bluuebunny/crossref_metadata_2025 huggingface dataset:
Balancing normalcy and safety: health-related needs in patients with a ventricular assist device within their home environment
Authors: Treß Florian , Spitz-Koeberich Christine , Rebafka Anne , Schibilsky David , Kugler Christiane
Published: November 2021

Aims

Ventricular assist device (VAD) implantation has become a well-established treatment strategy for patients suffering from advanced heart failure. Ventricular assist device treatment attempts to ameliorate the symptom burden but may create new challenges in patients’ lives. Lacking are insights into perceived challenges and health-related needs of patients with VAD within their home environment. Our study aimed to explore the perceived health-related needs of patients living with a VAD in their home environment.

Methods and results

We used a qualitative approach based on a hermeneutic, directed content analysis design. Telephone-based interviews were conducted with 10 patients with VAD from a single cardiology centre in Germany. Data collection and analyses were carried out using content-structuring content analyses. Normalcy and safety were identified as overarching themes: participants expressed a need to balance daily activities between striving for normalcy and maintaining safety. Underlying necessities reflecting this balance were categorized as functional, social, and mental health-related needs. Learning by doing, social-, and peer support were described as relevant requisites. Fulfilling these health-related needs could aid patients living with VAD in achieving the sense of normalcy and safety they seek.

Conclusion

Balancing health-related needs with striving for normalcy and safety, emerged as a new core concept for patients with VAD. Thus, being cognizant of this balance when caring for these patients, could facilitate coping after VAD implantation through increasing acceptance of limitations to daily functions by enhancing individual safety. A supportive social environment, including peer support, becomes vital in self-management programs preparing patients with VAD for their home environment.
Emergency rollout and conversion procedures during the three-arm robotic open-thoracotomy-view approach
Authors: Sakakura Noriaki , Nakada Takeo , Shirai Suguru , Takahara Hirotomo , Suzuki Ayumi , Takahashi Yusuke , Kuroda Hiroaki
Published: November 2021

OBJECTIVES

To conduct robotic lung resections (RLRs) with views similar to those in open-thoracotomy surgery (OTS), we adopted a vertical port placement and confronting upside-down monitor setting: the robotic open-thoracotomy-view approach (OTVA). We herein discuss the procedures for emergency rollout and conversion from the robotic OTVA to OTS or video-assisted thoracoscopic surgery (VATS).

METHODS

We retrospectively reviewed the cases of 88 patients who underwent RLR with three-arm OTVA using the da Vinci Xi Surgical System between February 2019 and July 2021. Robotic ports were vertically placed along the axillary line, and 2 confronting monitors and 2 assistants were positioned on each side of the patient. Three possible conversions were prepared: (i) emergency thoracotomy using an incision along the ribs in a critical situation, (ii) cool conversion using vertical incision thoracotomy in a calmer condition and (iii) conversion to confronting VATS. All staff involved in the surgery repeatedly rehearsed the emergency rollout in practice.

RESULTS

No emergent or cool conversion to OTS occurred. Two patients (2.3%) experienced confronting VATS conversions. One patient underwent an urgent conversion for a moderate haemorrhage from a pulmonary artery branch during left upper lobectomy in the introduction phase. Another patient underwent a calmer conversion during an extended RS6 + S10a segmentectomy, where staples could not be inserted appropriately due to lung lacerations. In all patients, postoperative courses were uneventful.

CONCLUSIONS

The OTVA setting is a possible option for RLRs. This report describes the emergent rollout and subsequent conversion procedures for this method.
Effects of the Partial M1 Muscarinic Cholinergic Receptor Agonist CDD-0102A on Stereotyped Motor Behaviors and Reversal Learning in the BTBR Mouse Model of Autism
Authors: Athnaiel Onella , Job Greeshma A , Ocampo Roberto , Teneqexhi Pamela , Messer William S , Ragozzino Michael E
Published: November 2021

Background

Autism spectrum disorders (ASD) are a set of neurodevelopmental disorders marked by a lack of social interaction, restrictive interests, and repetitive behaviors. There is a paucity of pharmacological treatments to reduce core ASD symptoms. Various lines of evidence indicate that reduced brain muscarinic cholinergic receptor activity may contribute to an ASD phenotype.

Methods

The present experiments examined whether the partial M1 muscarinic receptor agonist, 5-(3-ethyl-1,2,4-oxadiazol-5-yl)-1,4,5,6-tetrahydropyrimidine hydrochloride (CDD-0102A), alleviates behavioral flexibility deficits and/or stereotyped motor behaviors in the BTBR mouse model of autism. Behavioral flexibility was tested using a reversal learning test. Stereotyped motor behaviors were measured by eliciting digging behavior after removal of nesting material in a home cage and by measuring repetitive grooming.

Results

CDD-0102A (0.2 and 0.6 mg/kg but not 1.2 mg/kg) injected prior to reversal learning attenuated a deficit in BTBR mice but did not affect performance in B6 mice. Acute CDD-0102A treatment (1.2 and 3 mg/kg) reduced self-grooming in BTBR mice and reduced digging behavior in B6 and BTBR mice. The M1 muscarinic receptor antagonist VU0255035 (3 mg/kg) blocked the effect of CDD-0102A on grooming behavior. Chronic treatment with CDD-0102A (1.2 mg/kg) attenuated self-grooming and digging behavior in BTBR mice. Direct CDD-0102A infusions (1 µg) into the dorsal striatum reduced elevated digging behavior in BTBR mice. In contrast, CDD-0102A injections in the frontal cortex were not effective.

