bluuebunny/crossref_metadata_2025 huggingface dataset:
Parents’ experiences of requests for organ and tissue donation: the value of asking
Authors: Darlington Anne-Sophie , Long-Sutehall Tracy , Randall Duncan , Wakefield Claire , Robinson Victoria , Brierley Joe
Published: May 2019

Objective

A proportion of children die, making them potentially eligible to be organ/tissue donors. Not all are approached for donation, and experiences of those parents are not well understood. The objective was to investigate to what extent organ and tissue donation (OTD) is discussed as part of end-of-life care and to explore parents’ and healthcare professionals’ (HCPs) experiences.

Design

A retrospective qualitative study.

Setting

Multicentre study with participants recruited through two neonatal intensive care units (ICUs), two paediatric ICUs, a cardiac ICU and a children’s hospice.

Patients

Bereaved parents, parents of a child with a long-term condition (LTC) and HCPs.

Interventions

None.

Main outcomes and measures

Parents’ and HCPs’ views and experiences of discussions about OTD.

Results

24 parents of 20 children were interviewed: 21 bereaved parents and 3 parents of a child with a LTC. Seven parents were asked about donation (13 not asked), four agreed and two donated. 41 HCPs were interviewed. Themes: complexity of donation process, OTD as a coping strategy, the importance of asking, difficulty of raising the topic,\ and parents’ assumptions about health of organs (when donation is not discussed).

Conclusions

The findings add new knowledge about parents’ assumptions about the value of their child’s organs when discussions about OTD are not raised, and that HCPs do not routinely ask, are sometimes hesitant to ask in fear of damaging relationships, and the reality of the complexity of the donation process. Given the current levels of awareness around OTD, the topic should be raised.
Functional outcomes in children with anatomically repaired transposition of the great arteries with regard to congenital ventricular septal defect and coronary pattern
Authors: Häcker Anna-Luisa , Reiner Barbara , Oberhoffer Renate , Hager Alfred , Ewert Peter , Müller Jan
Published: May 2019

Objective

Despite decreasing mortality, functional impairments in children with transposition of the great arteries (TGA) are still a concern. This study analyses health-related physical fitness (HRPF), arterial stiffness and health-related quality of life (HRQoL) in children with anatomically repaired TGA regarding congenital ventricular septal defect (VSD) and coronary patterns.

Patients and methods

68 children with anatomically repaired TGA with or without VSD (12.9±3.7 years, 19.1% female) were investigated between August 2014 and October 2017. HRPF was assessed by five tests of the FITNESSGRAM, arterial stiffness was measured by oscillometric measurement using Mobil-O-Graph and HRQoL was analysed with a self-report questionnaire (KINDL-R). All test results were compared with a healthy reference cohort (n=2116, 49.1% female) adjusted for sex and age.

Results

Children with anatomically repaired TGA had significantly worse HRPF (z-score: −0.58±0.81, p<0.001), increased pulse wave velocity (TGA: 4.9±0.3 m/s vs healthy: 4.8±0.3 m/s, p=0.028) and central systolic blood pressure (TGA: 105.9±5.8 mm Hg vs healthy: 103.3±5.7 mm Hg, p=0.001). No difference was found for HRQoL between the two groups (total HRQoL score: TGA: 76.5±10.2 vs healthy: 75.2±10.1, p=0.315). Neither the coronary pattern nor a congenital VSD resulted in significant differences in all functional outcomes.

Conclusion

Children with anatomically repaired TGA exhibit impaired HRPF and increased arterial stiffness whereas their HRQoL is normal. The underlying coronary pattern seems to have no influence on the functional outcome, nor does an accompanied congenital VSD.
Assessing feasibility of routine identification tools for mental health disorder in neurology clinics
Authors: Bennett Sophie D , Heyman Isobel , Coughtrey Anna E , Buszewicz Marta , Byford Sarah , Dore Caroline J , Fonagy Peter , Ford Tamsin , Moss-Morris Rona , Stephenson Terence , Varadkar Sophia , Walker Erin , Shafran Roz
Published: May 2019

Objective

We aimed to test the feasibility of using an online parent-completed diagnostic assessment for detecting common mental health disorders in children attending neurology clinics. The assessment does not require intervention by a mental health professional or additional time in the clinic appointment.

Setting

Two parallel and related screening studies were undertaken: Study 1: Tertiary paediatric neurology clinics. Study 2: Secondary and tertiary paediatric neurology clinics.

Patients

Study 1: 406 Young people aged 7–18 attending paediatric neurology clinics. Study 2: 225 Young people aged 3–18 attending paediatric epilepsy clinics.

Interventions

Parents completed online versions of the Strengths and Difficulties Questionnaire (SDQ) and Development and Well-being Assessment (DAWBA).

Main outcome measures

We investigated: the willingness of families to complete the measures, proportion identified as having mental health disorders, time taken to complete the measures and acceptability to families and clinicians.

Results

The mean total difficulties score of those that had completed the SDQ fell in the ‘high’ and ‘very high’ ranges. 60% and 70% of the DAWBAS completed met criteria for at least one DSM-IV disorder in study 1 and 2 respectively. 98% of the parents reported that the screening methods used were acceptable.
Academic, behavioural and quality of life outcomes of slight to mild hearing loss in late childhood: a population-based study
Authors: Wang Jing , Quach Jon , Sung Valerie , Carew Peter , Edwards Ben , Grobler Anneke , Gold Lisa , Wake Melissa
Published: May 2019

Objective

To investigate the associations of hearing thresholds and slight to mild hearing loss with academic, behavioural and quality of life outcomes in children at a population level.

