bluuebunny/crossref_metadata_2025 huggingface dataset:
An oversampling method for imbalanced data based on spatial distribution of minority samples SD-KMSMOTE
Authors: Yang Wensheng , Pan Chengsheng , Zhang Yanyan
Published: October 2022

With the rapid expansion of data, the problem of data imbalance has become increasingly prominent in the fields of medical treatment, finance, network, etc. And it is typically solved using the oversampling method. However, most existing oversampling methods randomly sample or sample only for a particular area, which affects the classification results. To solve the above limitations, this study proposes an imbalanced data oversampling method, SD-KMSMOTE, based on the spatial distribution of minority samples. A filter noise pre-treatment is added, the category information of the near-neighbouring samples is considered, and the existing minority class sample noise is removed. These conditions lead to the design of a new sample synthesis method, and the rules for calculating the weight values are constructed on this basis. The spatial distribution of minority class samples is considered comprehensively; they are clustered, and the sub-clusters that contain useful information are assigned larger weight values and more synthetic sample numbers. The experimental results show that the experimental results outperform existing methods in terms of precision, recall, F1 score, G-mean, and area under the curve values when the proposed method is used to expand the imbalanced dataset in the field of medicine and other fields.
Identification of chicken LOC420478 as Bucky ball equivalent and potential germ plasm organizer in birds
Authors: Klein Sabine , Dosch Roland , Altgilbers Stefanie , Kues Wilfried A.
Published: October 2022

Bucky ball was identified as germ plasm organizer in zebrafish and has proven crucial for Balbiani body condensation. A synteny comparison identified an uncharacterized gene locus in the chicken genome as predicted avian counterpart. Here, we present experimental evidence that this gene locus indeed encodes a ‘Bucky ball’ equivalent in matured oocytes and early embryos of chicken. Heterologous expression of Bucky ball fusion proteins both from zebrafish and chicken with a fluorescent reporter revealed unique patterns indicative for liquid–liquid phase separation of intrinsically disordered proteins. Immuno-labeling detected Bucky ball from oocytes to blastoderms with diffuse distribution in matured oocytes, aggregation in first cleavage furrows, and co-localization to the chicken vasa homolog (CVH). Later, Bucky ball translocated to the cytoplasm of first established cells, and showed nuclear translocation during the major zygotic activation together with CVH. Remarkably, during the phase of area pellucida formation, Bucky ball translocated back into the cytoplasm at stage EGK VI, whereas CVH remained within the nuclei. The condensation of Bucky ball and co-localization with CVH in cleavage furrows and nuclei of the centrally located cells strongly suggests chicken Bucky ball as a germ plasm organizer in birds, and indicate a special importance of the major zygotic activation for germline specification.
Identifying the long-term survival beneficiary of chemotherapy for stage N1c sigmoid colon cancer
Authors: Liu Shan , Lin Yaobin , Huang Sihan , Xue Shufang , Huang Ruoyao , Chen Lu , Wang Chengyi
Published: October 2022

Sigmoid colon cancer often has an unsatisfactory prognosis. This study explored the effect of tumor deposits (TDs) on survival, and whether their presence/absence influence individualized treatment. Data of postoperative patients with sigmoid colon cancer were extracted from the Surveillance, Epidemiology, and End Results database. Overall survival (OS) was calculated using the Kaplan–Meier method and prognostic factors were identified using Cox regression analysis and random forest (RF). The nomogram's discrimination performance was evaluated using a concordance index (C-index), integrated discrimination improvement (IDI), calibration curves, and decision-curve analysis. The N1c group showed a worse prognosis than the N0 group. For N1c patients, a combination of surgery and chemotherapy prolonged survival, compared to surgery alone; however, the chemotherapy-surgery combination did not affect the OS of patients younger than 70 years, in stage T1–2, and/or of black race. Multivariable analysis and RF presented Age, T stage, and N stage were the most important predictors for OS. The novel nomogram had superiority to the TNM staging system with improved C-index and IDI, as well as good consistency and higher clinical benefit. TDs are associated with poor survival from sigmoid colon cancer, and considering TDs can inform the formulation of individual treatment regimens. The nomogram shows satisfactory prediction ability for OS.
Systematic analysis of the test design and performance of AI/ML-based medical devices approved for triage/detection/diagnosis in the USA and Japan
Authors: Yuba Mitsuru , Iwasaki Kiyotaka
Published: October 2022

The development of computer-aided detection (CAD) using artificial intelligence (AI) and machine learning (ML) is rapidly evolving. Submission of AI/ML-based CAD devices for regulatory approval requires information about clinical trial design and performance criteria, but the requirements vary between countries. This study compares the requirements for AI/ML-based CAD devices approved by the US Food and Drug Administration (FDA) and the Pharmaceuticals and Medical Devices Agency (PMDA) in Japan. A list of 45 FDA-approved and 12 PMDA-approved AI/ML-based CAD devices was compiled. In the USA, devices classified as computer-aided simple triage were approved based on standalone software testing, whereas devices classified as computer-aided detection/diagnosis were approved based on reader study testing. In Japan, however, there was no clear distinction between evaluation methods according to the category. In the USA, a prospective randomized controlled trial was conducted for AI/ML-based CAD devices used for the detection of colorectal polyps, whereas in Japan, such devices were approved based on standalone software testing. This study indicated that the different viewpoints of AI/ML-based CAD in the two countries influenced the selection of different evaluation methods. This study’s findings may be useful for defining a unified global development and approval standard for AI/ML-based CAD.
3D measurement techniques for the hindfoot alignment angle from weight-bearing CT in a clinical population
Authors: Pavani Chiara , Belvedere Claudio , Ortolani Maurizio , Girolami Mauro , Durante Stefano , Berti Lisa , Leardini Alberto
Published: October 2022