Conclusions

The results suggest that treatment with a partial M1 muscarinic receptor agonist may reduce repetitive behaviors and restricted interests in autism in part by stimulating striatal M1 muscarinic receptors.
A Non-Hyperelliptic Curve with Torsion Ceresa Cycle Modulo Algebraic Equivalence
Authors: Beauville Arnaud , Schoen Chad
Published: November 2021

We exhibit a non-hyperelliptic curve $C$ of genus $3$ such that the class of the Ceresa cycle $[C]-[C^-]$ in $JC$ modulo algebraic equivalence is torsion.
Ixodes scapularis (Ixodida: Ixodidae) Parasitizing an Unlikely Host: Big Brown Bats, Eptesicus fuscus (Chiroptera: Vespertilionidae), in New York State, USA
Authors: Occi James L , Campbell Victoria M , Fonseca Dina M , Robbins Richard G
Published: November 2021

Ixodes scapularis Say is a three-host tick that has been recorded feeding on over 150 different species of terrestrial vertebrates (mammals, birds, and reptiles). This tick is found throughout the northeastern, coastal southeastern, and upper midwestern United States and is considered the most significant vector of tick-borne pathogens to humans in North America. Despite its ubiquity and broad host range, I. scapularis previously has not been reported feeding on bats (Chiroptera). However, during 2019 and 2020, larvae and nymphs of I. scapularis were recovered from big brown bats, Eptesicus fuscus (Palisot de Beauvois), at four locations in rural New York State, USA. All Ixodes infested bats were injured and found on the ground; therefore, parasitism by I. scapularis was likely opportunistic. Nonetheless, the large number of pathogens known to be associated with bats and the frequency with which I. scapularis bites people suggest that this host–tick relationship is of at least potential epidemiological significance.
Ranger O Low Titer (ROLO): Whole Blood Transfusion for Forward Deployed Units
Authors: Song Kaoru H , Winebrenner Hans M , Able Ty E , Bowen Charles B , Dunn Noel A , Shevchik Joseph D
Published: November 2021

First-time use of Ranger O Low Titer (ROLO) blood and implementation of a forward-walking blood bank using predetermined donors proved essential in the survival of a 33-year-old active duty soldier following a complex blast injury during combat operations. The patient sustained significant bone, soft tissue, and vascular damage and continued to deteriorate despite resuscitation with cold-stored whole blood (WB). Only after utilizing the ROLO battle drill and transfusing with fresh WB was the patient able to be stabilized and evacuated. In this case report, we discuss how ROLO walking blood bank takes the next step in aiding resuscitation, providing smaller, forward-deployed units with blood resupply without the administrative burden of storage, particularly in resource-scarce environments. We provide an overview of WB and contrast its use to that of component therapy. In conjunction with the Golden Hour, ROLO can be incorporated as the standard damage control resuscitation to reduce the risks of noncompressible hemorrhage. By taking precautionary steps in the pre-deployment setting, ROLO offers an invaluable alternative to conventional resuscitation.
Immunophenotyping comparison of inflammatory cells betweenMalasseziafolliculitis and pityriasis versicolor lesions
Authors: Chen Yu , Yang Yan-Ping , Qiu Fang , Wang Yu-Jie , Fan Yi-Ming
Published: November 2021

Immunophenotyping of inflammatory dermal infiltrates in Malassezia folliculitis (MF) and pityriasis versicolor (PV) lesions is less reported. Immunohistochemistry was performed on 21 MF lesions, 10 PV lesions, and 10 control skin. CD3+, CD4+, CD8+, CD20+, CD68+, and CD117+ cells were increased in MF compared with PV and normal skin (P < 0.01–0.05), while CD3+, CD4+, and CD20+ cells were higher in PV than in normal skin (P < 0.05). Dermal CD1a+ cells were higher only in PV (P < 0.05). Although both cellular and humoral immune responses are involved in pathogenesis of MF and PV, their difference may contribute to clinicopathological discrepancy between two disorders.

Lay Summary

Malassezia folliculitis and pityriasis versicolor are common Malassezia-induced superficial mycoses. Their clinicopathological discrepancy may be due to the difference of cellular and humoral immune responses.
In vitro activity of eight antifungal drugs against Chaetomiaceae
Authors: Dolatabadi Somayeh , Najafzadeh Mohammad Javad , Houbraken Jos , Vicente Vania , de Hoog Sybren , Meis Jacques F
Published: November 2021

The incidence of infections caused by uncommon Chaetomiaceae (Chaetomium and related species) in humans has increased in the recent years. The in vitro activity of eight antifungal drugs (amphotericin B, five azoles, two echinocandins) against 42 morphologically identified Chaetomium strains was determined according to the Clinical and Laboratory Standards Institute (CLSI) guideline. The strains were subsequently identified based on sequences of the internal transcribed spacer 1 and 2 including the intervening 5.8S nrDNA region (ITS) and the partial β tubulin gene (tub2). Chaetomium globosum (n = 24), was the most frequently isolated species, followed by Amesia atrobrunnea (syn. Chaetomium atrobrunnea, n = 6), Dichotomopilus dolichotrichus (syn. Chaetomium dolichotrichum, n = 2) and Acrophialophora jodhpurensis, Chaetomium coarctatum, C. elatum, C. gracile, C. subaffine, C. tarraconense, C. unguicola, Dichotomopilus sp., Dichotomopilus variostiolatus, Ovatospora brasiliensis (all represented by a single strain). The geometric means of the minimum inhibitory concentrations/minimum effective concentrations (MICs/MECs) of the antifungals across all strains were (in increasing order): micafungin 0.12 µg/ml, itraconazole and posaconazole 0.21 µg/ml, amphotericin B 0.25 µg/ml, voriconazole 0.45 µg/ml, isavuconazole 0.54 µg/ml, caspofungin 2.57 µg/ml, and fluconazole 45.25 µg/ml. Micafungin had the lowest geometric mean followed by amphotericin B which had the largest range against tested isolates. All examined C. globosum strains had similar antifungal susceptibility patterns. Fluconazole and caspofungin could not be considered as an option for treatment of infections caused by Chaetomium and chaetomium-like species.