Methods

Design and participants:children aged 11–12 years in the population-based cross-sectional Child Health CheckPoint study within the Longitudinal Study of Australian Children.Audiometry:mean hearing threshold across 1, 2 and 4 kHz (better and worse ear); slight/mild hearing loss (threshold of 16–40 decibels hearing loss (dB HL)).Outcomes:National Assessment Program – Literacy and Numeracy, language, teacher-reported learning, parent and teacher reported behaviour and self-reported quality of life.Analysis:linear regression quantified associations of hearing threshold/loss with outcomes.

Results

Of 1483 children (mean age 11.5 years), 9.2% and 13.1% had slight/mild bilateral and unilateral hearing loss, respectively. Per SD increment in better ear threshold (5.7 dB HL), scores were worse on several academic outcomes (eg, reading 0.11 SD, 95% CI 0.05 to 0.16), parent-reported behaviour (0.06 SD, 95% CI 0.01 to 0.11) and physical (0.09 SD, 95% CI 0.04 to 0.14) and psychosocial (0.06 SD, 95% CI 0.01 to 0.11) Pediatric Quality of Life Inventory (PedsQL). Compared with normally hearing children, children with bilateral slight/mild losses scored 0.2–0.3 SDs lower in sentence repetition, teacher-reported learning and physical PedsQL but not other outcomes. Similar but attenuated patterns were seen in unilateral slight/mild losses.

Conclusions

Hearing thresholds and slight/mild hearing loss showed small but important associations with some child outcomes at 11–12 years. Justifying hearing screening or intervention at this age would require better understanding of its longitudinal and indirect effects, alongside effective management and appropriate early identification programmes.
False-positive serologies for acute hepatitis A and autoimmune hepatitis in a patient with acute Epstein–Barr virus infection
Authors: Valota Marika , Thienemann Friedrich , Misselwitz Benjamin
Published: May 2019

Acute hepatitis remains a diagnostic challenge, and numerous infectious, metabolic and autoimmune diseases need to be effectively excluded. We present a case of a young woman with malaise, fever, jaundice and deranged liver function tests. Testing for Epstein–Barr virus (EBV) virus capsid antigen IgM/IgG was positive. Total IgG was elevated, along with positive serology for anti-hepatitis A virus (HAV)-IgM, antinuclear antibodies (ANAs) and soluble liver antigen (SLA) leading to the differential diagnosis of acute hepatitis A and autoimmune hepatitis. No specific treatment was started and liver function gradually improved. At week 4, HAV IgG and IgM were negative. At month 4, ANA and SLA were negative and total IgG normalised; EBV nuclear antigen became positive. Testing for EBV is an investigation required at baseline in acute hepatitis and physicians should carefully evaluate serological results, including those for viral and autoimmune hepatitis that may be falsely positive in infectious mononucleosis.
An underestimated sexually transmitted infection: amoebiasis
Authors: Billet Anne Claire , Salmon Rousseau Arnaud , Piroth Lionel , Martins Capucine
Published: May 2019

Entamoeba histolyticais a cosmopolitan pathogenic parasite. It is spread via the feco-oral route and, to a lesser extent, via sexual intercourse. We report a case of hepatic and intestinal amoebiasis in a 67-year-old man who had never travelled to an endemic area. Abdominal CT investigations detected two liver abscesses and chronic colitis. Positive amoebic serology and a positive PCR test forE. histolyticain the hepatic liquid and faeces confirmed the diagnosis. Curative metronidazole and tiliquinol-tilbroquinol were administered successfully. The patient had been contaminated through heterosexual intercourse with his healthy French female partner who was a carrier of the parasite. Though unusual, amoebiasis as a result of sexual transmission should be considered in non-endemic areas in people who have never travelled abroad, particularly in the presence of clinical symptoms such as liver abscesses or chronic diarrhoea.
Course of upper eyelid retraction in thyroid eye disease
Authors: Lee Dong Cheol , Young Stephanie M , Kim Yoon-Duck , Woo Kyung In
Published: May 2019

Aims

To evaluate the natural course of upper eyelid retraction (UER) in patients with thyroid eye disease (TED) and factors affecting its course.

Methods

Retrospective non-interventional cohort study in a single tertiary institution from March 2006 to March 2015 on patients with TED with (1) unilateral or bilateral UER within 6 months from initial presentation, and (2) no prior interventions nor surgical treatment for their UER. Main outcomes and measures were mean margin reflex distance 1 (MRD1) and factors associated with UER improvement.

Results

There were a total of 61 patients and 81 eyes (41 unilateral and 20 bilateral UER). Mean age was 42.3±15.1 years. Mean MRD1 decreased from 6.1 mm at presentation to 4.8 mm at 12 months, and 4.4 mm at 24 months. The proportion of eyes with normalisation of lid height increased from 0% at presentation to 22.2% at 6 months, 37.0% at 12 months and 49.4% at 24 months. Mean time to normalisation of MRD1 was 18.0±12.4 months. A positive family history of TED was found to be associated with a 6.2 times lower likelihood of normalisation. Change in exophthalmometry, clinical activity score and thyroid-stimulating immunoglobulin were significantly correlated to change in MRD1 (p<0.05). There was no correlation between change in MRD1 and thyroid-stimulating hormone receptor antibodies.

Conclusion

An improved knowledge of the natural history of UER in TED will allow us to better decide and evaluate the optimal management for such patients.
Expanding the retinal phenotype of RP1: from retinitis pigmentosa to a novel and singular macular dystrophy
Authors: Riera Marina , Abad-Morales Víctor , Navarro Rafael , Ruiz-Nogales Sheila , Méndez-Vendrell Pilar , Corcostegui Borja , Pomares Esther
Published: May 2019

Purpose

This study aimed to identify the underlying genetic cause(s) of inherited retinal dystrophy (IRD) in 12 families of Kuwaiti origin affected by macular dystrophy and four Spanish patients affected by retinitis pigmentosa (RP).