Cone-beam CT (CBCT) scans now enable accurate measurements on foot skeletal structures with the advantage of observing these in 3D and in weight-bearing. Among the most common skeletal deformities, the varus/valgus of the hindfoot is the most complex to be represented, and a number of measure proposals have been published. This study aims to analyze and to compare these measurements from CBCT scans in a real clinical population with large such deformity. Ten patients with severe acquired adult flatfoot and indication for surgery underwent CBCT scans (Carestream, USA) while standing on that leg, before and after surgical correction. Corresponding 3D shape of each bone of the distal shank and hindfoot were defined (Materialise, Belgium). Six different techniques from the literature were used to calculate the varus/valgus deformity, i.e. the inclination of the hindfoot in the frontal plane of the shank. Standard clinical measurements by goniometers were taken for comparison. According to these techniques, and starting from a careful 3D reconstruction of the relevant foot skeletal structures, a large spectrum of measurements was found to represent the same hindfoot alignment angle. Most of them were very different from the traditional clinical measures. The assessment of the pre-operative valgus deformity and of the corresponding post-operative correction varied considerably. CBCT finally allows 3D assessment of foot deformities in weight-bearing. Measurements from the different available techniques do not compare well, as they are based on very different approaches. It is recommended to be aware of the anatomical and functional concepts behind these techniques before clinical and surgical conclusions.
DEB-TACE combined with hepatic artery infusion chemotherapy might be an affordable treatment option for advanced stage of HCC
Authors: Kondo Yasuteru , Morosawa Tatsuki , Minami Soichiro , Tanaka Yasuhito
Published: October 2022

Alternative treatment modalities are necessary because of the low response rates and unsuitability of molecular-targeted agents (MTA) and/or immune checkpoint inhibitors (iCIs) in HCC patients. Therefore, we analyzed whether drug-eluting beads (DEB)-transcatheter arterial chemoembolization (TACE) with low-dose-FP (Ultra-FP) therapy could improve the efficacy and safety of treatment in difficult-to-treat HCC patients, especially those with advanced stage HCC. From November 2017 to April 2021, 118 consecutive patients with non-resectable difficult-to-treat HCC were included in this study. All patients were treated with Ultra-FP therapy. After the weak DEB-TACE procedure, we administered low-dose FP for 2 weeks followed by resting for 4 weeks. The numbers of HCC patients CR/PR/SD/PD induced by Ultra-FP therapy were 36/52/17/13 (Modified RECIST) patients, respectively. The objective response rate of Ultra-FP therapy was 74.6% (88/118 patients). Tumor marker reduction was observed in 81.4% (96/118 patients). The objective response rate (ORR) in the HCC patients with portal vein tumor thrombosis (PVTT) was 75% (18/24 patients). Median overall survival (mOS) of all included HCC patients was 738 days. The mOS of HCC patients with PVTT (−)/PVTT (+) was 816 days/718 days. The proportion of patients based on ALBI grade system was not significantly different between pre- and after 3 course Ultra-FP therapy. Ultra-FP therapy might be an affordable treatment option for difficult-to-treat advanced HCC. ORR and overall survival after receiving Ultra-FP therapy were remarkable in comparison to various kinds of systemic therapy including MTA and iCIs.
Development of robust multifunctional CrNiCo-P/GCN catalyst for oxygen evolution reaction, electrochemical sensing, and photodegradation of roxarsone
Authors: Manavalan Shaktivel , Veerakumar Pitchaimani , Chen Shen-Ming , Karuppusamy Naveen
Published: October 2022

In this study, we designed a CrNiCo-P/GCN composite for use as a high-performance multifunctional catalyst for the oxygen evolution reaction (OER), electrochemical determination, and photodegradation of roxarsone (ROX).
Layer-by-layer assembly of CsPbX3 nanocrystals into large-scale homostructures
Authors: Cirignano Matilde , Fiorito Sergio , Barelli Matteo , Aglieri Vincenzo , De Franco Manuela , Bahmani Jalali Houman , Toma Andrea , Di Stasio Francesco
Published: October 2022

Layer-by-layer fabrication of CsPbX3 (where X = Cl, Br or I) nanocrystal films enabled by solid-state ligand exchange.
Defect-rich graphene-coated metamaterial device for pesticide sensing in rice
Authors: Xu Wendao , Wang Qi , Zhou Ruiyun , Hameed Saima , Ma Yungui , Lijuan Xie  , Ying Yibin
Published: October 2022

Sensitive and selective detection in a mixture using terahertz devices.
Impact of Obesity on Perioperative Complications on Treatment of Spinal Metastases: A Multicenter Surveillance Study from the German Spine Registry (DWG-Register)
Authors: Vinas-Rios Juan Manuel , Rauschmann Michael , Sellei Richard , Arabmotlagh Mohammad , Medina-Govea Fatima , Meyer Frerk ,   DWG-Register study group
Published: October 2022

Background The spine is a common location for the development of primary and metastatic tumors, spinal metastases being the most common tumor in the spine. Spinal surgery in obesity is challenging due to difficulties with anesthesia, intravenous access, positioning, and physical access during surgery. The objective was to investigate the effect of obesity on perioperative complications by discharge in patients undergoing surgery for spinal metastases.