Lay summary

Infections caused by uncommon fungi such as Chaetomium have increased in the recent years. Chaetomium globosum has been reported from onychomycosis and phaeohyphomycosis. This species often induces superficial infections in immunocompetent patients. The taxonomy of Chaetomium spp. has changed dramatically in the last years. Antifungal treatment is a crucial step for managing these kinds of infections. Therefore, the in vitro activity of eight antifungal drugs against Chaetomium strains was determined and β-tubulin (tub2) sequencing was applied to identify the strains. Chaetomium globosum was the most frequent species in our dataset. Based on the results of susceptibility testing, micafungin had the lowest geometric mean followed by amphotericin B. Fluconazole and caspofungin cannot be considered a proper treatment option for infections caused by Chaetomium and chaetomium-like species.
C60 cation as the carrier of the λ 9577 Å and λ 9632 Å diffuse interstellar bands: further support from the VLT/X-Shooter spectra
Authors: Nie T P , Xiang F Y , Li Aigen
Published: November 2021

Ever since they were first detected over 100 yr ago, the mysterious diffuse interstellar bands (DIBs), a set of several hundred broad absorption features seen against distant stars in the optical and near-infrared wavelength range, largely remain unidentified. The close match, both in wavelengths and in relative strengths, recently found between the experimental absorption spectra of gas-phase buckminsterfullerene ions (C$_{60}^{+}$) and four DIBs at $\lambda 9632\, {\rm \mathring{\rm A}}$, $\lambda 9577\, {\rm \mathring{\rm A}}$, $\lambda 9428\, {\rm \mathring{\rm A}}$ and $\lambda 9365\, {\rm \mathring{\rm A}}$ (and, to a lesser degree, a weaker DIB at $\lambda 9348\, {\rm \mathring{\rm A}}$) suggests that C$_{60}^{+}$ is a promising carrier for these DIBs. However, arguments against the C$_{60}^{+}$ identification remain and are mostly concerned with the large variation in the intensity ratios of the $\lambda 9632\, {\rm \mathring{\rm A}}$ and $\lambda 9577\, {\rm \mathring{\rm A}}$ DIBs. In this work, we search for these DIBs in the X-shooter archival data of the European Southern Observatory’s Very Large Telescope, and we identify the $\lambda 9632\, {\rm \mathring{\rm A}}$, $\lambda 9577\, {\rm \mathring{\rm A}}$, $\lambda 9428\, {\rm \mathring{\rm A}}$ and $\lambda 9365\, {\rm \mathring{\rm A}}$ DIBs in a sample of 25 stars. While the $\lambda 9428\, {\rm \mathring{\rm A}}$ and $\lambda 9365\, {\rm \mathring{\rm A}}$ DIBs are too noisy to allow any reliable analysis, the $\lambda 9632\, {\rm \mathring{\rm A}}$ and $\lambda 9577\, {\rm \mathring{\rm A}}$ DIBs are unambiguously detected and, after correcting for telluric water vapour absorption, their correlation can be used to probe their origin. To this end, we select a subsample of nine hot, O- or B0-type stars of which the stellar Mg ii contamination to the $\lambda 9632\, {\rm \mathring{\rm A}}$ DIB is negligibly small. We find that their equivalent widths, after being normalized by reddening to eliminate their common correlation with the density of interstellar clouds, exhibit a tight, positive correlation, supporting C$_{60}^{+}$ as the carrier of the $\lambda 9632\, {\rm \mathring{\rm A}}$ and $\lambda 9577\, {\rm \mathring{\rm A}}$ DIBs.
Agriculture after Brexit
Authors: Helm Dieter
Published: November 2021

Brexit repatriates agriculture policy and subsidies after over 40 years of determination by the European Commission. The paper starts by describing the baseline at Brexit, noting the relatively small economic contribution, the problems of competitiveness given the UK’s geology and geography, and the poor environmental outcomes. The scope for improvement is correspondingly large, and in particular through the impacts of the new agricultural policy based upon public money for public goods and for England, the Environmental Land Management Schemes. Larger and more long-term impacts will come through new trade agreements, through new technologies, including digitalization, robotics, and genetics, and through carbon farming and offsets. Finally, the paper sets out a framework for a future assessment of the impact of Brexit.
P010 Clinico-epidemiological characteristics and outcomes of Juvenile Idiopathic Arthritis (JIA) patients in Kenya: data from the KAPRI registry
Authors: Migowa A , Odhiambo R , Orwa J , Shah J
Published: November 2021

Background

Pediatric rheumatic diseases pose a significant disease burden upon children and their families (1–3). They lead to physical disability and diminished quality of life (1–3). Determination of the burden and clinical characteristics of these diseases is a critical first step to improving access to care and optimizing use of existing health systems for the well-being of these patients (4). This is in line with the goal of the Bone and Joint decade (2000–2010) aimed at increasing recognition and understanding of the impact of musculoskeletal diseases (5,6). The Kenya Pediatric Rheumatology Registry (KAPRI) offers a unique opportunity to pioneer and spearhead a systematic and organized format to inform policy and better healthcare provision. Our objective was to determine the patient characteristics, clinical features and outcomes of Juvenile Idiopathic Arthritis (JIA) patients assessed at the Aga Khan University Medical College East Africa from March 2019 to December 2020.

