bluuebunny/crossref_metadata_2025 huggingface dataset:
Anaerobic vibrio-like organisms cultured from blood: Desulfovibrio desulfuricans and Succinivibrio species
Authors: Porschen R K , Chan P
Published: May 2021

Two unusual anaerobic vibrio-like organisms were recovered from blood cultures of two patients. One isolate was identified as Desulfovibrio desulfuricans. It appeared to be the cause of a 24-h episode of fever, chills, and profuse perspiration. This is apparently the first documented report of human infection due to this organism. The second isolate was a Succinivibrio species. It has rarely been described as a cause of bacteremia. The clinical significance of the organism remains unclear.
Diagnostic Antigens and Antisera in Tablet Form
Authors: Berman Sanford , Vincent Gary , Altieri Patricia L. , Lowenthal Joseph P.
Published: May 2021

Diagnostic antigen suspensions and antisera can be prepared in tablet form with no loss in potency.
Pathogenicity of nonpigmented cultures of Chromobacterium violaceum
Authors: Sivendra R , Tan S H
Published: May 2021

Nonpigmented cultures of Chromobacterium violaceum have been found to be similar to pigmented cultures in their virulence for mice and the pathology of their infections. Clinicians and microbiologists should be prepared to consider nonpigmented C. violaceum in their differential diagnoses of infections caused by gram-negative bacteria. The laboratorian who is not aware of this possibility is likely to erroneously identify nonpigmented strains of C. violaceum as members of closely associated genera, particularly Aeromonas. It is known that violet pigmentation is not an essential feature or an exclusive character of the genus Chromobacterium. This study has also shown that pigmentation of C. violaceum is not related to its pathogenicity or to the pathology of its infections.
Comparison of the BACTOMETER microbial monitoring system with conventional methods for detection of microorganisms in urine specimens
Authors: Zafari Y , Martin W J
Published: May 2021

A rapid impedance-based screen for bacteriuria (less than 10(5) organisms per ml) was compared with a standard loop method, using 156 clinical urine specimens. Agreement between the methods was 96.8%.
Salt-dependent hemagglutination with Bunyaviridae antigens
Authors: Beaty B J , Shope R E , Clarke D H
Published: May 2021

Hemagglutination titers of antigens from nine serologic groups of Bunyaviridae were increased by hypertonic NaCl. The effect was predominantly on sonically treated antigens and was additive with the increase from sonic treatment alone.
Clinical trial with "R-75" strain live, attenuated, serum inhibitor-resistant intranasal influenza B vaccine
Authors: Spencer M J , Cherry J D , Powell K R
Published: May 2021

The "R-75" strain live, attenuated, serum inhibitor-resistant influenza B vaccine was administered intranasally by drops in two doses 14 days apart to 21 volunteers. Each vaccinee was paired with a close associate (roommate or workmate) who similarly received two doses of a placebo solution. Although about 50% of both vaccine and placebo recipients complained of symptoms after dosage, the severity of symptoms was greater in vaccine recipients. Fourfold serum hemagglutination-inhibiting antibody titer rises occurred in 38% of vaccine recipients, and four vaccines had fourfold titer rises of nasal hemagglutination-inhibiting antibody. Vaccine virus was isolated from three asymptomatic vaccine recipients. There was no virological or serological evidence of the vaccine virus spreading to placebo recipients.
Laboratory Evaluation of Serological Tests for Systemic Candidiasis: a Cooperative Study
Authors: Merz W. G. , Evans G. L. , Shadomy S. , Anderson S. , Kaufman L. , Kozinn P. J. , Mackenzie D. W. , Protzman W. P. , Remington J. S.
Published: May 2021

Three serological tests for candidiasis, agar gel diffusion (AGD-1), whole cell agglutination (AGGL-1), and latex agglutination (LAT), were evaluated by six laboratories with 100 coded sera. In addition, each of six laboratories performed a test of its choice, either the AGD-2, the AGD-3, the AGGL-2, or one of three counterimmunoelectrophoresis (CEP) methods (CEP-1, CEP-2, and CEP-3). Results are presented by laboratory for a group of 53 “candida-involved” cases (33 proven, 14 presumptive, and 6 probable) and 47 negative controls (41 normal and 6 other disease states). The AGD-1 test produced an overall average of 85.1% positive results in the candida-involved group and 5.0% positives in the control group. The LAT produced an overall average of 89.0% positives in the candida-involved group and 17.4% positives in the controls. The AGGL-1 test produced an overall average of 63.8% positives in the candida-involved group, with 12.3% positives in the controls. In the individual tests, the best performance was shown by the CEP-3 test (92.5% positives in the candida-involved group and 2.1% positives in controls) and the CEP-1 test (88.7% positive in the candida-involved group and no positives in the controls). The tests with the highest sensitivity were the AGGL-2 and CEP-2 (94.3 and 96.2%, respectively). These tests were also the least specific (80.9 and 76.6%, respectively). In the three common tests, the AGD-1 was the most reproducible, whereas the AGGL-1 produced considerable laboratory-to-laboratory variation. Since cell-free extracts of mechanically disrupted
C. albicans
were used for the LAT and all the AGD and CEP tests, the difference in performance was considered to be mainly due to antigenic composition and the conditions of the test. The results of this study confirm the value of serological tests for the diagnosis of systemic candidiasis, but point out the need for standardized reagents.
Precipitating antibodies in mycoplasma infection
Authors: Menonna J , Chmel H , Menegus M , Dowling P , Cook S
Published: May 2021

