Impact of COVID-19 on TB epidemiology in South Korea

SETTING: Five referral hospitals, South Korea.OBJECTIVE: To assess epidemiological changes in TB before and during the COVID-19 pandemic.DESIGN: This was a multicentre cohort study of 3,969 patients diagnosed with TB.RESULTS: We analysed 3,453 patients diagnosed with TB prior to the COVID-19 pandemic (January 2016-February 2020) and 516 during the pandemic (March-November 2020). During the pandemic, the number of patients visits declined by 15% from the previous 4-year average, and the number of patients diagnosed with TB decreased by 17%. Patients diagnosed during the pandemic were older than those diagnosed before the pandemic (mean age, 60.2 vs. 56.6 years, P < 0.001). The proportion of patients to have primary TB at a younger age (births after 1980) among those diagnosed with TB was significantly lower during the pandemic than before (17.8% in 2020 vs. 23.5% in 2016, 24.0% in 2017, 22.5% in 2018, 23.5% in 2019; P = 0.005).CONCLUSIONS: The COVID-19 pandemic resulted in a reduction in the number of visits to respiratory departments, leading to fewer patients being diagnosed with TB. However, our results suggest that universal personal preventive measures help to suppress TB transmission in regions with intermediate TB burden.

Associations of particulate matter with atopic dermatitis and chronic inflammatory skin diseases in South Korea

BACKGROUND

Particulate matter (PM) is a mixture of solid and liquid particles suspended in air, which originates from industrial plants or vehicle emissions. Although the skin is the primary body area of contact with air pollutants, the associations between PM and chronic inflammatory skin diseases has not been well established.

AIM

To investigate associations between PM and atopic dermatitis (AD) and between PM and other chronic inflammatory dermatoses, using data from the Korean Health Insurance Review and Assessment Service.

METHODS

Monthly disease statistics from the seven largest cities in South Korea (Seoul, Busan, Daegu, Incheon, Gwangju, Daejeon, Ulsan) and from Jeju Island (in total, a population of 23 288 000 for all eight areas) were included. Based on daily air pollution level and weather forecast from 2015 to 2019, multivariate negative binomial regression analysis was conducted to estimate monthly visits of AD with respect to outdoor air pollutants: coarse PM with a diameter of ≤ 10 μm (PM10) and fine PM with a diameter of ≤ 2.5 μm (PM2.5) ozone (O₃ ), nitrogen dioxide (NO₂ ), sulphur dioxide (SO₂ ) and carbon monoxide (CO).

RESULTS

Increases in the levels of PM2.5, PM10, SO₂ and CO were associated with significant increases in monthly patient visits for AD. Every 10 μg/m³ increase in PM2.5 and PM10 resulted in patient visit increases of 2.71% (95% CI 0.76-4.71; P < 0.01) and 2.01% (95% CI 0.92-3.11, P < 0.001), respectively, while every 1 part per billion (ppb) increase in SO₂ and every 100 ppb increase in CO resulted in visit increases of 2.26% (95% CI 1.35-3.17; P < 0.001) and 2.86% (95% CI 1.35-4.40; P < 0.001), respectively. O₃ and NO₂ were not associated with increased patient visits for AD. Increases in PM2.5 and PM10 concentrations were also significantly associated with increases in patient visits for psoriasis, seborrhoeic dermatitis and rosacea.

CONCLUSION

Our data suggest that PM is associated with AD and other chronic inflammatory skin diseases.

Fusion and subsidence rates of vertebral body sliding osteotomy: Comparison of 3 reconstructive techniques for multilevel cervical myelopathy

BACKGROUND CONTEXT

Vertebral body sliding osteotomy (VBSO) was previously reported as a technique to decompress spinal canal by translating the vertebral body anteriorly and is indicated for cervical myelopathy caused by spondylosis or ossification of the posterior longitudinal ligament. However, little is known about its fusion and subsidence rates.

PURPOSE

To compare the fusion and subsidence rates of VBSO, anterior cervical discectomy and fusion (ACDF), and anterior cervical corpectomy and fusion (ACCF).

STUDY DESIGN/SETTING

Retrospective cohort study PATIENT SAMPLE: One hundred sixty-eight patients who underwent VBSO, ACDF, or ACCF for the treatment of cervical myelopathy and were followed-up for more than 2 years were retrospectively reviewed.