Methods Retrospective analysis of data from the DWG-register on patients undergoing surgery for metastatic disease in the spine from January 2012 to December 2016. Preoperative variables included obesity (≥ 30 kg/m2), age, gender, and smoking status. In addition, the influence of pre-existing medical comorbidity was determined, using the American Society of Anesthesiologists (ASA) score.

Results In total, 528 decompressions with and without instrumentation undergoing tumor debulking, release of the neural structures, or tumor extirpation in metastatic disease of the spine were identified; 143 patients were obese (body mass index [BMI] ≥ 30 kg/m2), and 385 patients had a BMI less than 30 kg/m2. The mean age in the group with BMI 30 kg/m2 or higher (group 1) was 67 years (56.6%). In the group with BMI less than 30 kg/m2 (group 2), the mean age was 64 years. Most of the patients had preoperatively an ASA score of 3 and 4 (patients with severe general disease). The likelihood of being obese in the logistic regression model seems to be protective by 47.5-fold for blood loss 500 mL or higher. Transfusions occurred in 321/528 (60.7%) patients (group 1, n = 122 and group 2, n = 299; p = 0.04). A total of 19 vertebroplasties with percutaneous stabilization (minimally invasive spine [MIS]), 6 vertebroplasties, and 31 MIS alone were identified. The variables between these groups, with exception of preoperative status (ASA-score; p = 0.02), remained nonsignificant.

Conclusion Obese patients were predisposed to have blood loss more than 500 mL more often than nonobese patients undergoing surgery for spinal metastases but with perioperative blood transfusions, invasiveness, nor prolonged hospitalization. Early postoperative mobilization and a low threshold for perioperative venous thromboembolism (VTE) are important in obese patients to appropriately diagnose, treat complications, and minimize morbidity.
Potential L1 transfer effects in explicit and implicit knowledge of articles in L2 English
Authors: Kim Myeong Hyeon , Ionin Tania
Published: October 2022

This study investigates how L1-Korean L2-English learners perform with regard to articles in both explicit and
implicit tasks. It also examines the role of L1-transfer from Korean demonstratives to English definites in L2 article production.
21 native English speakers and 27 adult intermediate L1-Korean L2-English learners were tested. The participants completed an
elicited imitation task (EIT, implicit) and a forced-choice task (FCT, explicit). In the EIT, participants repeated sentences with
and without articles, while stating whether the sentence matched the picture. In the FCT, participants chose the correct article
for each item. The same sentences were used in both tasks. The results showed that in the FCT, learners were target-like in
anaphoric contexts, supplying the, but very frequently overused a in non-anaphoric (bridging) contexts, suggesting that they
equate definiteness with previous-mention. In the EIT, learners were less target-like than native speakers, yet the patterns of
the two groups were similar. We consider possible explanations for the different results obtained in the two tasks.
Predictive Validity of the HCR-20v3 Compared to the HCR-20v3 with the FAM in Women
Authors: Lieser Karolina , Rossdale Sapphire-Violet
Published: October 2022

Recent findings have highlighted unique risk factors for female-perpetrated violence as well as limitations in its risk assessment. To address these shortcomings, the Female Additional Manual (FAM) was designed as a complementary tool for the gender-neutral framework of the Historical, Clinical, Risk Management-20 (HCR-20). Little research has been undertaken exploring the predictive validity of the FAM, particularly when used with the most recent version of the HCR-20 (HCR-20v3), leaving equivocal evidence in regards of its use in clinical practice. The present study compared the predictive validity of the HCR-20v3 with and without the FAM for inpatient violence. The sample consisted of 42 female forensic psychiatric patients in a low to medium secure unit in the UK. Results revealed a significant difference in the predictive validity of the HCR-20v3 compared to the FAM when assessing for physical violence and no significant differences between the instruments’ validity in predicting nonphysical and any violence. In line with existing literature, the HCR-20v3 was an overall good predictor of violence. While the FAM was less accurate than the HCR-20v3 at predicting physical violence, it achieved moderate to large effect size in predicting each category of violence. The findings provide a degree of support for using the HCR-20v3 when assessing the risk of violence in women but do not demonstrate improved predictive power when adding the FAM.
Spatiotemporal distribution of size-fractioned phytoplankton in the Yalu River Estuary, China
Authors: Liu Yin , Song Lun , Song GuangJun , Wu JinHao , Wang Kun , Wang ZaoHui , Liu SuXuan
Published: October 2022

The grain size structure of phytoplankton has great influence on shellfish culture. The present study aimed to assess the spatial and temporal variation in the phytoplankton community structure in the Yalu River Estuary and to explore the relationship between the phytoplankton community structure and various environmental parameters in 2020. High-throughput sequencing was used in this study. The results showed that nanophytoplankton, especially Karlodinium veneficum, dominated the estuary throughout the year. The biomass ratio of picophytoplankton, nanophytoplankton, and microphytoplankton were 20:63:17 in spring, 30:44:26 in summer, 1:38:61 in autumn, and 2:45:53 in winter, respectively. Meanwhile, Dinophyta had the greatest biomass throughout the year, followed by Bacillariophyta. On the spatial dimension (Station average), COD, T, SST had a positive impact on total phytoplankton communities, and Dep had a negative impact. In the time dimension (Monthly average), the environmental factor that significantly controlled the phytoplankton community structure were NO2 and SST.
Sobolev embeddings into Orlicz spaces and isocapacitary inequalities
Authors: Cianchi Andrea , Maz’ya Vladimir
Published: October 2022