Methods

Data of JIA patients on age, gender, laboratory and clinical features at diagnosis and treatment options offered were extracted from the database. A further detailed chart review was undertaken to determine the proportion of patients who achieved remission or minimally active diseases.

Results

Among the 207 patients enrolled thus far, 16 (7.7%) were diagnosed to have JIA. Majority of the patients were females (75%; n = 12) with a mean age of 7 years and 3 months (Range : 1 year—13 years 7 months).

All patients had joint pain and swelling as the initial presenting complaints. Majority of the patients had polyarticular JIA (75%, n = 12). The other 4 patients were oligoarticular (n = 2) and systemic JIA (n = 2). Among the polyarticular JIA patients (n = 12), only 3 (25%) were rheumatoid factor (RF) positive and 1 was antinuclear antibody (ANA) positive. The oligoarticular and systemic JIA patients were all negative for antinuclear antibody, rheumatoid factor and cyclic citrullinated peptide antibodies (anti-ccp). Seven patients (43.8%) required biological therapies; tocilizumab (n = 2: systemic JIA), adalimumab (n = 2: polyarticular JIA), etanercept (n = 2: polyarticular JIA) andtofacitnib (n = 1: polyarticular JIA). One patient with systemic JIA on tocilizumab developed herpes simplex which was successfully managed with oral acyclovir. All the other patients did not develop any infections, allergic reactions or any other untoward events as adverse outcomes following the use of biological therapies. Five patients have attained remission as illustrated in the table below. Two patients have been lost to follow up.

Conclusion

Seronegative polyarticular JIA was the predominant form of JIA observed with a predilection to affect more girls and boys. Over a period of 2 years, remission has been attained among 31.25% of the patients (5 of 16) with use of synthetic disease modifying anti-rheumatic drugs and biological therapies.
P024 Efficacy and tolerance of methotrexate in patients with Juvenile Idiopathic Arthritis
Authors: Fazaa A , Rouatbi F , Miladi S , Ouenniche K , Souabni L , Kassab S , Chekili S , Ben Abdelghani K , Laatar A
Published: November 2021

Background

Juvenile idiopathic arthritis (JIA) is the most common inflammatory rheumatic disease for children. The therapeutic management depends on several factors and is based on different treatments including methotrexate (MTX). The aim of our study was to determine the efficacy and safety of MTX in JIA.

Methods

This is a monocentric retrospective study of 37 patients followed for JIA according to the 2001 International League of Association of Rheumatology (ILAR) criteria and treated with MTX. Socio-demographic, clinical, paraclinical and therapeutic data were collected. Disease activity was assessed by the JADAS score. Highly active JIA was defined as JADAS superior to 25.

Results

There were 25 boys (67.5%) and 12 girls (32.4%) with a median age of 6.3 years [4–13]. The average duration of the rheumatic disease was 2.7 years [2.5–5.3]. The type of JIA was: oligoarticular in 22 cases (59.4%), polyarticular in 10 cases (27%), arthritis related to enthesitis in 3 cases (8.1%) and systemic in 2 cases (5.4%). Twenty patients (54%) received oral corticosteroid therapy for a mean period of 1.7 years [0.6–3] with a mean daily dose of 10 mg/day of prednisone or equivalent.

Oral MTX was prescribed to all patients with a mean weekly dose of 10 mg/m2 body surface [10–15]. MTX was initiated after a mean period of 6.2 months [3.1–11.4] from diagnosis. The mean treatment duration was 50 months [34–66].

Observance of MTX was 80.5%. Remission with MTX was achieved in 28 patients (75.6%) after a mean treatment duration of 7.5 months [5–11], with a mean JADAS of 5.1 [3.5–10].

Despite good observance of MTX, eight patients (21.6%) continued to have high disease activity with a mean JADAS score of 32 [25–40].

Tolerance to oral MTX was good, with side effects occurring only with 5 patients (13.5%), such as epigastralgia in 2 cases (which disappeared after switching to the intramuscular administration), a skin reaction in one case, and hepatic cytolysis reversible when stopping the treatment in 2 other cases.

Conclusion

MTX still has a place in the therapeutic management of JIA and appears to be a well-tolerated and effective treatment.
P037 Does perinatal history and delivery enhance the risk of hip involvement in Juvenile Idiopathic Arthritis patients? A case-control study
Authors: Yasmine Makhlouf , Ferjani Hanene , Hassen Affes , Maatallah Kaouther , Ben Nessib Dorra , Triki Wafa , Kaffel Dhia , Mourad Jenzri , Hamdi Wafa
Published: November 2021

Background

Children are vulnerable to congenital and developmental hip disorders. One of the causes of coxitis among children is juvenile idiopathic arthritis (JIA). Existing data on associations between maternal and early childhood exposures highlighted the potential role of prematurity in JIA [1]. The aim of this study was to compare perinatal history in JIA children with coxitis compared with patients with other causes of hip involvement.

Methods

We conducted a cross-sectional study including children with JIA complicated with coxitis and patients with other causes of hip involvement. We recorded sociodemographic data and the hip disorder. The mode of delivery, the values of the neonatal birth weight as well as the delivery method (vaginal, cesarean (C) section) were retrieved from medical records. We divided the patients into two groups: G1: JIA patients with coxitis and G2: patients with other causes of hip involvement. We compared delivery mode, as well as perinatal outcomes between the two groups.