OUTCOME MEASURES

Fusion and subsidence rates, visual analog scale (VAS) scores for neck pain, neck disability index (NDI), and Japanese Orthopaedic Association (JOA) scores were assessed.

METHODS

Results of the VBSO, ACDF, and ACCF groups were compared using Student's t-test and chi-square test.

RESULTS

The fusion rate at 1-year postoperatively and the final follow-up for VBSO was 92.9% (37/42). VBSO demonstrated a higher 1-year fusion rate than ACDF (77.9% [74/95], p=0.04) and ACCF (74.2% [23/31], p=0.04). However, the fusion rate at the final follow-up did not demonstrate significant difference. The mean amount of subsidence (ACDF group, 1.5±1.2 mm; VBSO group, 1.5±1.5 mm; p=1.00) and rate of significant subsidence of > 3 mm (ACDF group, 13.7% [13/95]; VBSO group, 14.3% [6/42]; p=1.00) were similar for ACDF and VBSO. Furthermore, the mean amount of subsidence in VBSO was significantly less than that in ACCF (1.5±1.5 mm vs 2.4±2.0 mm; p=0.04). Neck pain VAS, NDI, and JOA scores were not significantly different among the groups.

CONCLUSIONS

VBSO demonstrated faster solid union than ACDF and ACCF, although the fusion rates at the final follow-up were similar. VBSO resulted in less subsidence than ACCF at the 1-year follow-up. VBSO could be applied safely when the shape and/or location of the pathologic foci and sagittal alignment favor its application without much concern for pseudarthrosis or subsidence.

Active Microelectronic Neurosensor Arrays for Implantable Brain Communication Interfaces

We have built a wireless implantable microelectronic device for transmitting cortical signals transcutaneously. The device is aimed at interfacing a microelectrode array cortical to an external computer for neural control applications. Our implantable microsystem enables presently 16-channel broadband neural recording in a nonhuman primate brain by converting these signals to a digital stream of infrared light pulses for transmission through the skin. The implantable unit employs a flexible polymer substrate onto which we have integrated ultra-low power amplification with analog multiplexing, an analog-to-digital converter, a low power digital controller chip, and infrared telemetry. The scalable 16-channel microsystem can employ any of several modalities of power supply, including via radio frequency by induction, or infrared light via a photovoltaic converter. As of today, the implant has been tested as a sub-chronic unit in non-human primates (~ 1 month), yielding robust spike and broadband neural data on all available channels.

Is the Combination of Convex Compression for the Proximal Thoracic Curve and Concave Distraction for the Main Thoracic Curve Using Separate-rod Derotation Effective for Correcting Shoulder Balance and Thoracic Kyphosis?

BACKGROUND

Posterior correction of the proximal thoracic curve in patients with adolescent idiopathic scoliosis has been recommended to achieve shoulder balance. However, finding a good surgical method is challenging because of the small pedicle diameters on the concave side of the proximal thoracic curve. If the shoulder height can be corrected using screws on the convex side, this would appear to be a more feasible approach.

QUESTIONS/PURPOSES

In patients with adolescent idiopathic scoliosis, we asked: (1) Is convex compression with separate-rod derotation effective for correcting the proximal thoracic curve, shoulder balance, and thoracic kyphosis? (2) Which vertebrum is most appropriate to serve as the uppermost-instrumented vertebra? (3) Is correction of the proximal thoracic curve related to the postoperative shoulder balance?

