Ameliorating effect of 2'-Fucosyllactose and 6'-Sialyllactose on lipopolysaccharide-induced intestinal inflammation

Human milk oligosaccharides (HMO) affect gut microbiota during neonatal development, particularly with respect to the immune system. Bovine milk-based infant formulas have low oligosaccharide contents. Thus, efforts to fortify infant formulas with HMO are being undertaken. Two major HMO, 2'-fucosyllactose (2'-FL) and 6'-sialyllactose (6'-SL), exert anti-inflammatory effects; however, the associations between anti-inflammatory effects induced by 2'-FL and 6'-SL co-treatment and gut microbiota composition and metabolite modulation remain unclear. Therefore, in this study, we evaluated the effects of a mixture of these HMO. To determine the optimal HMO ratio for anti-inflammatory effects and elucidate its mode of action, LPS-induced inflammatory HT-29 epithelial cells and intestinal inflamed suckling mice were treated with various mixtures of 2'-FL and 6'-SL. 2'-FL:6'-SL ratio of 5:1 was identified as the most effective pre-treatment HMO mixture in vitro; thus, this ratio was selected and used for low, middle, and high-dose treatments for subsequent in vivo studies. In vivo, high-dose HMO treatment restored LPS-induced inflammation symptoms, such as body weight loss, colon length reduction, histological structural damage, and intestinal gene expression related to inflammatory responses. High-dose HMO was the only treatment that modulated the major phyla Bacteroidetes and Firmicutes and the genera Ihubacter, Mageeibacillus, and Saccharofermentans. These changes in microbial composition were correlated with intestinal inflammation-related gene expression and short-chain fatty acid production. To our knowledge, our study is the first to report the effects of Ihubacter, Mageeibacillus, and Saccharofermentans on short chain fatty acid levels, which can subsequently affect inflammatory cytokine and tight junction protein levels. Conclusively, the HMO mixture exerted anti-inflammatory effects through changes in microbiota and metabolite production. These findings suggested that supplementation of infant formula with HMO may benefit formula-fed infants by forming unique microbiota contributing to neonatal development.

Effectiveness of sensory integration therapy in children, focusing on Korean children: A systematic review and meta-analysis

BACKGROUND

Sensory integration intervention is highly related to the child's effective interaction with the environment and the child's development. Currently, various sensory integration interventions are being applied, but research methodological problems are arising due to unsystematic protocols. This study aims to present the optimal intervention protocol by presenting scientific standards for sensory integration intervention through meta-analysis.

AIM

To prove the effectiveness of sensory integration therapy, examine the latest trend of sensory integration studies in Korea, and provide clinical evidence for sensory integration therapies.

METHODS

The database of Korean search engines, including RISS, KISS, and DBpia, was used to search for related literature published from 2001 to October 2020. The keywords, "Children", "Sensory integration", "Integrated sensory", "Sensory-motor", and "Sensory stimulation" were used in this search. Then, a meta-analysis was conducted on 24 selected studiesRISS, KISS, and DBpia, was used to search for related literature published from 2001 to October 2020. The keywords, "Children", "Sensory integration", "Integrated sensory", "Sensory-motor", and "Sensory stimulation" were used in this search. Then, a meta-analysis was conducted on 24 selected studies.

RESULTS

Sensory integration intervention has been proven effective in children with cerebral palsy, autism spectrum disorder, attention deficit/hyperactivity disorder, developmental disorder, and intellectual disability in relation to the diagnosis of children. Regarding sensory integration therapies, 1:1 individual treatment with a therapist or a therapy session lasting for 40 min was most effective. In terms of dependent variables, sensory integration therapy effectively promoted social skills, adaptive behavior, sensory processing, and gross motor and fine motor skills.

CONCLUSION

The results of this study may be used as therapeutic evidence for sensory integration intervention in the clinical field of occupational therapy for children, and can help to present standards for sensory integration intervention protocols.

Management of newborns and healthcare workers exposed to isoniazid-resistant congenital tuberculosis in the neonatal intensive care unit

BACKGROUND

Management of newborns and healthcare workers (HCWs) exposed to congenital tuberculosis (TB) in the neonatal intensive care unit (NICU) has been reported rarely.

AIM

To outline a contact investigation process for individuals exposed to congenital TB in the NICU and investigate nosocomial transmission. Additionally, to assess the efficacy and safety of window prophylaxis in exposed newborns.

METHODS

A baby, born at a gestational age of 28 + 1 weeks, was diagnosed with isoniazid-resistant congenital TB on the 39th day of admission to the level IV NICU. Newborns and HCWs exposed cumulatively for ≥8 h underwent contact investigation and follow-up for a year.

FINDINGS

Eighty-two newborns underwent contact investigation. All newborns displayed normal chest X-rays, and 42 hospitalized newborns tested negative for acid-fast bacilli stain and Xpert® MTB/RIF assay in their endotracheal sputum or gastric juices. Eighty received window prophylaxis: six of 75 on rifampin experienced mild adverse events, and none of the five on levofloxacin. After 12 weeks, five (6.1%) had a positive tuberculin skin test, all of whom had already received the Bacillus Calmette-Guérin vaccine and tested negative on TB interferon-gamma releasing assay. Of 119 exposed HCWs, three (2.5%) were diagnosed with latent TB infection and completed a four-month rifampin therapy. There was no active TB disease among exposed newborns and HCWs during a one-year follow-up.

CONCLUSION

Timely diagnosis of congenital TB is crucial for minimizing transmission among exposed neonates and HCWs in the NICU setting. In cases of isoniazid-resistant index patients, even premature newborns may consider the use of rifampin or levofloxacin for window prophylaxis.

Characterization of SsHog1 and Shk1 Using Efficient Gene Knockout Systems through Repeated Protoplasting and CRISPR/Cas9 Ribonucleoprotein Approaches in Sclerotinia sclerotiorum

Sclerotinia sclerotiorum is the causal agent of sclerotinia stem rot in over 400 plant species. In a previous study, the group III histidine kinase gene of S. sclerotiorum (Shk1) revealed its involvement in iprodione and fludioxonil sensitivity and osmotic stress. To further investigate the fungicide sensitivity associated with the high-osmolarity glycerol (HOG) pathway, we functionally characterized SsHog1, which is the downstream kinase of Shk1. To generate knockout mutants, split marker transformation combined with a newly developed repeated protoplasting method and CRISPR/Cas9 ribonucleoprotein (RNP) delivery approach were used. The pure SsHog1 and Shk1 knockout mutants showed reduced sensitivity to fungicides and increased sensitivity to osmotic stress. In addition, the SsHog1 knockout mutants demonstrated reduced virulence compared to Shk1 knockout mutants and wild-type. Our results indicate that the repeated protoplasting method and RNP approach can generate genetically pure homokaryotic mutants and SsHog1 is involved in osmotic adaptation, fungicide sensitivity, and virulence in S. sclerotiorum.