Methods

Clinical diagnoses were based on standard ophthalmic evaluations (best-corrected visual acuity, retinography, fundus autofluorescence imaging, optical coherence tomography, electroretinography and visual field tests). Panel-based whole exome sequencing was used to simultaneously analyse 224 IRD genes in one affected member of each family. The putative causative variants were confirmed by Sanger sequencing and cosegregation analyses. Haplotype analysis was performed using single nucleotide polymorphisms.

Results

A homozygous missense mutation c.606C>A (p.Asp202Glu) in RP1 was found to be the molecular cause of IRD in all 12 families from Kuwait. These patients exhibited comparable symptoms, including progressive decline in visual acuity since adolescence. Fundus autofluorescence images revealed bilateral macular retinal pigment epithelium disturbances, with neither perimacular flecks nor peripheral alterations. A shared haplotype spanning at least 1.1 Mb was identified in all families, suggesting a founder effect. Furthermore, RP1 variants involving nonsense and/or frameshifting mutations (three of them novel) were identified in three Spanish autosomal-recessive RP families and one dominant RP pedigree.

Conclusion

This study describes, for the first time, a macular dystrophy phenotype caused by an RP1 mutation; establishing a new genotype-phenotype correlation in this gene, expanding its mutation spectrum and further highlighting the clinical heterogeneity associated with IRD.
Clinical and biochemical analysis of the ageing tear film
Authors: Mann Aisling , Campbell Darren , Mirza Zeba , Hunt Olivia , Wolffsohn James Stuart , Tighe Brian J
Published: May 2019

Background

Tear film stability is important for healthy visual function, and yet little is known of the ageing mechanisms. The aim of this study was to investigate parallels between biochemical changes and clinical physical parameters, which occur in the tear film of two subject populations differing in age by over 30 years.

Methods

Two distinct age groups were chosen: 11 ‘younger’ (23.7±2.1 years) and 19 ‘older’ (63.0±4.0 years) subjects. A series of clinical tests were performed to access tear volume, tear film stability and general ocular health. Tear protein analyses from extracted Schirmer strips were conducted with the Agilent 2100 Bioanalyzer.

Results

Clinical investigations highlighted significant differences between the age groups. For example: McMonnies scores (p=0.009) and bulbar redness (p=0.038) were higher for the older group, whereas tear meniscus height was larger (p=0.018) in the younger group. Similarly, relative plasma-derived albumin levels were higher (17.1%±12.4%) in the tears of the older, compared with the younger (5.0%±9.6%) group. A protein peak at ∼23 kDa was observed in 53% of the older group samples but in only 36% of the samples of the younger subjects (p=0.122).

Conclusions

Distinct differences in tear film composition between the two age groups were observed. Parallels in terms of clinical symptoms which reflected a biochemical response (and vice versa) were found, but specific correlations between clinical measurements and biomarkers for individual subjects were not observed.
Illness perceptions in people newly diagnosed with glaucoma and ocular hypertension
Authors: McDonald Leanne , Boodhna Trishal , Ajtony Csilla , Turnbull Paula , Bourne Rupert R A , Crabb David P
Published: May 2019

Background/aims

To determine whether self-reported illness perceptions in newly diagnosed patients with primary open-angle glaucoma (POAG) and ocular hypertension (OHT) are more negative compared with peers who have lived with their diagnosis for more than 2 years.

Methods

A cross-sectional study of 58 newly diagnosed patients with POAG and OHT recruited at their first clinic visit. Electronic patient records were used to identify similar patients (n=58, related by age and severity of visual field loss) who had their diagnosis for >2 years. All participants completed the Brief Illness Perception Questionnaire (BIPQ), EQ5D general health measure and Type D Personality Scale (DS14).

Results

Average BIPQ scores were similar for people newly diagnosed with POAG and POAG diagnosed >2 years and were no different to newly diagnosed OHT and OHT diagnosed >2 years POAG (p=0.46). An analysis correcting for personality type (DS14) and general health (EQ5D) indicated newly diagnosed patients with POAG to have marginally better illness perceptions on individual BIPQ items quantifying impact on life in general, experience of symptoms and ‘understanding’ of their condition (all p<0.01). In contrast, patients with POAG with a diagnosis >2 years understood better their condition to be long-term (p<0.01).

Conclusions

Some illness perceptions differed between newly diagnosed people and patients living with their diagnosis for >2 years. Illness perception for people with manifest glaucoma and at risk of glaucoma (OHT) were similar; the latter might benefit from an intervention at diagnosis that highlights the better prognosis for OHT compared with POAG.
Incidence trends of conjunctival malignant melanoma in Canada
Authors: Ghazawi Feras M , Darwich Rami , Le Michelle , Jfri Abdulhadi , Rahme Elham , Burnier Julia Valdemarin , Sasseville Denis , Burnier Jr Miguel N , Litvinov Ivan V
Published: May 2019

Background

Melanoma is the most common primary malignancy of the eye in adults. While the epidemiology of uveal melanoma has recently been described in Canada, little is known about the epidemiology and geographic distribution of patients with conjunctival melanoma (CM) in Canada.

Methods

We conducted a population-based study of CM incidence across all Canadian provinces and territories during 1992–2010 using two independent population-based registries.

Results

190 patients were diagnosed with CM in Canada from 1992 to 2010. 55.3 % of these patients were men. The mean annual incidence rate of CM in Canada was 0.32 cases per million individuals (0.35 and 0.29 cases per million individuals for men and women, respectively). The incidence rates for Canadian provinces demonstrated that the eastern provinces of Nova Scotia and New Brunswick had higher age-adjusted incidence rates than the national average, with rates of 0.52 and 0.47 cases per million individuals per year, respectively.

