Oral Corticosteroids for Teprotumumab-Related Hearing Loss: A Case Report

Teprotumumab is a novel insulin-like growth factor-1 receptor inhibitor approved for the treatment of thyroid eye disease, but growing reports of hearing loss require further investigation. To date, an effective protocol for managing hearing loss in this setting has not been determined. Here, we present the first report of the resolution of teprotumumab-related hearing loss with prompt oral prednisone. A 70-year-old woman on teprotumumab experienced sudden hearing loss and tinnitus after her first infusion. An audiogram demonstrated a mild down-sloping to moderately severe mixed conductive and sensorineural hearing loss that was promptly treated with prednisone 60 mg for 6 days with a 1-week gradual taper. An audiogram 3 weeks later demonstrated return of hearing to normal thresholds, and the whole teprotumumab treatment course was completed without further issue. This case highlights the importance of audiometric monitoring, prompt identification of hearing symptoms, and the potential for oral steroids to reverse teprotumumab-related hearing loss.

Advances in the Treatment of Thyroid Eye Disease Associated Extraocular Muscle Myopathy and Optic Neuropathy

PURPOSE OF REVIEW

To review emerging treatments for thyroid eye disease (TED) associated extraocular muscle myopathy and dysthyroid optic neuropathy (DON).

RECENT FINDINGS

Emerging targeted biologic therapies may alter the disease course in TED. Teprotumumab, a type I insulin-like growth factor receptor inhibitor, is the most recent addition to the treatments available for TED-associated extraocular muscle myopathy causing diplopia. Small studies also suggest a potential therapeutic benefit for DON. Various recent studies have also expanded our knowledge on conventional TED therapies. The therapeutic landscape of TED and its sequelae has evolved in recent years. New targeted therapies have the potential to reduce the extraocular muscle and orbital volume expansion which can lead to diplopia and vision loss from optic nerve compression. Longer term efficacy and durability data is needed to determine the role biologics, such as teprotumumab, should play in the treatment of TED patients compared to the current standard of care.

Sentiment Analysis Surrounding Blepharoplasty in Online Health Forums

BACKGROUND

Upper and lower blepharoplasty are among the most common procedures in aesthetic surgery and are often emotionally laden due to the subjective nature of outcomes and implications with beauty and self-identity. This article capitalizes on the increasing wealth of patient-provided health information online and is the first to analyze the emotions surrounding blepharoplasty discussions in an open internet health forum, MedHelp.

METHODS

We used Python to scrape MedHelp for threads that contained "blepharoplasty" and then used IBM Watson Natural Language Understanding to perform sentiment analyses, calculating a general sentiment score (-1 to +1) as well as emotion scores for anger, sadness, joy, fear, and disgust (0 to 1) for posts and keywords contained within the posts. Keywords were then manually grouped into five distinct clinical categories: symptoms, doctor, treatment, medication, and body.

RESULTS

We collected 52 threads containing "blepharoplasty," yielding 154 posts and 1365 keywords. The average sentiment score was negative among all posts (-0.15) and keywords (-0.30). Among all posts and keywords, sadness had the highest score and disgust had the lowest score.

CONCLUSIONS

Fear and sadness are the predominant emotions for blepharoplasty patients online, and the most negative symptoms cited are not ones that surgeons typically expect.

Reactivation of Herpes Zoster Keratitis Following Shingrix Vaccine

We present a case of herpes zoster keratitis reactivation shortly following the Shingrix vaccine. In our patient, reactivation of herpes zoster keratitis occurred a few weeks following the herpes zoster subunit (HZ/su) vaccine. The development of herpes zoster ophthalmicus following HZ/su is exceedingly rare, with only one prior reported case found in the literature. Reporting of this potential correlation is important in understanding the full risks of vaccines and can help elucidate the etiology of such responses.