The effectiveness of counterimmunoelectrophoresis (CIEP) for detecting human precipitating antibodies to mcyoplasma antigen was compared with the conventional complement fixation (CF) method in a double-blind experiment. Fifty-one sera from patients suspected of having acute mycoplasma infection were tested by both techniques. Dense precipitin lines to mycoplasma antigen developed in 28 sera with CIEP. Twenty-six of 28 had elevated CF titers to this antigen. No precipitin bands were observed in sera with low antibody titers to mycoplasma. These findings indicate that the CIEP test is a specific method for reliably detecting elevated serum CF antibody levels in patients with acute or recent mycoplasma infection.
Purification of equine infectious anemia virus antigen by affinity chromatography
Authors: Sugiura T , Nakajima H
Published: May 2021

Affinity chromatography was performed to obtain highly purified antigen from equine infectious anemia (EIA) virus. After crude antigen was concentrated by polyethylene glycol precipitation of culture fluids from equine dermal cells persistently infected with EIA virus, and after the virus was disrupted with ether, it was added to a column of cyanogen bromide-activated Sepharose 4B to which EIA-specific antibody had been conjugated. The antigen was effectively released from the column with 5M MgCl2 and proved to be highly purified. Passive hemagglutination tests on sera from EAI infections were carried out, using the purified antigen. Results indicated that the passive hemagglutination test with the antigen was a specific laboratory test with high sensitivity for EIA infection.
Rapid urease test for mycobacteria: preliminary observations
Authors: Cox F R , Cox M E , Martin J R
Published: May 2021

A rapid and sensitive urease test for mycobacteria utilizing a cumulative radiometric technique is described. Definitive results were obtained within a 30-min incubation period. The procedure is simple and economical. Technical time involved is no greater than in conventional procedures.
Biochemical Characterization of Anaerobic Bacteria by an Impregnated Disk Method
Authors: Boyer Jere M.
Published: May 2021

An impregnated disk method was used to characterize 20 clinical isolates of anaerobic bacteria by utilization of substrate. The procedure was easy to perform, reliable, and economical.
Supplemental Material: Active Uplift of Southern Tibet Revealed
Authors: Taylor Michael , al. et
Published: May 2021

Description of the methodology for projecting various data types onto the swath profiles in Fig. 4 along with Google Earth imagery for evidence of an increase in the strike-slip component of faulting along the Gangdese Rifts in western Tibet.
AB0767 SEVERE BREAST ULCERATION IN BEHÇET’S DISEASE TREATED WITH CYCLOPHOSPHAMIDE: A CASE REPORT
Authors: Ball E. , Okane D. , Mccourt C. , Mccarron M. , Riddell C.
Published: May 2021

Background:

Behcet’s disease is a systemic autoimmune vasculitis that typically involves mucocutaneous surfaces, the eyes and the skin with varying manifestations. Skin ulceration often secondary to pathergy is a common feature.

Objectives:

To raise awareness of breast ulceration as a clinical manifestation in Behcet’s disease.

Methods:

We report a case of complex Bechet’s disease associated with severe refractory breast ulceration successfully treated with cyclophosphamide.

Results:

A 27 year old female patient presented to the rheumatology department with a non-healing lesion on her face secondary to a cat scratch. She reported previous episodes of ulceration usually as a result of minor trauma such as IV cannulation, as well as a two year history of severe oral and genital ulceration. She had also been diagnosed with ‘colitis’ requiring iliocaecal resection two years prior to presentation. Previous treatments for her bowel included azathioprine, infliximab, adalimumab and vedolizumab. Over the next three years she developed recurrent eye involvement in the form of scleritis with ongoing oral and genital ulceration. Further treatment under our care included ustekinumab, entanercept, benepali, certolizumab and tacrolimus with background prednisolone. She then developed a small area of broken skin on her left breast which continued to extend and ulcerate despite treatment with IV steroids. Tissue biopsy showed deep focal vasculitis with intravascular thrombi. Anticoagulation was commenced and she was treated with tocilizumab IV for 3 months with no clinical improvement. Involvement extended to include 80 percent of the breast surface and the nipple self-amputated. Due to the severity and extent of the ulceration which was extremely painful and distressing, she was given 3 months of IV cyclophosphamide at a dose of 15mg/kg every 2-3 weeks. The ulceration showed rapid clinical improvement (see Figure 1).

Figure 1.

Breast ulceration before and after 3 months of cyclophosphamide treatment

Conclusion:

Involvement of the breast in systemic vasculitides (such as GPA or PAN) has been reported, although usually manifesting as a palpable mass with diagnosis on biopsy 1. Similar presentations in Behcet’s disease have been recognised 2, although much less commonly. Our case demonstrates that severe breast ulceration can be a clinical manifestation of this condition and can be refractory to usual therapies.

References:

[1]Ren J, Liu J, Su J, Zhang J, Zhao J. Systemic vasculitis involving the breast: a case report and literature review. Rheumatol Int. 2019 Aug;39(8):1447-1455

[2]Soleto MJ, Marcos L. Behçet’s disease involving the breast. Eur Radiol. 2002 Dec;12 Suppl 3:S98-S100. doi: 10.1007/s00330-002-1420-4.

Disclosure of Interests:

None declared
AB0868-HPR ADHERENCE TO DISEASE-MODIFYING ANTIRHEUMATIC DRUGS IN RHEUMATIC DISEASES DURING COVID-19 PANDEMIC
Authors: Moreno-Arquieta I. A. , Sánchez Mendieta G. G. , Flores Alvarado D. E. , Esquivel Valerio J. A. , Galarza-Delgado D. Á.
Published: May 2021

Background:

The pandemic COVID-19 has set a new challenge in adherence to treatment in patients with rheumatic diseases. Prior studies in Latin America had reported adherence of 16.4% on Rheumatoid Arthritis (RA) and 45.9% in Systemic Lupus Erythematous (SLE). There is evidence that these patients believe their treatment increases the risk and gravity of COVID-19 and therefore, suspending the treatment could reduce this risk. It has been shown that a “Good adherence” is associated to a better survival.