Conclusions

This analysis demonstrates novel variations in CM incidence rates between different Canadian provinces. These results taken together with the data reported from the USA confirm the North-to-South geographic gradient of increasing CM incidence. This research highlights that the epidemiology of CM in North America is comparable to that of cutaneous malignant melanoma in contrast to the trends for uveal melanoma distribution.
Eplerenone for the treatment of chronic central serous chorioretinopathy: 3-year clinical experience
Authors: Petkovsek Daniel S , Cherfan Daniel G , Conti Felipe F , Hom Grant L , Ehlers Justin P , Babiuch Amy S , Rachitskaya Aleksandra V , Kaiser Peter K , Schachat Andrew P , Srivastava Sunil K , Sharma Sumit , Singh Rishi P
Published: May 2019

Background/aims

The efficacy of mineralocorticoid receptor antagonist eplerenone to treat chronic central serous chorioretinopathy (CSCR) has been established. However, previous studies have been limited by small cohort size and short follow-up duration. This study aims to report 3-year clinical outcomes of patients treated with eplerenone for chronic CSCR.

Methods

Institutional review board-approved retrospective chart analysis at a single institution from 2012 to 2018. Baseline best-corrected visual acuity and anatomical measurements related to degree of subretinal fluid (SRF) were collected at eplerenone initiation. Follow-up data were collected at the closest date to 12, 24 and 36 months.

Results

Data were obtained for 100 eyes of 83 patients at 1-year (mean 11.18 ± 4.00 months), 49 eyes at 2-year (24.01 ± 3.33 months) and 33 eyes at 3-year (mean 35.5 ± 7.89 months) follow-up visits. The rate of complete SRF resolution was 31%, 28% and 33%, respectively. At final follow-up, logarithm of the minimum angle of resolution visual acuity change from baseline was +0.10 ± 0.24 (p = 0.130). Average change from baseline at final follow-up for central subfield thickness was −97 ± 140.6 µm (p < 0.001), cube volume was –1.07 ± 1.71 mm3 (p < 0.001), macular thickness –28. 5 ± 47.5 µm (p < 0.001), maximum SRF height was −95.6 ± 160.5 µm (p < 0.001) and maximum SRF diameter was −1169.0 ± 1638.7 µm (p = 0.008).

Conclusion

Anatomical improvement occurs primarily within the first year of eplerenone treatment for chronic CSCR.
Association of urinary metal profiles with serum uric acid: a cross-sectional study of traffic policemen in Wuhan, China
Authors: Dai Xiayun , Deng Qifei , Guo Dongmei , Ni Lei , Li Jichao , Chen Zhenlong , Zhang Ling , Xu Tian , Song Weili , Luo Yongbin , Hu Ling , Hu Caiying , Yi Guilin , Pan Zhiwei
Published: May 2019

Objectives

Serum uric acid (SUA) is both a strong antioxidant and one of the key risk factors of cardiovascular diseases (CVDs). We aimed to investigate the associations of urinary metal profile with SUA in traffic policemen in Wuhan, China.

Design

A cross-sectional study was carried out in traffic policemen.

Setting

A seriously polluted Chinese city.

Participants

A total of 186 traffic policemen were recruited in this study. About 56 of them worked in the logistics department and the other 130 maintained traffic order or dealt with traffic accidents on the roads. All these subjects had worked as a policeman for at least 1 year.

Main outcome measures

SUA.

Results

The significantly negative association of lead with SUA was consistent between single-metal and multiple-metal models (p=0.004 and p=0.020, respectively). Vanadium, chromium and tin were reversely associated with SUA levels in the single-metal models after false discovery rate (FDR) adjustment (allP_FDR< 0.05). One IQR increase in vanadium, chromium, tin and lead was associated with 26.9 µmol/L (95% CI −44.6 to −9.2; p=0.003), 27.4 µmol/L (95% CI −46.1 to −8.8; p=0.004), 11.2 µmol/L (95% CI −18.9 to −3.4; p=0.005) and 16.4 µmol/L (95% CI −27.6 to −5.2; p=0.004) decrease in SUA, respectively. Significant interaction between smoking and vanadium on decreased SUV was found (pfor interaction= 0.007 and p_FDR= 0.028).

Conclusions

Urinary vanadium, chromium, tin and lead were negatively associated with SUA. Vanadium and cigarette smoking jointly affected SUA levels. Further studies are needed to replicate these findings and to investigate the potential mechanisms.
Clinical and Cost-effectiveness of a Comprehensive geriatric assessment and management for Canadian elders with Cancer—the 5C study: a study protocol for a randomised controlled phase III trial
Authors: Puts Martine T E , Hsu Tina , Mariano Caroline , Monette Johanne , Brennenstuhl Sarah , Pitters Eric , Ray Jack , Wan-Chow-Wah Doreen , Kozlowski Natascha , Krzyzanowska Monika , Amir Eitan , Elser Christine , Jang Raymond , Prica Anca , Krahn Murray , Beland Francois , Bergman Simon , Koneru Rama , Lemonde Manon , Szumacher Ewa , Zidulka Joan , Fung Shek , Li Anson , Emmenegger Urban , Mehta Rajin , Flemming Kendra , Breunis Henriette , Alibhai Shabbir M H
Published: May 2019

Introduction

Geriatric assessment and management is recommended for older adults with cancer referred for chemotherapy but no randomised controlled trial has been completed of this intervention in the oncology setting.

Trial design

A two-group parallel single blind multi-centre randomised trial with a companion trial-based economic evaluation from both payer and societal perspectives with process evaluation.