METHODS

Between 2015 and 2017, we treated 672 patients with scoliosis. Of those, we considered patients with elevated left shoulder, Lenke Type 2 or 4, or King Type V idiopathic scoliosis as potentially eligible. Based on that, 17% (111 of 672) were eligible; 5% (6 of 111) were excluded because of other previous operations and left-side main thoracic curve, 22% (24 of 111) were excluded because they did not undergo surgery for the proximal thoracic curve with only pedicle screws, 21% (23 of 111) were excluded because the proximal thoracic curve was not corrected by convex compression and separate rod derotation, and another 3% (3 of 111) were lost before the minimum study follow-up of 2 years, leaving 50% (55 of 111) for analysis. During the study period, we generally chose T2 as the uppermost level instrumented when the apex was above T4, or T3 when the apex was T5. Apart from the uppermost-instrumented level, the groups did not differ in measurable ways such as age, sex, Cobb angles of proximal and main thoracic curves, and T1 tilt. However, shoulder balance was better in the T3 group preoperatively. The median (range) age at the time of surgery was 15 years (12 to 19 years). The median follow-up duration was 26 months (24 to 52 months). Whole-spine standing posteroanterior and lateral views were used to evaluate the improvement of radiologic parameters at the most recent follow-up and to compare the radiologic parameters between the uppermost-instrumented T2 (37 patients) and T3 (18 patients) vertebra groups. Finally, we analyzed radiologic factors related to shoulder balance, defined as the difference between the horizontal lines passing both superolateral tips of the clavicles (right-shoulder-up was positive), at the most recent follow-up.

RESULTS

Convex compression with separate-rod derotation effectively corrected the proximal thoracic curve (41° ± 11° versus 17° ± 10°, mean difference 25° [95% CI 22° to 27°]; p < 0.001), and the most recent shoulder balance changed to right-shoulder-down compared with preoperative right-shoulder-up (8 ± 11 mm versus -8 ± 10 mm, mean difference 16 mm [95% CI 12 to 19]; p < 0.001). Proximal thoracic kyphosis decreased (13° ± 7° versus 11° ± 6°, mean difference 2° [95% CI 0° to 3°]; p = 0.02), while mid-thoracic kyphosis increased (12° ± 8° versus 18° ± 6°, mean difference -7° [95% CI -9° to -4°]; p < 0.001). Preoperative radiographic parameters did not differ between the groups, except for shoulder balance, which tended to be more right-shoulder-up in the T2 group (11 ± 10 mm versus 1 ± 11 mm, mean difference 10 mm [95% CI 4 to 16]; p = 0.002). At the most recent follow-up, the correction proportion of the proximal thoracic curve was better in the T2 group than the T3 group (67% ± 10% versus 49% ± 22%, mean difference 19% [95% CI 8% to 30%]; p < 0.001). In the T2 group, T1 tilt (6° ± 4° versus 6° ± 4°, mean difference 1° [95% CI 0° to 2°]; p = 0.045) and shoulder balance (-14 ± 11 mm versus -7 ± 9 mm, mean difference -7 mm [95% CI -11 to -3]; p = 0.002) at the most recent follow-up improved compared with those at the first erect radiograph. The most recent shoulder balance was correlated with the correction proportion of the proximal thoracic curve (r = 0.29 [95% CI 0.02 to 0.34]; p = 0.03) and change in T1 tilt (r = 0.35 [95% CI 0.20 to 1.31]; p = 0.009).

CONCLUSION

Using the combination of convex compression and concave distraction with separate-rod derotation is an effective method to correct proximal and main thoracic curves, with reliable achievement of postoperative thoracic kyphosis and shoulder balance. T2 was a more appropriate uppermost-instrumented vertebra than T3, providing better correction of the proximal thoracic curve and T1 tilt. Additionally, spontaneous improvement in T1 tilt and shoulder balance is expected with upper-instrumented T2 vertebrae. Preoperatively, surgeons should evaluate shoulder balance because right-shoulder-down can occur after surgery in patients with a proximal thoracic curve.

LEVEL OF EVIDENCE

Level III, therapeutic study.

Cervical spine lateral radiograph versus whole spine lateral radiograph: A retrospective comparative study to identify a better modality to assess cervical sagittal alignment