Results

The study included 81 patients. There was a male predominance (59.3% males vs 40.7% females) with a sex-ratio of 1.45. The mean age of diagnosis was 9.9 years [1–16]. The mean disease duration was 9 months [0.1–156]. Hip disorders were distributed as follows: Legg-Calvé-Perthes disease (n = 3), epiphysiolysis of the femur head (n = 30), transient synovitis of the hip n = 7, septic hip (n = 10), tumor (n = 4), hip dislocation (n = 8), hip dysplasia (n = 4), juvenile idiopathic arthritis with coxitis (n = 15). The mean birth weight of the children was 3.4 kg [1.3–9]. About half of the patients had a natural delivery (55.6%) and most of them a face presentation (71.6%). A twin pregnancy was reported only in 2.5% of cases. Childbirth complications were reported in 7.4% of cases: umbilical cord prolapse (n = 1), Meconium aspiration syndrome (n = 1), failure to descend (n = 1), acute fetal distress (n = 3). Most of them had a normal growth and psychomotor development (96% and 97% respectively). There was no statistical difference between the two groups regarding delivery mode and fetal presentation before birth (P = 0.07, P = 0.48 respectively). Similarly, weight at birth was similar between JIA children and patients with other hip involvement (P = 0.52).

Conclusion

Our study showed that maternal and perinatal history did not differ between JIA patients with coxitis and patients with other causes of hip involvement.
P045 Tofacitinib Treatment in Refractory Juvenile Dermatomyositis: A Case Series
Authors: Bowler Hailey A , Patel Aarat M
Published: November 2021

Background

Juvenile Dermatomyositis (JDM) is a systemic, autoimmune disease affecting the skin, blood vessels, and proximal skeletal muscles of juvenile individuals. A subset of JDM patients present with subclinical or resolved muscle involvement but continue to have skin disease. In these cases, first and second line treatments including glucocorticoids are sometimes insufficient for controlling the disease, necessitating escalation of treatment. Several recent studies have investigated the response of Tofacitinib, an oral Janus Kinase inhibitor approved for the treatment of rheumatoid arthritis, in DM patients and patients with inflammatory skin diseases

Objectives

Due to the reported ability of JAK inhibitors to suppress type 1 interferon (IFN) signalling, which is suspected to be upregulated in JDM, we evaluated the efficacy of treatment with Tofacitinib in four JDM patients.

Methods

Three patients with juvenile dermatomyositis without evidence of current muscle involvement and one patient with evidence of muscle involvement began treatment with Tofacitinib 5 mg daily after they had failed or had adverse effects to first- and second-line immunosuppressive agents. Their medical records were reviewed with improvement measured using the Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) activity score. Throughout their treatment they were additionally monitored for improvement in markers of inflammation and muscle enzymes including CK, LDH, and aldolase. Patients were monitored for adverse effects to Tofacitinib.

Results

Three of four patients within the case series showed significant improvement of their CDASI scores over the initial first three months and two out of four patients showed continued improvement over the first six months. Patient #2 required use of Intravenous Immunoglobulin (IVIG) therapy in response to a flare despite continued use of Tofacitinib within the first six months. This patient also continues to require concomitant use of Hydroxychloroquine and IVIG however remains in skin remission. This patient has developed calcinosis despite having no active rash or muscle disease. TOF dose was increased to 5 mg bid for this patient. Patient #4 initially presented with mild skin disease. Other outcomes included significant improvement in arthritis with the addition of methotrexate. This patient also recieved a topical skin steroid injection by dermatology.

Conclusion

Tofacitinib is believed to play a role in the inhibition of IFN signalling pathways that are overactive in dermatomyositis. Three of the four patients within this retrospective study showed significant improvement of cutaneous disease with Tofacitinib use. Further controlled studies will show the utility of JAK inhibition in JDM.
P047 Musculoskeletal symptoms as first clinical presentation of juvenile-onset systemic lupus erythematosus: Experience from a military internal medicine department
Authors: Hannech E , Boussetta N , Guediche N H , Arfaoui B , Ajili F , Abdelhafidh N , Sayhi S , Louzir B
Published: November 2021

Background

Juvenile-onset systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder occurring before the age of sixteen. The clinical manifestations are variable and the management of the disease at this age may be different. The aim of our study was to investigate first clinical presentation of juvenile-onset SLE.

Methods

We conducted a retrospective study in a military internal medicine department. We accessed medical records of 103 patients with SLE diagnosed according to the revised 1997 American College of Rheumatology (ACR) criteria or the 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria. Only patients with an age of lupus-onset < the age of sixteen were included. Clinical data were collected and analyzed. The statistical analysis was performed using SPSS 23.0 software.

Result

There were eight juvenile-onsets SLE: two males and six females. The median age at the diagnosis was 13.7 + 1.9 years-old (11–16). First clinical presentations are shown in table 1.

Arthritis and hematological involvement tended to be associated (p = 0.07). Hypocomplementemia and positive anti-DNA antibodies were detected in 50% of cases.

All patients received Hydroxychloroquine and most of them combined corticosteroids (7cases).

Conclusion

Our study showed that musculoskeletal manifestations especially arthritis were frequent at the diagnosis of juvenile-onset SLE. According to the aggressive pharmacological treatment, a multidisciplinary approach should be required
P063 Consensus-based recommendations for treat to target management of immunoglobulin A vasculitis
Authors: Abu-Zaid M H , Tabra S A , Salah S , Lotfy H , Abdulhady H , Salah H , El Gaafary M , Farag Y , Eissa M , Maher S Esam , Radwan A , El-Shanawany Amira T , Medhat B M , El Mikkawy D , Mosa D M , El Deriny G , Mortada M , Osman N S , Fouad N A , Elkaraly N E , Mohamed S S , Hassan W A , Amer Y , Nasef S I , El Miedany Y
Published: November 2021

Background

IgAvasculitis (IgAV) is the commonest cause of vasculitis in childhood.

