bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognosis and follow-up of young patients admitted to a critical coronary care unit with acute coronary syndrome
Authors: Arroyo Monino DF , Barea Gonzalez C , Ruiz Garcia MP , Seoane Garcia T , Garcia Rubira JC
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

The presence of young patients admitted to a Critical Coronary Care Unit (CCCU) with the diagnosis of Acute Coronary Syndrome (ACS) is very common nowadays. The prognosis of these patients seems to be better than the elderly ones, although there are few records that endorse this statement.

Objective

Our aim is to carry out a follow-up of this population and study their prognosis during the index hospitalization and the follo-up.

Methods

Retrospective, descriptive, unicentric and observational registry of young patients (<45 years old) admitted to one CCCU with the diagnosis of ACS between January 2.010 and November 2.020. The follow-up of these patients was performed using the electronic platform of Andalusian Health Security System.

Results

A total number of 252 patients were included in the registry, with a mean age of 40 years old, being male 206 (81,7%). The main reason of the admission was ACS with persistent ST segment elevation (STEMI) (177 patients – 70,2%). The most prevalent risk factor in this population was active smoking (198 patients – 78,6%). The main underlying mechanism of the ACS was the rupture of an atherosclerotic plaque (194 patients – 77%) and in most cases, there was only 1 coronary artery affected (153 patients – 60,7%). Intra-hospital mortality was low (2 patients died of cardiovascular cause – 0,8%, and 1 died of non-cardiovascular cause – 0,4%). Left ventricle ejection fraction (LVEF) at the discharge was preserved in 166 patients (65,9% - mean 58%), and reduced (<40%) in 37 patients (14,7%). The median of the follow-up was 77 months (minimum 1 month and maximum 132 months). A total number of 5 patients died during this follow-up (2%, 3 during the first year), 3 of them of cardiovascular cause; these 3 patients had reduced LVEF at the discharge. During this follow-up, 64 (25,4%) patients were re-admitted to the hospital due to cardiovascular causes, most of them (30 – 11,9%) with the diagnosis of chest pain and 20 of them (7,9%) with the diagnosis of a new ACS.

Conclusions

Young patients admitted to our CCCU with the diagnosis of ACS presented most frequently with STEMI, affecting predominantly one coronary artery. Most of them had preserved LVEF at the discharge. The prognosis of this group of patients is good, with a low intra-hospital mortality and during the follow-up, with clear relation with the presence of reduced LVEF at the discharge. Re-admission was relatively frequent, mostly due to chest pain.
Impact of COVID-19 pandemic on admissions and management of acute coronary syndrome: a single tertiary cardiac centre experience in the United Kingdom
Authors: Tomson J , Khanra D , Ntoskas T , Wrigley B
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction: Global reports are suggestive of decline in number of patients attending hospital with acute coronary syndromes (ACS) and a reduction in the number of cardiac procedures since the onset of COVID-19 pandemic.

Purpose

The aim of the study was to compare the trend of presentations and management among ACS patients in a single tertiary cardiac centre in the West midlands of United Kingdom (UK) during the early lock down period of COVID-19 pandemic (Group 2020) in comparison to the same period of 2019 (Group 2019).

Methods

In this descriptive study patients’ records were extracted retrospectively from the electronic database who presented with ST segment elevation myocardial infarction (STEMI), non- ST segment elevation myocardial infarction (NSTEMI) and Unstable angina (UA), during the 30 day period from mid-March to mid-April of 2020 (Group 2020), and the same period of 2019 (Group 2019).

Results

In comparison to group 2019, total number of ACS (153 vs 91) including STEMI (70 vs 59), NSTEMI (76 vs 31) and UA (7 vs 1) were lower in group 2020 (Fig 1A). Inter-hospital transfer (IHT) dropped from 2019 to 2020 (55 vs 17). In group 2020, percutaneous coronary angioplasty (PCI) for STEMI was similar to group 2019 (83.05% vs 88.57%) but PCI for NSTEMI were higher (80.65% vs 48.68%). No coronary artery bypass graft (CABG) services were available during the studied period (Fig 1B).  In terms of troponin I (Trop I) levels at the time of admission, 47.25% of all ACS presentations were over 1000ng/L in group 2020 compared to 28.76% in group 2019 (Fig 1C). On assessment of left ventricular ejection fraction (LVEF) at the time of admission, 24% of all ACS were severely impaired (LVEF < 40%) compared to 13.79% in 2019 (Fig 1D). 37 (31 IHT) patients in group 2019 and 16 (11 IHT) patients in group 2020 had no transthoracic echocardiogram data. There was an overall reduction in number of days spent in hospital per ACS patient from 4.78 days in 2019 to 3.70 days in 2020 and a further reduction for STEMI patients from 5.16 days in 2019 to 3.83 days in 2020. 5 ACS patients died in 2020 in comparison to 6 patients in 2019.

Conclusion

The reduced number of admissions is likely to be a result of nation-wide lock-down and public fear. Proportion of ACS patients with high level of troponin I values and severely impaired LVEF may be explained due to late presentation. It remains necessary to address public fear and to ensure that ACS patients are managed in accordance with ACS management guidelines even in the times of COVID-19 pandemic. Abstract Figure.
Time to awakening tendency and withdrawal of life supporting treatment (WLST) in patients treated with therapeutic hypothermia after cardiac arrest
Authors: Rivadeneira Ruiz M , Olivares Martinez B , Seoane Garcia T , Arroyo Monino DF , Altarejos Salido F , Garcia Rubira JC
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction and objectives

Treatment with therapeutic hypothermia after cardiac arrest remains controversial. It is still unclear how long it takes these patients to recover neurological responsiveness, and the time until awakening varies widely. The aim of our study was to identify the patients who had a later awakening and the factors related to late post-arrest awakening.

