bluuebunny/crossref_metadata_2025 huggingface dataset:
POS0921 EFFICACY AND SAFETY OF ACEMETACIN IN THE TREATMENT OF 1215 ACTIVE ANKYLOSING SPONDYLITIS PATIENTS: DATA FROM A PROSPECTIVE COHORT MANAGED BY SMART-PHONE SPONDYLOARTHRITIS MANAGEMENT SYSTEM
Authors: Zhang J. , Hu L. , Ji X. , Wang Y. , Huang F.
Published: May 2021

Background:

Biological DMARDs have widely used in the treatment of AS in last two decades, but NSAIDs still serves as a cornerstone in the treatment. Given the wide use of Acemetacin in AS and relative lack of clinical evidence on the selection of NSAIDs in the treatment of AS, the investigation on acemetacin treating AS is of great significance.

Objectives:

Our study aims to investigate efficacy and safety of acemetacin in the treatment of AS.

Methods:

Data on efficacy and safety is available in 1215 patients from the Chinese Ankylosing Spondylitis Imaging Cohort (CASPIC), which is collected through the Smart-phone SpondyloArthritis Management System (SpAMS)[1]. Patients’ self-assessments are completed online at baseline and every subsequent clinic visit. Physician-reported assessments, laboratory tests, and treatments were recorded by rheumatologists at every clinic visit.

Results:

1215 patients with AS were registered, of whom 992 were treated with acemetacin and 123 were treated with other NSAIDs. The results showed that total back pain and BASFI were significantly improved after three-month treatment of acemetacin, while comparing to other NSAIDs (P=0.027 and 0.015, respectively). After six-month treatment, patients taking acemetacin showed greater improvement in PGA (P=0.013), total back pain (P=0.049), night back pain (P=0.047), BASFI (P=0.042), ASDAS (P=0.007) and CRP (P=0.032) compared to those taking other NSAIDs. During the follow-up periods, no serious adverse events were reported. Mild abnormal liver function occurred in nine patients (9/992) treated with acemetacin and in six patients treated with other NSAIDs (6/123). See Table 1 for details.

Conclusion:

Acemetacin showed better efficacy and acceptable safety profile in the treatment of active ankylosing spondylitis comparing with other NSAIDs.

References:

[1]Ji, X., et al., Improvement of Disease Management and Cost Effectiveness in Chinese Patients with Ankylosing Spondylitis Using a Smart-Phone Management System: A Prospective Cohort Study. BioMed research international, 2019. 2019: p. 2171475.

Table 1.

The comparation of two groups at 0, 3 and 6 months after treatment

Baseline3 months6 months95%CIP95%CIP95%CIPPGA-0.13(-0.49, 0.24)0.494-0.28(-0.74, 0.18)0.235-0.59(-1.06, -1.13)0.013*Total back pain-0.03(-0.37, 0.32)0.889-0.50(-0.94, -0.06)0.027*-0.44(-0.88, -0.002)0.049*Night back pain0.01(-0.36, 0.38)0.956-0.30(-0.75, 0.16)0.203-0.46(-0.91, -0.006)0.047*BASFI-0.30(-0.59, 0.004)0.053-0.55(-0.99, -0.11)0.015*-0.34(-0.67, -0.01)0.042*ASDAS-0.10(-0.29, 0.08)0.287-0.15(-0.46, 0.16)0.342-0.41(-0.70, -0.11)0.007*CRP-4.39(-8.87, 0.10)0.0550.91(-10.39, 12.21)0.874-7.86(-15.03, -0.68)0.032*

Disclosure of Interests:

None declared
POS0148 MATERNAL AND NEONATAL OUTCOMES IN PREGNANT WOMEN WITH PSORIASIS AND PSORIATIC ARTHRITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Xie W. , Huang H. , Zhang Z.
Published: May 2021

Background:

Psoriasis and psoriatic arthritis (PsA) are inflammatory diseases that affect women in their reproductive years. The evidence regarding the pregnancy outcomes in psoriasis and PsA is more limited and conflicting, to a large extent, confusing our knowledge on this topic.

Objectives:

We aim to investigate whether maternal psoriasis and PsA are associated with adverse pregnancy outcomes.

Methods:

We searched multiple electronic databases from inception to 3 August 2020, and reference lists of selected articles. Observational studies reporting at least one pregnancy outcomes in women with psoriasis or PsA with a comparator of general population or healthy subjects were included. Data were pooled by random-effects models (DerSimonian and Laird method) and expressed as odds ratio (OR) and 95% confidence interval (CI).

Results:

Overall, 16 studies were included in the meta-analysis. The pooled analyses showed pregnant women with psoriatic diseases have significantly higher risk of adverse maternal outcomes compared with general population (caesarean delivery: 1.33 (1.17-1.52); preterm birth: 1.32 (1.15-1.52); (pre)eclampsia: 1.28 (1.14-1.43); gestational diabetes: 1.19 (1.10-1.30); gestational hypertension: 1.30 (1.18-1.44) (Figure 1). However, no statistically increased risks of fetal complications were observed in women with psoriatic diseases (small for gestational age: 1.02 (0.93-1.11); low birth weight: 1.15 (0.93-1.42); congenital malformations: 1.03 (0.93-1.14); Apgar score <7: 1.07 (0.81-1.39); neonatal mortality: 1.13 (0.90-1.43); stillbirth: 1.19 (0.95-1.50)). Subgroup analysis found similar results in women with either psoriasis or PsA regarding maternal outcomes, but the magnitude of risk estimates seems to be greater in PsA.