Participants

A total of 350 participants aged 70+, diagnosed with a solid tumour, lymphoma or myeloma, referred for first/second line chemotherapy, who speak English/French, have an Eastern Collaborative Oncology Group Performance Status 0–2 will be recruited. All participants will be followed for 12 months.

Intervention

Geriatric assessment and management for 6 months. The control group will receive usual oncologic care. All participants will receive a monthly healthy ageing booklet for 6 months.

Objective

To study the clinical and cost-effectiveness of geriatric assessment and management in optimising outcomes compared with usual oncology care.

Randomisation

Participants will be allocated to one of the two arms in a 1:1 ratio. The randomisation will be stratified by centre and treatment intent (palliative vs other).

Outcome

Quality of life.

Secondary outcomes

(1) Cost-effectiveness, (2) functional status, (3) number of geriatric issues successfully addressed, (4) grades3–5 treatment toxicity, (5) healthcare use, (6) satisfaction, (7) cancer treatment plan modification and (8) overall survival.

Planned analysis

For the primary outcome we will use a pattern mixture model using an intent-to-treat approach (at 3, 6 and12 months). We will conduct a cost-utility analysis alongside this clinical trial. For secondary outcomes 2–4, we will use a variety of methods.

Ethics and dissemination

Our study has been approved by all required REBs. We will disseminate our findings to stakeholders locally, nationally and internationally and by publishing the findings.

Trial registration number

NCT03154671.
Associations of presence or absence of exercise and/or physical activity with non-restorative sleep by gender and age: a cross-sectional study
Authors: Hidaka Tomoo , Endo Shota , Kasuga Hideaki , Masuishi Yusuke , Kakamu Takeyasu , Kumagai Tomohiro , Fukushima Tetsuhito
Published: May 2019

Objectives

Non-restorative sleep (NRS) is related to qualitative aspects of sleep. The associations of NRS with exercise (EX; a planned and purposeful activity) and physical activity (PA; daily bodily movement) by gender and age have not yet been clarified. We investigated the associations of EX and/or PA with NRS by gender and age.

Design

A cross-sectional study.

Setting

The data on gender, age, presence of NRS and engagement in EX and/or PA were obtained from database and questionnaire of specified medical check-ups in FY 2013 in Japan. The analysis was conducted in 2017.

Participants

The subjects comprised 90 122 residents (38 603 males and 51 519 females), aged 40–74 years, who had completed the specified medical check-ups.

Outcome measure

The presence of NRS was assessed using a question asking whether or not the subjects usually got enough sleep. NRS was considered to be present when the subjects answered ‘No’. Binary logistic regression analysis was used to assess the associations of presence or absence of EX and/or PA with NRS. The OR and 95% CI of NRS prevalence were calculated and compared between those engaged in both EX and PA and the others.

Results

Except for 40s and 70s among males and 40s and 50s among females, the absence of EX or PA was associated with higher ORs of NRS than referent. ORs were more than twice compared with the referents in males in their 50s (OR 2.030(95% CI 1.675 to 2.459)) and 60s (OR 2.148(95% CI 1.970 to 2.343)) and females in their 60s (OR 2.142(95% CI 1.994 to 2.302)) when they engaged in neither EX nor PA.

Conclusions

Healthcare providers must take into account the similarities and differences in the associations of EX and/or PA with NRS by gender and age when they support people with NRS.
Effectiveness and cost-effectiveness of a virtual multidisciplinary stroke care clinic for community-dwelling stroke survivors and caregivers: a randomised controlled trial protocol
Authors: Chau Janita Pak Chun , Lo Suzanne Hoi Shan , Lee Vivian Wing Yan , Choi Kai Chow , Shum Edward Wai Ching , Hung Zevari Sheung Sheung , Mok Vincent Chung Tong , Siow Elaine Kee Chen , Ching Jessica Yuet Ling , Lam Simon Kwun Yu , Yeung Jonas Hon Ming , Li Siu Hung , Lau Alexander Yuk Lun
Published: May 2019

Introduction

The virtual multidisciplinary stroke care clinic (VMSCC) is the first nurse-led clinic developed to offer support to community-dwelling stroke survivors and caregivers, and to promote poststroke recovery. This two-arm randomised controlled trial will evaluate its effectiveness on survivors’ self-efficacy (SE), survivors’ and caregivers’ health-related quality of life (HRQoL) and cost-effectiveness on emergency admissions and length of readmission hospital stay.

Methods and analysis

A consecutive sample of 384 stroke survivor–caregiver dyads will be recruited from four hospitals. An online platform that embraces readily accessible and reliable information will be developed. Participants randomly assigned to the intervention group will receive usual care plus the VMSCC service. The service includes access to a tablet containing 30 videos demonstrating appropriate self-care strategies, communication with a registered nurse monthly through video and telephone calls and regular blood pressure monitoring. Primary outcomes include survivors’ SE in self-management and survivors’ and caregivers’ HRQoL. Secondary outcomes include survivors’ performance of self-management behaviours, depression and social participation; and caregivers’ coping strategies, satisfaction with caring and depression. Data will be collected at baseline, and at 3 and 6 months after commencing the intervention. Survivors’ and caregivers’ satisfaction with the service will be assessed at 6-month follow-up. Multivariable regressions and generalised estimating equations model will be conducted. Survivors’ emergency admissions and length of hospital stay will be evaluated during the 6-month follow-up period. Cost-effectiveness analysis will be performed on the average total cost incurred.

Discussion

The results will inform stakeholders about incorporating the VMSCC service into current stroke rehabilitation service.