Methods

We performed a retrospective analysis of patients admitted in the Coronary Care Unit between 2006 and 2020 after a cardiac arrest. Patients were eligible if they remained comatose after return of spontaneous circulation (ROSC), with a Glasgow Coma Scale less than 10. We measured the time until awakening, defined as obedience to verbal commands.

Results

Amongst 271 cardiac arrest survivors, 182 remained comatose. Mean age was 65,8 ± 0,98 and there were 29% of females. 70 patients (38,5%) were treated with therapeutic hypothermia with a target temperature of 33ºC using an endovascular device. 60 patients (33%) awakened and median time of awakening was 4 days. The tendency of the awakening was similar if the patient was or not cooled before (Figure1: median: 4, p25: 3, p75: 6). 18 patients (30%) regained neurological responsiveness 5 days after cardiac arrest without differences between groups (p >0,001) (Figure 2: 28,2% cooling group versus 33,3% no control temperature group). We did not find variables associated with a later awakening in the multiple logistic regression analysis adjusted for age, sex, hospital admission year, initial rhythm and Glasgow Scale, and therapeutic hypothermia use.

Conclusions

The main cause of mortality after a cardiac arrest is the withdrawal of life support treatment. In our cohort, one third of the patients were late awakaners. Therefore, and in consistency with previous reports, we consider that the observation period to assess the neurological outcome should be extended to more than five days before WLST. Abstract Figure 1 and 2
Early vs late development of acute kidney injury and its prognostic relevance in ACS patients
Authors: Sara B , Monteiro JJ , Carvalho P , Ribeiro Carvalho C , Chemba J , Ferreira C , Moreira JI
Published: April 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Acute kidney injury (AKI) in acute coronary syndrome (ACS) patients is a well-known marker of worse prognosis. However, it remains unclear how timing of AKI development correlates with mortality and morbidity;

Objective

Assess the timing of AKI development and evaluate its short and long term prognostic impact.

Methods

Retrospective study of patients with ACS periodically included in our center registry between March/2013 and December/2018. AKIwas defined as increase in creatinine ≥0.3 mg/dl or ≥50% within 48 h after admission. Patients were classified into 3 groups according to the occurrence and timing of AKI development : no-AKI(NA), early-AKI(EA)(<48h) and late-AKI(LA) (>48 h). The primary endpoints were all cause mortality and a composite of all cause mortality, nonfatal myocardial infarction/stroke and readmission in the follow-up.

Results

We included 518 patients (67 ± 13 years; 73% males, 46% STEMI) of whom 17% developed AKI(8% EA and 9% LA). Patients with AKI, particularly EA, were older (NA: 67± 17; EA 80± 12; LA 74 ± 16, p< 0.001), had more hypertension, previous heart failure (9% vs 1.5%, p < 0.001) and dementia (7 vs 0.5%, p < 0.001). Coronariograhy was performed more often in NA patients (98%), followed by LA (100%) and lastly EA (87.5%), p < 0.001. During hospitalization, those who developed AKI had a higher Killip Kimball class (p = 0.043) and lower ejection fraction (EF) (p = 0.05). In-hospital mortality was significantly higher in patients with EA (12,5%) than LA (2.2%) or LA (2.3%)( p= 0.029) ; During a median follow-up of 35 months, the composite endpoint was particularly higher in the EA group, but no differences were found between LA and NA group. In multivariate analysis, only EA was an independent predictor of all-cause mortality (HR: 3.8 IC 95% 1.8-8.1, p = 0.001) and composite endpoint (HR:2.02 IC95%1.1-3.8; p = 0.032), even after adjusting for age, EF and Killip Kimball class;

Conclusion

In this population of ACS patients, AKI is a frequent complication and the timing of its development has major prognostic implications, since early AKI(<48h) is associated with worse outcomes. Curiously, mortality and CV events in patients with LA are not different from those who do not develop AKI.
Ageing forests and carbon storage: a case study in boreal balsam fir stands
Authors: Harel Antoine , Thiffault Evelyne , Paré David
Published: April 2021

The pattern of change in carbon (C) accumulation with forest ageing can vary greatly amongst different forest types. Documenting how C accumulates in various forest ecosystems in the absence of logging makes it possible to predict what would be the outcome of extending forest rotations or in dedicating more land to conservation on C storage. This study was conducted in boreal balsam fir (Abies balsamea (L.) Mill.) forests of Quebec, in eastern Canada. We compared carbon stocks in forest pools (aboveground (live) biomass, deadwood, FH horizon and mineral soil) of mature (70 years after harvest) vs old-growth stands (stands with no signs or history of human disturbance). Total ecosystem C stocks were not significantly different between mature and old-growth stands. However, as mature stands transition to old-growth stage, there appears to be a shift of C from live biomass pools towards deadwood and soil FH horizons. Coarse woody debris in old-growth stands were also found to be at more advanced stages of decay. The variability of C stocks was also high amongst old-growth stands; however, there was no obvious difference in structural diversity between mature and old-growth stands. Results suggest that ageing balsam fir stands through the lengthening of forest rotations (e.g. past the maturity age of 70 years) or by placing them under conservation, while not creating an important C sink, still contributes to maintain large forest C stocks across landscapes. Preserving or increasing the presence of old-growth forests is an important aspect of ecosystem-based forest management; our study concludes that it could also be compatible with sustainable forest carbon management.
Multimodal Integration Across Spatiotemporal Scales to Guide Invertebrate Locomotion
Authors: Mongeau Jean-Michel , Schweikert Lorian E , Davis Alexander L , Reichert Michael S , Kanwal Jessleen K
Published: April 2021