Sobolev embeddings into Orlicz spaces on domains in the Euclidean space or, more generally, on Riemannian manifolds are considered. Highly irregular domains where the optimal degree of integrability of a function may be lower than the one of its gradient are focused. A necessary and sufficient condition for the validity of the relevant embeddings is established in terms of the isocapacitary function of the domain. Compact embeddings are discussed as well. Sufficient conditions involving the isoperimetric function of the domain are derived as a by-product.
Application of machine learning to explore the genomic prediction accuracy of fall dormancy in autotetraploid alfalfa
Authors: Zhang Fan , Kang Junmei , Long Ruicai , Li Mingna , Sun Yan , He Fei , Jiang Xueqian , Yang Changfu , Yang Xijiang , Kong Jie , Wang Yiwen , Wang Zhen , Zhang Zhiwu , Yang Qingchuan
Published: October 2022

Fall dormancy (FD) is an essential trait to overcome winter damage and for alfalfa (Medicago sativa) cultivar selection. The plant regrowth height after autumn clipping is an indirect way to evaluate FD. Transcriptomics, proteomics, and quantitative trait locus mapping have revealed crucial genes correlated with FD; however, these genes cannot predict alfalfa FD very well. Here, we conducted genomic prediction of FD using whole-genome SNP markers based on machine learning-related methods, including support vector machine (SVM) regression, and regularization-related methods, such as Lasso and ridge regression. The results showed that using SVM regression with linear kernel and the top 3000 genome-wide association study (GWAS)-associated markers achieved the highest prediction accuracy for FD of 64.1%. For plant regrowth height, the prediction accuracy was 59.0% using the 3000 GWAS-associated markers and the SVM linear model. This was better than the results using whole-genome markers (25.0%). Therefore, the method we explored for alfalfa FD prediction outperformed the other models, such as Lasso and ElasticNet. The study suggests the feasibility of using machine learning to predict FD with GWAS-associated markers, and the GWAS-associated markers combined with machine learning would benefit FD-related traits as well. Application of the methodology may provide potential targets for FD selection, which would accelerate genetic research and molecular breeding of alfalfa with optimized FD.
Fourier Dimension Estimates for Sets of Exact Approximation Order: The Well-Approximable Case
Authors: Fraser Robert , Wheeler Reuben
Published: October 2022

We obtain a Fourier dimension estimate for sets of exact approximation order introduced by Bugeaud for certain approximation functions $\psi $. This Fourier dimension estimate implies that these sets of exact approximation order contain normal numbers.
Incidental discovery of desmoid-type fibromatosis encapsulating granular cell tumor in a neck mass
Authors: Qureshi Abid , Andrade Roberto , Saavedra Jonathan , Xiao Philip , Asarian Armand
Published: October 2022

Multiple primary cancers are defined as primary malignant tumors of different histological origins in one person. Desmoid-type fibromatosis (DF) is an extremely rare, locally aggressive, connective tissue malignancy that can be rooted anywhere in the body with the most common sites being thoracic wall and extremities. In contrast, granular cell tumors are rare neoplasms derived from Schwann cells commonly found in the oral cavity, skin and gastrointestinal tract. Moreover, diagnosing a patient with two primary cell tumors has become more common and the challenge of treatment becomes the focus in clinical situations. However, findings of a mass containing DF encapsulated by a granular cell tumor. Currently, there are no established guidelines for this rare condition. This case report serves to raise awareness of these two uncommon primary tumors emerging in an idiosyncratic nature.
A Healthcare-Associated Infection With Monkeypox Virus of a Healthcare Worker During the 2022 Outbreak
Authors: Le Pluart Diane , Ruyer-Thompson Mirabelle , Ferré Valentine Marie , Mailhe Morgane , Descamps Diane , Bouscarat Fabrice , Lescure François-Xavier , Lucet Jean-Christophe , Yazdanpanah Yazdan , Ghosn Jade
Published: October 2022

This article describes a case of healthcare-associated monkeypox infection in France during the 2022 outbreak. A female medical resident accidently pricked herself with a soiled subcutaneous needle used to harvest a vesicle of a patient infected by monkeypox virus and developed 4 days later a unique skin lesion, positive for monkeypox virus.
001 Egyptian consensus-based recommendations for the diagnosis and targeted management of Kawasaki disease. An initiative by the Egyptian College of Pediatric Rheumatology
Authors: El Miedany Y , Lotfy H , Salah S , Abu-Zaid M. H , Mohamed S. S , Esam Maher S , El Gaafary M , Abdulhady H , Hassan W. A , Mortada M , Amer Y , Osman N. S , Medhat B. M , Farag Y , Eissa M , Radwan A , Nasef S. I , Elkaraly N. E , El-Shanawany Amira T , El Mikkawy D , Mosa D. M , El Deriny G , Fouad N. A , Tabra S. A
Published: October 2022

Background

Kawasaki disease (kDa) is a self-limiting acute vasculitis that affects small and medium-sized vessels, and is the most common cause of acquired heart disease in children. It is also an important reason for long-term cardiac disease into adulthood. Rapid diagnosis and management of kDa is challenging due to the heterogeneity of the disease, yet is vital for improving outcome. To date, there are no Egyptian nationally agreed, evidence-based guidelines concerning the diagnosis and management of kDa in children. Consequently, treatment regimens vary broadly.