Conclusion:

Pregnant women with psoriasis and PsA have excess risk of adverse maternal events, with seemingly higher risk in women with PsA, but not adverse neonatal events. Close monitoring of the mothers’ clinical status before and during pregnancy are decidedly required in daily practice.

Figure 1.

Forest plots of the odds ratio for the risk of adverse pregnancy outcomes in patients with psoriatic diseases.

Disclosure of Interests:

None declared
POS1137 IDENTIFYING ADULT HYPOPHOSPHATASIA IN THE RHEUMATOLOGY UNIT
Authors: Feurstein J. , Behanova M. , Haschka J. , Roetzer K. , Uyanik G. , Witsch-Baumgartner M. , Schett G. , Zwerina J. , Kocijan R.
Published: May 2021

Background:

The most frequent manifestation in adult Hypophosphatasia (HPP) is musculoskeletal pain.1,2 The unspecific nature of its clinical presentation may prevent correct diagnosis.3

Objectives:

Identifying adult hypophosphatasia in the rheumatology unit.

Methods:

Over a period of 10 years 9,522 patients were screened in a rheumatological outpatient unit. Serum ALP levels ≤ 40 U/l were found in 524 patients. After screening for secondary causes, 73 patients were invited for clinical evaluation. Genetic testing was performed in 23 patients with suspected HPP. Logistic regression models were used to estimate the association of each clinical factor with HPP.

Results:

Mutations in the ALPL gene were observed in 57% of genetically screened patients. Arthralgia, fractures and pain were the leading symptoms in HPP patients. Chondrocalcinosis (OR 29.12; 95% CI 2.02-1593.52) and dental disease (OR 8.33; 95% CI 0.93-143.40) were associated with HPP independent of BMI. Onset of symptoms in HPP was at 35.1 (14.3) years, with a mean duration from symptoms to diagnosis of 14.4 (8.1) years. Bone mineral density (BMD) and trabecular bone score (TBS) as well as bone turnover markers were not indicative for HPP.

Conclusion:

HPP can mimic joint diseases.4 Thus, in patients with uncertain rheumatologic complaints and low ALP, HPP should be considered as potential diagnosis.

References:

[1]Durrough C, Colazo JM, Simmons J, et al. Characterization of physical, functional, and cognitive performance in 15 adults with hypophosphatasia. Bone 2021;142:115695.

[2]Seefried L, Kishnani PS, Moseley S, et al. Pharmacodynamics of asfotase alfa in adults with pediatric-onset hypophosphatasia. Bone 2021;142:115664.

[3]Högler W, Langman C, Gomes da Silva H, et al. Diagnostic delay is common among patients with hypophosphatasia: initial findings from a longitudinal, prospective, global registry. BMC musculoskeletal disorders 2019;20(1):80.

[4]Seefried L, Dahir K, Petryk A, et al. Burden of Illness in Adults With Hypophosphatasia: Data From the Global Hypophosphatasia Patient Registry. Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research 2020;35(11):2171-78.

Disclosure of Interests:

None declared.
POS1155 INFECTIOUS RISK DURING BIOLOGIC THERAPY FOR INFLAMMATORY RHEUMATIC DISEASES: DATA FROM THE TUNISIAN BINAR REGISTRY
Authors: Boussaid S. , Ben Aissa R. , Kochbati S. , Elleuch M. , Abdelmoula L. , Laatar A. , Hamdi W. , Gharsallah I. , Bouagina E. , Baklouti S. , Bergaoui N. , Younes M.
Published: May 2021

Background:

The development of biologics for the treatment of systemic rheumatic diseases increased the risk of infections. The management of this complication deserves particular attention since it remains a major cause of morbidity and mortality.

Objectives:

The aim of our study was to determine infection frequency under biological treatment and consequences on the therapeutic management.

Methods:

Patients included in the Biological National Registry (BINAR) from 2016 to 2020. Data related to the disease, biological agents, and infections occurring under biologic disease-modifying antirheumatic drugs (bDMARDs) were collected.

Results:

The study included 298 patients with a mean age of 49.2 years [18-79] 175 patients with rheumatoid arthritis and 123 with spondyloarthritis (Axial Spondyloarthritis=48, Enteropathic Arthritis=41, Psoriatic Arthritis=34). Anti Tumor necrosis factor-alpha (Anti-TNF) agents were the most prescribed bDMARDs in 87.9% (n=263) of patients: Infliximab 20.4% (n=61),Etanercept 23.1%(n=69), Adalimumab 24.6%(n=74) and Certolizumab (n=79). No patients were treated with Golimumab. Tocilizumab and Rituximab were prescribed respectively in 10.4% (n=31) and 5% (n=15) of patients. Infections occured in 9 patients (3.1%) with a total of 13 infectious episodes 12 bacterial and a viral one. The site of infections was: respiratory (38%), urinary (15%), cutaneous (23%), ORL (8%), infective endocarditis (8%), and other (8%). The infectious agent was identified in only 3 patients. The outcomes were favorable in most cases except in one patient where there was a definitive interruption of bDMARDs. The patient was hospitalized for sepsis complicating a cutaneous infection with favorable outcomes under antibiotics within a week. The biological agent with higher risk of infections was Tocilizumab (p = 0.056), unlike Rituximab (p = 0.483) and Anti-TNF (p = 0.082). All patients who had an infectious episode were under corticosteroids.