Objectives:

Describe the adherence to DMARDs in patients with Rheumatic diseases during COVID-19.

Methods:

Descriptive, cross-sectional, self-report study conducted in rheumatology outpatient clinic of University Hospital in Monterrey, México. Consecutive patients with RA, SLE, Inflammatory Myopathies and Systemic Sclerosis, were approached during their routine appointments, March 2020 to December 2020 period during COVID-19 pandemic. They were asked how many days of the month they took the DMARD indicated in the previous appointment, with Based on this, adherence was classified into four categories: Good 100-75% (> 21 days), Regular 74-50% (21-15 days), Bad 49-25% (14-8 days) and Null <25% (<7 days). Data was obtained from our internal electronic patient record registry and analyzed with SPSS V.22.

Results:

n (DMARDs)GoodRegularBadNulln (%)n (%)n (%)n (%)Rheumatoid Arthritis302255 (84.4)13 (4.3)20 (6.6)14 (4.6)Systemic Lupus Erithematous126111 (88)3 (2.3)8 (6.3)4 (3.1)Inflammatory Myopathies1110 (90.9)0 (0)1 (9)0 (0)Systemic Sclerosis3027 (90)2 (6.6)1 (3.3)0 (0)TOTAL469

Conclusion:

Despite what it is believed, patients are not changing therapeutic regimes. The adherence found in this group of patients was good, for the definition used in this study. It should be considered that the self-report method may overestimate adherence, so the data found must be correlated with objective methods in the future.

References:

[1]Resende Prudente L, Souza Diniz J, Matteucci Ferreira TXA, Marçal Lima D, Antônio Silva N, Saraiva G, et al. Medication adherence in patients in treatment for rheumatoid arthritis and systemic lupus erythematosus in a university hospital in Brazil. Patient Preference and Adherence. 2016:10 863–870.

[2]Michaud K, Wipfler K, Shaw Y, et al. Experiences of patients with rheumatic diseases in the United States during early days of the COVID-19 pandemic. ACR Open Rheumatol 2020. doi:10.1002/acr2.11148.

[3]Waimann ChA, Marengo MF, de Achaval S, Cox VL, Garcia-Gonzalez A, Reveille JD. Electronic Monitoring of Oral Therapies in Ethnically Diverse and Economically Disadvantaged Patients With Rheumatoid Arthritis. Arthritis & Rheumatism. 2013:6 1421-1429.

Disclosure of Interests:

None declared
AB0770 A RARE CASE OF SYNOVIAL METASTASIS REVEALED BY KNEE PAIN
Authors: Yasmine M. , Miladi S. , Fazaa A. , Mariem S. , Ouenniche K. , Souebni L. , Kassab S. , Chekili S. , Ben Abdelghani K. , Laatar A.
Published: May 2021

Background:

Intra-articular masses are not frequently encountered in clinical practice. However, the differential diagnosis can be broad. Synovial metastasis is a rare presentation that carries a poor prognosis with a poor survival rate.

Objectives:

Here by a case of synovial metastasis of the knee joint in a patient diagnosed with an adenocarcinoma of the lung.

Methods:

A 60-year-old man with no remarkable past medical history presented to our department of rheumatology with right knee pain. He described a dull ache and swelling in his right knee with a dragging sensation, waking him up at night on a regular basis. The symptoms lasted from 6 months and were partially improved by analgesics and anti-inflammatory drugs. On examination, temperature was normal. The knee was edematous, erythematous, and warm with a range of motion of <90°. Laboratory investigations showed high acute phase reactants, the erythrocyte sedimentation rate was 75 mm. A plain radiograph of the left knee demonstrated a lytic lesion of the upper tibia. A magnetic resonance imaging of the right knee showed diffuse enlargement of the joint space due to a tissue infiltration within the synovium. These structures demonstrated heterogeneously increased T2 signal and intermediate T1 intensity characteristics. Most of the joint space was replaced by hyper enhancing synovium. At that time, differential considerations included severe inflammatory arthritis and synovial chondromatosis rather than unusual metastasis.

Results:

Biopsy concluded to synovial metastasis from primary adenocarcinoma. Further investigations were necessary. Chest tomography showed a tumor process of left lower lobe associated with mediastinal lymphadenopathy. The patient was treated with palliative external radiotherapy to the right knee. The evolution was marked by the appearance of multiple tracheobronchial fistulas. The patient died 3 months later due to the progression of the disease.

Conclusion:

We report a rare case of synovial metastasis concomitant to a lung adenocarcinoma. It is important to make a rapid diagnosis as early recognition of malignant infiltration into joints ensure appropriate multidisciplinary management decisions.