It is characterized by small vessel vasculitis of the skin, gastrointestinal tract, kidneys, joints, and, rarely, the lungs and the central nervous system. There is paucity of international guidelines for management of IgA V. the Objective is to develop guidelines specific for Egyptian children with IgA vasculitis.

Method

This study was carried out to achieve an Egyptian expert consensus on a treat-to-target management strategy for IgA vasculitis using Delphi technique. The preliminary scientific committee identified a total of 16 key clinical questions according to the Patient/Population, Intervention, Comparison, and Outcomes (PICO) approach. Delphi process was implemented (2-rounds) to reach a consensus.

Results

An online questionnaire were sent to expert panel (n = 26) who participated in the two rounds. At the end of round 2, a total of 20 recommendation items, categorized into 2 sections were obtained. Agreement with the recommendations (rank 7–9) ranged from 91.7–100%. Consensus was reached (i.e. ≥75% of respondents strongly agreed or agreed) on the wording of all the 20 clinical standards identified by the scientific committee. Algorithms for the management have been suggested.

Conclusion

This was an expert, consensus recommendations for the diagnosis and treatment of IgA V and IgA V nephritis, based on best available evidence and expert opinion.
O006. Clinical features of paediatric HIV arthropathy
Authors: Harrison Michael J , Brice Nicola , Slamang Waheba , Webb Kate , Scott Christiaan
Published: November 2021

Background

Advanced HIV infection is associated with an inflammatory arthritis, however few reports have described this disorder in children. This study aimed to describe the clinical features of HIV arthropathy in a case series of children in South Africa and compare these with features of JIA.

Methods

Retrospective data were collected from HIV-infected children with HIV arthropathy enrolled in a Paediatric Rheumatology clinic in Cape Town, South Africa. Data from a recently described, published cohort of children with JIA enrolled in the same clinic were included for comparison. Ethical approval was granted by the Human Research Ethics Committee of the University of Cape Town, with a waiver for consent.

Results

Eleven cases of HIV arthropathy were identified. Cases predominantly affected boys (8/11), and the median age of onset was 10.3 years (IQR 6.9–11.6). Most cases presented in the setting of advanced immunosuppression, with a median absolute CD4+ count of 389 cells/uL (IQR 322–449) and median CD4+ proportion of 19.5% (IQR 14.8–25.0) at presentation. The clinical presentation was variable, with both oligoarthritis (6/11) and polyarthritis (5/11) being prevalent. All cases exhibited large joint involvement, which was usually asymmetrical. In addition, four children had asymmetrical small joint involvement. Associated features included enthesitis (4/11) and dactylitis (1/11). The most consistent laboratory feature was elevated acute phase reactants, and typical ultrasonographic findings were joint effusions and synovial hypertrophy. JIA and HIV arthropathy presented at a similar age, with median age at HIV arthritis onset of 10.3 years (IQR 6.9–11.6) versus 9.25 years (IQR 4.5–12.3) at arthritis onset in the JIA subgroup. HIV arthropathy cases were predominantly male (M/F ratio 3.0), whereas JIA cases had an equal sex distribution (M/F ratio 0.9). Oligo-articular disease was more frequently described in children with HIV arthropathy (55%), compared to those with JIA (38%).

Conclusion

In this series, most cases of HIV arthropathy exhibited asymmetrical large joint oligoarthritis or polyarthritis, and presented in older boys with advanced immunosuppression. HIV arthropathy appears to present at a similar age to JIA, with a comparable pattern of joint involvement to oligo-articular and poly-articular JIA subtypes.
A Machine Learning Approach for Predicting Real-time Risk of Intraoperative Hypotension in Traumatic Brain Injury
Authors: Feld Shara I. , Hippe Daniel S. , Miljacic Ljubomir , Polissar Nayak L. , Newman Shu-Fang , Nair Bala G. , Vavilala Monica S.
Published: November 2021

Background:

Traumatic brain injury (TBI) is a major cause of death and disability. Episodes of hypotension are associated with worse TBI outcomes. Our aim was to model the real-time risk of intraoperative hypotension in TBI patients, compare machine learning and traditional modeling techniques, and identify key contributory features from the patient monitor and medical record for the prediction of intraoperative hypotension.

Methods:

The data included neurosurgical procedures in 1005 TBI patients at an academic level 1 trauma center. The clinical event was intraoperative hypotension, defined as mean arterial pressure <65 mm Hg for 5 or more consecutive minutes. Two types of models were developed: one based on preoperative patient-level predictors and one based on intraoperative predictors measured per minute. For each of these models, we took 2 approaches to predict the occurrence of a hypotensive event: a logistic regression model and a gradient boosting tree model.

Results:

The area under the receiver operating characteristic curve for the intraoperative logistic regression model was 0.80 (95% confidence interval [CI]: 0.78-0.83), and for the gradient boosting model was 0.83 (95% CI: 0.81-0.85). The area under the precision-recall curve for the intraoperative logistic regression model was 0.16 (95% CI: 0.12-0.20), and for the gradient boosting model was 0.19 (95% CI: 0.14-0.24). Model performance based on preoperative predictors was poor. Features derived from the recent trend of mean arterial pressure emerged as dominantly predictive in both intraoperative models.