Development of a Parturition Detection System for Korean Native Black Goats

Korean Native Black Goats deliver mainly during the cold season. However, in winter, there is a high risk of stunted growth and mortality for their newborns. Therefore, we conducted this study to develop a KNBG parturition detection system that detects and provides managers with early notification of the signs of parturition. The KNBG parturition detection system consists of triaxial accelerometers, gateways, a server, and parturition detection alarm terminals. Then, two different data, the labor and non-labor data, were acquired and a Decision Tree algorithm was used to classify them. After classifying the labor and non-labor states, the sum of the labor status data was multiplied by the activity count value to enhance the classification accuracy. Finally, the Labor Pain Index (LPI) was derived. Based on the LPI, the optimal processing time window was determined to be 10 min, and the threshold value for labor classification was determined to be 14 240.92. The parturition detection rate was 82.4%, with 14 out of 17 parturitions successfully detected, and the average parturition detection time was 90.6 min before the actual parturition time of the first kid. The KNBG parturition detection system is expected to reduce the risk of stunted growth and mortality due to hypothermia in KNBG kids by detecting parturition 90.6 min before the parturition of the first kid, with a success rate of 82.4%, enabling parturition nursing.

Uninsured immigrants in the United States significantly delayed the initiation of prenatal care after the changes to the Public Charge Rule

OBJECTIVE

We estimated the impact of the changes made to the Public Charge Rule on the initiation of prenatal care among uninsured immigrants in the United States.

STUDY DESIGN

We used a difference-in-differences approach to analyse the impact of the changes made to the Public Charge Rule (first difference) on initiation of prenatal care between uninsured and privately insured immigrants (second difference).

METHODS

We used the natality data by the National Center for Health Statistics as the main data source, which includes all singleton births in a hospital to an immigrant birthing person aged from 15 to 44. The study covers three phases: (1) the period prior to the leaked draft Executive Orders concerning changes made to the public charge policy-from January 2014 to December 2016; (2) the period after the draft Executive Orders were leaked until the proposal of the Public Charge Rule-from January 2017 to September 2018; and (3) post proposal of the Public Charge Rule -from October 2018 to December 2019.

RESULTS

After the proposal of the Public Charge Rule in 2018, the odds of initiating prenatal care in the first trimester decreased among uninsured immigrants by 12% (odds ratio [OR]: 0.880; 95% confidence interval [CI]: 0.832, 0.931) compared to privately insured immigrants. The odds of second trimester initiation of prenatal care was also negatively associated with the leak of the draft Executive Orders (OR: 0.942; 95% CI: 0.905, 0.981).

CONCLUSION

The results of this study suggest that uninsured immigrants in the United States significantly delayed prenatal care after the changes were made to the Public Charge Rule.

Monitoring of Benzimidazole Resistance in Botrytis cinerea Isolates from Strawberry in Korea and Development of Detection Method for Benzimidazole Resistance

Botrytis cinerea is a major fungal plant pathogen that causes gray mold disease in strawberries, leading to a decrease in strawberry yield. While benzimidazole is widely used as a fungicide for controlling this disease, the increasing prevalence of resistant populations to this fungicide undermines its effectiveness. To investigate benzimidazole resistant B. cinerea in South Korea, 78 strains were isolated from strawberries grown in 78 different farms in 2022, and their EC50 values for benzimidazole were examined. As a result, 64 strains exhibited resistance to benzimidazole, and experimental tests using detached strawberry leaves and the plants in a greenhouse confirmed the reduced efficacy of benzimidazole to control these strains. The benzimidazole resistant strains identified in this study possessed two types of mutations, E198A or E198V, in the TUB2 gene. To detect these mutations, TaqMan probes were designed, enabling rapid identification of benzimidazole resistant B. cinerea in strawberry and tomato farms. This study utilizes TaqMan real-time polymerase chain reaction analysis to swiftly identify benzimidazole resistant B. cinerea, thereby offering the possibility of effective disease management by identifying optimum locations and time of application.

Analysis of the effectiveness of cognitive rehabilitation for patients with chronic mental illness: A meta-analysis

BACKGROUND

People suffering from chronic mental illness are sensitive to stressful stimuli, lack coping skills, and have low self-esteem due to problems such as social situations. They also experience depression, isolation, fear, and frustration. Due to cognitive dysfunction, people suffering from chronic mental illness have inadequate cognitive processes that lead to distorted thinking.

AIM

To confirm the effectiveness of cognitive rehabilitation therapy in improving cognitive function and alleviating behavioral and psychological symptoms in patients with chronic mental illness, and to identify the cognitive function that had the main effect.

METHODS

The quality of the studies was evaluated using the Assessment of Multiple Systematic Reviews criteria, and data published from 2011 to December 2022 were searched using PubMed, Cochrane, RISS, KISS, and DBpia. The keywords used in the search were “mental illness,” “cognitive rehabilitation,” “cognition,” and “mental.” A meta-analysis was conducted on the 12 selected papers.

RESULTS

The level of evidence for the 12 documents was that of a randomized experimental study. Intervention types in cognitive rehabilitation can be divided into cognitive behavior, cognitive training, cognitive rehabilitation, and computerized cognitive programs. Most of the studies were on schizophrenia, and the measurement areas were cognitive functions (e.g., concentration, memory, and executive function) as well as depression, sociability, and quality of life. As a result of the meta-analysis of each variable, the effect size for cognitive rehabilitation treatment was in the following order: Sociability, memory, concentration, executive function, quality of life, and depression. Particularly, sociability and memory exhibited significant effects.

CONCLUSION

Cognitive rehabilitation aids cognitive function and sociability in patients with chronic mental illness and can be used as evidence for cognitive rehabilitation in mental health and occupational therapy.