Disclosure of Interests:

None declared
Bladder perivascular epithelioid cell tumour and tuberous sclerosis complex: a rare association
Authors: Tee Jo Lin , Chambers Jonathan , Strutton Geoffrey
Published: May 2021

Bladder perivascular epithelioid cell tumours (PEComas) associated with tuberous sclerosis complex (TSC) are rare, with only one other case report in the literature to date. We present our case of a bladder PEComa in a young adult female with TSC arising de novo. Histopathology showed features in keeping with an angiomyolipoma and confirmatory immunohistochemical stains were positive for both melanocytic and smooth muscle markers. She was well at the 6-month follow-up post-surgical resection. Given the rarity of such lesions in the bladder, we discuss the diagnostic and prognostic challenges, clinical implications and a brief review of the literature to date.
Benign intracranial hypertension associated with inhaled corticosteroids in a child with asthma
Authors: Trayer James , O'Rourke Declan , Cassidy Lorraine , Elnazir Basil
Published: May 2021

A 13-year-old male asthmatic presented to the general paediatric clinic with papilloedema identified following a check-up with his optician due to blurred vision. His asthma was well controlled on a moderate dose of inhaled corticosteroid and there had been no recent increase or decrease in the dose. A diagnosis of benign intracranial hypertension (BIH) was made based on a raised cerebrospinal fluid opening pressure, papilloedema, a normal neurological examination and normal neuroimaging. The only associated risk factor was his inhaled corticosteroids. He was commenced on acetazolamide and the inhaled corticosteroid dose was reduced, resulting in resolution of his papilloedema. This case serves to highlight that steroid side effects including BIH may occur at moderate doses of inhaled corticosteroids and that inhaled corticosteroid dose should be regularly reviewed and decreased to the lowest dose that maintains asthma control.
Severe psoriasis presenting with rapidly progressive (crescentic) IgA-predominant glomerulonephritis
Authors: Garces Christopher Cantoria , Hernandez Garcilazo Nora , Sharma Akhil , Nader Georgette
Published: May 2021

IgA nephropathy (IgAN) is commonly associated with psoriasis; however, psoriasis presenting with crescentic IgAN is uncommon. A 49-year-old man with erythrodermic psoriasis with arthritis and stage 2 chronic kidney disease presented to the emergency department with worsening peripheral oedema and difficulty breathing. The patient had been hospitalised previously for a psoriasis flare. He was found to have an acute kidney injury on chronic kidney disease and was diagnosed with crescentic IgA glomerulonephritis on his first hospitalisation. He was treated with corticosteroids and was discharged stable with a plan to start cyclophosphamide in the outpatient setting. On his current hospitalisation, cyclophosphamide was added to his corticosteroids. Crescentic IgAN is rare. Its management has been based largely on observational studies. Our case highlights the importance of starting combined corticosteroids and cyclophosphamide early in crescentic IgAN and that corticosteroid monotherapy is insufficient in controlling disease progression.
Predicting the 10-year risk of cataract surgery using machine learning techniques on questionnaire data: findings from the 45 and Up Study
Authors: Wang Wei , Han Xiaotong , Zhang Jiaqing , Shang Xianwen , Ha Jason , Liu Zhenzhen , Zhang Lei , Luo Lixia , He Mingguang
Published: May 2021

Background/aims

To investigate the feasibility and accuracy of using machine learning (ML) techniques on self-reported questionnaire data to predict the 10-year risk of cataract surgery, and to identify meaningful predictors of cataract surgery in middle-aged and older Australians.

Methods

Baseline information regarding demographic, socioeconomic, medical history and family history, lifestyle, dietary and self-rated health status were collected as risk factors. Cataract surgery events were confirmed by the Medicare Benefits Schedule Claims dataset. Three ML algorithms (random forests [RF], gradient boosting machine and deep learning) and one traditional regression algorithm (logistic model) were compared on the accuracy of their predictions for the risk of cataract surgery. The performance was assessed using 10-fold cross-validation. The main outcome measures were areas under the receiver operating characteristic curves (AUCs).

Results

In total, 207 573 participants, aged 45 years and above without a history of cataract surgery at baseline, were recruited from the 45 and Up Study. The performance of gradient boosting machine (AUC 0.790, 95% CI 0.785 to 0.795), RF (AUC 0.785, 95% CI 0.780 to 0.790) and deep learning (AUC 0.781, 95% CI 0.775 to 61 0.786) were robust and outperformed the traditional logistic regression method (AUC 0.767, 95% CI 0.762 to 0.773, all p<0.05). Age, self-rated eye vision and health insurance were consistently identified as important predictors in all models.

Conclusions

The study demonstrated that ML modelling was able to reasonably accurately predict the 10-year risk of cataract surgery based on questionnaire data alone and was marginally superior to the conventional logistic model.
Genetic associations of central serous chorioretinopathy: a systematic review and meta-analysis
Authors: Chen Zhen Ji , Lu Shi Yao , Rong Shi Song , Ho Mary , Ng Danny Siu-Chun , Chen Haoyu , Gong Bo , Yam Jason C , Young Alvin L , Brelen Marten , Tham Clement C , Pang Chi Pui , Chen Li Jia
Published: May 2021

Aims

To identify single-nucleotide polymorphisms (SNPs) associated with central serous chorioretinopathy (CSCR) by a systematic review and meta-analysis, and to compare the association profiles between CSCR, neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV).

Methods

We searched the EMBASE, PubMed and Web of Science for genetic studies of CSCR from the starting dates of the databases to 12 September 2020. We then performed meta-analyses on all SNPs reported by more than two studies and calculated the pooled OR and 95% CIs. We also conducted sensitivity analysis and adopted the funnel plot to assess potential publication bias.

Results

Totally 415 publications were reviewed, among them 10 were eligible for meta-analysis. We found 10 SNPs that have been reported at least twice. Meta-analysis and sensitivity analysis confirmed significant associations between CSCR and six SNPs in three genes, namely age-related maculopathy susceptibility 2 (ARMS2) (rs10490924, OR=1.37; p=0.00064), complement factor H (CFH) (rs800292, OR=1.44; p=7.80×10−5; rs1061170, OR=1.34; p=0.0028; rs1329428, OR=1.40; p=0.012; and rs2284664, OR=1.36; p=0.0089) and tumour necrosis factor receptor superfamily, member 10a (TNFRSF10A) (rs13278062, OR=1.34; p=1.44×10−15). Among them, onlyTNFRSF10Ars13278062 showed the same trend of effect on CSCR, nAMD and PCV, while the SNPs inARMS2andCFHshowed opposite trends in the SNP associations.