Objectives

To develop a consensus, evidence-based recommendations for the diagnosis, evaluation and management of children living with kDa.

Methods

This study was carried out to achieve an Egyptian expert consensus on a management strategy for kDa using Delphi technique. A multistep process strategy was adopted, which started by developing 16 key clinical questions by scientific committee according to the Patient/Population, Intervention, Comparison, Outcomes and Time (PICOT) approach. The core leadership team identified clinicians and researchers with expertise in pediatric rheumatology all over Egypt. An evidence-based, systematic, literature review was conducted to compile evidence for the kDa management. Delphi process was implemented (3-rounds) to reach a consensus.

Results

Twenty-five expert panel participated in the 3 rounds with response rate 100%. A total of 21 recommendations, categorized into 9 domains (Definition, disease activity, predicting the development of coronary disease, assessment and monitoring (lab, imaging), treatment (acute and after acute attack), management of resistant cases, management of complications (cardiac complications, MAS and arthritis), vaccination and long term follow up. The Agreement with the recommendations (rank 7–9) ranged from 83.6–95.7%. The Consensus was reached (i.e. ≥75% of respondents strongly agreed or agreed) on all the clinical standards. Algorithm for management has also been developed.

Conclusion

This was an expert, consensus recommendations for the diagnosis and treatment of kDa, based on best available evidence and expert opinion. The recommendations provided a management approach based on easy-to-use algorithm and with the support of complementary tests.

The implication to policy, practice, research and advocacy

to provide updated recommendations for better management of kDa.
11 Evaluation of doctors’ knowledge (excluding rheumatologists and pediatricians) of juvenile idiopathic arthritis
Authors: Tbini Houssem , Jemmali Samia , Boussaid Soumaya , Ammou Ahlem Ben , Rahmouni Safa , Rekik Sonia , Zouaoui Khaoula , Sahli Hela , Elleuch Mohammed
Published: October 2022

Background

Juvenile idiopathic arthritis (JIA) is the most common pediatric inflammatory arthritis. However, this disease is not fully understood by all practitioners.

Objectives

The objective of this survey is to assess the level of knowledge and attitudes of doctors excluding rheumatologists and pediatricians on the management of JIA.

Methods

In this cross-sectional descriptive study, an anonymous questionnaire composed of 20 questions, designed with the Google-Forms software, was sent via social networks to doctors from different specialties (excluding rheumatologists and pediatricians) and to interns and residents of the University Hospitals of Tunis.

Results

A total of 100 physicians responded to the questionnaire (61 women and 39 men). The mean age was 31.01 ± 5.64 [24–51] years. Fifty-seven percent of the participants were in training, 27% worked in public hospitals and 16% in private clinics. Most participants were general practitioners (32%), followed by ophthalmologists (9%), gynecologists (7%), and internists (5%). the mean length of service was 4.99 ± 4.5 [0–22] years. Thirty-six participants affirmed they have been confronted with patients with JIA. Twenty percent of participants believed they have knowledge about JIA. Among them, 25% believed they have sufficient knowledge, the others had superficial knowledge. Thirty-four percent of participants knew the definition of the disease according to the age, 17% knew its frequency and 18% had an idea about its various sub forms. The most frequent sub form was known only by 32 participants.

Regarding the complications of JIA, only 25% of the participants thought of the macrophage activation syndrome in case of deterioration of the general state, fever, and pancytopenia. In addition, 44% of participants knew that JIA can be complicated by ocular involvement.

Concerning the presence of rheumatoid factors and anti-nuclear antibodies during JIA, 64% and 60% respectively answered that their presence was not necessary.

Concerning the care of JIA, 64% of participants referred these patients to rheumatologists, 31% to a pediatrician, and 5% took care of them themselves.

The interest of methotrexate and biological treatments were known by 48% of the participants. However, 37% of participants had no idea of the therapeutic management of JIA.

Concerning the prognosis, only 25% of the participants know the sub forms of bad prognosis. However, 48% had no idea about the prognosis of the disease.

Conclusion

The level of knowledge of doctors on JIA is low to average. Training for physicians on this potentially serious disease is needed.
15 Fertility in juvenile idiopathic arthritis
Authors: Ammou Ahlem Ben , Rahmouni Safa , Boussaid Soumaya , Tbini Houssem , Jemmali Samia , Rekik Sonia , Zouaoui Khaoula , Sahli Hela , Elleuch Mohammed
Published: October 2022

Background

Juvenile idiopathic arthritis (JIA) is a chronic rheumatic disease seen in children below 16 years of age. However, it may persist into adulthood. The damage caused by the disease can influence the sex life and fertility of adults with long-standing JIA.

Objectives

To study the fertility of patients with JIA.

Methods

We conducted a retrospective study including adults with long-standing JIA according to the International League of Associations for Rheumatology (ILAR) criteria.

A detailed questionnaire was completed for each participant by interviewing them as well as by information obtained from their medical records. We identified among the adult patients, those who are married, their age at marriage, the number of gestation and parity, the age of the first child, miscarriages, and occurrence of menopause.