Ethics and dissemination

This protocol was approved by the Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee (CREC Ref. No.: 2017.660). All participants will provide written informed consent. Results will be disseminated through scientific publications, and presentations at local and international conferences.

Trial registration number

ChiCTR1800016101; Pre-results.
Factors associated with adverse drug reaction occurrence and prognosis, and their economic impacts in older inpatients in Taiwan: a nested case–control study
Authors: Liao Pei-Ju , Mao Chien-Tai , Chen Tun-Liang , Deng Shin-Tarng , Hsu Kuang-Hung
Published: May 2019

Objective

Older patients are likely to have higher disease complexity and more drug prescriptions of which are associated with a higher incidence of adverse drug reactions (ADR). This study aimed to investigate factors associated with ADR occurrence, prognosis and medical expenses in older inpatients.

Design

A nested case–control study.

Setting

A medical centre located in north Taiwan.

Participants

539 reported ADR cases from a patient cohort containing 108 548 older inpatients were collected from 2006 to 2012. There were 1854 non-ADR matched controls; a maximum of 1:5 matched by age, sex and principal diagnosis were collected.

Exposure

Polypharmacy, the number of drugs prescribed, comorbidities and the admission department were factors associated with ADRs, as well as subsequent poor prognosis, length of stay and medical expenses.

Primary and secondary outcome measures

ADR occurrence and poor prognosis (mortality, discharge against medical advice in critical conditions, or admitted to intensive care unit) were the primary outcomes. Additional medical expenses and the length of hospital stay were the secondary outcomes.

Results

The admission department, number of comorbidities and number of drug prescriptions before ADRs were associated with ADR occurrence among older inpatients. ADR severity was a significant prognostic factor among ADR cases. The multivariate-adjusted OR of 1.63 (95% CI 1.36 to 1.95) for poor prognosis was found as the number of comorbidities increased. Patients prescribed ≥11 drugs including psychoactive drugs showed 2.45-fold (95% CI 1.40 to 4.28) poorer prognosis than other patients. ADRs caused the addition of US$1803.8, US$360.8 and 5.6 days in total medical expenses, drug expenses and length of stay among affected older inpatients, respectively.

Conclusions

The number of comorbidities and polypharmacy including the use of psychoactive drugs has significant impacts on ADR occurrence and prognosis among older inpatients. The findings provide clues for future prescription modification and patient’s safety improvement in geriatric care.
Determinants of cigarette smoking status in a national cohort of black and white adult ever smokers in the USA: a cross-sectional analysis of the REGARDS study
Authors: Parekh Trisha M , Wu Chengyi , McClure Leslie A , Howard Virginia J , Cushman Mary , Malek Angela M , Harrington Kathleen F , Cherrington Andrea L , Dransfield Mark T , Bhatia Smita
Published: May 2019

Objectives

While awareness of cigarette smoking’s harmful effects has increased, determinants associated with smoking status remain understudied, including potential racial differences. We aim to examine factors associated with former versus current smoking status and assess whether these associations differed by race.

Setting

We performed a cross-sectional analysis using the population-based Reasons for Geographic and Racial Differences in Stroke(REGARDS)study.

Outcome measures

Logistic regression was used to calculate the OR of former smoking status compared with current smoking status with risk factors of interest. Race interactions were tested using multiplicative interaction terms.

Results

16 463 participants reported smoking at least 100 cigarettes in their lifetime. Seventy-three per cent (n=12 067) self-reported former-smoker status. Physical activity (reference (REF) <3×/week; >3×/week: OR=1.26, 95% CI 1.11 to 1.43), adherence to Mediterranean diet (REF: low; medium: OR=1.46, 95% CI 1.27 to 1.67; high: OR=2.20, 95% CI 1.84 to 2.64), daily television viewing time (REF: >4 hours; <1 hour: OR=1.32, 95% CI 1.10 to 1.60) and abstinence from alcohol use (REF: heavy; none: OR=1.50, 95% CI 1.18 to 1.91) were associated with former-smoker status. Male sex, higher education and income $35 000–$74 000 (REF: <$20 000) were also associated with former-smoker status. Factors associated with lower odds of reporting former-smoker status were younger age (REF: ≥65 years; 45–64 years: OR=0.34, 95% CI 0.29 to 0.39), black race (OR=0.62, 95% CI 0.53 to 0.72) and single marital status (REF: married status; OR=0.66, 95% CI 0.51 to 0.87), being divorced (OR=0.60, 95% CI 0.50 to 0.72) or widowed (OR=0.70, 95% CI 0.57 to 0.85). Significant interactions were observed between race and alcohol use and dyslipidaemia, such that black participants had higher odds of reporting former-smoker status if they were abstinent from alcohol (OR=2.32, 95% CI 1.47 to 3.68) or had a history of dyslipidaemia (OR=1.31, 95% CI 1.06 to 1.62), whereas these relationships were not statistically significant in white participants.

Conclusion

Efforts to promote tobacco cessation should consist of targeted behavioural interventions that incorporate racial differences.
Levels of Lipoprotein (a) in patients with coronary artery disease with and without inflammatory rheumatic disease: a cross-sectional study
Authors: Holm Sverre , Oma Ingvild , Hagve Tor-Arne , Saatvedt Kjell , Brosstad Frank , Mikkelsen Knut , Rydningen Hans , Risnes Ivar , Almdahl Sven Martin , Ueland Thor , Aukrust Pål , Halvorsen Bente , Hollan Ivana
Published: May 2019

Objectives

Patients with various inflammatory rheumatic diseases (IRDs) have increased risk of atherothrombotic disease. Lipoprotein (a) (Lp(a)) is a risk factor for atherosclerosis but its role in IRD with accompanying coronary artery disease (CAD) is still unclear. We aimed to examine if serum Lp(a) levels differed between CAD patients with and without accompanying IRD.