Proximate Content Monitoring of Black Soldier Fly Larval (Hermetia illucens) Dry Matter for Feed Material using Short-Wave Infrared Hyperspectral Imaging

Edible insects are gaining popularity as a potential future food source because of their high protein content and efficient use of space. Black soldier fly larvae (BSFL) are noteworthy because they can be used as feed for various animals including reptiles, dogs, fish, chickens, and pigs. However, if the edible insect industry is to advance, we should use automation to reduce labor and increase production. Consequently, there is a growing demand for sensing technologies that can automate the evaluation of insect quality. This study used short-wave infrared (SWIR) hyperspectral imaging to predict the proximate composition of dried BSFL, including moisture, crude protein, crude fat, crude fiber, and crude ash content. The larvae were dried at various temperatures and times, and images were captured using an SWIR camera. A partial least-squares regression (PLSR) model was developed to predict the proximate content. The SWIR-based hyperspectral camera accurately predicted the proximate composition of BSFL from the best preprocessing model; moisture, crude protein, crude fat, crude fiber, and crude ash content were predicted with high accuracy, with R2 values of 0.89 or more, and root mean square error of prediction values were within 2%. Among preprocessing methods, mean normalization and max normalization methods were effective in proximate prediction models. Therefore, SWIR-based hyperspectral cameras can be used to create automated quality management systems for BSFL.

Meta-analysis on the effectiveness of parent education for children with disabilities

BACKGROUND

Parents of children with disabilities often have difficulty understanding their child's behavior and are unable to do it appropriately because they do not know what to do. The more we properly understand children with disabilities, the more positive the importance of parent education becomes in various aspects.

AIM

To demonstrate the effectiveness of parent education for children with disabilities in various aspects and present it as evidence that can be used clinically.

METHODS

For a meta-analysis on the effectiveness of parent education for children with disabilities, literature was collected from 2002 to 2022 using PubMed, Embase, Web of Science, Directory of Open Access Journals, and Europe PMC. Search terms were "disabled children," "disabled children," "parent education," "parent training," and "parent coaching." The final searched literature included a total of 11 articles. To calculate the effect size, the mean, standard deviation, and sample size of the experimental and control groups were analyzed, and a meta-analysis was performed using RevMan version 5.4.1. To analyze statistical heterogeneity, a chi-square test was performed to evaluate the significance of Q statistics to indicate statistical heterogeneity.

RESULTS

The final literature totaled 11 articles, and a total of 4 items were analyzed. There were 5 studies on parental depression, the heterogeneity was 98%, and the effect size for parental depression was 0.35 [confidence interval (CI: 0.30-0.40)], indicating a small but statistically significant effect size. There were 4 studies on parenting attitude, the heterogeneity was 100%, the effect size on parenting attitude was 0.41 (CI: 0.37-0.46), which was a medium effect size, and the P value showed a statistically significant score. Additionally, face-to-face parent education was found to have a larger effect size than non-face-to-face education. Regarding parent education methods, face-to-face parent education had a medium effect size [0.57 (CI: 0.52-0.61]), while non-face-to-face parent education had a small effect size [0.23 (CI: 0.18-0.28]).

CONCLUSION

Parental education has shown high effectiveness in child development, and it has proven to be even more effective when face-to-face parenting education is conducted. Accordingly, more effective and objective data was presented. Based on this study, it is believed that parent education research applying various diagnostic groups should continue to be conducted.

A Phase II Trial Evaluating Rapid Mid-Treatment Nodal Shrinkage to Select for Adaptive Deescalation in p16+ Oropharyngeal Cancer Patients Undergoing Definitive Chemoradiation

PURPOSE/OBJECTIVE(S)

The purpose of this study is to determine if rapid mid-treatment nodal shrinkage (RMNS) can identify patients with p16+ oropharyngeal cancer (OPC) who can be safely deescalated with reduced dose chemoradiation therapy (CRT). The primary endpoint was 2-year progression free survival (PFS).

MATERIALS/METHODS

Inclusion criteria were as follows: T1-3, N1, M0 (AJCC 8th edition) p16+ OPC with <10 pack-year smoking history. All patients were initially planned for standard dose CRT (70 Gy) and weekly cisplatin. Patients were evaluated with a CT scan at week 4 for RMNS, defined as >40% nodal volumetric reduction from baseline. If RMNS was achieved, they proceeded to deescalated CRT (60 Gy). If not, they received standard CRT. Biomarker correlates were collected at baseline and week 4 of CRT including plasma TTMV (tumor tissue modified viral) HPV DNA and MRI diffusion weighted imaging (DWI). Univariate logistic regression analyses (UVA) were performed to evaluate predictors of RMNS. Odds ratios with 95% CI are reported, using a p<0.05 for statistical significance with a two-sided test. Wilcoxon rank sum tests were used to evaluate differences between the two groups using p < 0.05, 2-sided) for statistical significance. All statistical procedures were performed using R () with no adjustments for multiple testing.

RESULTS

Thirty-six patients were enrolled: median age: 60 years; 81% male; primary site: 36% base of tongue, 53% tonsil, 11% both; T-stage: 39% T1, 50% T2, 11% T3; N-stage: 100% N1; any smoking history: 58% yes, 42% no; 67% (n = 24) had RMNS and received deescalated CRT while the remaining proceeded to standard CRT. At a median follow-up of 32.4 months, 2-year PFS between the standard and deescalated groups were 91.7% vs 90.9%, respectively (p = 0.97). All patients with recurrence underwent successful salvage treatment with 2-year OS 100% for all patients. On UVA, rapid TTMV HPV DNA clearance (baseline to week 4) (OR 12.0 [1.65-250], p = 0.034), lower MRI diffusivity (ADC) at baseline (OR 0.79 [0.61-0.97], p = 0.042) and week 4 (OR 0.76 [0.60-0.91], p = 0.009), and higher MRI diffusional kurtosis at baseline (OR 1.09 [1.01-1.21], p = 0.051) and week 4 (OR 1.24 [1.09-1.52], p = 0.009) were significantly associated with RMNS. When comparing the deescalated and standard cohorts, the mean baseline and week 4 MRI ADC were significantly lower and week 4 MRI diffusional kurtosis was significantly higher in the deescalated group.

CONCLUSION

In this phase II study, rapid mid-treatment nodal shrinkage appeared to select favorable risk p16+ oropharynx cancer patients for treatment de-escalation. Rapid clearance of TTMV HPV DNA at week 4 as well as MRI DWI biomarkers of low ADC and high diffusional kurtosis values were correlated with RMNS. A larger study is planned to incorporate RMNS and biomarkers for further treatment de-escalation. Additional trial information is available at ClinicalTrials.gov (Identifier: NCT03215719).