Results

A total of 29 Patients were enrolled, the M/F sex ratio was 0.71. The mean age was 35.69 ± 11.72 [18–61] years. The mean age of disease onset was 11.10 ± 4.25 [2–16] years. The average disease duration was 24.48 ± 12.76 [1–47] years. The mean BMI was 21.20 ± 4.89 [14.17–27.55] kg/m², 36.9% of patient had a BMI ≥ 25 kg/m². Fourteen patients had hip involvement.

Seven patients (6 women, 1 man) were married (24%). The mean age at marriage was 23.75 ± 7.5 [20–35] years. The mean delay between disease onset and marriage was 10 ± 6.68 [6–20] years. Six patient had children, the mean number of gestation and parity were 2.56 ± 2.88 [0–6] and 2 ± 2.29 [0–6] respectively. Miscarriage was noted in 2 patients. Menopause was observed in 3 patients, the mean age at menopause was 46.67 ± 1.53 [45–48] years.

Conclusion

Most of our patients were not married. This reflects the significant impact of the disease on the social and sexual life of JIA patients at adulthood.
17 Anemia in juvenile idiopathic arthritis: analysis of associated factors
Authors: Tbini Houssem , Rahmouni Safa , Boussaid Soumaya , Ammou Ahlem Ben , Jemmali Samia , Rekik Sonia , Zouaoui Khaoula , Sahli Hela , Elleuch Mohammed
Published: October 2022

Background

Anaemia is the most frequent hematological disorder in chronic inflammatory rheumatic disease. Few studies have focused on this impairment in juvenile idiopathic arthritis (JIA).

Objectives

To identify the factors associated with anaemia in JIA.

Methods

We conducted a retrospective study including adults with long-standing JIA according to the International League of Associations for Rheumatology (ILAR) criteria over a period of 28 years (1994–2022). Demographic, clinical, biological, and radiographic data were collected. These parameters were compared according to the presence or absence of anaemia.

Results

Seventeen women and 12 men were enrolled. The mean age was 35.69 ± 11.72 [18–61] years. The mean age of disease onset was 11.10 ± 4.25 [2–16] years. The average diagnostic delay was 52.96 ± 95.97 [0–336] months. The average disease duration was 24.48 ± 12.76 [1–47] years.

The polyarticular form was the most frequent (n = 16). Rheumatoid factor, ACPA and antinuclear antibodies were present in 41.4%, 24.1% and 17.2% of cases respectively. Mean CRP values were 42.74 ± 63.37 [2–218] mg/l, a biological inflammatory syndrome was present in 19 cases.

NSAIDs, corticosteroids and methotrexate were used in 62.1% (n = 18), 69% (n = 20) and 79.3% (n = 23) respectively.

Anaemia was noted in 69% (n = 20) of cases, it was hypochromic in 8 cases and microcytic in 11 cases. The mean haemoglobin value was 11.31 2.10 [6.5–15] g/dl.

Anaemia was associated with the following parameters in our study: female sex (88.2% vs 41.7%; p = 0.008), absence of anti-nuclear antibodies (76.9% vs 20%; p = 0.026) and corticosteroid therapy (85% vs 33.3%; p = 0.005). However, the comparison of patients according to the presence of anaemia did not show any significant difference for these parameters: age, age at onset, diagnostic delay, duration of symptoms, extra-articular manifestations, CRP value, presence of biological inflammatory syndrome, rheumatoid factor, ACPA, erosive nature and treatment (NSAIDs and methotrexate).

Conclusion

Anaemia is common in JIA. Its treatment is part of the overall management of the disease.
20 Does hip involvement affect foot and ankle in juvenile idiopathic arthritis?
Authors: Myriam Moalla , Hanene Ferjani , Wafa Triki , Dorra Ben Nessib , Kaouther Maatallah , Dhia Kaffel , Wafa Hamdi
Published: October 2022

Background

Although ankle and foot involvements are common in juvenile idiopathic arthritis (JIA), they are often neglected. Hip involvement, also common in JIA, may affect these joints by creating a chronic imbalance of the musculoskeletal system. However, no studies have been published on this subject.

Objective

We aimed to describe ankle and foot impairment in a cohort of patients with JIA and to study the correlation between these impairments and the presence of hip arthritis.

Methods

A monocentric cross-sectional study was conducted including JIA patients fulfilling the 2001 ILAR criteria. Patients with congenital malformation of the ankle or foot or with any other foot impairment due to a disease other than JIA were not included. Foot examination was performed on bare feet both in supine and standing position. We completed with an analysis of footprint with a podoscope and shoes examination. Patients were divided in two groups depending on the presence or the absence of hip arthritis on pelvis X-ray, hip ultrasound or hip magnetic resonance imaging.

Results

We included 35 patients (M/F = 15/20). Hip arthritis was noted in 45.7%. Oligoarticular (43.8%) and enthesitis-related arthritis (25%) were the most frequent form of JIA. Functional complaints related to foot and ankle were reported in 34.3% of cases. The pain was the most frequent symptom (91%), mainly in the hindfoot and ankle (50%). Foot pain was more frequently encountered in the absence of hip arthritis (52%, vs 31.2% in presence of hip arthritis). Physical examination revealed limitation of the talocrural joint in 20% of cases and feet tenosynovitis in 14.3% of cases. Achille tendon enthesitis was found in 8.6% of patients. These abnormalities were more prevalent in the absence of hip arthritis. Half of the patients had hindfoot deviation dominated by hindfoot varus (22.9%). In the group with hip arthritis, a hallux valgus was found in 14.3%, a supraductus of the 2nd toe, and claw toe in one case each. An anomaly of the footprint was noted in 28 patients, including 11 in the group with hip involvement: 7 cases of cavus foot and 4 cases of flat foot. There were no correlations between foot or ankle anomalies with hip impairment apart from an association of flat foot with the absence of coxitis, and a leg length discrepancy more important in the group with hip arthritis.