Conclusions

This study confirmed the associations ofARMS2,CFHandTNFRSF10Awith CSCR, and revealed thatARMS2,CFHandTNFRSF10Amay affect different phenotypic expressions of CSCR, nAMD and PCV.
Optic nerve tortuosity and displacements during horizontal eye movements in healthy and highly myopic subjects
Authors: Wang Xiaofei , Chang Stanley , Grinband Jack , Yannuzzi Lawrence A , Freund K Bailey , Hoang Quan V , Girard Michael JA
Published: May 2021

Aims

(1) To assess the morphology and 3-dimensional (3D) displacements of the eye globe and optic nerve (ON) in adduction/abduction using MRI. (2) To assess differences between healthy emmetropic and highly myopic (HM) subjects.

Methods

MRI volumes of both eyes from 18 controls and 20 HM subjects in primary gaze, abduction and adduction (15°) were postprocessed. All ONs were manually segmented and fitted to a 3D curve to assess ON tortuosity. ON displacements were evaluated in four quasicoronal planes which were perpendicular to the ON in primary gaze and were 3 mm apart.

Results

Axial length was higher in the HM group (28.62±2.60 vs 22.84±0.89 mm; p<0.0001). Adjusted ON tortuosities (ie, ON tortuosities estimated before myopia onset) were lower in HM eyes (0.9063±0.0591) versus controls (1.0152±0.02981) in primary gaze, adduction (0.9023±0.05538 vs 1.0137±0.0299) and abduction (0.9100±0.0594 vs 1.0182±0.0316); p<0.0001 for all cases. In all eyes, ON displacements in adduction were significantly different from those in abduction in the naso-temporal direction (p<0.0001 in all planes) but not in the supero-inferior direction. ON displacements in the posterior segments of the ON were smaller in the HM group in both gaze directions and were larger in the anterior-most ON segment in adduction only.

Conclusion

The adjusted tortuosity of the ON was significantly lower in HM eyes, suggesting that eyes destined towards HM exhibited higher ON traction forces during eye movements before the onset of myopia. Our ON metrics may be valuable to explore a potential link between eye movements and axial elongation.
Risk factors for ophthalmic artery stenosis and occlusion in patients with retinoblastoma treated with intra-arterial chemotherapy
Authors: Zhou Min , Wen Xuyang , Jia Shichong , Han Yanping , He Xiaoyu , Han Minglei , Xu Wei , Fan Jiayan , Jia Renbing , Fan Xianqun
Published: May 2021

Purpose

To explore the risk factors for ophthalmic artery (OA) stenosis and occlusion after intra-arterial chemotherapy (IAC) with selective ophthalmic artery catheterisation (OAC) in the treatment of retinoblastoma.

Design

Retrospective, single centre case-control study.

Methods

The study was conducted including consecutive patients with unilateral or bilateral intraocular retinoblastoma undergoing IAC between June 2016 and June 2019 with a follow-up time of 4 years. Main outcomes are rate of IAC-induced OA occlusion and OA diameter.

Results

346 attempted OAC infusions were successful. The total incidence of OA occlusion was 15.89%. The occlusion and control groups were similar in patients’ age, sex and disease stage. Median OA diameter was 0.49 mm in those with OA occlusion, and 0.66 mm in those without occlusion. In the occlusion group, the OA diameter difference was significantly larger between the first IAC and the final IAC (0.22mm vs 0.12mm, p=0.001). In both groups, the median number of IAC treatments was 3. Multivariate Cox regression models included initial OA diameter (OR: 0.005, p=0.001), ratio of OA orifice diameter differences between first and last IAC to the initial OA orifice diameter (OR: 4.661, p=0.003), and number of IAC (OR: 1.538, p=0.042) as clinical features significantly associated with OA occlusion.

Conclusions

The OA diameter at first IAC treatment, the ratio of OA orifice diameter differences between first and last IAC to the initial OA orifice diameter and total number of IAC treatments may be three main clinical predictors for OA occlusion after IAC for retinoblastoma.
Case series of shrinking hydroxyapatite orbital implants
Authors: Han Louis S , Keillor Rodney B , Weatherhead Robert G
Published: May 2021

Background

An orbital implant is used after enucleation or evisceration surgery to replace the volume lost and to aid in prosthesis fitting and movement. Different materials have been used through the years. The authors noted that with bone-derived hydroxyapatite orbital implants, some patients lose their orbital volume.

Methods

The operating theatre record was searched to find patients who had their hydroxyapatite orbital implant removed at Dunedin Hospital, New Zealand, between 2011 and 2015. The original implant size and size at removal were noted. Histological results were noted. Medical notes were reviewed.

Results

A total of six patients had hydroxyapatite orbital implants removed during this time. Four patients had implants that were smaller than their original sizes. All specimens had fibrovascular infiltration noted, three had chronic inflammatory cells and one had osteoclastic activity.