Synopsis

Locomotion is a hallmark of organisms which has enabled adaptive radiation to an extraordinarily diverse class of ecological niches, and allows animals to move across vast distances. Sampling from multiple sensory modalities enables animals to acquire rich information to guide locomotion. Locomotion without sensory feedback is haphazard; therefore, sensory and motor systems have evolved complex interactions to generate adaptive behavior. Notably, sensory-guided locomotion acts over broad spatial and temporal scales to permit goal-seeking behavior, whether to localize food by tracking an attractive odor plume or to search for a potential mate. How does the brain integrate multimodal stimuli over different temporal and spatial scales to effectively control behavior? In this review, we classify locomotion into three ordinally ranked hierarchical layers that act over distinct spatiotemporal scales: stabilization, motor primitives, and higher-order tasks, respectively. We discuss how these layers present unique challenges and opportunities for sensorimotor integration. We focus on recent advances in invertebrate locomotion due to their accessible neural and mechanical signals from the whole brain, limbs, and sensors. Throughout, we emphasize neural-level description of computations for multimodal integration in genetic model systems, including the fruit fly, Drosophila melanogaster, and the yellow fever mosquito, Aedes aegypti. We identify that summation (e.g., gating) and weighting—which are inherent computations of spiking neurons—underlie multimodal integration across spatial and temporal scales, therefore suggesting collective strategies to guide locomotion.
Modified capitonnage technique for giant pulmonary hydatid cyst surgery
Authors: Aydin Yener , Ulas Ali Bilal , Ince Ilker , Kuran Emre , Keskin Hilmi , Kirimli Sevde Nur , Kasali Kamber , Ogul Hayri , Eroglu Atilla
Published: April 2021

OBJECTIVES

This study investigated the effectiveness of the modified technique (Aydin Technique), which was applied for capitonnage in the surgical treatment of giant pulmonary hydatid cysts.

METHODS

Twenty-two cases were operated on for giant hydatid cysts with a total of 23 modified techniques for capitonnage (bilateral giant hydatid cyst in 1 case) in our clinic between January 2018 and December 2020. The demographic data were recorded.

RESULTS

Thirteen out of 22 (59.1%) of cases were male and 9 (40.9%) were female. The mean age was 22.0 ± 15.8 and 14 cases (63.6%) were children. Hydatid cysts were intact in 13 (56.5%) cases and ruptured in 10 (43.5%) cases. Hydatid cyst diameters were on average 123 ± 21 mm. A modified method was performed for capitonnage in all cases while decortication was performed in 2 (8.7%) cases due to pleural thickening. Radiological atelectasis was observed in 6 cases (27.3%) postoperatively. The patients with atelectasis recovered without any clinical problem and no intervention was needed. In 1 case, an infection developed at the incision site. Postoperative prolonged air leak, empyema and mortality were not observed in any of the cases. The postoperative mean length of hospital stay was 7.18 ± 2.15 days. The mean follow-up period was 19.5 ± 11.5 months. No recurrence was encountered in the follow-up of the patients.

CONCLUSIONS

The results of this study may suggest to perform this new-described modified Aydin technique to avoid major capitonnage complications of the giant pulmonary hydatid cyst surgery.
Effect of COVID-19 on hospital visits in Ningbo, China: an interrupted time-series analysis
Authors: Yang Zong-ming , Wu Meng-yin , Lu Jie-ming , Li Tie-zheng , Shen Peng , Tang Meng-ling , Jin Ming-juan , Lin Hong-Bo , Shui Li-ming , Chen Kun , Wang Jian-bing
Published: April 2021

Objective

Unprecedented rigorous public health measures were implemented during the coronavirus disease 2019 (COVID-19) epidemic, but it is still unclear how the intervention influenced hospital visits for different types of diseases. We aimed to evaluate the impact of the intervention on hospital visits in Yinzhou District, Ningbo, Zhejiang province, China.

Methods

We conducted an interrupted time-series analysis from 1 January 2017 to 6 September 2020 based on the Yinzhou Health Information System in Ningbo, Zhejiang province. The beginning of the intervention was on 23 January 2020, and thus, there were 160 weeks before the intervention and 32 weeks after the implementation of the intervention. Level changes between expected and observed hospital visits in the post-intervention period were estimated using quasi-Poisson regression models.

Results

Compared with the expected level, there was an estimated decrease of −22.60% (95% confidence interval (CI): −27.53%, −17.36%) in the observed total hospital visits following the intervention. Observed hospital visits for diseases of the respiratory system were found to be decreased dramatically (−62.25%; 95% CI: −65.62%, −58.60%). However, observed hospital visits for certain diseases were estimated to be increased, including diseases of the nervous system (+11.17%; 95% CI: +3.21%, +19.74%); diseases of pregnancy, childbirth and the puerperium (+27.01%; 95% CI: +17.89%, +36.85%); certain conditions originating in the perinatal period (+45.05%; 95% CI: +30.24%, +61.56%); and congenital malformation deformations and chromosomal abnormalities (+35.50%; 95% CI: +21.24%, +51.45%).