Rapid Detection of Single- and Co-Contaminant Aflatoxins and Fumonisins in Ground Maize Using Hyperspectral Imaging Techniques

Aflatoxins and fumonisins, commonly found in maize and maize-derived products, frequently co-occur and can cause dangerous illness in humans and animals if ingested in large amounts. Efforts are being made to develop suitable analytical methods for screening that can rapidly detect mycotoxins in order to prevent illness through early detection. A method for classifying contaminated maize by applying hyperspectral imaging techniques including reflectance in the visible and near-infrared (VNIR) and short-wave infrared (SWIR) regions, and fluorescence was investigated. Machine learning classification models in combination with different preprocessing methods were applied to screen ground maize samples for naturally occurring aflatoxin and fumonisin as single contaminants and as co-contaminants. Partial least squares-discriminant analysis (PLS-DA) and support vector machine (SVM) with the radial basis function (RBF) kernel were employed as classification models using cut-off values of each mycotoxin. The classification performance of the SVM was better than that of PLS-DA, and the highest classification accuracies for fluorescence, VNIR, and SWIR were 89.1%, 71.7%, and 95.7%, respectively. SWIR imaging with the SVM model resulted in higher classification accuracies compared to the fluorescence and VNIR models, suggesting that as an alternative to conventional wet chemical methods, the hyperspectral SWIR imaging detection model may be the more effective and efficient analytical tool for mycotoxin analysis compared to fluorescence or VNIR imaging models. These methods represent a food safety screening tool capable of rapidly detecting mycotoxins in maize or other food ingredients consumed by animals or humans.

Durability and Performance Analysis of Polymer Electrolyte Membranes for Hydrogen Fuel Cells by a Coupled Chemo-mechanical Constitutive Model and Experimental Validation

In this paper, a chemo-mechanically coupled behavior of Nafion 212 is investigated through predictive multiphysics modeling and experimental validation. Fuel cell performance and durability are critically determined by the mechanical and chemical degradation of a perfluorosulfonic acid (PFSA) membrane. However, how the degree of chemical decomposition affects the material constitutive behavior has not been clearly defined. To estimate the degradation level quantitatively, fluoride release is measured. The PFSA membrane in tensile testing shows nonlinear behavior, which is modeled by J₂ plasticity-based material modeling. The material parameters, which contain hardening parameters and Young's modulus, are characterized in terms of fluoride release levels by inverse analysis. In the sequel, membrane modeling is performed to investigate the life prediction due to humidity cycling. A continuum-based pinhole growth model is adopted in response to mechanical stress. As a result, validation is conducted in comparison with the accelerated stress test (AST) by correlating the size of the pinhole with the gas crossover generated in the membrane. This work provides a dataset of degraded membranes for performance and suggests the quantitative understanding and prediction of fuel cell durability with computational simulation.

Development of a Mercury Bromide Birefringence Measurement System Based on Brewster's Angle

Mercury bromide (Hg₂Br₂) has been used to develop acousto-optic tunable filters (AOTFs) because it has several advantages, including a high refractive index, a broad optical bandwidth, and a relatively high figure of merit. Therefore, the measurement of its birefringence is a highly important factor for ensuring AOTF quality. However, for single crystals, it is difficult (at the millimeter scale) to quantify the birefringence using an ellipsometer, as this equipment is only designed to conduct measurements on thin films. In this study, a simple birefringence measurement system for Hg₂Br₂ was developed based on Brewster's angle at the millimeter scale. The planar distributions of the Hg₂Br₂ crystal along the (100), (010), and (001) planes were used in the experiments. The developed measurement system can measure the reflected light intensity of the Hg₂Br₂ crystal depending on the incidence angles (rotations at 0.01125° steps) and can calculate the ordinary and extraordinary refractive indices and birefringence. The calculated birefringence of the Hg₂Br₂ crystal was 0.8548; this value exhibits an error of 0.64% compared with a value of 0.86 reported in the literature. The developed measurement system demonstrates the ability to be used to evaluate the quality of birefringent single crystals.

Abstract WMP109: Aged Maternal Biome Impairs Offspring Health

Background: The gut and its microbiome have become highlighted because of their holistic effect on the body in health and disease. The bi-directional communication of the gut-brain axis is highly involved in, among others, the immune response. Additionally, the maternal gut microbiome affects offspring brain, immune system, and gut microbiome formation and development. Therefore, an aged and unhealthy maternal biome that is may increase both stroke risk factors among offspring.

Method: Young female C57B6 mice 3-month (M) of age had their host gut bacteria cleared via antibiotic treatment prior to recolonization via fecal microbiome transplants from 3M control, and 18M reproductively senescent female mice. The subsequent offspring was aged to 18 months, followed by behavioral tests, glucose tolerance, and blood pressure measurement, prior to a transient 90-minute middle cerebral artery occlusion (MCAO).

Results: Compared to control females with 3M biome, females with an aged biome had decreased fecundity from 26.4 days to 54.75 days at the onset of breeding to birth of pups (p=0.0018). There was no change in estrus cycle between the groups. The offspring gut microbiome had been affected in a sex specific manner. Female pups from dysbiotic, aged, biome mothers differed significantly in terms of b-diversity compared to those from control mothers (p=0.009) with pathogenic increases to firmicutes shifting the F:B ratio. There was a less pronounced trend in male offspring (p=0.241). Interestingly, no weight differences were observed in offspring depending on the maternal biome. At 2M of age, a depressive phenotype in tail suspension test was noted for male(p=0.0001) and female (p=0.0059). However, at 6M and older, the depressive phenotype subsided. Male offspring at 18M demonstrated a significant change (p=0.0001) in Glucose tolerance test compared to age matched females.

Conclusion: The maternal microbiome has a significant impact on offspring biome composition and health. Mice from mothers with aged microbiome exhibited early life depressive phenotypes, slower glucose metabolism, and a pathogenic gut microbiome composition. Therefore, maternal gut has transgenerational health effects which may be exacerbating stroke risk and potentially outcome.

New Approaches to Produce Large-Area Single Crystal Thin Films

Wafer-scale growth of single crystal thin films of metals, semiconductors, and insulators is crucial for manufacturing high-performance electronic and optical devices, but still challenging from both scientific and industrial perspectives. Recently, unconventional advanced synthetic approaches have been attempted and have made remarkable progress in diversifying the species of producible single crystal thin films. This review introduces several new synthetic approaches to produce large-area single crystal thin films of various materials according to the concepts and principles.