Conclusion:

Our results confirm that bDMARDs are predisposing to infections, but data from BINAR showed that most infections were trivial with no serious outcomes. Therefore, infections should be assessed in patients under bDMARDs for an early therapeutic intervention.

Disclosure of Interests:

None declared.
Large cell neuroendocrine carcinoma arising from the anterior mediastinum
Authors: Montebello Annalisa , Zahra Bianco Elizier , Babic Darko , Delicata Nicholas Paul , Azzopardi Neville
Published: May 2021

Anterior mediastinal large cell neuroendocrine carcinomas (LCNECs) are extremely rare, extremely aggressive malignancies that carry a dismal prognosis. We discuss a woman aged 60 years who presented with a 2-month history of recurrent severe constant epigastric pain. Abdominal examination revealed massive hepatomegaly and a CT scan of the liver confirmed coarse liver lesions. Histology from a liver biopsy was consistent with a large cell (non-small cell) neuroendocrine carcinoma. A CT scan of the chest showed a large anterior mediastinal mass unrelated to the lung, suggesting that the anterior mediastinum was the primary origin of the tumour. The patient was planned to receive platinum/etoposide chemotherapy for a metastatic mediastinal large cell neuroendocrine carcinoma. Unfortunately, her health deteriorated, and she was unfit to undergo any further treatment. She was treated palliatively and died 2 months after the diagnosis.
Rare case of ballooning herniation of the tympanic membrane
Authors: Engert Tobias , Metternich Frank Uwe
Published: May 2021

Herniation of the tympanic membrane is a rare benign malformation of the tympanic membrane into the external auditory canal. It may be asymptomatic or associated with symptoms such as aural fullness, tinnitus, otalgia or hearing loss. We present a case of a symptomatic herniation of the tympanic membrane and its surgical therapy with hernia excision and tympanoplasty. An internal review board exemption was obtained.
Clinical application of foot strike run retraining for military service members with chronic knee pain
Authors: Mazzone Brittney , Yoder A , Condon R , Farrokhi S
Published: May 2021

Introduction

Military training is associated with a high incidence of knee pain. Conversion from a rearfoot to non-rearfoot strike during running is effective at reducing knee pain in research environments. The purpose of this report was to demonstrate run retraining as a clinical intervention for service members with knee pain.

Methods

Sixteen service members with running-related chronic knee pain underwent run retraining that converted foot strike from a rearfoot to a non-rearfoot strike using real-time visual feedback. The Lower Extremity Functional Scale (LEFS) and Numerical Pain Rating Scale (NPRS) for knee pain during running were assessed pretraining, at the final training session and at a 1-month follow-up. During running, foot inclination angle and vertical ground reaction force (VGRF) average loading rate were measured pretraining and at 1 month of follow-up.

Results

Service members underwent 7.4±1.0 training sessions over the course of 15.8±4.6 days. LEFS improved by 8±6 points immediately after retraining, with an overall improvement of 10±6 points from pretraining to 1-month follow-up (p<0.01). NPRS improved by 2.0±0.4 points immediately after retraining, with an overall improvement of 2.0±0.4 points from pretraining to 1-month follow-up (p<0.01). Conversion to a non-rearfoot strike pattern was apparent at follow-up for all but two patients. VGRF average loading rate decreased by 56%±17% (p<0.01) from pretraining to 1-month follow-up.

Conclusions

Knee pain and function improved as a result of non-rearfoot strike run retraining, which supports the clinical use of this evidence-based intervention.
Protocol for the Acute Myocardial Infarction Study in Northeastern China (AMINoC): a real-world prospective cohort study
Authors: Li Tianyi , Wu Junduo , Liu Jia , Sun Wei , Qi Chao , Liu Bin , Wells George A , Wang Junnan
Published: May 2021

Introduction

Acute myocardial infarction (AMI) has become one of the major causes of mortality and morbidity in China. However, little is known about the characteristics, medical care and outcomes of patients with AMI in Northeastern China. The Acute Myocardial Infarction Study in Northeastern China (AMINoC) is aimed at obtaining timely real-world knowledge in terms of characteristics, clinical care and outcomes of patients with AMI and at providing care-quality improvement efforts in Northeastern China.

Methods and analysis

The AMINoC is a real-world, prospective, multicentre cohort study. The study selected 20 hospitals using stratified cluster sampling from different levels of hospitals among nine districts throughout Jilin Province. Hospitalised patients with a primary diagnosis of AMI in each site are consecutively enrolled for 1 year. Demographic characteristics, clinical data, treatments, outcomes and cost are collected by local investigators. Patient follow-up after discharge is planned for up to 2 years.

Ethics and dissemination

The protocol has been approved by the ethics committee at the Second Hospital of Jilin University. The findings of this study will be published in peer-reviewed journals and medical conferences.

Trial registration

NCT04451967.
Association of socioeconomic status with medical assistance in dying: a case–control analysis
Authors: Redelmeier Donald A , Ng Kelvin , Thiruchelvam Deva , Shafir Eldar
Published: May 2021

Objectives

Economic constraints are a common explanation of why patients with low socioeconomic status tend to experience less access to medical care. We tested whether the decreased care extends to medical assistance in dying in a healthcare system with no direct economic constraints.

Design

Population-based case–control study of adults who died.

Setting

Ontario, Canada, between 1 June 2016 and 1 June 2019.

Patients

Patients receiving palliative care under universal insurance with no user fees.

Exposure

Patient’s socioeconomic status identified using standardised quintiles.