Conclusions

Our findings provided scientific evidence that cause-specific hospital visits evolve differently following the intervention during the COVID-19 epidemic.
Gut microbiome and resistome changes during the first wave of the COVID-19 pandemic in comparison with pre-pandemic travel-related changes
Authors: Peng Ye , Zhang Dengwei , Chen Ting , Xia Yankai , Wu Peng , Seto Wai-Kay , Kozyrskyj Anita L , Cowling Benjamin J , Zhao Jincun , Tun Hein M
Published: April 2021

COVID-19-associated measures had a greater impact on gut microbiota, antibiotic resistance genes and biocide resistance genes than did pre-pandemic international travel. During the COVID-19 pandemic, Actinobacteria richness decreased, whereas genes conferring resistance to beta-lactam, polystyrene and phthalate increased. Such alterations may affect both colonization resistance and acquisition and spread of antimicrobial resistance in future travels.
Mol* Viewer: modern web app for 3D visualization and analysis of large biomolecular structures
Authors: Sehnal David , Bittrich Sebastian , Deshpande Mandar , Svobodová Radka , Berka Karel , Bazgier Václav , Velankar Sameer , Burley Stephen K , Koča Jaroslav , Rose Alexander S
Published: April 2021

Large biomolecular structures are being determined experimentally on a daily basis using established techniques such as crystallography and electron microscopy. In addition, emerging integrative or hybrid methods (I/HM) are producing structural models of huge macromolecular machines and assemblies, sometimes containing 100s of millions of non-hydrogen atoms. The performance requirements for visualization and analysis tools delivering these data are increasing rapidly. Significant progress in developing online, web-native three-dimensional (3D) visualization tools was previously accomplished with the introduction of the LiteMol suite and NGL Viewers. Thereafter, Mol* development was jointly initiated by PDBe and RCSB PDB to combine and build on the strengths of LiteMol (developed by PDBe) and NGL (developed by RCSB PDB). The web-native Mol* Viewer enables 3D visualization and streaming of macromolecular coordinate and experimental data, together with capabilities for displaying structure quality, functional, or biological context annotations. High-performance graphics and data management allows users to simultaneously visualise up to hundreds of (superimposed) protein structures, stream molecular dynamics simulation trajectories, render cell-level models, or display huge I/HM structures. It is the primary 3D structure viewer used by PDBe and RCSB PDB. It can be easily integrated into third-party services. Mol* Viewer is open source and freely available at https://molstar.org/.
DeepGOWeb: fast and accurate protein function prediction on the (Semantic) Web
Authors: Kulmanov Maxat , Zhapa-Camacho Fernando , Hoehndorf Robert
Published: April 2021

Understanding the functions of proteins is crucial to understand biological processes on a molecular level. Many more protein sequences are available than can be investigated experimentally. DeepGOPlus is a protein function prediction method based on deep learning and sequence similarity. DeepGOWeb makes the prediction model available through a website, an API, and through the SPARQL query language for interoperability with databases that rely on Semantic Web technologies. DeepGOWeb provides accurate and fast predictions and ensures that predicted functions are consistent with the Gene Ontology; it can provide predictions for any protein and any function in Gene Ontology. DeepGOWeb is freely available at https://deepgo.cbrc.kaust.edu.sa/.
The long and the short of it: unlocking nanopore long-read RNA sequencing data with short-read differential expression analysis tools
Authors: Dong Xueyi , Tian Luyi , Gouil Quentin , Kariyawasam Hasaru , Su Shian , De Paoli-Iseppi Ricardo , Prawer Yair David Joseph , Clark Michael B , Breslin Kelsey , Iminitoff Megan , Blewitt Marnie E , Law Charity W , Ritchie Matthew E
Published: April 2021

Application of Oxford Nanopore Technologies’ long-read sequencing platform to transcriptomic analysis is increasing in popularity. However, such analysis can be challenging due to the high sequence error and small library sizes, which decreases quantification accuracy and reduces power for statistical testing. Here, we report the analysis of two nanopore RNA-seq datasets with the goal of obtaining gene- and isoform-level differential expression information. A dataset of synthetic, spliced, spike-in RNAs (‘sequins’) as well as a mouse neural stem cell dataset from samples with a null mutation of the epigenetic regulator Smchd1 was analysed using a mix of long-read specific tools for preprocessing together with established short-read RNA-seq methods for downstream analysis. We used limma-voom to perform differential gene expression analysis, and the novel FLAMES pipeline to perform isoform identification and quantification, followed by DRIMSeq and limma-diffSplice (with stageR) to perform differential transcript usage analysis. We compared results from the sequins dataset to the ground truth, and results of the mouse dataset to a previous short-read study on equivalent samples. Overall, our work shows that transcriptomic analysis of long-read nanopore data using long-read specific preprocessing methods together with short-read differential expression methods and software that are already in wide use can yield meaningful results.
O06 Baseline predictors of methotrexate-related adverse events in methotrexate-naïve patients with RA
Authors: Sherbini Ahmad A , Gwinnutt James M , Hyrich Kimme L , Verstappen Suzanne M M ,   RAMS Co-Investigators
Published: April 2021

Background/Aims 

Methotrexate (MTX) is the most common treatment for rheumatoid arthritis (RA). The prevalence of adverse events (AEs) associated with MTX treatment for RA have been studied extensively, but there are limited data on the predictors of these AEs. This study aims to summarise the prevalence rates of MTX AEs, including gastrointestinal (GI), neurological, mucocutaneous, and elevated alanine transaminase (ALT) enzyme, and to identify baseline demographic and clinical predictors of these AEs.