Epoxy-Based Catalyst-Free Self-Healing Elastomers at Room Temperature Employing Aromatic Disulfide and Hydrogen Bonds

In this paper, catalyst-free room-temperature healing epoxy vitrimer-like materials (S-vitrimer) are introduced. The S-vitrimer can be healed at room temperature without any external stimuli such as solvent, pressure, heat, and catalyst through an aromatic disulfide exchange reaction and a hydrogen bond because the glass transition temperature of the S-vitrimer is lower than room temperature. Self-healing materials are attracting widespread attention nowadays with their potential to increase the durability of the materials. However, there is still elevating need for research, considering the limitations of various self-healing methods. To the best of our knowledge, epoxy-based catalyst-free room-temperature healing materials have not been investigated until now, yet they are promising to make self-healing easier. Moreover, the S-vitrimer showed higher healing efficiency when healed for a longer time and at a higher temperature. Especially when healed at room temperature for 96 h, the S-vitrimer presented an 80% healing efficiency. The S-vitrimer also showed an 80% healing efficiency when healed at 60 °C for 48 h. To investigate the factors affecting self-healing behavior, three control experiments were carried out. Control experiments showed that the S-vitrimer is healed mainly due to a disulfide exchange reaction, but hydrogen bonds also contribute to self-healing behavior. Also, it was found that tightly packed segments can hinder self-healing through control experiments.

CNT-Reinforced Self-Healable Epoxy Dynamic Networks Based on Disulfide Bond Exchange

The design and utilization of polymers with healing capability have drawn increasing attention owing to their enhanced chain mobility and opportunity to heal minor cracks in composites. Rehealable thermoset polymers promise reduction in the maintenance cost and thus prolonged lifetime, reshaping, and recyclability. Introducing reversible covalent bonds is the mainstay strategy to achieve such plasticity in crosslinked polymers. Herein, we report a dynamic epoxy, which includes associative covalent adaptive networks (CANs) based on disulfide exchange bonds. Epoxy resin is chosen to study rehealing, as it is one of the most critical thermosetting polymers for various industries from aerospace to soft robotics. This study enlightens us about not only the consequences of CANs in the epoxy but also various factors such as soft segments and carbon nanotubes (CNTs). Epoxy dynamic networks are investigated in an attempt to explore the synergistic effect of the soft-segmented resins and CNTs on the healing and reshaping characteristics of epoxy networks along with varying stiffness. This research discusses epoxy dynamic networks in three main aspects: crosslink density, CAN density, and CNTs. Introducing soft segments into the epoxy network enhances the healing efficiency due to the increased chain mobility. A higher CAN density accelerates network rearrangement, improving the healing efficiency. It should also be noted that even with a low weight fraction of nanotubes, CNT-reinforced samples restored their initial strength more than neat samples after healing. The tensile strength of dynamic networks is at least 50 MPa, which is significant for their utility in primary or secondary structural components.

Is altitude a determinant of the health benefits of nature exposure? A systematic review and meta-analysis

Introduction

Nature exposure is a widely accepted option for promoting public health owing to the recent surge of scientific evidence. However, the actual settings to facilitate this initiative is yet to be extensively reviewed. In this systematic review, we have aimed to provide an up-to-date summary of interventional studies investigating the psycho-physiological effects of forests and urban forests, including details on their physical settings, and investigate an effect-modifying role of altitude and summarize data on the magnitude and shape of the association.

Methods

A keyword search using five electronic academic databases (PubMed, Embase, PsycINFO, Web of Science, and Scopus) was conducted to identify relevant articles published in English from the inception year to the end of February 2022. The methodological quality was evaluated using the ROBINS-I or ROB2 tool, depending on the study design. Meta-regression and random effects model were jointly used to examine the relationship between altitude and health outcomes.

Results

We included 27 eligible studies and 31 cases extracted from 19 studies were used for the meta-analysis. In the meta-regression, we observed a non-linear association between altitude and psycho-physiological effects. Altitude had a positive quadratic association with anxiety (p < 0.000, adjusted R ² = 96.79%), depression (p < 0.000, adjusted R ² = 98.78%), and fatigue (p < 0.000, adjusted R ² = 64.74%) alleviating effects. Conversely, altitude demonstrated a negative non-linear association with the blood pressure-lowering effect (p = 0.009, adjusted R ² = 32.83%). Additionally, the thermal index (THI) and illuminance (lx) levels were significantly associated with effect sizes of psychological restoration.

Discussion

This review provides moderate-certainty evidence for an effect-modifying role of altitude. The meta-regression results suggested the optimal and minimal altitude ranges for psychological restoration and physiological relaxation, respectively. Despite some limitations, the study findings provide a significant basis for utilizing altitude, which is easily accessible and simple, to promote the health benefits of nature-based initiatives.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022310894, identifier: CRD42022310894.

Near-infrared hyperspectral imaging for online measurement of the viability detection of naturally aged watermelon seeds

The viability status of seeds before sowing is important to farmers as it allows them to make yield predictions. Monitoring the seed quality in a rapid and nondestructive manner may create a perfect solution, especially for industrial sorting applications. However, current offline laboratory-based strategies employed for the monitoring of seed viability are time-consuming and thus cannot satisfy industrial needs where there is a substantial number of seeds to be analyzed. In this study, we describe a prototype online near-infrared (NIR) hyperspectral imaging system that can be used for the rapid detection of seed viability. A wavelength range of 900-1700 nm was employed to obtain spectral images of three different varieties of naturally aged watermelon seed samples. The partial least square discriminant analysis (PLS-DA) model was employed for real-time viability prediction for seed samples moving through a conveyor unit at a speed of 49 mm/sec. A suction unit was further incorporated to develop the online system and it was programmatically controlled to separate the detected viable seeds from nonviable ones. For an external validation sample set showed classification accuracy levels of 91.8%, 80.7%, and 77.8% in relation to viability for the three varieties of watermelon seed with healthy seedling growth. The regression coefficients of the classification model distinguished some chemical differences in viable and nonviable seed which was verified by the chromatographic analysis after the detection of the proposed online system. The results demonstrated that the developed online system with the viability prediction model has the potential to be used in the seed industry for the quality monitoring of seeds.

Concomitant left atrial appendage closure with left ventricular assist device surgery can reduce ischemic cerebrovascular accidents

Background

It remains unknown if concomitant left atrial appendage closure (LAAC) at the time of left ventricular assist device (LVAD) surgery can reduce ischemic cerebrovascular accidents.

Purpose

The purpose of this study is to assess the impact of LAAC at LVAD surgery on the incidence of ischemic cerebrovascular accidents.

