUFA), vegetables, nuts and fruits, dairy products and fish and red wine, due to high content of vitamins, minerals and flavonoids may be useful in boosting immunity. Moderate physical activity may also cause an extensive increase in numerous and varied lipid super-pathway metabolites, including oxidized derivatives called oxylipins. Emerging evidence suggests that dietary supplements containing flavonoids, carotenoids, coenzyme Q10 (CoQ10), vitamins, minerals and antioxidants modulate gene and protein expression and thereby modify endogenous metabolic pathways, and consequently enhance the immunity. Mediterranean-type diet and multiple bioactive nutrients, fatty acids, amino acids, vitamins and minerals as well as moderate physical activity may be crucial for enhancing immunomodulation.

GAS LEAKS FROM BIOPSY VALVES OF GASTROINTESTINAL ENDOSCOPY-ITS VISUALIZATION AND SEMI=QUANTIFICATION UTILIZING SCHLIEREN OPTICAL SYSTEM

<Background> With the global epidemic of COVID-19, there has been a growing concern about the risk of exposure to the virus among healthcare workers. Gastrointestinal (GI) endoscopy has been considered as one of the high infectious procedures because of the high risk of aerosol exposure. However, that caution is mainly directed at secretions and aerosols from the patient's mouth, and less attention is currently paid to air leaks from the endoscopic system itself. Although a few reports have been published on air leaks from GI endoscopic systems, no systematic and quantitative studies of air leaks have been conducted. Schlieren system is an optical device for visualizing minute changes in airflow that are invisible to the naked eye, by using differences in the refractive index of the medium, and has been mainly used in the field of engineering. We aimed to systematically evaluate air leaks from GI endoscopic systems using Schlieren system, and to determine the relationship between the amount of leakage and insufflation conditions including the types of biopsy valves. <Methods> The following experiments were performed on explanted swine stomachs while maintaining an intra-gastric pressure at each preset value. We attempted to visualize air leaks using System Schlieren (SS100, Kato Koken, Kanagawa, Japan). In all experiments, biopsy forceps were inserted and withdrawn 3 cm per 3 seconds. This action was repeated five times in each experiment. Experiment 1: Examined the feasibility of the Schlieren device in visualizing air leaks from biopsy valves. Experiment 2: The intragastric pressure was varied in the range of 4 to 15 mmHg and the air leaks were quantified and compared in each pressure. Experiment 2: Compared the air leaks between the types of biopsy valves, e.g. reusable, disposable, universal, deteriorated reusable valves after more than 10 times of uses. Image J (National Institute of Health, US) was used to measure the initial velocity and area of the leak on obtained images. The average values of initial velocity and leakage area over five sessions were calculated. For the leak area analysis, image analysis was performed for both forceps insertion and withdrawal. <Results> Experiment 1: Air leaks were seen at the moment of forceps insertion and withdrawal (Fig 1). Experiment 2: There was a linear relationship between intragastric pressure and initial velocity/diffusion range of the leak (Fig2A). Experiment 3: Disposable and deteriorated reusable biopsy valves had larger initial velocity/diffusion range of the leak (Fig2B). <Conclusions> We successfully visualized air leaks from GI endoscopic systems using the Schlieren system. We herein recommend the use of lower intragastric pressure at the times of insertion/withdrawal of forceps, and avoidance of using disposable/deteriorated biopsy valves, for less gas leakage and possibly less aerosol exposure.(Figure presented)Figure1. Visualization of air leak from biopsy valve(Figure presented)Figure 2. Results of analysis on air leakage from biopsy valve