Conclusions

Bone-derived hydroxyapatite orbital implants can reduce in size, and this may occur due to osteoclastic activity. The surgeon must consider this scenario when choosing the type of implant to be used after enucleation or evisceration.
Methods, challenges and benefits of a health monitoring programme for Norwegian Olympic and Paralympic athletes: the road from London 2012 to Tokyo 2020
Authors: Clarsen Benjamin , Steffen Kathrin , Berge Hilde Moseby , Bendiksen Fredrik , Fossan Bjørn , Fredriksen Hilde , Gjelsvik Hilde , Haugvad Lars , Kjelsberg Mona , Ronsen Ola , Torgalsen Thomas , Walløe Anders , Bahr Roald
Published: May 2021

Objective

To describe the implementation of a health monitoring programme for Norwegian Paralympic and Olympic candidates over five consecutive Olympic and Paralympic Games cycles (London 2012, Sochi 2014, Rio de Janeiro 2016, PyeongChang 2018 and Tokyo 2020).

Methods

Athletes were monitored for 12–18 months preparing for the games using a weekly online questionnaire (OSTRC-H2) with follow-up by physicians and physiotherapists, who provided clinical care and classified reported problems.

Results

Between 2011 and 2020, 533 Olympic and 95 Paralympic athletes were included in the monitoring programme, with an overall response of 79% to the weekly questionnaire and a total observation period of 30 826 athlete weeks. During this time, 3770 health problems were reported, with a diagnosis rate of 97%. The average prevalence of health problems at any given time was 32% among Olympic athletes and 37% among Paralympic athletes. Acute traumatic injuries represented the greatest burden for Olympic team sport athletes, and illnesses represented the greatest burden for Olympic endurance and Paralympic athletes. On average, Olympic athletes lost 27 days and Paralympic athletes lost 33 days of training per year due to health problems.

Conclusion

Conducting long-term health monitoring of Olympic and Paralympic athletes is challenging, particularly because athletes travel frequently and often relate to many medical providers. This programme has been implemented and improved within Team Norway for five Olympic and Paralympic cycles and during this time we believe it has helped protect our athletes’ health.
Multi-strategy intervention increases school implementation and maintenance of a mandatory physical activity policy: outcomes of a cluster randomised controlled trial
Authors: Nathan Nicole , Hall Alix , McCarthy Nicole , Sutherland Rachel , Wiggers John , Bauman Adrian E , Rissel Chris , Naylor Patt-Jean , Cradock Angie , Lane Cassandra , Hope Kirsty , Elton Benjamin , Shoesmith Adam , Oldmeadow Christopher , Reeves Penny , Gillham Karen , Duggan Bernadette , Boyer James , Lecathelinais Christophe , Wolfenden Luke
Published: May 2021

Objectives

To assess if a multi-strategy intervention effectively increased weekly minutes of structured physical activity (PA) implemented by classroom teachers at 12 months and 18 months.

Methods

A cluster randomised controlled trial with 61 primary schools in New South Wales Australia. The 12-month multi-strategy intervention included; centralised technical assistance, ongoing consultation, principal’s mandated change, identifying and preparing school champions, development of implementation plans, educational outreach visits and provision of educational materials. Control schools received usual support (guidelines for policy development via education department website and telephone support). Weekly minutes of structured PA implemented by classroom teachers (primary outcome) was measured via teacher completion of a daily log-book at baseline (October–December 2017), 12-month (October–December 2018) and 18-month (April–June 2019). Data were analysed using linear mixed effects regression models.

Results

Overall, 400 class teachers at baseline, 403 at 12 months follow-up and 391 at 18 months follow-up provided valid primary outcome data. From baseline to 12-month follow-up, teachers at intervention schools recorded a greater increase in weekly minutes of PA implemented than teachers assigned to the control schools by approximately 44.2 min (95% CI 32.8 to 55.7; p<0.001) which remained at 18 months, however, the effect size was smaller at 27.1 min (95% CI 15.5 to 38.6; p≤0.001).

Conclusion

A multi-strategy intervention increased mandatory PA policy implementation. Some, but not all of this improvement was maintained after implementation support concluded. Further research should assess the impact of scale-up strategies on the sustainability of PA policy implementation over longer time periods.

Trial registration number

Australian New Zealand Clinical Trials Registry (ACTRN12617001265369).
Rehabilitation post-COVID-19: cross-sectional observations using the Stanford Hall remote assessment tool
Authors: O’Sullivan Oliver , Barker-Davies R M , Thompson K , Bahadur S , Gough M , Lewis S , Martin M , Segalini A , Wallace G , Phillip R , Cranley M
Published: May 2021

Introduction

The multisystem COVID-19 can cause prolonged symptoms requiring rehabilitation. This study describes the creation of a remote COVID-19 rehabilitation assessment tool to allow timely triage, assessment and management. It hypotheses those with post-COVID-19 syndrome, potentially without laboratory confirmation and irrespective of initial disease severity, will have significant rehabilitation needs.

Methods

Cross-sectional study of consecutive patients referred by general practitioners (April–November 2020). Primary outcomes were presence/absence of anticipated sequelae. Binary logistic regression was used to test association between acute presentation and post-COVID-19 symptomatology.

Results

155 patients (n=127 men, n=28 women, median age 39 years, median 13 weeks post-illness) were assessed using the tool. Acute symptoms were most commonly shortness of breath (SOB) (74.2%), fever (73.5%), fatigue (70.3%) and cough (64.5%); and post-acutely, SOB (76.7%), fatigue (70.3%), cough (57.4%) and anxiety/mood disturbance (39.4%). Individuals with a confirmed diagnosis of COVID-19 were 69% and 63% less likely to have anxiety/mood disturbance and pain, respectively, at 3 months.