Conclusions

Our study confirms the frequency of foot and ankle involvement as well as hip arthritis during JIA, hence the importance of their systematic screening even in asymptomatic children. Larger-scale studies would be necessary to evaluate with more precision the relation that there could be between hip and foot impairment.
24 Scoliosis in children with juvenile idiopathic arthritis: any link?
Authors: Rania Ben Aissa , Hanene Ferjani , Mariam Moalla , Dorra Ben Nessib , Wafa Triki , Kaouther Maatallah , Dhia Kaffel , Wafa Hamdi
Published: October 2022

Background

Juvenile idiopathic arthritis (JIA) is an unusual aetiology of scoliosis in childhood. With few data in literature, the associated factors of scoliosis in JIA are still unknown.

Objectives

To describe the incidence and associated factors of scoliosis in children with JIA.

Methods

A cross-sectional study including children with JIA according to the International League of Associations for Rheumatology (ILAR). The recorded data included anthropometric measurements (weight, size, body mass index (BMI), and leg length), disease characteristics (JIA subtypes and duration), and static foot posture disorders. Regarding scoliosis, we collected clinical and radiographic findings.

Results

Thirty-five patients, forty-three percent of the patients were boys (n = 15). The mean age was 12.2 ± 3.61 years. The mean disease duration was 4.1 ± 3.29 years. The mean patient global assessment and the mean visual analogic scale were 3.4 ± 3.02 and 3.37 ± 2.92, respectively. The patient's distribution of JIA subtypes was oligoarticular (n = 13), enthesitis-related arthritis (n = 9), polyarticular (n = 4), undifferentiated (n = 4), psoriasis-related JIA (n = 4) and systemic-onset (n = 1). The mean CRP and ESR were 7.51 ± 11.85 mg/l and 18.88 ± 15.53 mm, respectively. The mean JADAS was 7.58 ± 6.3. Seventeen percent of the patients had an inactive disease (n = 6). Seven patients (20%) (6 females) had developed scoliosis during their disease, the spine regions of scoliosis were thoracolumbar scoliosis (n = 6) and thoracic scoliosis (n = 1). There was no specific distribution of scoliosis among JIA subtypes (p = 0.464). Most patients with scoliosis had associated leg length discrepancy (71.43% vs 28.57%, p = 0.025). Static foot posture disorders were present in most patients with scoliosis (85.71% vs 14.29%) but this difference was not significant (p = 0.673) compared with patients with no scoliosis. Weight, size and BMI were not associated with scoliosis (p = 0.955, p = 0.922, p = 0.303 respectively).

Conclusion

Our study shows that scoliosis is associated with leg length discrepancy. Indeed, the joint inflammation of the lower limb may explain the postural syndrome in children with JIA, with a prompt impact on the axial skeleton.
25 Impact of early feeding on the occurrence of juvenile idiopathic arthritis
Authors: Rabhi Emna , Triki Wafa , Ferjani Hanene , Nessib Dorra Ben , Maatallah Kaouther , Kaffel Dhia , Hamdi Wafa
Published: October 2022

Background

Juvenile idiopathic arthritis (JIA) is considered to be an autoimmune disease, which is a result of an immune reaction caused or triggered by environmental factors in a genetically susceptible individual. However, interactions between early feeding and risk Juvenile idiopathic arthritis (JIA) remains largely unexplored.

Objectives

To determine the impact of early alimentation on the occurrence of JIA in Tunisia.

Methods

We conducted a case-control study including 26 children with JIA fulfilling the international league against rheumatism (ILAR) 2010 criteria compared with a homogeneous control group of 21 children hospitalized in a paediatric orthopedic unit for traumatic reasons and healthy for any chronic inflammatory rheumatism. Parents of patients were asked after having their consent to participate. We collected the following data: Type of JIA, juvenile disease activity score (JADAS), type of feeding, total duration of breastfeeding, duration of exclusive breastfeeding and age at introduction of gluten. Patients were divided into two groups: group 1 (G1): JIA patients, group 2 (G2): control group. Data were analyzed using the SPSS statistical package. A p-value < 0.05 was considered significant.