Methods 

The Rheumatoid Arthritis Medication Study (RAMS) is a UK multi-centre prospective cohort study of patients with RA starting MTX for the first time. Relevant demographic, medication, clinical and disease related data were collected at baseline. AEs were reported at six and twelve months follow-ups. The prevalence rates of AEs were calculated based on the proportions of patients who reported having had an AE within one year of follow-up. The associations between candidate baseline predictors and AEs were assessed using multivariable logistic regression.

Results 

A total of 2,089 patients were included with a mean age of 58.4 (standard deviation: 13.5) years, 1390 (66.5%) were women. 1,814 and 1,579 patients completed the 6 and 12 months follow-up visits, respectively. The prevalence rates of the AEs within one year of follow-up were: GI = 777 (40.6%), mucocutaneous = 441 (23.1%), neurological = 487 (25.5%), elevated ALT (> upper limit of normal [ULN]) = 286 (15.5%). Younger age and being a woman were associated with increased risk of GI AEs, (age: OR 0.97 per year increase in age, 95% CI 0.98, 1.00; male sex: OR 0.58 vs female, 95% CI 0.46, 0.74) (Table 1). Higher baseline Health Assessment Questionnaire (HAQ) score was an independent predictor of GI, mucocutaneous, and neurological AEs. Furthermore, having ALT >1xULN at baseline or history of diabetes was associated with increased risk of subsequent ALT elevation during the study follow-up.

Conclusion 

In patients with RA starting MTX, GI AEs were the most commonly reported AEs during the first year of follow-up. The identified predictors of AEs may facilitate discussions between clinicians and patients prior to commencing MTX, and may lead to increased adherence and consequently improved effectiveness.

Disclosure 

A.A. Sherbini: None. J.M. Gwinnutt: Grants/research support; BMS. K.L. Hyrich: Member of speakers’ bureau; Abbvie. Grants/research support; Pfizer, UCB, BMS. S.M.M. Verstappen: Consultancies; Celltrion. Member of speakers’ bureau; Pfizer. Grants/research support; BMS.
O11 Examining BASDAI by gender: differing scores, but similar patterns of disease
Authors: Maguire Sinead , Gallagher Phil , O'Shea Finbar
Published: April 2021

Background/Aims 

Research has shown that females with axial spondyloarthritis (axSpA) score worse on patient reported outcomes (PROs) than males. However, this does not always correlate to worse clinical findings. The purpose of this study was to understand why women with axSpA have worse BASDAI scores than men, by examining how both genders score across the components of the BASDAI. The Ankylosing Spondylitis Registry of Ireland (ARSI) is a national registry on patients with axSpA in Ireland and a source of epidemiological data.

Methods 

Analysis of the ASRI was preformed using IBM SPSS version 26. Patients were analysed on the basis of gender. Comparison of baseline characteristics and mean BASMI, BASFI, HAQ and ASQoL were tested for significance using an independent two tailed t-test and a Mann Whitney U test. Mean total BASDAI score and mean score for each component of the BASDAI were compared and tested for significance with the same statistical tests. A chi-squared test for independence was used to determine significance in variation of HLA-B27 status and radiographic findings.

Results 

A total of 857 patients were included in the analysis. Patient population was 24.9% (213) female and 75.1% (644) male with a mean age of 45.9 years and mean disease duration of 19.4 years (means: BASDAI 4.02, BASMI 4, BASFI 3.67, HAQ 0.53, ASQoL 6.48). Females had worse BASDAI(4.6 vs 3.83, p < 0.01), HAQ(0.6 vs 0.51, p = 0.03) and ASQoL scores (7.62 vs 6.12, p < 0.01) than males. BASFI scores were worse in females which did not reach significance (3.89 vs 3.63, p = 0.26). However, females had significantly better BASMI scores than males (3.51 vs 4.16, p < 0.01). Within the BASDAI, females scored significantly worse than males across all components (Fatigue: 5.56 vs 4.51, p < 0.01; Spinal pain: 5.51 vs 4.63, p < 0.01; Other pain: 3.82 vs 3.19, p = 0.01; Discomfort: 4.05 vs 3.29, p < 0.01; EMS: 4.55 vs 3.94, p = 0.01), however duration of EMS did not reach significance (3.54 vs 3.12, p = 0.07)(table 1). Within the BASDAI, females recorded highest mean scores for fatigue (5.56), while males recorded highest mean scores for spinal pain(4.63). Lowest mean scores for both genders was for EMS duration (3.54 vs 3.12). Ranking of the BASDAI components by mean scores show similarity in the ranking of discomfort, EMS, other pain and EMS duration.

Conclusion 

AxSpA females have consistently worse PROs but have better spinal mobility than males. Despite females recording worse BASDAI scores than males, the pattern of disease activity manifestation is similar in 4 of the 6 components of the BASDAI. However, fatigue is the most problematic symptom in females with active axSpA while spinal pain is the most problematic symptom for males. This variation by gender should be kept in consideration when evaluating a patient with suspected active axSpA.