A 3-D elasticity theory based model for acoustic radiation from multilayered anisotropic plates

A theoretical model built upon three-dimensional elasticity theory is developed to investigate the acoustic radiation from multilayered anisotropic plates subjected to a harmonic point force excitation. Fourier transform technique and stationary phase method are combined to predict the far-field radiated sound pressure of one-side water immersed plate. Compared to equivalent single-layer plate models, the present model based on elasticity theory can differentiate radiated sound pressure between dry-side and wet-side excited cases, as well as discrepancies induced by different layer sequences for multilayered anisotropic plates. These results highlight the superiority of the present theoretical model especially for handling multilayered anisotropic structures.

Effects of mean flow on transmission loss of orthogonally rib-stiffened aeroelastic plates

This paper investigates the sound transmission loss (STL) of aeroelastic plates reinforced by two sets of orthogonal rib-stiffeners in the presence of external mean flow. Built upon the periodicity of the structure, a comprehensive theoretical model is developed by considering the convection effect of mean flow. The rib-stiffeners are modeled by employing the Bernoulli-Euler beam theory and the torsional wave equation. While the solution for the transmission loss of the structure based on plate displacement and acoustic pressures is given in the form of space-harmonic series, the corresponding coefficients are obtained from the solution of a system of linear equations derived from the plate-beam coupling vibration governing equation and Helmholtz equation. The model predictions are validated by comparing with existing theoretical and experimental results in the absence of mean flow. A parametric study is subsequently performed to quantify the effects of mean flow as well as structure geometrical parameters upon the transmission loss. It is demonstrated that the transmission loss of periodically rib-stiffened structure is increased significantly with increasing Mach number of mean flow over a wide frequency range. The STL value for the case of sound wave incident downstream is pronouncedly larger than that associated with sound wave incident upstream.

Fluid flow induced calcium response in osteoblasts: mathematical modeling

Fluid flow in the bone lacuno-canalicular network can induce dynamic fluctuation of intracellular calcium concentration ([Ca(2+)](i)) in osteoblasts, which plays an important role in bone remodeling. There has been limited progress in the mathematical modeling of this process probably due to its complexity, which is controlled by various factors such as Ca(2+) channels and extracellular messengers. In this study we developed a mathematical model to describe [Ca(2+)](i) response induced by fluid shear stress (SS) by integrating the major factors involved and analyzed the effects of different experimental setups (e.g. [Ca(2+)](i) baseline, pretreatment with ATP). In this model we considered the ATP release process and the activities of multiple ion channels and purinergic receptors. The model was further verified quantitatively by comparing the simulation results with experimental data reported in literature. The results showed that: (i) extracellular ATP concentration has more significant effect on [Ca(2+)](i) baseline (73% increase in [Ca(2+)](i) with extracellular ATP concentration varying between 0 and 10 μM), as compared to that induced by SS (25% variation in [Ca(2+)](i) with SS varying from 0 to 3.5 Pa); (ii) Pretreatment with ATP-medium results in different [Ca(2+)](i) response as compared to the control group (ATP-free medium) under SS; (iii) Relative [Ca(2+)](i) fluctuation over baseline is more reliable to show the [Ca(2+)](i) response process than the absolute [Ca(2+)](i) response peak. The developed model may improve the experimental design and facilitate our understanding of the mechanotransduction process in osteoblasts.

Transmission loss of orthogonally rib-stiffened double-panel structures with cavity absorption

The transmission loss of sound through infinite orthogonally rib-stiffened double-panel structures having cavity-filling fibrous sound absorptive materials is theoretically investigated. The propagation of sound across the fibrous material is characterized using an equivalent fluid model, and the motions of the rib-stiffeners are described by including all possible vibrations, i.e., flexural displacements, bending, and torsional rotations. The effects of fluid-structure coupling are account for by enforcing velocity continuity conditions at fluid-panel interfaces. By taking full advantage of the periodic nature of the double-panel, the space-harmonic approach and virtual work principle are applied to solve the sets of resultant governing equations, which are eventually truncated as a finite system of simultaneous algebraic equations and numerically solved insofar as the solution converges. To validate the proposed model, a comparison between the present model predictions and existing numerical and experimental results for a simplified version of the double-panel structure is carried out, with overall agreement achieved. The model is subsequently employed to explore the influence of the fluid-structure coupling between fluid in the cavity and the two panels on sound transmission across the orthogonally rib-stiffened double-panel structure. Obtained results demonstrate that this fluid-structure coupling affects significantly sound transmission loss (STL) at low frequencies and cannot be ignored when the rib-stiffeners are sparsely distributed. As a highlight of this research, an integrated optimal algorithm toward lightweight, high-stiffness and superior sound insulation capability is proposed, based on which a preliminary optimal design of the double-panel structure is performed.