Design

A cross-sectional observational, patient-based cohort study.

Setting

Referred centre for coronary artery bypass grafting in the South Eastern part of Norway.

Participants

67 CAD patients with IRD (CAD/IRD) and 52 CAD patients without IRD (CAD/non-IRD). All patients were Caucasians, aged >18 years, without any clinically significant infection or malignancy.

Methods

Lp(a) levels in serum were analysed by particle enhanced immunoturbidimetric assay, and Lp(a) levels were related to clinical and biochemical characteristics of the patient population.

Results

We found no differences in serum levels of Lp(a) between CAD patients with and without IRD. In general, we found that Lp(a) correlated poorly with clinical and biochemical parameters including C reactive protein with the same pattern in the CAD/non-IRD and CAD/IRD groups.

Conclusions

Our data do not support a link between inflammation and Lp(a) levels in CAD and in general Lp(a) levels were not correlated with other risk factors for cardiovascular disease.
Clinical implications of early caudate dysfunction in Parkinson’s disease
Authors: Pasquini Jacopo , Durcan Rory , Wiblin Louise , Gersel Stokholm Morten , Rochester Lynn , Brooks David James , Burn David , Pavese Nicola
Published: May 2019

Objective

Although not typical of Parkinson’s disease (PD), caudate dopaminergic dysfunction can occur in early stages of the disease. However, its frequency and longitudinal implications in large cohorts of recently diagnosed patients remain to be established. We investigated the occurrence of caudate dopaminergic dysfunction in the very early phases of PD (<2 years from diagnosis) using123I-FP-CIT single photon emission CT and determined whether it was associated with the presence or subsequent development of cognitive impairment, depression, sleep and gait problems.

Methods

Patients with PD and healthy controls were identified from the Parkinson’s Progression Markers Initiative (PPMI) database. We defined a clinically significant caudate dysfunction as123I-FP-CIT binding <–2 SDs compared with the controls’ mean and categorised three groups accordingly (no reduction, unilateral reduction, bilateral reduction). All statistical analyses were adjusted for mean putamen binding.

Results

At baseline, 51.6% of 397 patients had normal caudate dopamine transporter binding, 26.0% had unilateral caudate involvement, 22.4% had bilaterally impaired caudate.

Compared with those with a baseline normal caudate function, at the4-year follow-up patients with a baseline bilateral caudate involvement showed a higher frequency of cognitive impairment (p<0.001) and depression (p<0.001), and worse cognitive (p<0.001), depression (<0.05) and gait (<0.001) ratings. Significant caudate involvement was observed in 83.9% of the population after 4 years (unilateral 22.5%, bilateral 61.4%).

Conclusions

Early significant caudate dopaminergic denervation was found in half of the cases in the PPMI series. Baseline bilateral caudate involvement was associated with increased risk of developing cognitive impairment, depression and gait problems over the next 4 years.
Cognitive functional therapy (CFT)-based rehabilitation improves clinical outcomes in UK military personnel with persistent low back pain
Authors: Conway Dean , Ladlow P , Ferreira J , Mani-Babu S , Bennett A N
Published: May 2019

Introduction

Low back pain (LBP) has been reported as the most common reason for presentation to the Medical Centre in the British Military, and the most common re-referral for the same condition. In 2015, the UK Defence Medical Rehabilitation Centre (DMRC) adopted a cognitive functional therapy (CFT) approach to spinal rehabilitation in line with National Institute for Health and Care Excellence and military best practice guidelines. The aim of this study is to evaluate the functional and psychosocial outcomes of all patients with chronic LBP treated with CFT-based multidisciplinary rehabilitation at DMRC, Headley Court.

Methods

A prospective observational service evaluation of British Military patients (n=238) with LBP who attended 3 weeks of inpatient multidisciplinary CFT-based programme from 2015 to the end of 2017 at DMRC was analysed. Functional outcomes include: multistage locomotion test (MSLT) and sit and reach test. Psychosocial outcomes include: Tampa Scale of Kinesiophobia, Oswestry Disability Index, Brief Pain Inventory (BPI), General Anxiety Disorder-7 and Patient Health Questionnaire-9.

Results

There were significant improvements in endurance (MSLT), range of motion, kinesiophobia, pain-related lifestyle interference (BPI-Lifestyle), anxiety and depression (p≤0.001). However, no improvements in pain intensity (BPI-Intensity) were demonstrated (p>0.05).

Conclusion

After 3 weeks of CFT-based multidisciplinary rehabilitation, function and psychosocial health improved with symptoms of pain being less obtrusive to activities of daily activity. There were however no patient-reported reductions in pain intensity. The improvements demonstrated are indicative of outcomes that facilitate greater integration back to work or into society.
Microglial activation after ischaemic stroke
Authors: Zhang Shengxiang
Published: May 2019

Ischaemic stroke can induce rapid activation of microglia. As the resident immune cells of the central nervous system, microglial activation is believed to play a central role in neuroinflammation and pathological progression of ischaemic tissue. The activation of microglia after ischaemia involves several stereotypical events including morphological transformation, proliferation and polarisation. Studies using confocal or two-photon imaging techniques have revealed that the degree of microglial activation is correlated with the degree of ischaemia. Activated microglia display diverse polarisation phenotypes. It remains largely unclear regarding whether activated microglia are beneficial or detrimental to poststroke recovery. This mini-review focuses on the morphological and functional aspects of microglial activation, with particular attention to progress in two-photon imaging studies.
Characteristic strength of soils underlying foundations considering effect of spatial variability
Authors: Shi Guicai , Pan Yutao , Sun Zhaohua , Liu Yong , Lee Fook-Hou
Published: May 2019

