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This report describes a 19-year-old girl with a chest radiograph strongly suggestive of cardiomegaly. Although she did not consent to haemodynamic studies, cardiomegaly wasru led out on the basis of the clinical course. Careful radiological study proved the existence of a large mass in the anterior mediastinum, simulating cardiomegaly. At thoracotomy a thymolipoma weighing 450 g was resected. The pathogenesis of thymolipoma is discussed. [ABSTRACT FROM PUBLISHER]

Dancers frequently perform jumps in the context of a prolonged, continuous dance piece. The purpose of this study is to explore the lower-extremity energetics in healthy dancers performing repetitive dance jumps (sautés) before and after typical dance-specific choreography. Lower-extremity kinetic data were collected from 14 healthy female dancers during a series of sautés performed before and after 3 minutes of dance. Percent contributions of the lower-extremity joints to the whole-limb mechanical energy expenditure during ground contact were calculated. The jumps performed at the beginning were compared with the jumps at the end of the dance choreography. Dancers maintained the jump rate and consistent whole-limb mechanical energy expenditure between the jump series. As expected, for both jump series, the sautés had greater relative energetic contribution from the ankle and knee as compared with lesser contribution from the hip and toe. However, we observed lesser contribution from the knee and greater contribution from the hip after a 3-minute dance. After performing typical dance choreography, the dancers demonstrated a distal to proximal redistribution of individual joints' contribution to whole-limb mechanical energy expenditure.

Introduction: Individuals with Down syndrome (DS) often exhibit a severe speech impairment, with important consequences on language intelligibility. For these cases, the use of Augmentative Alternative Communication instruments, that increase an individual's communication abilities, becomes crucial. Talkitt is a mobile application created by Voiceitt Company, exploiting speech recognition technology and artificial intelligence models to translate in real-time unintelligible sounds into clear words, allowing individuals with language production impairment to verbally communicate in real-time., Methods: The study evaluated the usability and satisfaction related to the Talkitt application use, as well as effects on adapted behavior and communication, of participants with DS. A final number of 23 individuals with DS, aged 5.54 to 28.9 years, participated in this study and completed 6 months of training. The application was trained to consistently recognize at least 20 different unintelligible words (e.g., nouns and/or short phrases)/person., Results: Results revealed good usability and high levels of satisfaction related to the application use. Moreover, we registered improvement in linguistic abilities, particularly naming., Discussion: These results paves the road for a potential role of Talkitt application as a supportive and rehabilitative tool for DS., Competing Interests: DW and SS have a commercial and financial interest in the Talkitt application, since they are, respectively, CoFounder and CEO and Director of Business Development of Voiceitt. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Costanzo, Fucà, Caciolo, Ruà, Smolley, Weissberg and Vicari.)

Purpose: Morphological differences between the two primary great toe flexors - flexor hallucis longus (FHL) and flexor hallucis brevis (FHB) - likely drive differences in how these muscles contribute to functional toe flexor torque production. The aim of the study was to investigate FHL and FHB activation in two isometric toe flexion tasks - one called a "toe-pushing" task with the metatarsophalangeal (MTP) joints dorsiflexed and the interphalangeal (IP) joints in neutral and another called a "toe-gripping" task with the MTP joints in neutral and flexed IP joints., Methods: Twenty participants' FHL and FHB muscles were instrumented with intramuscular electromyography electrodes. Muscle activation was normalized to a maximum voluntary contraction and compared between the two isometric toe flexor force production tasks., Results: Overall, participants utilized these two toe flexors completely differently in the two tasks. In the toe-gripping task, the FHL was activated to a much greater extent than the FHB. In fact, 18 our of 20 participants activated FHL at more than 70% maximum voluntary contraction and half of participants activated FHB at less than 10%. In contrast, muscle activation during the toe-pushing task appeared more reliant on the FHB for most participants., Conclusions: Different contributions from the FHL and FHB to toe flexor force production in these two tasks are potentially driven by differences in muscle functional length among other factors. These findings help to inform the selection of rehabilitation and training exercises meant to preferentially target intrinsic or extrinsic foot musculature.