Methods

Between January 2012 and November 2021, 310 patients underwent LVAD surgery with HeartMate II or III. Out of 310 patients, 98 patients (31.6%) underwent concomitant LAAC. The cohort was divided into two groups: patients with LAAC (Group A, n=98) and without LAAC (Group B, n=212). To minimize device bias, LVAD surgery with HeartWare HVAD device was excluded. The ischemic cerebrovascular accident was defined as ischemic stroke, hemorrhagic stroke or transient ischemic attack. We reviewed early and long-term clinical outcomes. The incidence of ischemic cerebrovascular accidents was compared between two groups using the Kaplan-Meier method. We also investigated if LAAC was associated with ischemic cerebrovascular accidents by Cox proportional hazards analysis.

Results

There were no significant differences in baseline characteristics between two groups including age (Group A: 55.0±12.3 years old, Group B: 56.9±14.1 years old, p=0.26), preoperative CHADS2 score (Group A: 2.40±1.1, Group B: 2.58±1.1, p=0.19) and history of atrial fibrillation (Group A: 42.9%, Group B: 42.5%, p=0.95). In-hospital mortality was not significantly different between the two groups (Group A: 7.1%, Group B: 12.3%, p=0.16). In terms of postoperative complications, there were no significant differences between two groups in requiring extracorporeal membrane oxygenation, re-exploration for bleeding and newly required hemodialysis. Median follow up period was 474 days. Thirty-five patients (11.2%) developed ischemic cerebrovascular accidents (5 patients in Group A and 30 patients in Group B). The rate of freedom from ischemic cerebrovascular accidents in Group A (94.1% at 500 days and 94.1% at 1500 days) was significantly higher than that in Group B (88.2% at 500 days and 77.4% at 1500 days; log rank=0.024). In a Cox proportional hazards regression analysis including LAAC, age, history of atrial fibrillation, diabetes mellitus and Heartmate 3 device implantation, LAAC was associated with reducing the incidence of ischemic cerebrovascular accidents (hazard ratio 0.37, 95% CI 0.13–0.89, p=0.02).

Conclusion

Concomitant LAAC at the time of LVAD surgery can reduce ischemic cerebrovascular accidents without increasing perioperative mortality and complications.

Funding Acknowledgement

Type of funding sources: None.

Field Application of a Vis/NIR Hyperspectral Imaging System for Nondestructive Evaluation of Physicochemical Properties in ‘Madoka’ Peaches

Extensive research has been performed on the in-field nondestructive evaluation (NDE) of the physicochemical properties of ‘Madoka’ peaches, such as chromaticity (a*), soluble solids content (SSC), firmness, and titratable acidity (TA) content. To accomplish this, a snapshot-based hyperspectral imaging (HSI) approach for filed application was conducted in the visible and near-infrared (Vis/NIR) region. The hyperspectral images of ‘Madoka’ samples were captured and combined with commercial HSI analysis software, and then the physicochemical properties of the ‘Madoka’ samples were predicted. To verify the performance of the field-based HSI application, a lab-based HSI application was also conducted, and their coefficient of determination values (R²) were compared. Finally, pixel-based chemical images were produced to interpret the dynamic changes of the physicochemical properties in ‘Madoka’ peach. Consequently, the a* values and SSC content shows statistically significant R² values (0.84). On the other hand, the firmness and TA content shows relatively lower accuracy (R² = 0.6 to 0.7). Then, the resultant chemical images of the a* values and SSC content were created and could represent their different levels using grey scale gradation. This indicates that the HSI system with integrated HSI software used in this work has promising potential as an in-field NDE for analyzing the physicochemical properties in ‘Madoka’ peaches.

The influence of anastomotic techniques on postoperative anastomotic complications: Results of the Oesophago-Gastric Anastomosis Audit

BACKGROUND

The optimal anastomotic techniques in esophagectomy to minimize rates of anastomotic leakage and conduit necrosis are not known. The aim of this study was to assess whether the anastomotic technique was associated with anastomotic failure after esophagectomy in the international Oesophago-Gastric Anastomosis Audit cohort.

METHODS

This prospective observational multicenter cohort study included patients undergoing esophagectomy for esophageal cancer over 9 months during 2018. The primary exposure was the anastomotic technique, classified as handsewn, linear stapled, or circular stapled. The primary outcome was anastomotic failure, namely a composite of anastomotic leakage and conduit necrosis, as defined by the Esophageal Complications Consensus Group. Multivariable logistic regression modeling was used to identify the association between anastomotic techniques and anastomotic failure, after adjustment for confounders.

RESULTS

Of the 2238 esophagectomies, the anastomosis was handsewn in 27.1%, linear stapled in 21.0%, and circular stapled in 51.9%. Anastomotic techniques differed significantly by the anastomosis sites (P < .001), with the majority of neck anastomoses being handsewn (69.9%), whereas most chest anastomoses were stapled (66.3% circular stapled and 19.3% linear stapled). Rates of anastomotic failure differed significantly among the anastomotic techniques (P < .001), from 19.3% in handsewn anastomoses, to 14.0% in linear stapled anastomoses, and 12.1% in circular stapled anastomoses. This effect remained significant after adjustment for confounding factors on multivariable analysis, with an odds ratio of 0.63 (95% CI, 0.46-0.86; P = .004) for circular stapled versus handsewn anastomosis. However, subgroup analysis by anastomosis site suggested that this effect was predominantly present in neck anastomoses, with anastomotic failure rates of 23.2% versus 14.6% versus 5.9% for handsewn versus linear stapled anastomoses versus circular stapled neck anastomoses, compared with 13.7% versus 13.8% versus 12.2% for chest anastomoses.

CONCLUSIONS

Handsewn anastomoses appear to be independently associated with higher rates of anastomotic failure compared with stapled anastomoses. However, this effect seems to be largely confined to neck anastomoses, with minimal differences between techniques observed for chest anastomoses. Further research into standardization of anastomotic approach and techniques may further improve outcomes.

High-Performance Indium–Tin Oxide (ITO) Electrode Enabled by a Counteranion-Free Metal–Polymer Complex

Although multicomponent inorganic thin films (metal-oxides, -carbides, -nitrides, and -chalcogenides) have been synthesized by polymer-assisted deposition (PAD), synthesis of high-performance transparent conducting oxides (TCOs) has been rarely reported. TCO requires (i) removal of impurities, (ii) high-density oxide film, (iii) homogeneity in crystal structures and film morphology, and (iv) controllable elemental doping. This study performs a systematic investigation on preparation of stable multicomponent metal-polymer complex solutions by removing the counteranions in the solution. This study also proposes accurate acid-base titration for each metal species in order to minimize the amount of PEI, thus maximizing the density of the film. As a representative TCO, Sn-doped In₂O₃ (ITO) films have been achieved. The ITO film has an excellent sheet resistance (24.5 Ω/sq) at 93% optical transparency, with a figure of merit of 2.1 × 10^-2 Ω^-1, which is comparable to the best.