Conclusions

Rehabilitation assessment should be offered to all patients suffering post-COVID-19 symptoms, not only those with laboratory confirmation and considered independently from acute illness severity. This tool offers a structure for a remote assessment. Post-COVID-19 programmes should include SOB, fatigue and mood disturbance management.
Value improvement at the point of care: engaging and empowering front-line teams with a new quality improvement methodology
Authors: Gupta Poonam , Chacko Gracy , Mavin Paul , McDonald Ian , El Hassan Mawahib , Omari Emad , Ali Azhar , Siddiqui Raana , Khan Needa , McKenzie Lisa , Bolender Tricia , Andrews William
Published: May 2021

Background

Healthcare organisations require systems to consistently meet the needs of their patients while providing excellent quality of care. The value improvement (VI) approach was developed by the Institute for healthcare improvement and successfully piloted at Raigmore Hospital, Scotland. It showed positive results in improving outcomes and reducing costs. Our multidisciplinary team from a tertiary care cardiac hospital in Doha, Qatar wanted to see if we could improve value in a clinically and geographically distinct context. We sought to understand the effectiveness of this approach as an integrative management philosophy that aims for continuous improvement in the quality of services by increasing efficiency and reducing waste.

Methods

This study evaluates the outcomes achieved from applying the VI methodology. The method is rooted in a framework that emphasises standardisation, continuous process improvement and rightsizing capacity to demand. The main tools include a data box score, a visual management board and weekly communication huddles.

Results

As a result of the VI methodology, our team achieved improvements across performance, staff capacity and cost domains. Compared with the 4–8 weeks baseline data collection period, these improvements included an increase in discharges before 13:00 hour by 61%, a reduction in the number of blood samples per patient per day by 20%, an increase in nursing time spent in direct patient care by 18%, and an increase in staff satisfaction to 40%.

Conclusions

We found that the VI approach offered a systematic method for continuously improving the quality of care by focusing attention each week on safety, efficiency and patient experience. The team improved numerous processes and outcomes resulting in a positive impact on patients and families and increased the engagement of staff in continuous improvement. In this way, we improved our capacity to undertake and complete quality projects.
Importance of living arrangements and coparenting quality for young children’s mental health after parental divorce: a cross-sectional parental survey
Authors: Bergström Malin , Salari Raziye , Hjern Anders , Hognäs Robin , Bergqvist Kersti , Fransson Emma
Published: May 2021

Background

Parental separation has been associated with adverse child mental health outcomes in the literature. For school-aged children, joint physical custody (JPC), that is, spending equal time in both parents’ homes after a divorce, has been associated with better health and well-being than single care arrangements. Preschool children’s well-being in JPC is less studied. The aim of this study was to investigate the association of living arrangements and coparenting quality with mental health in preschool children after parental separation.

Methods

This cross-sectional population-based study includes 12 845 three-year-old children in Sweden. Mental health was measured by parental reports of the Strength and Difficulties Questionnaire and coparenting quality with a four-item scale. The living arrangements of the 642 children in non-intact families were categorised into JPC, living mostly with one parent and living only with one parent.

Results

Linear regression models, adjusted for sociodemographic confounders, showed an association between increased mental health problems and living mostly and only with one parent (B=1.18; 95% CI 0.37 to 2.00, and B=1.20; 95% CI 0.40 to 2.00, respectively), while children in intact families vs JPC did not differ significantly (B=−0.11; 95% CI −0.58 to 0.36). After adjusting the analyses for coparenting quality, differences in child mental health between the post divorce living arrangements were, however, minimal while children in intact families had more mental health problems compared with JPC (B=0.70; 95% CI 0.24 to 1.15). Factorial analysis of covariance revealed that low coparenting quality was more strongly related to mental health problems for children in intact families and JPC compared with children living mostly or only with one parent.

Conclusions

This study suggests that coparenting quality is a key determinant of mental health in preschool children and thus should be targeted in preventive interventions.
Incidence and impact of incivility in paramedicine: a qualitative study
Authors: Credland Nicola Jane , Whitfield Clare
Published: May 2021

Background

Incivility or rudeness is a form of interpersonal aggression. Studies suggest that up to 90% of healthcare staff encounter incivility at work with it being considered ‘part of the job’.

Methods

Qualitative, in-depth, semistructured interviews (n=14) undertaken between June and December 2019. Purposive sampling was used to identify front-line paramedics working for one NHS Ambulance Trust. Interviews lasted between 16 and 45 min, were audiorecorded, verbatim transcribed and analysed using thematic analysis.

Results

Four themes were identified: paramedics reported a lack of respect displayed both verbally and non-verbally from other professional groups. The general public and interdisciplinary colleagues alike have unrealistic expectations of the role of a paramedic. In order to deal with incivility paramedics often reported taking the path of least resistance which impacts on ways of working and shapes subsequent clinical decision-making, potentially threatening best practice. Finally paramedics report using coping strategies to support well-being at work. They report that a single episode of incivility is easier to deal with but subsequent episodes compound the first.

Conclusions

This study highlights the effect incivility can have on operational paramedics. Incivility from the general public and other health professionals alike can have a cumulative effect impacting on well-being and clinical decision-making.
Frequent attendance at the emergency department shows typical features of complex systems: analysis of multicentre linked data
Authors: Burton Christopher , Stone Tony , Oliver Phillip , Dickson Jon M , Lewis Jen , Mason Suzanne M
Published: May 2021

Objective

Frequent attendance at the ED is a worldwide problem. We hypothesised that frequent attendance could be understood as a feature of a complex system comprising patients, healthcare and society. Complex systems have characteristic statistical properties, with stable patterns at the level of the system emerging from unstable patterns at the level of individuals who make up the system.

Methods

Analysis of a linked dataset of routinely collected health records from all 13 hospital trusts providing ED care in the Yorkshire and Humber region of the UK (population 5.5 million). We analysed the distribution of attendances per person in each of 3 years and measured the transition of individual patients between frequent, infrequent and non-attendance. We fitted data to power law distributions typically seen in complex systems using maximum likelihood estimation.