Background: Super-spreaders are individuals infecting disproportionately large numbers of contacts. They probably play a crucial role in the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We describe a super-spreading event within a team working in an open-space office and investigate factors potentially having facilitated SARS-CoV-2 transmission., Methods: In this retrospective cohort study, semi-structured telephone interviews with all team members were carried out to identify symptoms, contacts, and adherence to basic hygiene measures. During site visits, we gathered information about workplace and seating arrangements. The secondary attack rate in office and households was calculated. Potential respiratory viral co-infections were assessed by multiplex PCR. SARS-CoV-2 whole-genome sequencing was performed using a tiled-amplicon sequencing approach., Results: Of 13 team members, 11 fell ill with Coronavirus disease 2019 (COVID-19). Due to the sequence of events and full genome sequence data, one person was considered the index case for this outbreak, directly infecting 67 to 83% of the teammates. All team members reported repetitive close contacts among themselves during joint computer work, team meetings and a "Happy Birthday" serenade. Two individuals shared nuts and dates. The arrangement of the office and meeting rooms precluded sufficient adherence to physical distancing. The index case and a further individual were diagnosed with an adenovirus serotype 4 co-infection., Conclusion: We identified several environmental and behavioral factors that probably have facilitated the transmission of SARS-CoV-2. The relevance of the adenovirus co-infection remains unclear and merits further investigation.

Achilles tendinopathy is a well-known pathology that can display interindividual variations in chronicity, symptom presentation, and tendon morphology. Furthermore, symptoms may fluctuate within an individual throughout the stages of the pathology. Although pain is often used as a marker of condition severity, individuals may not consistently report pain due to periods of remission. Persons with tendinosis, which is characterized by advanced morphological alterations, have shown consistent changes in neuromechanics that indicate adaptations in the sensory-motor and the central nervous systems. The current treatment strategy involves repetitive resistance exercise aiming to achieve recovery of lost function. This treatment approach, however, has gauged such functional recovery through symptom relief and return to sport, which, in our opinion, may not suffice and may not prevent symptom recurrence or tendon rupture. In this physiologically informed perspective, we briefly review what is currently known about the consequences of Achilles tendon degeneration and examine the topic of reversing these changes. Shortcomings of contemporary treatment strategies are discussed and we therefore call for a new paradigm to focus on the whole-body level, targeting not only the tendon but also the reversal of the neuromotor control system adaptations., (Copyright © 2020 Kulig, Chang and Ortiz-Weissberg.)

Background: HIV drug resistance and suboptimal adherence are the main reasons for treatment failure among HIV-infected individuals. As genotypic resistance testing is not routinely available in resource-limited settings such as Uganda, data on transmitted and acquired resistance are sparse., Methods: This observational follow-up study assessed the virological outcomes of patients diagnosed with virological failure or transmitted HIV drug resistance in 2015 at the adults' outpatient clinic of the Infectious Diseases Institute in Kampala, Uganda. Initially, 2430 patients on antiretroviral therapy (ART) underwent virological monitoring, of which 190 had virological failure and were subsequently eligible for this follow-up study. Nine patients diagnosed with transmitted drug resistance were eligible. In patients with a viral load > 1000 copies/mL, genotypic resistance testing was performed., Results: Of 190 eligible patients, 30 (15.8%) had either died or were lost to follow-up. A total of 148 (77.9%) were included, of which 98 had had a change of ART regimen, and 50 had received adherence counseling only. The majority was now on second-line ART (N = 130, 87.8%). The median age was 39 years (interquartile range: 32-46), and 109 (73.6%) were women. Virological failure was diagnosed in 29 (19.6%) patients, of which 24 (82.8%) were on second-line ART. Relevant drug resistance was found in 25 (86.2%) cases, of which 12 (41.3%) carried dual and 7 (24.1%) triple drug resistance., Conclusion: Two years after initial virological failure, most patients followed up by this study had a successful virological outcome. However, a significant proportion either continued to fail or died or was lost to follow-up.