Main outcome measure

Whether the patient received medical assistance in dying.

Results

A total of 50 096 palliative care patients died, of whom 920 received medical assistance in dying (cases) and 49 176 did not receive medical assistance in dying (controls). Medical assistance in dying was less frequent for patients with low socioeconomic status (166 of 11 008=1.5%) than for patients with high socioeconomic status (227 of 9277=2.4%). This equalled a 39% decreased odds of receiving medical assistance in dying associated with low socioeconomic status (OR=0.61, 95% CI 0.50 to 0.75, p<0.001). The relative decrease was evident across diverse patient groups and after adjusting for age, sex, home location, malignancy diagnosis, healthcare utilisation and overall frailty. The findings also replicated in a subgroup analysis that matched patients on responsible physician, a sensitivity analysis based on a different socioeconomic measure of low-income status and a confirmation study using a randomised survey design.

Conclusions

Patients with low socioeconomic status are less likely to receive medical assistance in dying under universal health insurance. An awareness of this imbalance may help in understanding patient decisions in less extreme clinical settings.
Association of meteorological parameters with intussusception in children aged under 2 years: results from a multisite bidirectional surveillance over 7 years in India
Authors: Das Manoja Kumar
Published: May 2021

Objectives

The study aimed to document the association between intussusception in Indian children and meteorological parameters and examine regional variations.

Design

A bidirectional (retrospective and prospective) surveillance between July 2010 and September 2017.

Setting

At 20 hospitals in India, retrospective case record review during July 2010 and March 2016 and prospective surveillance during April 2016 and September 2017 were performed.

Participants

2161 children aged 2–24 months with first intussusception episode were included.

Interventions

The monthly mean meteorological parameters (temperature, sunshine, rainfall, humidity and wind speed) for the study sites were collected.

Methods

The association between monthly intussusception cases and meteorological parameters was examined at pooled, regional and site levels using Pearson (r) and Spearman’s rank-order (ρ) correlation, factorial analysis of variance, and Poisson regression or negative binomial regression analyses.

Results

The intussusception cases were highest in summer and lowest in autumn seasons. Pearson correlation analysis showed that temperature (r=0.056; p<0.05), wind speed (r=0.134; p<0.01) and humidity (r=0.075; p<0.01) were associated with monthly intussusception cases. Spearman’s rank-order correlation analysis found that temperature (ρ=0.049; p<0.05), wind speed (ρ=0.096; p<0.01) and sunshine (ρ=0.051; p<0.05) were associated with monthly intussusception cases. Poisson regression analysis resulted that monthly intussusception case was associated with rising temperature (North region, p<0.01 and East region, p<0.05), sunshine (North region, p<0.01), humidity (East region, p<0.01) and wind speed (East region, p<0.01). Factorial analysis of variance revealed a significant seasonal difference in intussusception cases for pooled level (p<0.05), 2–6 months age group (p<0.05) and North region (p<0.01). Significant differences in intussusception cases between summer and autumn seasons were observed for pooled (p<0.01), children aged 2–6 months (p<0.05) and 7–12 months (p<0.05).

Conclusions

Significant correlations between intussusception cases and temperature, humidity, and wind speed were observed at pooled and regional level in India. A peak in summer months was noted, which may be used for prediction, early detection and referral for appropriate management of intussusception.
PUTRA-Adol study: protocol for an observational follow-up study to assess the tracking of dietary patterns linked to cardiometabolic risk factors and its prospective relationship with non-alcoholic fatty liver disease, carotid intima-medial thickness and mental well-being during adolescence in Malaysia
Authors: Appannah Geeta , Emi Nor Aishah , Magendiran Mugambikai , Mohd Shariff Zalilah , Anuar Zaini Azriyanti , Shamsuddin Nurainul Hana , Suppiah Subapriya , Mohamad Saini Suraini , Thambiah Subashini C , Ching Siew Mooi
Published: May 2021

Introduction

Growing evidence suggesting that dietary intakes of adolescents are generally of poor quality but not adequately assessed in relation to the early manifestation of non-communicable diseases. This study aimed; (1) to examine tracking of an empirical dietary pattern (DP) linked to cardiometabolic risk factors and, (2) to assess prospective relationships between a DP characterised by high intakes of dietary energy density (DED) and added sugar, and cardiometabolic risk factors, non-alcoholic fatty liver disease (NAFLD), carotid intima-medial thickness (CIMT) and mental well-being during adolescence.

Methods and analysis

The PUTRA-Adol is a prospective follow-up study that builds up from 933 Malaysian adolescents who were initially recruited from three southern states in Peninsular Malaysia in 2016 (aged 13 years then). Two sessions are planned; the first session will involve the collection of socio-economy, physical activity, dietary intakes, mental well-being, body image, risk taking behaviour, sun exposure, family functioning and menstrual (in women) information. The second session of data collection will be focused on direct assessments such as venesection for blood biochemistry, anthropometry and ultrasonography imaging of liver and bilateral carotid arteries. Z-scores for an empirical DP will be identified at 16 years using reduced rank regression. Multilevel modelling will be conducted to assess the tracking of DP and prospective analysis between the DP, cardiometabolic health, NAFLD, CIMT and mental well-being.

Ethics and dissemination

Ethical approval for the conduct of this follow-up study was obtained from the Universiti Putra Malaysia’s Ethics Committee for Research Involving Human Subjects (JKEUPM) (Reference number: JKEUPM-2019–267). The findings from this study will be disseminated in conferences and peer-reviewed journals.