Results

The data included 3.6 million attendances at EDs in 13 hospital trusts. 29/39 (74.3%) analyses showed a statistical fit to a power law; 2 (5.1%) fitted an alternative distribution. All trusts’ data fitted a power law in at least 1 year. Differences over time and between hospital trusts were small and partly explained by demographics. In contrast, individual patients’ frequent attendance was unstable between years.

Conclusions

ED attendance patterns are stable at the level of the system, but unstable at the level of individual frequent attenders. Attendances follow a power law distribution typical of complex systems. Interventions to address ED frequent attendance need to consider the whole system and not just the individual frequent attenders.
Evaluating the utility of Rapid Response EEG in emergency care
Authors: Wright Norah M K , Madill Evan S , Isenberg Derek , Gururangan Kapil , McClellen Hannah , Snell Samuel , Jacobson Mercedes P , Gentile Nina T , Govindarajan Prasanthi
Published: May 2021

Background

Timely management of non-convulsive status epilepticus (NCSE) is critical to improving patient outcomes. However, NCSE can only be confirmed using electroencephalography (EEG), which is either significantly delayed or entirely unavailable in emergency departments (EDs). We piloted the use of a new bedside EEG device, Rapid Response EEG (Rapid-EEG, Ceribell), in the ED and evaluated its impact on seizure management when used by emergency physicians.

Methods

Patients who underwent Rapid-EEG to rule out NCSE were prospectively enrolled in a pilot project conducted at two ED sites (an academic hospital and a community hospital). Physicians were surveyed on the perceived impact of the device on seizure treatment and patient disposition, and we calculated physicians’ sensitivity and specificity (with 95% CI) for diagnosing NCSE using Rapid-EEG’sBrain Stethoscopefunction.

Results

Of the 38 patients enrolled, the one patient with NCSE was successfully diagnosed and treated within minutes of evaluation. Physicians reported that Rapid-EEG changed clinical management for 20 patients (53%, 95% CI 37% to 68%), primarily by ruling out seizures and avoiding antiseizure treatment escalation, and expedited disposition for 8 patients (21%, 95% CI 11% to 36%). At the community site, physicians diagnosed seizures by their sound usingBrain Stethoscopewith 100% sensitivity (95% CI 5% to 100%) and 92% specificity (95% CI 62% to 100%).

Conclusion

Rapid-EEG was successfully deployed by emergency physicians at academic and community hospitals, and the device changed management in a majority of cases. Widespread adoption of Rapid-EEG may lead to earlier diagnosis of NCSE, reduced unnecessary treatment and expedited disposition of seizure mimics.
Protein tyrosine phosphatase receptor type C (PTPRC or CD45)
Authors: Al Barashdi Maryam Ahmed , Ali Ahlam , McMullin Mary Frances , Mills Ken
Published: May 2021

The leucocyte common antigen, protein tyrosine phosphatase receptor type C (PTPRC), also known as CD45, is a transmembrane glycoprotein, expressed on almost all haematopoietic cells except for mature erythrocytes, and is an essential regulator of T and B cell antigen receptor-mediated activation. Disruption of the equilibrium between protein tyrosine kinase and phosphatase activity (from CD45 and others) can result in immunodeficiency, autoimmunity, or malignancy. CD45 is normally present on the cell surface, therefore it works upstream of a large signalling network which differs between cell types, and thus the effects of CD45 on these cells are also different. However, it is becoming clear that CD45 plays an essential role in the innate immune system and this is likely to be a key area for future research. In this review ofPTPRC(CD45), its structure and biological activities as well as abnormal expression of CD45 in leukaemia and lymphoma will be discussed.
Molecular heterogeneity of pancreatic intraductal papillary mucinous neoplasms and implications for novel endoscopic tissue sampling strategies
Authors: Rift Charlotte Vestrup , Melchior Linea Cecilie , Scheie David , Hansen Carsten Palnæs , Lund Eva Løbner , Hasselby Jane Preuss
Published: May 2021

Aims

Intraductal papillary mucinous neoplasms (IPMNs) may be precursor lesions of pancreatic cancer. The path towards malignancy is associated with mutations in tumour suppressor—and oncogenes that may serve as biomarkers during diagnostic investigation. A novel micro forceps has made it possible to obtain biopsies from the cyst wall for analysis by next generation sequencing (NGS), providing an opportunity for early detection and intervention. However, the impact of spatial tumour heterogeneity on the representability of the biopsies has not been determined. The primary aim is to characterise the impact of molecular heterogeneity of the luminal cyst wall on tissue sampling strategies with small biopsies.

Methods

We performed NGS and immunohistochemical phenotyping on 18 resected IPMNs with varying degrees of dysplasia and for a subset, concomitant carcinoma, using a commercially available NGS-panel of 51 oncogenes. We simulated endoscopic biopsies by performing punch biopsies (PBs) of the cyst wall from resected specimens.

Results

In total, 127 NGS analyses were performed. ConcomitantKRASandGNASwas a common feature of the IPMNs. Mutations inKRASandGNASwere associated with low-grade dysplasia whereas alterations inTP53, SMAD4,CDKN2AandPIK3CAwere associated with high-grade dysplasia and/or carcinoma. The mutational analysis of the PBs from the cyst wall was compared with the whole lesion. No difference was detected between PBs and whole lesions when the cumulated mutational profile in increasing order of randomly performed PBs was compared.

Conclusions

Small IPMN biopsies from the cyst wall are adequate to yield a molecular diagnosis.