Background: Despite increased antiretroviral therapy (ART) coverage and the raised CD4 threshold for starting ART, opportunistic infections (OIs) are still one of the leading causes of death in sub-Saharan Africa. There are few studies from resource-limited settings on long-term reporting of OIs other than tuberculosis., Methods: Patients starting ART between April 2004 and April 2005 were enrolled and followed-up for 10 years in Kampala, Uganda. We report incidences, patterns and risk factors using Cox proportional hazards models of OIs among all patients and among patients with CD4 cell counts >200 cells/μL., Results: Of the 559 patients starting ART, 164 patients developed a total of 241 OIs during 10 years of follow-up. The overall incidence was highest for oral candidiasis (25.4, 95% confidence interval (CI): 20.5-31.6 per 1000 person-years of follow-up), followed by tuberculosis (15.3, 95% CI: 11.7-20.1), herpes zoster (12.3, 95% CI: 9.1-16.6) and cryptococcal meningitis (3.0, 95% CI: 1.7-5.5). Incidence rates for all OIs were highest in the first year after ART initiation and decreased with the increase of the current CD4 cell count. Factors independently associated with development of OIs were baseline nevirapine-based regimens, time-varying higher viral load, time-varying lower CD4 cell count and time-varying lower hemoglobin. In patients developing OIs at a current CD4 cell count >200 cells/μL, factors independently associated with OI development were time-varying increase in viral load and time-varying decrease in hemoglobin, whereas a baseline CD4 cell count <50 cells/μL was protective., Conclusion: We report high early incidences of OIs, decreasing with increasing CD4 cell count and time spent on ART. Ongoing HIV replication and anemia were strong predictors for OI development independent of the CD4 cell count. Our findings support the recommendation for early initiation of ART and suggest close monitoring for OIs among patients recently started on ART, with low CD4 cell count, high viral load and anemia., Competing Interests: The authors have declared that no competing interests exist.

Background: In contrast to other locations, foreign bodies in pleura and chest wall have been rarely reported and there is no consensus with regard to treatment., Methods: Between 1971 and 2001, 22 patients with foreign bodies in pleura or chest wall were admitted to our department. Their charts were reviewed for preoperative diagnosis, history, kind and location of the foreign bodies, length of retention, management of patients, and complications., Results: Three etiologic groups were identified: iatrogenic (11 patients), traumatic-intentional (10), and accidental (1). Foreign bodies were extracted in 21 patients: at thoracotomy in 6, direct pleuroscopy in 6, video-thoracoscopy in 4, and simple incision in 5. One foreign body was left behind because of objection of parents. There were no complications and no deaths. Follow-up lasted from one year to 7 years in 15 patients (68.2%). Seven patients did not show for follow-up., Conclusions: Foreign bodies should be removed from pleura and chest wall, when possible. Small, blunt, peripherally located foreign bodies may be left behind if difficulties at extraction are anticipated. Thoracotomy may be needed for treatment of associated injuries, and for removal of materials used in plombage, because of adhesions. In others the use of videothoracoscopy is preferable. Physicians performing diagnostic and therapeutic procedures in anatomic proximity of pleura should exert utmost care to avoid iatrogenic introduction of a foreign body.

Background: One third of foreign bodies retained in the gastrointestinal tract are present in the esophagus. Their management depends on the anatomic location, shape and size of the foreign body, and duration of impaction., Methods: Between 1971 and 2001, 32 patients with foreign bodies in the esophagus were admitted to our service in the Wolfson Medical Center. Their charts were reviewed for preoperative diagnosis, kind and location of foreign body, length of retention, management of patients, complications, and length of hospitalization., Results: One patient was admitted with perforation of the esophagus. Thirty of the foreign bodies have been extracted at rigid esophagoscopy and two at thoracotomy. There was one complication (tear of esophageal mucosa) and one death., Conclusions: The presence of a foreign body in the esophagus is a challenging problem. Perforations may result in death. Impaction mandates immediate extraction. Our experience indicates that the use of a rigid esophagoscope is safe and reliable. Based on this experience and that of other authors, we recommend the use of the rigid endoscope as the instrument of choice for extracting foreign bodies from the esophagus. Surgeons in training should be taught rigid esophagoscopy.