Analytical modeling of sound transmission across finite aeroelastic panels in convicted fluids

An analytical approach is formulated to account for the effects of mean flow on sound transmission across a simply supported rectangular aeroelastic panel. The application of the convected wave equation and the displacement continuity condition at the fluid-panel interfaces ensures the exact handling of the complex aeroelastic coupling between panel vibration and fluid disturbances. To explore the mean flow effects on sound transmission, three different cases (i.e., mean flow on incident side only, on radiating side only, and on both sides) are separately considered in terms of refraction angular relations and sound transmission loss (STL) plots. Obtained results show that the influence of the incident side mean flow upon sound penetration is significantly different from that of the transmitted side mean flow. The contour plot of refraction angle versus incident angle for the case when the mean flow is on the transmitted side is just a reverse of that when the mean flow is on the incident side. The aerodynamic damping effects on the transmission of sound are well captured by plotting the STL as a function of frequency for varying Mach numbers. However, as the Mach number is increased, the coincidence dip frequency increases when the flow is on the incident side but remains unchanged when in the flow is on the radiating side. In the most general case when the fluids on both sides of the panel are convecting, the refraction angular relations are significantly different from those when the fluid on one side of the panel is moving and that on the other side is at rest.

A multi-scale view of skin thermal pain: from nociception to pain sensation

All biological bodies live in a thermal environment, including the human body, where skin is the interface with a protecting function. When the temperature is out of the normal physiological range, skin fails to protect, and the pain sensation is evoked. Furthermore, in medicine, with advances in laser, microwave and similar technologies, various thermal therapeutic methods have been widely used to cure disease/injury involving skin tissue. However, the corresponding problem of pain relief has limited further application and development of these thermal treatments. Skin thermal pain is induced through both direct (i.e. an increase/decrease in temperature) and indirect (e.g. thermomechanical and thermochemical) ways, and is governed by complicated thermomechanical-chemical-neurophysiological responses. However, a complete understanding of the underlying mechanisms is still far from clear. In this article, starting from an engineering perspective, we aim to recast the biological behaviour of skin in engineering system parlance. Then, by coupling the concepts of engineering with established methods in neuroscience, we attempt to establish multi-scale modelling of skin thermal pain through ion channel to pain sensation. The model takes into account skin morphological plausibility, the thermomechanical response of skin tissue and the biophysical and neurological mechanisms of pain sensation.

Strain rate sensitivity of skin tissue under thermomechanical loading

There have been limited studies addressing the thermally dependent mechanical properties of skin tissue, although this can contribute to a variety of medical applications. To address this, an experimental study on the tensile behaviour of pig skin tissue under different thermal loading conditions and different mechanical stretching rates was performed. The results indicate that there is a significant variation among skin tensile behaviours under different temperatures and loading rates, which is correlated with dermal collagen denaturation. The Ogden model was used to summarize the effect of the strain rate and the temperature upon the measured constitutive response through two parameters (alpha and mu). These results can be used in future models to improve clinical thermal treatments for skin tissue.

Analytical and experimental investigation on transmission loss of clamped double panels: implication of boundary effects

The air-borne sound insulation performance of a rectangular double-panel partition clamp mounted on an infinite acoustic rigid baffle is investigated both analytically and experimentally and compared with that of a simply supported one. With the clamped (or simply supported) boundary accounted for by using the method of modal function, a double series solution for the sound transmission loss (STL) of the structure is obtained by employing the weighted residual (Galerkin) method. Experimental measurements with Al double-panel partitions having air cavity are subsequently carried out to validate the theoretical model for both types of the boundary condition, and good overall agreement is achieved. A consistency check of the two different models (based separately on clamped modal function and simply supported modal function) is performed by extending the panel dimensions to infinite where no boundaries exist. The significant discrepancies between the two different boundary conditions are demonstrated in terms of the STL versus frequency plots as well as the panel deflection mode shapes.