This study is aimed to compare whole-spine lateral radiograph (WLR) and cervical lateral radiograph (CLR) in terms of T1 slope visibility and cervical sagittal parameters and to identify the superior imaging modality for assessment of cervical sagittal parameters. We retrospectively reviewed the radiographic data of 60 consecutive adult patients (male-to-female ratio, 38:22; mean age, 55.6 ± 1.3 years) who presented with only neck pain (without radiculopathy or myelopathy). All the patients underwent standing CLR and WLR. The following parameters were measured and analyzed: 1. T1 slope visibility, 2. T1 slope, 3. C7 slope, 4. C0–C2 Cobb angle (CAC0–C2), 5. C2–C7 Cobb angle (CAC2–C7), and 6. cervical sagittal vertical axis (cSVA). The visibility of the T1 slope was significantly lower with WLR than with CLR (28.3% vs 83.3%, P  = .049). The mean CAC2–C7 on WLR was significantly less lordotic than that on CLR (11.2 ± 9.2° vs 14.3 ± 11.3°; P = .01). The mean cSVA was translated more posteriorly on WLR than on CLR (9.9 ± 18.9 mm vs 15.0 ± 13.4 mm, P = .04). However, no significant differences in T1 slope, C7 slope, and CAC0–C2 were found between CLR and WLR. This study shows that standing CLR could provide better visualization of the upper endplate of T1. Furthermore, WLR taken in hands on clavicle position distorted radiographic measurements such as CAC2-C7 and cSVA. Therefore, CLR performed in the standing position seems to allow more-accurate measurements of cervical sagittal parameters.

Highly efficient ultra-low blaze angle multilayer grating

We have developed an advanced process for blaze angle reduction of x-ray gratings for the soft, tender, and EUV spectral ranges. The process is based on planarization of an anisotropically etched Si blazed grating followed by a chemically selective plasma etch. This provides a way to adjust the blaze angle to any lower value with high accuracy. Here we demonstrate the reduction of the blaze angle to an extremely low value of 0.04°±0.004°. For a 100 lines/mm grating with a Mo/Si multilayer coating, the grating exhibits diffraction efficiency of 58% in the 1^st diffraction order at a wavelength of 13.3 nm. This technique will be applicable to a wide range of uses of high efficiency gratings for synchrotron sources, as well as for Free Electron Lasers (FEL).

Accurate Determination of the Neutron Skin Thickness of ^{208}Pb through Parity-Violation in Electron Scattering

We report a precision measurement of the parity-violating asymmetry A_{PV} in the elastic scattering of longitudinally polarized electrons from ^{208}Pb. We measure A_{PV}=550±16(stat)±8(syst) parts per billion, leading to an extraction of the neutral weak form factor F_{W}(Q^{2}=0.00616  GeV^{2})=0.368±0.013. Combined with our previous measurement, the extracted neutron skin thickness is R_{n}-R_{p}=0.283±0.071  fm. The result also yields the first significant direct measurement of the interior weak density of ^{208}Pb: ρ_{W}^{0}=-0.0796±0.0036(exp)±0.0013(theo)  fm^{-3} leading to the interior baryon density ρ_{b}^{0}=0.1480±0.0036(exp)±0.0013(theo)  fm^{-3}. The measurement accurately constrains the density dependence of the symmetry energy of nuclear matter near saturation density, with implications for the size and composition of neutron stars.

Treatment outcomes in multidrug-resistant tuberculosis according to pyrazinamide susceptibility

BACKGROUND: Pyrazinamide (PZA) is an important anti-tuberculosis drug for multidrug-resistant tuberculosis (MDR-TB). However, PZA has recently been demoted within the hierarchy of TB drugs used for MDR-TB.METHODS: We conducted a retrospective cohort study to investigate treatment outcomes for simple MDR-TB (susceptible to both second-line injectable drugs and fluoroquinolones) according to PZA susceptibility.RESULTS: Among 216 pulmonary MDR-TB patients included in the study, 68 (31.5%) were PZA-resistant (PZA-R). The mean age was 41.8 years, and 63.4% were male. Baseline characteristics such as comorbidity, previous TB history, acid-fast bacilli (AFB) smear positivity and cavitation were similar in PZA-susceptible (PZA-S) and PZA-R patients. The number of potentially effective drugs was slightly higher among PZA-S patients than among the PZA-R (5.1 vs. 4.8, respectively; P = 0.003). PZA was more frequently used in PZA-S patients (73.0%) than in the PZA-R (14.7%), while para-aminosalicylic acid was more frequently used in PZA-R than in PZA-S patients (76.5% vs. 50.7%). The treatment success rate was similar in PZA-S (77.7%) and PZA-R (75.0%) patients. PZA resistance was not associated with treatment success in multivariate analysis.CONCLUSIONS: PZA-resistant simple MDR-TB patients had the same treatment success rate as the PZA-susceptible group even without using novel anti-TB drugs.