Conclusions:

This study developed a model for real-time prediction of intraoperative hypotension in TBI patients, which can use computationally efficient machine learning techniques and a streamlined feature-set derived from patient monitor data.
UVEAL EFFUSION ASSOCIATED WITH LOCALIZED SCLERODERMA BECAUSE OF SCLERAL FIBROSIS
Authors: Li Siyan , Liu Wenbo , Zhao Mingwei , Li Yuhui , Li Xiaoxin , Shi Xuan
Published: November 2021

Background/Purpose:

To report a case of uveal effusion associated with localized scleroderma because of scleral collagen fibrosis. Partial-thickness sclerectomy treatment was successful in acquiring the resolution of the uveal effusion.

Methods:

Case report.

Results:

A 44-year-old Chinese woman with known localized scleroderma visited the retinal clinic complaining of insidious onset blurring of vision in both eyes for 8 months. The best-corrected visual acuity was 20/200. Ophthalmoscopy revealed apparent inferior bullous serous retinal detachments in the right eye. Optical coherence tomography showed subretinal fluid and folds of the retinal pigment epithelium layer in both eyes. B-scan ultrasonographic image of the right eye confirmed a 360-degree serous retinal detachment in the right eye accompanied with increased thickness of the ocular wall. Ultrasound biomicroscopy of the anterior segment detected a shallow ciliary body detachment in the right eye. Fluorescein angiography and indocyanine green angiography demonstrated the leopard-spot pattern in all phases. Partial-thickness sclerectomy treatment was successful in acquiring the resolution of the uveal effusion. Histopathologic examinations of the sclera flaps revealed scleral collagen fibrosis.

Conclusion:

This clinicopathologic report first describes a patient with localized scleroderma and scleral collagen fibrosis, resulting in uveal effusion that responded to partial-thickness sclerectomy.
Observation of Conjunctiva-Associated Lymphoid Tissue With In Vivo Confocal Microscopy in Healthy Patients and Patients With Meibomian Gland Dysfunction
Authors: Liu Yuting , Wang Yingbin , Jin Xin , Zhang Nan , Shi Yan , Zhu Rui , Wang Jingrao , Dong Yueyan , Zhang Hong
Published: November 2021

Purpose:

The purpose of this study was to assess the distribution and morphological variation of conjunctiva-associated lymphoid tissue (CALT) in healthy human subjects and patients with meibomian gland dysfunction (MGD) using laserscanningin vivo confocal microscopy.

Methods:

A total of 34 healthy subjects and 32 patients with MGD were enrolled. All subjects underwent a conventional examination consisting of slitlamp biomicroscopy, tear film break-up time, and the Schirmer test. In vivo microscopy was applied to analyze the morphological changes in the diffuse lymphoid layer and lymphoid follicles in CALT. Conjunctival impression cytology (CIC) of samples of patients' palpebral conjunctiva and immunofluorescence staining of CD4 and CD8 antibodies were also performed to indicate the immune response status of CALT.

Results:

In the MGD group, the density of diffuse lymphocytes (P < 0.001), follicles (P < 0.001), and perifollicular lymphocytes was higher (P < 0.001) and the central reflection of the follicles was stronger (P < 0.001) than in the control group, while there was no difference in the follicle area (P = 0.758). Besides, diffuse lymphocyte density was correlated with telangiectasia, and follicular center reflection intensity was correlated with plugging. CIC immunofluorescence staining showed a higher percentage of CD4+ (P < 0.001) and CD8+ (P < 0.001) cells in the MGD group than in the control group.

Conclusions:

Using laser scanning in vivo confocal microscopy and CIC immunofluorescence staining, we observed the activation of CALT in patients with MGD, and some CALT-related parameters correlated with the lid margin findings of patients with MGD.
Marking DMEK Grafts Using Bandage Contact Lens Interface Technique: Doubling the Utilization During the Acute Shortage of Donor Corneas
Authors: Basak Samar K. , Basak Soham
Published: November 2021

Purpose:

The purpose of this study was to describe a novel bandage contact lens (BCL) interface technique for marking the Descemet membrane endothelial keratoplasty (DMEK) graft so that a single donor cornea can be used effectively for 2 recipients during acute shortage.

Methods:

This was a retrospective comparative case series. In group A, 37 eyes underwent DMEK using a graft marked by the ‟BCL interface technique” that was compared with 49 conventional DMEK grafts marked through the stromal window (group B). In group A, a resized BCL with a central 3-mm hole with the concavity up was placed between the stroma and peeled-off DM. This BCL with DM was flipped for S-stamping on the DM side. Final trephination was performed on a second Teflon block. The remaining anterior lamellar tissues of group A were used on the same day for other keratoplasty procedures. Endothelial cell density (ECD) and endothelial cell loss between the 2 groups were compared after 3 and 6 months.

Results:

The ECD at 3 months in group A (n = 35) versus group B (n = 45) was 2228 ± 270/mm2 versus 2302 ± 254/mm2 (P = 0.48), and the ECD at 6 months (n = 23 and 22) was 2058 ± 324/mm2 versus 2118 ± 260/mm2 (P = 0.72). The corresponding endothelial cell loss was 23.3% ± 6.8% versus 20.3% ± 6.1% (P = 0.18) at 3 months and 29.1% ± 8.4% versus 26.7% ± 8.0% (P = 0.34) at 6 months. Among anterior tissues of group A, 17 (45.9%) were used for deep anterior lamellar keratoplasty, 18 (48.6%) were used for larger therapeutic and tectonic grafts, and 2 were used as keratoprosthesis carriers. Donor detachment rate (8.6% vs. 8.9%) was similar in both groups without primary graft failures.