Discussion

The findings gathered from this study will provide evidence on prospective relationships between DPs, cardiometabolic risk factors, NAFLD, early atherosclerosis and mental well-being and that it may be mediated particularly DED and added sugar during adolescence.
Efficacy and safety of butylphthalide for patients who had acute ischaemic stroke receiving intravenous thrombolysis or endovascular treatment (BAST trial): study protocol for a randomised placebo-controlled trial
Authors: Zhang Xuelei , Wang Anxin , Zhang Jing Yu , Jia Baixue , Huo Xiaochuan , Zuo Yingting , Tian Xue , Wang Yilong , Miao Zhongrong
Published: May 2021

Introduction

As a neuroprotective medication, butylphthalide (NBP) may help protect against cerebral ischaemic injury. However, evidence on whether NBP influences the outcomes of patients who had acute ischaemic stroke who are receiving revascularisation treatment is limited. This study aims to evaluate whether additional NBP therapy can improve the functional outcome of patients who receive intravenous recombinant tissue plasminogen activator and/or endovascular treatment (EVT).

Methods and analysis

The study will be a randomised, double-blind, placebo-controlled, multiple-centre, parallel group trial. The sample size is estimated at 1200 patients. Eligible patients will be randomised at a 1:1 ratio to receive either NBP or placebo daily for 90 days, which will include 14 days of injections and 76 days of capsules. The first use of NBP/placebo will be started within 6 hours of onset of ischaemic stroke. The primary outcome is the functional outcome as assessed by the 90-day modified Rankin Scale, adjusted for baseline scores on the National Institutes of Health Stroke Scale. The primary safety outcome is the percentage of serious adverse events during the 90 days of treatment. This trial will determine whether NBP medication benefits patients who had acute ischaemic stroke who receive intravenous thrombolysis or EVT.

Ethics and dissemination

The protocol was written according to the general ethical guidelines of the Declaration of Helsinki and approved by the Institutional Review Board/Ethics Committee of Beijing Tiantan Hospital, Capital Medical University with approval number KY 2018-003-02. Ethics committees of all participating sites have approved the study . Results of the study will be published in peer-reviewed scientific journals and shared in scientific presentations.

Trial registration number

NCT03539445.
Trends in health expectancies: a systematic review of international evidence
Authors: Spiers Gemma F , Kunonga Tafadzwa Patience , Beyer Fiona , Craig Dawn , Hanratty Barbara , Jagger Carol
Published: May 2021

Objectives

A clear understanding of whether increases in longevity are spent in good health is necessary to support ageing, health and care-related policy.

Design

We conducted a systematic review to update and summarise evidence on trends in health expectancies, in Organisation for Economic Co-operation and Development (OECD) high-income countries.

Data sources

Four electronic databases (MEDLINE, 1946–19 September 2019; Embase 1980–2019 week 38; Scopus 1966–22 September 2019, Health Management Information Consortium, 1979–September 2019), and the UK Office for National Statistics website (November 2019).

Eligibility criteria

English language studies published from 2016 that reported trends in healthy, active and/or disability-free life expectancy in an OECD high-income country.

Data extraction and synthesis

Records were screened independently by two researchers. Study quality was assessed using published criteria designed to identify sources of bias in studies reporting trends, and evidence summarised by narrative synthesis.

Findings

Twenty-eight publications from 11 countries were included, covering periods from 6 to 40 years, between 1970 and 2017. In most countries, gains in healthy and disability-free life expectancy do not match the growth in total life expectancy. Exceptions were demonstrated for women in Sweden, where there were greater gains in disability-free years than life expectancy. Gains in healthy and disability-free life expectancy were greater for men than women in most countries except the USA (age 85), Japan (birth), Korea (age 65) and Sweden (age 77).

Conclusion

An expansion of disability in later life is evident in a number of high-income countries, with implications for the sustainability of health and care systems. The recent COVID-19 pandemic may also impact health expectancies in the longer term.
Infection-associated biofilms and statins: protocol for systematic review
Authors: Valencia Dora Yesenia , Habila Magdiel , McClelland D Jean , Degarege Abraham , Madhivanan Purnima , Krupp Karl
Published: May 2021

Introduction

Owing to their propensity for being associated with infections, biofilms have become a focus in infectious disease research. There is evidence suggesting that statins, which are commonly used for prevention of cardiovascular disease, may prevent biofilm-associated infections, but this association has not been well-understood.

Methods and analysis

This systematic review protocol will include six database searches from their inception to 20 August 2020. A medical librarian will conduct the searches in PubMed, EMBASE, Web of Science, CINAHL, LILACS and CENTRAL, without any limits. Bibliographies of selected articles, previously published reviews and high-yield journals that publish on statins and/or biofilms will be searched to identify additional articles. The screening and data extraction will be conducted by two independent reviewers using DistillerSR. All included papers will also be evaluated for quality using Cochrane Risk of Bias Assessment tool, and we will examine for publication bias. If there are two or more studies with quantitative estimates that can be combined, we will conduct a meta-analysis after assessing for heterogeneity. We will report all findings according to the Preferred Reporting Items for Systematic reviews and Analyses-P framework.

Ethics and dissemination

There are conflicting results on the effect of statins on biofilm-associated infections. The rise of antibiotic resistance in medical settings warrants a deeper understanding of this association, especially if statins can be used as a novel antibiotic. The findings of this review will assess the association between statin use and biofilm-associated infection to inform future medical practice. No formal ethical review is required for this protocol. All findings will be published in a peer-reviewed journal.