POS0859 C-REACTIVE PROTEIN AND INTERLEUKIN-6: POTENTIAL BIOMARKERS OF DISEASE ACTIVITY AND TREATMENT RESPONSE IN SYSTEMIC SCLEROSIS-INTERSTITIAL LUNG DISEASE

Background

Clinically feasible and valid biomarkers of systemic sclerosis-interstitial lung disease (SSc-ILD) are needed. While promising candidate biomarkers are under investigation (e.g., KL-6, CCL-8), clinical assays for these proteins are not currently available. C-reactive protein (CRP) measurements are feasible, cost-effective, and have been shown to predict mortality in SSc.1 Measuring interleukin (IL)-6, a proinflammatory cytokine implicated in SSc-ILD pathogenesis, is also feasible in most clinical settings.

Objectives

(1) To investigate whether CRP and IL-6 levels change in response to treatment with immunosuppression in SSc-ILD; (2) To explore whether the change in CRP and IL-6 predict the future course of forced vital capacity (FVC).

Methods

CRP and IL-6 levels were measured in serum at baseline and after 12 months in participants of Scleroderma Lung Study (SLS) II (patients with active SSc-ILD receiving 24 months of mycophenolate or 12 months cyclophosphamide followed by 12 months of placebo2). Measured values were log-transformed to remove skewness. The FVC%-predicted was measured every 3 months over the course of 24 months. Spearman’s correlations evaluated the relationship between baseline CRP or IL-6 measurements and other patient parameters. Paired t-tests were used to compare the change in individual CRP and IL-6 measurements from baseline to 12 months. Linear mixed effects models were used to examine the relationship between the change in CRP and IL-6 (baseline to 12 months) and the subsequent course of the FVC (12 to 24 months). All analysis were performed for the entire cohort and separately by treatment arm.

Results

Of the 142 participants of SLS II, 101 had CRP and IL-6 measurements at baseline and 12 months. Baseline CRP and IL-6 levels correlated significantly with higher modified Rodnan skin score (CRP: r=0.3, P=0.005; IL-6: r=0.2, P=0.01) and shorter disease duration (CRP: r=-0.3, P=0.005; IL-6: r=-0.2, P=0.01) and were higher in patients with diffuse SSc (CRP: P=0.007; IL-6: P=0.01). Relationships to baseline FVC and DLCO were not observed. CRP decreased significantly from baseline to 12 months in the whole group (P=0.01), but the decrease was slightly greater in patients randomized to mycophenolate versus cyclophosphamide (-0.47 vs. -0.33 ug/mL). IL-6 also decreased from baseline to 12 months in the whole group with a trend towards significance (P=0.10) (Figure 1). The mean decrease in IL-6 was again slightly greater in patients randomized to mycophenolate versus cyclophosphamide (-0.31 vs. -0.10 pg/mL). After controlling for baseline FVC and treatment arm in the mixed effects model, there was a relationship between the decrease in CRP from baseline to 12 months and an improved course of FVC 12 to 24 months (Estimate -0.64), but this did not reach significance (P=0.14). However, after controlling for baseline FVC and treatment arm, a greater decrease in IL-6 from baseline to 12 months was significantly associated with a greater improvement in FVC from 12 to 24 months (Estimate -1.28; P=0.01).

Figure 1.

Change in CRP (A) and IL-6 (B) from baseline to 12 months by treatment arm in SLS II. CYC=cyclophosphamide (Blue), MMF=mycophenolate (red)

Conclusion

Patients with active SSc-ILD receiving one year of immunosuppressive therapy in the SLS II study experienced reductions in their CRP and IL-6 levels over this interval. The magnitude of the decrease in CRP and IL-6 over the first year also correlated with the course of FVC over the ensuing 12 months. These findings suggest a dynamic relationship between CRP and IL-6 measurements and the course of SSc-ILD in patients on immunosuppressive therapy. Further investigation of these findings is warranted.

References

[1]Liu et al. Arthritis Care Res 2013.

[2]Tashkin et al. Lancet Resp Med 2016.

Disclosure of Interests

Elizabeth Volkmann Speakers bureau: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Grant/research support from: Forbius, Kadmon, Horizon, Boehringer Ingelheim, Donald Tashkin: None declared, Holly Wilhalme: None declared, Marka Lyons: None declared, Grace Kim: None declared, Jonathan Goldin: None declared, Michael Roth Grant/research support from: Genentech, Shervin Assassi Consultant of: Boehringer Ingelheim

POS0852 SYMPTOMS OF GASTROESOPHAGEAL REFLUX ARE A BETTER PREDICTOR OF SYSTEMIC SCLEROSIS-RELATED INTERSTITIAL LUNG DISEASE PROGRESSION THAN QUANTITATIVE RADIOGRAPHIC ASSESSMENT OF ESOPHAGEAL PARAMETERS

Background

Esophageal dysfunction affects the majority of patients with systemic sclerosis (SSc). Gastroesophageal reflux (GERD)-associated microaspiration may serve as an inciting and/or exacerbating factor in the pathogenesis of interstitial lung disease (ILD) in SSc. Few studies have investigated the relationship between objective measures of esophageal involvement in SSc and the progression of SSc-ILD.

Objectives

(1) To investigate whether patient-reported symptoms of GERD predict SSc-ILD severity and progression; (2) To explore whether quantitative radiographic measurements of esophageal parameters predict SSc-ILD severity and progression.

Methods

Participants of Scleroderma Lung Study (SLS) II (24 months of mycophenolate versus 12 months cyclophosphamide followed by 12 months of placebo in patients with active SSc-ILD) were included.1 The UCLA SCTC GIT 2.0 was used to assess the severity of reflux at baseline. Quantitative image analysis was used to calculate the diameter and area of the esophagus in the area of maximum dilation. Univariate and multivariable linear regression analyses were used to evaluate the relationship between baseline reflux scores/esophageal parameters and the severity and progression of SSc-ILD based on the quantitative radiographic extent of ILD (QILD) and fibrosis (QLF) in the lobe of maximum involvement (LM). All multivariable models controlled for treatment arm and baseline ILD severity, as well as proton pump inhibitor (PPI) use.