Disclosure 

S. Maguire: None. P. Gallagher: None. F. O'Shea: None.
O15 Using a smartphone app to characterise and quantify skin colour changes in Raynaud's attacks
Authors: Dinsdale Graham , Manning Joanne , Herrick Ariane , Dickinson Mark , Taylor Christopher
Published: April 2021

Background/Aims 

The lack of objective outcome measures for Raynaud's phenomenon (RP) has been a major limiting factor in development of effective treatments. At present, the Raynaud's Condition Score (RCS) is the only validated outcome measure, and is highly subjective. Mobile phone technology could provide a way forward. We have developed a smartphone app for RP monitoring that guides the patient through the process of capturing images of their hands during RP episodes, as well as capturing other data through post-attack and daily questionnaires. One of the objectives of our research programme (reported here) was to compare digital image (photographic) parameters to the RCS.

Methods 

40 patients with RP (8 with primary RP, 32 with RP secondary to systemic sclerosis) were recruited (40 female, median age (range): 57 years (25-74), median (range) duration of RP symptoms: 17 (0-53) years). Patients were given a smartphone handset with a pre-installed Raynaud’s Monitoring app and were trained on how to use it/take usable photographs. They were then asked to take photographs of RP attacks over a 14 day period and also to record the RCS for each episode. The app specifically prompts the patient to take a picture of their hand every minute during an attack, until confirmation is given that the attack is complete. At a 2nd visit, the handsets, images, and data were collected for analysis. The mean colour change during each RP attack was quantified (semi-automated method) by the Bhattacharyya distance (BD) in colour space between a region of interest (e.g. a section of a digit) and a control region (dorsal hand). BD was then compared to the RCS using ANOVA, after controlling for patient variability in the range of RCS values used by each patient.

Results 

A total of 3,030 images were collected, describing 229 RP attacks. The median RCS reported was 6 (inter-quartile range [IQR]: 4), while the median for BD was 5.6 (IQR 3.2). ANOVA showed that measured values of the mean image BD were significantly different when different values of RCS were recorded by the patient (p < 0.001), i.e. attacks where patients selected different values of RCS had significantly different values of BD. Across all attacks/patients the F-value from ANOVA for RCS was 76.2, suggesting that the variation in BD for different values of RCS is much greater than the variation in BD for any one value of RCS.

Conclusion 

Patients successfully used a smartphone app to collect photographs and data during episodes of RP. A strong association was found between skin colour change (via BD) and the gold-standard RCS. Mobile phone-documented colour change therefore has potential as an objective measure of RP. Further validation work is now required, as well as studies examining sensitivity to change.

Disclosure 

G. Dinsdale: None. J. Manning: None. A. Herrick: None. M. Dickinson: None. C. Taylor: None.
P012 Raynaud's phenomenon: a primary care problem?
Authors: Winstone Katie E , Anderson Marina E , Stickland Anna E
Published: April 2021

Background/Aims 

Despite an established awareness of Raynaud’s phenomenon (RP), defined as an episodic vasospasm of the arteries in the extremities, no studies have yet described the way in which the phenomenon is assessed and managed within a primary care setting. The primary aim of this study is to evaluate the way in which Raynaud’s Phenomenon commonly presents, is investigated, and managed within a UK general practice (GP); auditing concordance with the National Institute for Health and Care Excellence (NICE) Clinical Knowledge Summary (CKS) 2020 guidance.

Methods 

An audit of 79 patients with a coded diagnosis of RP was completed at Green Lane Medical Centre, a Merseyside General Practice. Patient care was audited against standards within the NICE CKS.

Results 

The patient group was comprised of 53 females (67.1%) and 26 males (32.9%). 89.9% (71/79) of patients have a working diagnosis of primary RP. Patient age at the time of audit: 4% aged 0-18; 29% aged 19-45; 30% aged 46-60; 37% aged 60+. 59.5% (47/79) of patients had 2 or more troubling symptoms of RP documented by their GP, with 12.7% (10/79) describing a classic triphasic colour change. Examination findings were documented for 55.7% (44/79) of patients and 27.9% (22/79) received an autoantibody screen. 26.6% (21/79) of patients were referred to secondary care, with 42.9% (9/21) of these referrals specifying an intention to rule out Secondary RP. Documentation available regarding patient management indicated that conservative advice was provided to 62.5% (40/64) of patients, the most common being a patient information sheet (26/64). Medical management was offered to 39.1% (25/64) of patients but was declined by 24.0% (6/25) of those to whom it was offered, with most (16/19) patients who were commenced on medical therapy discontinuing by the time of audit. In secondary care, 81.0% (17/21) of referred patients had further investigations, 57.1% (12/21) received reassurance before or after the investigations and conservative advice was the most common management.

Conclusion 

This study suggests that GPs play a major role in the assessment and management of patients with RP; 73.4% (58/79) of patients were not referred to secondary care. Of those that were referred, the majority were due to worsening or severe symptoms, or suspected secondary RP, in line with the CKS guidance. Most patients present with 2 or more of the symptoms described in the NICE CKS guidance and the use of examination and screening blood tests in primary care appears to be the mainstay of assessment. In accordance with the CKS guidance, most patients are provided with information and lifestyle advice. High rates of medical therapy discontinuation suggest that assessment of severity of symptoms and improved patient education of medication side effects may play a role in determining the most appropriate candidates for medical therapy.