Conclusions:

The BCL interface technique is a simple and safe technique for stamping DMEK grafts. Anterior corneal tissues can be used for additional keratoplasties during donor shortage.
Facilitators and Barriers to Glaucoma Medication Adherence
Authors: Gatwood Justin , Brooks Callee , Meacham Ryan , Abou-Rahma Joseph , Cernasev Alina , Brown Eric , Kuchtey Rachel W.
Published: November 2021

Précis:

Patient education and dosing self-efficacy are important factors related to ongoing adherence to glaucoma topical treatment, and patients view their disease management as a shared effort with their provider.

Purpose:

Glaucoma affects nearly 3 million Americans, and medication adherence has been reported to be as low as 20% in this patient population; however, key limitations to our understanding of this behavior in adults with glaucoma exist.

Patients and Methods:

This research used an electronic survey including validated concepts related to topical medication use and an in-person interview to investigate the influencers of and solutions for challenges to medication adherence in adults with glaucoma. Patient eligibility was determined upon arrival to a regularly-scheduled visit to the Vanderbilt Eye Institute, during which they were asked for consent to complete the survey. Responses were captured by tablet and assessed using descriptive and inferential statistics. The primary focus was instrument correlations with the Adherence to Refills and Medications Scale score and were run between Adherence to Refills and Medications Scale, and the totaled score for each individual questionnaire as well as individual items. Recorded interviews were thematically assessed by multiple study team members.

Results:

Survey results of adults with glaucoma suggested that self-efficacy, forgetfulness, fear of side effects, and dosing ability were all related to self-reported medication adherence. Despite most having glaucoma for several years, discrepancies in disease knowledge were observed. Patient interviews uncovered 3 overall themes related to glaucoma treatment: (1) glaucoma management as a shared responsibility; (2) the importance of patient education; and (3) specific adherence facilitators and barriers.

Conclusion:

Glaucoma medication adherence interventions may benefit from focusing on developing patient medication-taking self-efficacy, disease-related education, and engagement with their provider.
Pelvic Abscess by Fusarium fujikuroi in an Immunocompetent Woman
Authors: Aggarwal Abhimanyu , DelPilar-Morales Esteban
Published: November 2021

Invasive Fusarium spp. infections are commonly seen as opportunistic infections, predominantly in immunocompromised patients. However, on very rare occasions, it has been reported to cause invasive diseases in immunocompetent patients, mostly after a breach in the normal physical barrier. We present the case of a woman who after delivery by cesarean section, developed pelvic abscess that was communicating with the endometrial cavity, culture noted positive for Escherichia coli and Fusarium fujikuroi. To our knowledge, this is also the first ever reported case of pelvic abscess by Fusarium spp. Follow-up imaging showed complete resolution of the abscess after treatment. Here, we present a review of all invasive Fusarium spp. infections in immunocompetent patients, except skin and soft tissue infections, reported in the literature to date.
Prevalence of Adverse Health Behaviors and Conditions Among Maritime Workers, BRFSS 2014 to 2018, 38 States
Authors: Evoy Richard , Case Samantha
Published: November 2021

Objective:

To analyze health behaviors and conditions among maritime workers using Behavioral Risk Factor Surveillance System (BRSS).

Methods:

BRFSS data from 2014 to 2018 were used to calculate weighted prevalence estimates and adjusted prevalence ratios (aPRs) for 10 health behaviors and conditions. Logistic regression was used to compare aPRs between maritime workers and all other US workers.

Results:

Compared with other workers, maritime workers had higher weighted prevalence estimates for six of 10 health behaviors and conditions: binge drinking, smoking, obese/overweight, diabetes, cancer, and chronic obstructive pulmonary disease. Maritime workers had significantly higher aPRs for binge drinking (aPR = 1.28) and smoking cigarettes (aPR = 1.39) compared with all other US workers.

Conclusions:

This study uses BRFSS data to estimate the prevalence of adverse health conditions across maritime industries. This study can serve as the foundation for additional follow-on research.
Sonographic Screening of Distance Runners for the Development of Future Achilles and Patellar Tendon Pain
Authors: Cushman Daniel M. , Petrin Ziva , Cummings Keith , Eby Sarah F. , English Joy , Teramoto Masaru
Published: November 2021

Objective:

The 2 primary aims of this study were to identify ultrasonographic tendon abnormalities in asymptomatic runners and to examine the likelihood of developing pain in runners with ultrasound abnormalities compared with those without abnormalities.

Design:

Longitudinal, prospective cohort study.

Setting:

2019 Salt Lake City Marathon.

Participants:

Recreational half-marathon and full-marathon runners.

Assessment of Risk Factors:

The Achilles and patellar tendons of asymptomatic runners were examined with ultrasound imaging before a running event. Runners were monitored for self-reported outcomes of pain in the examined tendons at 1, 3, 6, and 12 months after the event.

Main Outcome Measures:

Development of pain based on the presence of asymptomatic tendon abnormalities.

Results:

One hundred thirty-eight runners (36.2 ± 12.0 years, 49.3% men, and 31.2% full-marathon runners) were included. Ultrasound abnormalities of the Achilles and patellar tendons were identified in 24.6% and 39.1% of the runners before the race, respectively. Ultrasound abnormalities were significantly associated with approximately a 3-fold increase [hazard ratio (HR) = 2.55, P = 0.004] in the hazard of developing pain in the Achilles tendon and patellar tendon (HR = 1.67, P = 0.042) over the year after the race. Positive and negative predictive values of developing pain over the year were 34.1% and 87.2%, respectively, for abnormal findings in the Achilles tendon, and 22.9% and 85.0%, respectively, for the patellar tendon.

Conclusions:

The presence of ultrasonographic abnormalities is associated with increased development of pain in the Achilles and patellar tendons within 1 year of a marathon or half marathon.