PROSPERO registration number

CRD42020193985.
Success and limiting factors in health service innovation: a theory-generating mixed methods evaluation of UK projects
Authors: Leedham-Green Kathleen , Knight Alec , Reedy Gabriel B
Published: May 2021

Objectives

To explore and explain success and limiting factors in UK health service innovation.

Design

Mixed methods evaluation of a series of health service innovations involving a survey and interviews, with theory-generating analysis.

Setting

The research explored innovations supported by one of the UK’s Academic Health Science Networks which provides small grants, awards and structural support to health service innovators including clinical academics, health and social care professionals and third-sector organisations.

Participants

All recipients of funding or support 2014–2018 were invited to participate. We analysed survey responses relating to 56 innovation projects.

Results

Responses were used to conceptualise success along two axes: value creation for the intended beneficiaries and expansion beyond its original pilot. An analysis of variance between categories of success indicated that participation, motivation and evaluation were critical to value generation; organisational, educational and administrative support were critical to expansion; and leadership and collaborative expertise were critical to both value creation and expansion. Additional limiting factors derived from qualitative responses included difficulties navigating the boundaries and intersections between organisations, professions, sectors and cultures; a lack of support for innovation beyond the start-up phase; a lack of protected time; and staff burn-out and turnover.

Conclusions

A nested hierarchy of innovation needs has been derived via an analysis of these factors, providing targeted suggestions to enhance the success of future innovations.
Cluster-randomised controlled trial of Stroke 1-2-0 education programme to reduce stroke prehospital delay in China: a study protocol
Authors: Wang Yong , Liu Yang , Liu Renyu , Zhao Jing
Published: May 2021

Introduction

Stroke is the leading cause of death and disability in China. The median time of stroke pre-hospital delay is more than 15 hours, mainly due to the lack of awareness on stroke symptoms and calling emergency services. We developed Stroke 1-2-0 recognition tool in China, by adapting Face, Arm, Speech and Time. Our preliminary findings suggested that Stroke 1-2-0 can improve public’s knowledge of the stroke symptoms, but its impact on the prehospital delay is still unclear. Furthermore, these findings were mainly obtained from Shanghai, one of the largest metropolises in China. However, more than half of population in China lives in the rural area. Given the striking disparities in socioeconomic status and quality of stroke care across the nation, a multicentre trial is warranted.

Methods and analysis

Stroke 1-2-0 education programme will adopt a multicentre, cluster-randomised controlled design. We aimed to recruit 32 communities from 16 counties across China. Each county includes two communities having more than 100 000 residents. The two communities sampled in the same county will be randomly assigned to receive either Stroke 1-2-0 education programme or usual care. The primary objective of this study is to evaluate the impact of Stroke 1-2-0 public education programme in reducing stroke prehospital delay among adults residing in the community, compared with the usual care. The intervention will be implemented for 1 year. The primary outcomes are the symptom onset to hospital arrival time (‘onset-to-door time’, ODT) and 3-hour hospital arriving rate. We will use an intention-to-treat approach. A linear mixed model will be used to control for potential cluster effects.

Ethics and dissemination

This study is approved by the Shanghai Minhang District Central Hospital Institutional Review Board (Shanghai, China). The findings will be disseminated via peer-reviewed publications and conference presentations.

Trial registration number

ChiCTR2000040782.
Trainee doctors’ experiences of learning and well-being while working in intensive care during the COVID-19 pandemic: a qualitative study using appreciative inquiry
Authors: Warren Jennifer , Plunkett Emma , Rudge James , Stamoulis Christina , Torlinski Tomasz , Tarrant Carolyn , Mullhi Randeep
Published: May 2021

Objectives

Concern about trainee work-related well-being has been raised in recent years and is the subject of several reviews, reports and research studies. This study aimed to understand the experiences of trainees working in a large intensive care unit during the first surge of the COVID-19 pandemic from an educational and operational perspective in order to highlight what worked and what could be improved.

Design

A qualitative study using peer-to-peer semistructured interviews, developed using appreciative inquiry methodology, was conducted during July 2020. Responses were analysed using a thematic analysis technique.

Setting

A large, tertiary intensive care unit in the UK.

Participants

All trainees in anaesthesia and intensive care working on the intensive care unit during the first surge were invited to participate.

Results

Forty interviews were conducted and four over-arching themes were identified. These were: feeling safe and supported; physical demands; the emotional burden of caring; and a sense of fulfilment, value and personal development. Positive aspects of the organisational response to the pandemic included communication, personal protective equipment supply, team working and well-being support. Suggestions for improvement focused on rest facilities, rota patterns and hierarchies, creating opportunities for reflection and ensuring continued educational and training opportunities despite operational demands.

Conclusions

Trainees described opportunities for learning and fulfilment, as well as challenges, in working through a pandemic. Trainees described their needs and how well these were met during the pandemic. Ideas for improvement most frequently related to basic needs including safety and fatigue, but suggestions also related to supporting learning and development. The appreciative inquiry methodology of the project facilitated effective reflection on positive aspects of trainee experiences.
Changes in presentations with features potentially indicating cancer in primary care during the COVID-19 pandemic: a retrospective cohort study
Authors: Scott Lauren J , Murphy Mairead , Price Sarah , Lewis Rhys , Denholm Rachel , Horwood Jeremy , Palmer Tom , Salisbury Chris
Published: May 2021

Objectives

To investigate how the COVID-19 pandemic affected the number of people aged 50+ years presenting to primary care with features that could potentially indicate cancer, and to explore how reporting differed by patient characteristics and in face-to-face vs remote consultations.