Disclosure 

K.E. Winstone: None. M.E. Anderson: None. A.E. Stickland: None.
P111 Osteoporosis is a significant predictor of frailty in older community dwelling adults: findings from the Hertfordshire Cohort Study
Authors: Laskou Faidra , Jameson Karen , Dennison Elaine
Published: April 2021

Background/Aims 

Frailty is associated with a range of adverse health outcomes, including falls and fractures. Previous work in a Japanese cohort found that the presence of both osteoporosis (OP) and sarcopenia (SP) increased the risk of frailty compared to the presence of OP or SP alone. We examined these relationships in a comparable cohort of community dwelling older people in the UK.

Methods 

Our study comprised of 432 participants (216 men and 216 women) of the UK the Hertfordshire Cohort Study (HCS). Participants were assessed at baseline and followed up 5 years later with questionnaires, clinical examination, measures of physical performance and grip strength. Proximal femur bone mineral density (BMD) values were determined using dual-energy X-ray absorptiometry. OP was defined at BMD T- scores < = -2.5 at the femoral neck or use of anti-osteoporosis medication. Cut-offs for low grip strength; <30kg for men and <20kg for women and ALM index < =7.23kg/m2 for men, < =5.67kg/m2 for women, were used to define SP. Frailty was defined using the Fried definition. Logistic regressions were performed to analyse associations of OP/SP as explanatory variables for frailty.

Results 

The mean (SD) age of participants was 75.7 (2.6) years. At baseline, the prevalence of frailty and pre-frailty was 12.2% (men, 8%, women, 16.3 %), and 57% (men, 55.7%; women, 58.2%) respectively. Individuals living with frailty were older, tended to drink less alcohol, have lower physical activity, lower walking speed and grip strength (P < 0.001). They were more likely to be female compared to non-frail subjects (P = 0.007). Co-existence of SP, OP and frailty was observed in 0.6% of the population; 0.6% had SP and frailty; 1.6% had OP and frailty and 1.6% of the study population had SP and OP. 71.8% did not have SP, OP or frailty at baseline. SP was significantly associated with frailty at baseline (p < 0.001). The cumulative incidence of frailty during the 5-year period was 2.47% /year (2.13%/year in men, 2.89%/year in women) and that of SP was 2.14%/year (2.84% in men, 1.35%/year in women). The presence of OP at baseline was a significant predictive factor for the occurrence of frailty at follow-up (odds ratio [OR], 3.04; 95% confidence interval [95% CI], 1.11,8.38; P = 0.031), while the risk of developing frailty was also increased in those participants who were both osteoporotic and sarcopenic at baseline; though this was not significant (OR; 10.08, 95% CI,0.55,186.08; P = 0.12).

Conclusion 

Our findings demonstrate that the presence of OP is a significant predictive factor for developing frailty and might be used as a trigger for appropriate interventions to reduce or reverse its development in older adults. Our findings are in accordance with the previous reports in Asian populations and warrant further investigation in other national cohorts.

Disclosure 

F. Laskou: None. K. Jameson: None. E. Dennison: None.
P113 How has COVID-19 affected the treatment of osteoporosis? The answers from a global survey
Authors: Fuggle Nicholas R , Singer Andrea , Harvey Nicholas , Reginster Jean-Yves , Cooper Cyrus , Greenspan Susan
Published: April 2021

Background/Aims 

The COVID-19 pandemic has had profound effects on the health of the global population both directly, via the sequelae of the infection, and indirectly, including the relative neglect of chronic disease management. Together the International Osteoporosis Federation and National Osteoporosis Foundation sought to ascertain the impact on osteoporosis management.

Methods 

Questionnaires were electronically circulated to a sample of members of both learned bodies and included information regarding the location and specialty of respondents, current extent of face to face consultations, alterations in osteoporosis risk assessment, telemedicine experience, alterations to medication ascertainment and delivery, and electronic health record (EHR) utilisation. Responses were collected, quantitative data analysed, and qualitative data assessed for recurring themes.

Results 

Responses were received from 209 healthcare workers from 53 countries, including 28% from Europe, 24% from North America, 19% from the Asia Pacific region, 17% from the Middle East, and 12% from Latin America. Most respondents were physicians (85%) with physician assistants, physical therapists and nurses/nurse practitioners represented in the sample. The main three specialties represented included rheumatology (40%), endocrinology (22%) and orthopaedics (15%).In terms of the type of patient contact, 33% of respondents conducted telephone consultations and 21% video consultations. Bone mineral density assessment by dual-energy x-ray absorptiometry (DXA) usage was affected with only 29% able to obtain a scan as recommended. The majority of clinicians (60%) had systems in place to identify patients receiving subcutaneous or intravenous medication, and 43% of clinicians reported difficulty in arranging appropriate osteoporosis medications during the COVID-19 crisis.

Conclusion 

To conclude through surveying a global sample of osteoporosis healthcare professionals, we have observed an increase in telemedicine consultations, delays in DXA scanning, interrupted supply of medications and reductions in intravenous medication delivery.