Vibroacoustic behavior of clamp mounted double-panel partition with enclosure air cavity

A theoretical study on the vibroacoustic performance of a rectangular double-panel partition clamp mounted in an infinite acoustic rigid baffle is presented. With the clamped boundary condition taken into account by the method of modal function, a double Fourier series solution to the dynamic response of the structure is obtained by employing the weighted residual method (i.e., the Galerkin method). The double series solution can be considered as the exact solution of the problem, as the structural and acoustic-structural coupling effects are fully accounted for and the solution converges numerically. The accuracy of the theoretical predictions is checked against existing experimental data, with good agreement achieved. The influence of several key parameters on the sound isolation capability of the double-panel configuration is then systematically studied, including panel dimensions, thickness of air cavity, elevation angle, and azimuth angle of incidence sound. The present method is suitable for double-panel systems of finite or infinite extent and is applicable for both low- and high-frequency ranges. With these merits, the proposed method compares favorably with a number of other approaches, e.g., finite element method, boundary element method, and statistical energy analysis method.

Skin biothermomechanics for medical treatments

Electromagnetic heating, such as microwave, radiofrequency, and laser etc., is widely used in medical treatments. Recent advances in these technologies resulted in remarkable developments of thermal treatments for a multitude of diseases and injuries involving skin tissue. The comprehension of heat transfer and related thermomechanics in skin tissue during these treatments is thus of great importance, and can contribute to the further developments of these medical applications. Biothermomechanics of skin is highly interdisciplinary, involving bioheat transfer, burn damage, biomechanics, and physiology. The aim of this study is to develop a computational approach to examine the heat transfer process, heat-induced mechanical response, as well as the associated pain level, so that the differences among the clinically applied heating modalities can be quantified. In this paper, numerical simulation with the finite difference method (FDM) was used to analyze the temperature, burn damage, and thermal stress distributions in the skin tissue subjected to various thermal treatments. The results showed that the thermomechanical behavior of skin tissue is very complex: blood perfusion has little effect on thermal damage, but a large influence on skin temperature distribution, which, in turn, influences significantly the resulting thermal stress field; for laser heating, the peak temperature is higher for lasers with shorter wavelengths, but the peak is closer to the skin surface; the thermal stress due to laser and microwave heating is mainly limited to the top epidermis layer due to the exponential decrease of heat generation along skin depth; the thin (and commonly overlooked) stratum corneum layer dominates the thermomechanical response of skin tissue.

Sound absorption of cellular metals with semiopen cells

A combined experimental and theoretical study is presented for the feasibility of using aluminum foams with semiopen cells for sound-absorption applications. The foams are processed via negative-pressure infiltration, using a preform consisting of water-soluble spherical particles. An analytical model is developed to quantify the dependence of pore connectivity on processing parameters, including infiltration pressure, particle size, wetting angle, and surface tension of molten alloy. Normal sound-absorption coefficient and static flow resistance are measured for samples having different porosity, pore size, and pore opening. A theory is developed for idealized semiopen metallic foams, with a regular hexagonal hollow prism having one circular aperture on each of its eight surfaces as the unit cell. The theory is built upon the acoustic impedance of the circular apertures (orifices) and cylindrical cavities due to viscous effects, and the principle of electroacoustic analogy. The predicted sound-absorption coefficients are compared with those measured. To help select processing parameters for producing semiopen metallic foams with desirable sound-absorbing properties, emphasis is placed on revealing the correlation between sound absorption and morphological parameters such as pore size, pore opening, and porosity.

Tyrosine kinase expression profile in bladder cancer

The expression pattern of tyrosine kinase in bladder cancer cells was evaluated by PCR amplification with degenerate primers derived from conserved catalytic domain in tyrosine kinase. The results indicated that TRK-E and Arg kinases were more abundantly expressed than several other kinases in bladder cancer. In addition, we identified a novel clone whose sequence could not be matched in GeneBank. This clone may represent a serine/threonine kinase based on sequence similarity.