In Eurocode EC7, a “characteristic” strength is used as a cautious estimate of the local average strength that governs the bearing capacity of the foundation. The objective of this paper is to examine the correlation between the local average strength and the bearing capacity of a stiff caisson foundation resting on spatially variable ground using random finite element analyses. The results show that using the local average strength over some assumed or postulated failure zones tends to overestimate the mean bearing capacity of the ground. This can be attributed to two possible reasons. Firstly, the postulated failure zone is unlikely to be fully reflective of the real failure zone in spatially variable ground. Secondly, the bearing capacity is more affected by the strength of the weak zones than that of the strong zones. Both of these factors lead to a lowering of the bearing capacity. A more indicative way of determining a characteristic strength that will give a better indication of the bearing capacity is also recommended, together with a strength reduction factor that accounts for the effect of spatial variability.
Strategic timing and rate of sulphur fertilization improves sulphur use efficiency in subirrigated greenhouse-grown chrysanthemums
Authors: Sutton William J. , Bozzo Gale G. , Carlow Chevonne , MacDonald William N. , Shelp Barry J.
Published: May 2019

Industry standards for nutrient delivery to greenhouse-grown ornamentals are typically in excess of the plant’s needs and can be reduced without causing adverse effects. Previous studies have reduced the level of specific nutrients or suite of nutrients over the entire crop cycle or at the onset of reproductive growth. Here, two split-plot experiments (four blocks each) were conducted with subirrigated, potted, disbudded chrysanthemums (Chrysanthemum morifolium Ramat.) grown under greenhouse conditions with sulphate treatment (2.25 mmol L−1 S supplied continuously over the crop cycle in experiment 2 only and 2.25, 1.125, or 0.5625 mmol L−1 S interrupted at inflorescence emergence) as the main plot and cultivar (‘Olympia’ and ‘Covington’) as the sub-plot. Morphological characteristics of plants with fully-expanded inflorescences were unaffected by decreasing S delivery over the crop cycle. Dry mass (DM) yields and S budgets revealed that supply-based S use and S uptake efficiencies increased markedly in both cultivars with decreasing S delivery. Minor amounts of reduced-S, rather than sulphate, were lost from leaves of ‘Covington’ during inflorescence development. High quality chrysanthemums had sufficient leaf-S (0.17%–0.23% DM) at inflorescence emergence even with the lowest S supply, which would deliver an approximate 87.5% reduction in S over the crop cycle compared with industry standards. The primary mechanism to obtain sufficient S for the growth of chrysanthemums in these studies was increased uptake efficiency.
TIM-3 Dictates Functional Orientation of the Immune Infiltrate in Ovarian Cancer
Authors: Fucikova Jitka , Rakova Jana , Hensler Michal , Kasikova Lenka , Belicova Lucie , Hladikova Kamila , Truxova Iva , Skapa Petr , Laco Jan , Pecen Ladislav , Praznovec Ivan , Halaska Michael J. , Brtnicky Tomas , Kodet Roman , Fialova Anna , Pineau Josephine , Gey Alain , Tartour Eric , Ryska Ales , Galluzzi Lorenzo , Spisek Radek
Published: May 2019

Purpose:

In multiple oncological settings, expression of the coinhibitory ligand PD-L1 by malignant cells and tumor infiltration by immune cells expressing coinhibitory receptors such as PD-1, CTLA4, LAG-3, or TIM-3 conveys prognostic or predictive information. Conversely, the impact of these features of the tumor microenvironment on disease outcome among high-grade serous carcinoma (HGSC) patients remains controversial.

Experimental Design:

We harnessed a retrospective cohort of 80 chemotherapy-naïve HGSC patients to investigate PD-L1 expression and tumor infiltration by CD8+ T cells, CD20+ B cells, DC-LAMP+ dendritic cells as well as by PD-1+, CTLA4+, LAG-3+, and TIM-3+ cells in relation with prognosis and function orientation of the tumor microenvironment. IHC data were complemented with transcriptomic and functional studies on a second prospective cohort of freshly resected HGSC samples. In silico analysis of publicly available RNA expression data from 308 HGSC samples was used as a confirmatory approach.

Results:

High levels of PD-L1 and high densities of PD-1+ cells in the microenvironment of HGSCs were strongly associated with an immune contexture characterized by a robust TH1 polarization and cytotoxic orientation that enabled superior clinical benefits. Moreover, PD-1+TIM-3+CD8+ T cells presented all features of functional exhaustion and correlated with poor disease outcome. However, although PD-L1 levels and tumor infiltration by TIM-3+ cells improved patient stratification based on the intratumoral abundance of CD8+ T cells, the amount of PD-1+ cells failed to do so.

Conclusions:

Our data indicate that PD-L1 and TIM-3 constitute prognostically relevant biomarkers of active and suppressed immune responses against HGSC, respectively.
Abstract SY34-02: The impact of O2 availability on human cancer
Authors: Simon M. Celeste
Published: May 2019

During the past century, it has been established that regions within solid tumours experience mild to severe O2 deprivation owing to aberrant vascular function. These hypoxic regions are associated with altered cellular metabolism, as well as increased resistance to radiation and chemotherapy. As discussed in this Timeline, over the past decade work from many laboratories has elucidated the mechanisms by which hypoxia-inducible factors (HIFs) modulate tumour cell metabolism, angiogenesis, growth and metastasis. The central role played by intra-tumoural hypoxia and HIF in these processes has made them attractive therapeutic targets in the treatment of multiple human malignancies.

Citation Format: M. Celeste Simon. The impact of O2 availability on human cancer [abstract]. In: Proceedings of the AACR 101st Annual Meeting 2010; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr SY34-02