Design, setting and participants

A retrospective cohort study of general practitioner (GP), nurse and paramedic primary care consultations in 21 practices in South-West England covering 123 947 patients. The models compared potential cancer indicators reported in April–July 2019 with April–July 2020.

Main outcome measures

Potential indicators of cancer were identified using code lists for symptoms, signs, test results and diagnoses listed in the National Institute for Health and Care Excellence suspected cancer referral guidance (NG12).

Results

During April–July 2019, 17% of registered patients aged 50+ years reported a potential cancer indicator in a consultation with a GP or nurse. During April–July 2020, this reduced to 11% (incidence rate ratio (IRR) 0.64, 95% CI 0.62 to 0.67, p<0.001). Reductions in potential cancer indicators were stable across age group, sex, ethnicity, index of multiple deprivation quintile and shielding status, but less marked in patients with mental health conditions than without (IRR 0.75, 95% CI 0.72 to 0.79, interaction p<0.001). Proportions of GP consultations with potential indicators of cancer reduced between 2019 and 2020 for face-to-face consultations (IRR 0.84, 95% CI 0.76 to 0.92, p<0.001) and increased for remote consultations (IRR 1.17, 95% CI 1.07 to 1.29, p=0.001), although it remained lower in remote consulting than face-to-face in April–July 2020. This difference was greater for nurse/paramedic consultations (face-to-face: IRR 0.61, 95% CI 0.44 to 0.83, p=0.002; remote: IRR 1.60, 95% CI 1.10 to 2.333, p=0.014).

Conclusion

The number of patients consulting with presentations that could potentially indicate cancer reduced during the first wave of the COVID-19 pandemic. Patients should be encouraged to continue contacting primary care for persistent signs and symptoms, and GPs and nurses should be encouraged to probe patients for further information during remote consulting, in the absence of non-verbal cues.
Live streaming ward rounds using wearable technology to teach medical students: a pilot study
Authors: Mill Tobias , Parikh Shefali , Allen Archie , Dart Gemma , Lee Daniel , Richardson Charlotte , Howell Keith , Lewington Andrew
Published: May 2021

Background

The COVID-19 pandemic resulted in a loss of clinical clerkship opportunities for medical students. To address this problem while maintaining patient safety, this pilot study explored the feasibility of using a wearable headset to live stream teaching ward rounds to remotely based medical students.

Methods

Three live streamed teaching ward rounds were delivered to three groups of medical students (n=53) using the Microsoft HoloLens 2 device and Microsoft Teams software, and results pooled for analysis. Feedback was gathered from students and instructors using the evaluation of technology-enhanced learning materials (ETELM). Patient feedback was gathered using the Communication Assessment Tool to explore any impact on interpersonal communication.

Results

The response rate for the ETELM-learner perceptions was 58% (31/53), 100% for the ETELM-instructor perceptions. Students strongly agreed that the overall quality of the teaching session and instructors was excellent. However, 32% experienced issues with audio or video quality and one remote student reported cyber sickness. The statement ‘educational activities encouraged engagement with session materials/content’ returned the most varied response. Instructors reported technological problems with delivery while using the HoloLens 2 device and environmental noise in the ward was a disruptive factor. Preparation and skilled facilitation were key to delivering a high-quality teaching session. Patients reacted generally favourably to the technology and no negative effects on interpersonal communication were identified.

Conclusion

The experience of live streamed ward rounds was well received by patients, medical students and teaching faculty. However, there remain limitations to the routine use of HoloLens 2 technology in our setting including steep learning curves, hardware costs and environmental factors such as noise and WiFi connectivity. Live streamed ward rounds have potential postpandemic implications for the judicious use of resources, and the possibility for few educationally minded clinicians to teach at scale in a patient-friendly manner.
First-line contact aspiration versus first-line stent retriever for acute posterior circulation strokes: an updated meta-analysis
Authors: Ye Gengfan , Wen Xuebin , Wang Hongcai , Sun Chengfeng , Pan Zhihao , Chen Maosong , Wang Boding , Li Zhenqiang
Published: May 2021

Background

Both stent retriever (SR) and contact aspiration (CA) are widely used as first-line strategies for acute posterior circulation strokes (PCS). However, it is still unclear how CA and SR compare as the first-line treatment of acute PCS. Several new studies have been published recently, so we aimed to perform an updated meta-analysis.

Methods

The meta-analysis was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement. Random-effects models were performed to pool the outcomes and the value of I2was calculated to assess the heterogeneity.

Results

Ten observational studies with 1189 patients were included, among whom 492 received first-line CA and 697 received first-line SR. The pooled results revealed that first-line CA could achieve a significantly higher proportion of modified Thrombolysis In Cerebral Infarction (mTICI) 2b/3 (OR 1.90, 95% CI 1.33 to 2.71, I2=0%), mTICI 3 (OR 1.95, 95% CI 1.15 to 3.31, I2=59.6%), first-pass effect (OR 2.91, 95% CI 1.51 to 5.58, I2=0%), lower incidence of new-territory embolic events (OR 0.20, 95% CI 0.05 to 0.83, I2=0%), and shorter procedure time (mean difference −29.4 min, 95% CI −46.8 to −12.0 min, I2=62.8%) compared with first-line SR. At 90-day follow-up, patients subjected to first-line CA showed a higher functional independence (modified Rankin Scale score 0–2; OR 1.38, 95% CI 1.01 to 1.87, I2=23.5%) and a lower mortality (OR 0.71, 95% CI 0.50 to 1.00, p=0.050, I2=0%) than those subjected to first-line SR.