Disclosure 

N.R. Fuggle: None. A. Singer: None. N. Harvey: None. J. Reginster: None. C. Cooper: None. S. Greenspan: None.
On the Complexity of Resting State Spiking Activity in Monkey Motor Cortex
Authors: Dąbrowska Paulina Anna , Voges Nicole , von Papen Michael , Ito Junji , Dahmen David , Riehle Alexa , Brochier Thomas , Grün Sonja
Published: April 2021

Resting state has been established as a classical paradigm of brain activity studies, mostly based on large-scale measurements such as functional magnetic resonance imaging or magneto- and electroencephalography. This term typically refers to a behavioral state characterized by the absence of any task or stimuli. The corresponding neuronal activity is often called idle or ongoing. Numerous modeling studies on spiking neural networks claim to mimic such idle states, but compare their results with task- or stimulus-driven experiments, or to results from experiments with anesthetized subjects. Both approaches might lead to misleading conclusions. To provide a proper basis for comparing physiological and simulated network dynamics, we characterize simultaneously recorded single neurons’ spiking activity in monkey motor cortex at rest and show the differences from spontaneous and task- or stimulus-induced movement conditions. We also distinguish between rest with open eyes and sleepy rest with eyes closed. The resting state with open eyes shows a significantly higher dimensionality, reduced firing rates, and less balance between population level excitation and inhibition than behavior-related states.
Modelling the spatial distribution of mycetoma in Sudan
Authors: Hassan Rowa , Simpson Hope , Cano Jorge , Bakhiet Sahar , Ganawa Eltayeb , Argaw Daniel , Newport Melanie J , Deribe Kebede , Fahal Ahmed Hassan
Published: April 2021

Background

Mycetoma is a neglected tropical disease that is reported worldwide and Sudan has the highest reported number of mycetoma infections across the globe. The incidence, prevalence and burden of mycetoma globally are not precisely known and its risk factors remain largely unelucidated.

Methods

This study aimed to identify the environmental predictors of fungal and bacterial mycetoma in Sudan and to identify areas of the country where these niche predictors are met. Demographic and clinical data from confirmed mycetoma patients seen at the Mycetoma Research Centre from 1991 to 2018 were included in this study. Regression and machine learning techniques were used to model the relationships between mycetoma occurrence in Sudan and environmental predictors.

Results

The strongest predictors of mycetoma occurrence were aridity, proximity to water, low soil calcium and sodium concentrations and the distribution of various species of thorny trees. The models predicted the occurrence of eumycetoma and actinomycetoma in the central and southeastern states of Sudan and along the Nile river valley and its tributaries.

Conclusion

Our results showed that the risk of mycetoma in Sudan varies geographically and is linked to identifiable environmental risk factors. Suitability maps are intended to guide health authorities, academic institutes and organisations involved in planning national scale surveys for early case detection and management, leading to better patient treatment, prevention and control of mycetoma.
Genetic, bioacoustic and morphological analyses reveal cryptic speciation in the warbling vireo complex (Vireo gilvus: Vireonidae: Passeriformes)
Authors: Carpenter Amanda M , Graham Brendan A , Spellman Garth M , Klicka John , Burg Theresa M
Published: April 2021

Cryptic species are closely related taxa that are difficult to separate morphologically, but are reproductively isolated. Here we examine the warbling vireo complex (Vireo gilvus), a widespread songbird speculated to be comprised of more than one cryptic species. We included three taxa within the complex: two of the western (Vireo gilvus swainsonii and Vireo gilvus brewsteri) subspecies and the single eastern (Vireo gilvus gilvus) subspecies. We used mtDNA and microsatellite loci to assess the congruence of genetic data to the current subspecies boundaries. We then incorporated bioacoustic, morphometric and ecological niche modelling analyses to further examine differences. We found two genetic groups with mtDNA analysis, splitting eastern and western warbling vireos. Microsatellite analyses revealed four genetic groups: an eastern group, a Black Hills group and two western groups that do not agree with current western subspecies boundaries based on phenotypic data. Our results suggest that eastern and western warbling vireos have been reproductively isolated for a long period of time and therefore may be best treated as separate species. However, more research into areas of contact to examine the presence of hybridization is advised before making a taxonomic revision. Differences between the two western genetic groups appear less clear, requiring additional research.
Escaping the Classroom: Replacing Traditional Lecture With Interactive Learning Stations in Nursing Education
Authors: Stringfellow Elizabeth Joy
Published: April 2021

The daily evolution of the nursing profession has charged nurse educators to be innovative and creative in their teaching strategies, with the goal of engaging and motivating students and promoting lifelong learning. Educational escape rooms use multiple teaching/learning strategies, such as problem-based learning, flipping the classroom, and gamification, to engage learners and promote active learning. The educational escape room experience provides a way to engage and empower nursing students and assist in meeting learning objectives. This article describes an interactive educational escape activity for hematologic disorders.
Complete Fasciotomy Using a Radial Approach for Acute Forearm Compartment Syndrome: A New Technique
Authors: Abihssira Sharon , Gerosa Thibault , Masmejean Emmanuel H.
Published: April 2021

Acute forearm compartment syndrome is damaging but rare. Early treatment reduces mid and long-term sequelae. The palmar compartment is most frequently involved but the dorsal compartment and mobile wad are also at risk. Multiple fasciotomies approaches have been described but are associated with long-term complications. In particular, wound management is important. Mini-invasive techniques are not available for acute forearm compartment syndrome. Acute leg release via a single approach has been developed and proven effective. Likewise, we present a lateral S-shaped approach for fasciotomies of the 3 forearm compartments in the case of acute forearm compartment syndrome.