Results

Forty-seven children (26 diagnosed with JIA and 21 controls) with a mean age of 10.07 years ± 4.96 were enrolled. JIA subtypes were in decreasing order of frequency: oligoarticular (45.8%), enthesitis-related arthritis (20.8%), undifferentiated JIA (12.5%), seronegative polyarticular JIA (8.3%), juvenile psoriatic arthritis (8.3%), and seropositive polyarticular JIA (4.2%). The mean JADAS was 6.966 ± 5.38. There was no significant difference between the G1 and G2 with regard to the duration of breastfeeding (12.23 ± 3.8 months vs 8.14 ± 4.1 months, p = 0.09), exclusive breastfeeding (3.8 ± 3.6 vs 4.1 ± 2.62, p = 0.40) and age at introduction of gluten (G1: 8.48 ± 5.30 months vs G2: 7.48 ± 1,2 months, p = 0.35)

Conclusion

Our study didn’t show any impact of early alimentation on the occurrence of JIA in Tunisia. However, more studies are necessary to conclude these issues.
37 Subtype frequencies and demographic characteristics of juvenile idiopathic arthritis in Batna, Algeria
Authors: Hadef Djohra , Slimani Samy , Khamari Mohamed Choukri , Mekaoussi Walid , Belot Alexandre , Quartier Pierre
Published: October 2022

Background

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood. There is a disparity in the prevalence of Juvenile idiopathic arthritis (JIA) subsets between different geographical areas or ethnic groups. In Arabic and African populations, data describing JIA are scarce. However, the epidemiological studies remain the best tool to understand the disease and to improve its management.

Objectives

To determine subtype, frequency, demographic and clinical features of JIA in Batna -Algeria- and to compare the findings with other JIA populations worldwide.

Methods

A multicentre retrospective descriptive study was conducted in Batna health centers (public and private sectors), over a seven-year period from January 2013 to December 2019, based on data collected on JIA patients. As public sector source, we referred to the department of pediatrics of the university hospital center (CHU Benflis Touhami Batna), and as private sector source, we referred to private adult rheumatologists based in Batna. The studied variables were: gender, age at the initial symptoms, age at diagnosis, JIA subtype based on International League of Associations for Rheumatology (ILAR) criteria, symptoms at onset, disease duration at the latest follow up, presence of uveitis, auto antibodies (antinuclear antibodies, Rheumatoid Factor and anti-CCP) pattern, joint imaging results, JIA status at the time of enrolment and the latest follow-up.

Results

The study included a total of 69 cases of JIA that were being followed in Batna health centers over the study period. The female to male ratio was 1.83. The median age at diagnosis was 9 years (range 1–16). Forty-six patients (72%) were diagnosed within the first year after disease onset. At the latest follow-up, the median disease duration onset was 1 year (range 1–8 years). There were 34 oligoarthritis (49.3%), 9(13%) rheumatoid factor (RF) negative polyarticular JIA, 8(11.6%) RF positive polyarticular JIA, 6(8.7%), systemic arthritis, 6(8.7%) enthesitis-related arthritis, 3(4.3%) psoriatic arthritis and 3(4.3%) undifferentiated arthritis. Nine patients (18.7%) were anti-nuclear antibody (ANA) positive, and 21 patients (30.4%) had indeterminate ANA status.

Conclusion

Oligoarthritis was the most common JIA subtype in our study. The RF positive polyarthritis frequency was higher than in literature. Prospective multicentre studies are necessary to better identify the JIA peculiarities in our country.

Disclosure of Interest

None declared
39 Pediatric monoarthritis of the elbow: atypical onset of a common disease
Authors: Ibrahim Rehab Ali
Published: October 2022

Background

Oligoarticular type of juvenile idiopathic arthritis (oligoJIA) is considered the most common type of JIA. It usually affects one or < 4 joints. The knee is the most common affected joint followed by the ankle and wrist. Oligoarticular JIA presenting with erosive elbow monoarthritis as an initial sign of the disease is a rare condition which needs prompt diagnosis and management.

Objective

To recognize that isolated chronic elbow monoarthrits is an atypical presentation for oligoJIA.

Case presentation: A 14-year-old volleyball player female child presented with chronic recurrent left elbow swelling of six months’ duration. No history of morning stiffness, constitutional symptoms, other joint swelling, uveitis, or skin manifestations were reported. On examination there was mild cubitus valgus with elbow effusion associated with limited last degree elbow extension with no other signs of inflammation or infection (redness, tenderness, hotness). Hypermobility was noted in both elbows and knees. Patient was advised to rest the elbow and symptomatic treatment was recommended. On follow up there was mild improvement of the swelling, so further investigations were ordered. Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), Rheumatoid factor (RF) and antinuclear antibody (ANA) showed average normal values. X-ray of the elbow showed degenerative changes. Musculoskeletal ultrasound showed mild elbow effusion and magnetic resonance imaging (MRI) was ordered revealing effusion and early joint erosion at the ulnar articular surface with no synovial hypertrophy. Arthroscopy was recommended to detect the underlying pathology and histopathology revealed chronic active synovitis suggesting JIA. Non-steroidal anti-inflammatory drugs (NSAIDs) were recommended but one month later knee arthritis was noted, so methotrexate was started and the condition started to improve.

Results

We report a 14-year-old female child who presented with atypical isolated chronic swelling of the elbow and was diagnosed by arthroscopy and histopathology. Non-steroidal anti-inflammatory drugs (NSAIDS) were tried as a first line treatment followed by methotrexate.

Conclusion

Chronic elbow monoarthritis is an atypical onset of oligoJIA and its diagnosis is important to prevent irreversible joint damage. Synovial biopsy can have a major role in the diagnosis of atypical monoarticular JIA and can help in early diagnosis and management improving the outcome.

The implication to policy, practice, research, and advocacy: Monoarthritis of the elbow as initial sign of oligoJIA is an atypical onset of this disease and in the absence of systemic signs or other clinical indicators determining the exact cause of monoarthritis in children might be difficult. Synovial biopsy can have an important role in the diagnosis of monarticular arthritis in pediatric patients.