Conclusions

This meta-analysis suggests that the first-line CA strategy could achieve better recanalization and clinical outcomes for acute PCS than first-line SR. Limited by the quality of included studies, this conclusion should be drawn with caution.
Effectiveness and safety of endovascular thrombectomy for large versus medium vessel occlusions: a single-center experience
Authors: Shek Kevin , Alcock Susan , Ghrooda Esseddeeg , Trivedi Anurag , McEachern James , Kaderali Zul , Shankar Jai
Published: May 2021

Background

The effectiveness and safety of endovascular thrombectomy (EVT) for medium vessel occlusions (MeVO) in the anterior intracranial circulation for patients with acute ischemic stroke (AIS) has yet to be definitively established. We compared outcomes in patients undergoing EVT for large vessel occlusion (LVO) versus those with MeVO.

Methods

This retrospective cohort study, using an intention to treat design, compared the 90-day modified Rankin Scale (mRS) score between 43 patients with MeVO and 199 with LVO in the anterior intracranial circulation. Secondary outcome measures included vessel recanalization using the Thrombolysis in Cerebral Infarction (TICI) score, procedural complications, post-EVT intracranial hemorrhage (ICH), and infarct size.

Results

The rate of good functional outcome (90-day mRS 0–2) was higher in patients with LVO than in those with MeVO (32.9% vs 27%), but this was not statistically significant (p=0.19). The rate of EVT procedural complications was also not significantly different between the groups (p=0.10), nor was the rate of ICH (p=0.30). There was also no significant difference in TICI scores between groups (p=0.12). Infarct size was larger in the LVO group (p<0.01). Multivariate analysis showed older age, not receiving recombinant tissue plasminogen activator (r-tPA), and larger infarct size were independent predictors of poor functional outcome at 90 days.

Conclusion

The 90-day mRS and rate of periprocedural complications were not significantly different between patients treated for LVO and those treated for MeVO with EVT. Older age, not receiving r-tPA, and larger infarct size were independent predictors of poor outcome at 90 days.
Thermal, trapped and chromo-natural inflation in light of the swampland criteria and the trans-Planckian censorship conjecture
Authors: Berera Arjun , Brandenberger Robert , Kamali Vahid , Ramos Rudnei O.
Published: May 2021

We consider thermal, trapped and chromo-natural inflation in light of the swampland criteria and the Trans-Planckian Censorship Conjecture (TCC). Since thermal inflation occurs at energies low compared to those of Grand Unification, it is consistent with the TCC, and it is also consistent with the refined swampland conditions. Trapped and chromo-natural inflation are candidates for primordial (high energy scale) inflation. Since in both of these scenarios there are effective damping terms in the scalar field equation of motion, the models can easily be consistent with the swampland criteria. The TCC, on the other hand, constrains these scenarios to only take place at low energies.
Nonperturbative aspects of spontaneous symmetry breaking
Authors: Gamboa J. , López-Sarrión J.
Published: May 2021

Spontaneous symmetry breaking is studied in the ultralocal limit of a scalar quantum field theory, that is when [Formula: see text] (or infrared limit). In this infrared approximation the theory [Formula: see text] is formally two-dimensional and its Euclidean solutions are instantons. For BPST-like solutions with [Formula: see text], the map between [Formula: see text] in two dimensions and self-dual Yang–Mills theory is carefully discussed.
Complete unification in 10d E8
Authors: Aranda Alfredo , de Anda Francisco J.
Published: May 2021

A grand unification scenario is presented that is based on quantum field theory, and where a single [Formula: see text] gauge superfield in 10 dimensions is used to obtain all the particle content of the Standard Model at low energies. The key feature of the formulation lies in the dimensional reduction used to break the gauge symmetry and to determine the low energy spectrum. It is shown that, through the orbifold [Formula: see text], and its corresponding Wilson lines, the symmetry is broken to the Standard Model one, generating a particular model that includes the Minimal Supersymmetric Standard Model spectrum. Furthermore it is also shown that the model is free of gauge anomalies at all levels by itself, i.e. without the need to include any additional representations of fields. Thus a complete unification of the Standard Model into a single gauge superfield is shown to be formally plausible. Although this paper does not include a phenomenological study of the specific model (currently being investigated), some interesting questions and observations are included as motivation for the scenario.
Reliable Part Guided Multiple Level Attention Learning for Person Re-Identification
Authors: Geng Yanbing , Lian Yongjian , Yang Shunmin , Zhou Mingliang , Cao Jingchao
Published: May 2021

Person Re-ID is challenged by background clutter, body misalignment and part missing. In this paper, we propose a reliable part-based multiple levels attention deep network to learn multiple scales salience representation. In particular, person alignment and key point detection are sequentially carried out to locate three relative stable body components, then fused attention (FA) mode is designed to capture the fine-grained salient features from effective spatial of valuable channels of each part, regional attention mode is succeeded to weight the importance of different parts for highlighting the representative parts while suppressing the valueless ones. A late fusion-based multiple-task loss is finally adopted to further optimize the valuable feature representation. Experimental results demonstrate that the proposed method achieves state-of-the-art performances on three challenging benchmarks: Market-1501, DukeMTMC-reID and CUHK03.