Results

Among the 141 of 142 SLS II participants with patient-reported reflux scores at baseline, the mean score was 0.57, indicating moderate reflux. The mean maximal esophageal diameter and area at baseline were 22 mm and 242 mm2, respectively. There were no significant correlations between reflux scores, esophageal diameter, esophageal area and QILD-LM and QLF-LM at baseline. However, in the 96 participants with HRCT scans available at 24 months, increased reflux scores were significantly associated with worsening of QLF-LM and QILD-LM (Figure 1). Even after controlling for disease severity at baseline, treatment arm and PPI use, reflux scores remained significantly associated with change in QLF-LM (P-value 0.05) and QILD-LM (P-value 0.003). Neither the maximum esophageal area, nor the maximum esophageal diameter was associated with the change in QILD-LM or QLF-LM in univariate or multivariate analyses.

Figure 1.

Increased reflux scores at baseline are associated with increased progression (worsening) of QILD (A) and QLF (B) in the lobe of maximum involvement in patients with SSc-ILD.

Conclusion

Increased self-reported reflux was independently associated with worsening radiographic fibrosis and ILD in patients receiving treatment for SSc-ILD. The maximum esophageal diameter and esophageal area did not correlate with reflux scores and did not predict severity or progression of SSc-ILD. These findings illustrate the importance of eliciting a careful patient history of reflux symptoms in patients with ILD and further highlight the need for improved objective measures of esophageal dysfunction in SSc.

References

[1]Tashkin et al. Lancet Resp Med 2016.

Disclosure of Interests

Elizabeth Volkmann Speakers bureau: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Grant/research support from: Forbius, Horizon, Kadmon, Boehringer Ingelheim, Donald Tashkin: None declared, Mei Leng: None declared, Grace Kim: None declared, Jonathan Goldin: None declared, Michael Roth Grant/research support from: Genentech

POS0068 CHANGES IN QUANTITATIVE INTERSTITIAL LUNG DISEASE SCORES ON HIGH-RESOLUTION CT IN IDIOPATHIC INFLAMMATORY MYOSITIS

Background

The idiopathic inflammatory myopathies (IIM) are autoimmune connective tissue diseases affecting skeletal muscle, skin and other organ systems. IIM-related interstitial lung disease (IIM-ILD) is the most common extra-muscular manifestation, being the leading cause of morbidity and mortality. Several studies have suggested that ILD pattern based on chest high-resolution computed tomography (HRCT) can be related to disease course and treatment response, but the results vary considerably. Moreover, the clinical impact of the quantitative ILD (QILD) score, a validated computer-aided scoring system in assessing ILD severity from HRCT, and its longitudinal changes have not yet been evaluated in IIM-ILD.

Objectives

This study aims to investigate ILD patterns and QILD scores in patients with IIM-ILD, to identify their clinical impact, and to delineate longitudinal changes of QILD measurement.

Methods

A total of 80 patients with IIM (polymyositis 22, and dermatomyositis 58) who underwent at least 2 times of serial HRCT scans were included. Visual ILD patterns were assessed by multiple thoracic radiologists. Quantitative analysis of HRCT was presented as total extent of QILD scores (%) in whole lung and most severe zone. Individual time-estimated ΔQILD score between first 2 visits was derived using a linear approximation of yearly change, where the duration of median (IQR) was 1.0 (0.4-1.6) years in the first 2 HRCT scans.

Results

The median (IQR) age of the patients was 52.0 (43.5-58.5) years and 60 (75.0%) were women. Baseline median score of whole lung-QILD and most severe zone-QILD were 28.1% (19.1-43.8) and 68.0% (45.5-81.8), respectively, and QILD score showed significant correlations with pulmonary function tests (r=-0.349, p=0.002 for % predicted forced vital capacity; and r=-0.381, p=0.001 for % predicted diffusing capacity for carbon monoxide). The individual time-estimated yearly ΔQILD score between first 2 visits presented that approximately half of the patients showed improvement or stability in QILD scores; however, when patients were sorted by visual assessment in ILD subtype on HRCT, approximately two-thirds of the patients with usual interstitial pneumonia (UIP) pattern were aggravated in QILD scores and less than half of subjects with nonspecific interstitial pneumonia and organizing pneumonia were aggravated (Figure 1, 80% for UIP vs. 44.4% for non-UIP, p=0.013). There was no immunosuppressive drugs related to meaningful improvement in QILD scores during first 2 visits. Notably, we observed significant aggravation of QILD scores in tacrolimus users (n=7, median time-estimated whole lung-yarly ΔQILD 20.3 (2.7-38.4)) compared with tacrolimus non-users (n=73, median time estimated whole lung-yearly ΔQILD -1.2 (-8.3-6.5)). Among 80 patients, 6 (7.5%) were died due to various lung complications. Higher baseline QILD scores were noted in deaths (median whole lung-QILD 45.4 (32.9-56.5)) than in survivors (median whole lung-QILD 26.9 (19.0-42.4)), albeit not significant (p=0.084). Poor survival rate was observed in patients with high grade of ground glass opacity by visual assessment in right upper lobe (log-rank test, p=0.042). Among subgroup of patients with 3 serial HRCT scans (n=41), dynamic changes of four distinct patterns (improving, worsening, convex, and concave) were observed.

Figure 1.

Cleveland dot plot of individual time-estimated yearly ΔQILD during fist 2 visits.

Conclusion

The changes in QILD score in IIM-ILD are dynamic and present different by visual assessment. QILD score has the potential for evaluation of the severity changes, prognosis and medication response in patients with IIM-ILD.

References

[1]Tashkin DP, et al. Ann Rheum Dis 2016;75(2):374-81.

7 truncated values in the graph A. NSIP: nonspecific interstitial pneumonia; OP: organizing pneumonia; UIP: usual interstitial pneumonia.

Disclosure of Interests

None declared

Textbook outcome following oesophagectomy for cancer: international cohort study

Background

Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.

Methods

Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).

Results

Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter ‘no major postoperative complication’ had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P &lt; 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P &lt; 0.001) were independently associated with a significantly increased likelihood of textbook outcome.

Conclusion

Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.

Textbook outcome following oesophagectomy for cancer: international cohort study

BACKGROUND

Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.

METHODS

Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).

RESULTS

Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter 'no major postoperative complication' had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome.

CONCLUSION

Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.