Frequency of irritable bowel syndrome in spondyloarthritis: a multicentric cross-sectional study and meta-analysis

OBJECTIVE

To evaluate the prevalence of symptoms and factors associated with irritable bowel syndrome (IBS) in axial spondyloarthritis (ax-SpA).

METHODS

In a cross-sectional multicentric study, consecutive patients with ax-SpA treated with biologics in five rheumatology departments were asked for IBS Rome IV criteria. Demographic data, lifestyle behaviours and disease characteristics were recorded. Second, a systematic literature review and meta-analysis were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

Of the 500 patients with ax-SpA included, 124 reported IBS symptoms (25%). Female gender, unemployment, higher Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and worse Bath Ankylosing Spondylitis Functional Index scores, multiple lines of biologics, fibromyalgia, anxiety, depression and lower physical activity were associated with IBS symptoms. In multivariate model, the risk of IBS was associated with anxiety and physical inactivity. From the literature review, the prevalence of IBS in patients with SpA was 15.4% (8.8% to 23.3%). Meta-analysis of the five studies comparing the presence of IBS in patients with SpA (323/7292) and healthy controls (484/35587) showed a significant increase of IBS in patients with SpA (OR=1.59 (1.05 to 2.40)).

CONCLUSION

The prevalence of IBS symptoms was high in the ax-SpA population and should therefore be considered in the presence of gastrointestinal disorders. The presence of IBS symptoms was associated with anxiety and low physical activity in multivariate analysis. Patients with IBS symptoms tended to have more difficult to manage disease characterised by higher activity, worse functional score and multiple lines of treatment in univariate analysis.

Reducing radiation exposure and cancer risk for children with scoliosis: EOS the new gold standard

PURPOSE

Children are exposed to significant radiation doses during the investigation and treatment phases of scoliosis. EOS is a new form of low-dose radiation scan which also yields great image quality. However, currently its use is discouraged in the UK due to higher costs. We aimed to quantify the additional radiation dose and cancer risk.

METHODS

We retrospectively reviewed all paediatric cases who received both standing whole spine roentgenograms and EOS scans as part of their investigations for scoliosis during a six-month period. We compared the radiation doses between the two modalities and estimated the additional mean lifetime cancer risk per study.

RESULTS

We identified 206 children (mean age 14.4) who met the criteria of having both scans. Dose area products (dGycm2) were converted to estimated effective doses (mSv). The total mean doses were 0.68 mSv (PA 0.49 + Lat 0.19) for plain films, and 0.13 mSv (PA 0.08 + Lat 0.04) for EOS scans (p < 0.001). Additional lifetime cancer risk of a plain film was 543% greater than EOS for both sexes (1/10727 versus 1/5827 in males, 1/34483 versus 1/6350 in females).

CONCLUSION

There is approximately 5.4-fold increase in risk of cancer for both boys and girls with roentgenograms over EOS, with girls being the most impacted. This carries a significant impact when considering the need for repeat imaging on additional lifetime malignancy risk in children. In our opinion, EOS dual planar scanning is the new gold standard when X-ray of the whole spine is required.

LEVEL OF EVIDENCE

III.

Thoracolumbar spine trauma: a guide for the FRCS examination

Thoracolumbar spine injuries are commonly seen in trauma settings and have a high risk of causing serious morbidity. There can be controversy when it comes to classifying thoracolumbar injuries within the spinal community, but there remains a need to classify, evaluate and manage thoracolumbar fractures. This article aims to provide a guide on classification of thoracolumbar spine injuries using the AO Spine Thoracolumbar Injury Classification System (AO TLICS).

Experimental and theoretical study of photo-dissociation spectroscopy of pyrene dimer radical cations stored in a compact electrostatic ion storage ring

In this paper, we present an experimental and theoretical study of the photo-dissociation of free-flying dimer radical cations of pyrene (C16H10)2+. Experimentally, the dimers were produced in the plasma of an electron cyclotron resonance ion source and stored in an electrostatic ion storage ring, the Mini-Ring for times up to 10 ms and the photo-dissociation spectrum was recorded in the 400 to 2000 nm range. Two broad absorption bands were observed at 550 (2.25 eV) and 1560 nm (0.79 eV), respectively. Theoretical simulations of the absorption spectrum as a function of the temperature were performed using the Density Functional based Tight Binding approach within the Extended Configuration Interaction scheme (DFTB-EXCI) to determine the electronic structure. The simulation involved all excited electronic states correlated asymptotically with the five lowest excited states D1-D5 of the monomer cation and a Monte Carlo exploration of the electronic ground state potential energy surface. The simulations exhibit three major bands at 1.0, 2.1 and 2.8 eV respectively. They allow assigning the experimental band at 1560 nm to absorption by the charge resonance (CR) excited state correlated with the ground state of the monomer D0. The band at 550 nm is tentatively attributed to dimer states correlated with excited states D2-D4, in the monomer cation. Simulations also show that the CR band broadens and shifts towards longer wavelength with increasing temperature. It results from the dependence on the geometry of the energy gap between the ground state and the lowest excited state. The comparison of the experimental spectrum with theoretical spectra at various temperatures allows us to estimate the temperature of the stored (C16H10)2+ in the 300-400 K range, which is also in line with the expected temperatures of the ions deduced from the analysis of the natural decay curve.

Photo-dissociation of naphthalene dimer cations stored in a compact electrostatic ion storage ring

Naphthalene dimer cations [C₁₀H₈]₂ ⁺ have been produced by using an electron cyclotron resonance plasma ion source and stored in a compact electrostatic ion storage ring. We show that the radiative cooling of these cations is much slower than the isolated monomer naphthalene cations. We also report on photo-dissociation studies in the gas phase of naphthalene dimer cations at high internal energy. The dissociation energy is estimated to 0.5 eV in close agreement with previous measurements but a factor of 2 smaller than recent (density functional theory (DFT) and ab initio) theoretical studies. As uncertainties on theory as well as on the experiment cannot be as large as this difference, we conclude that this discrepancy may be due to temperature effects with possible isomerization. As an interpretation of the photo-dissociation spectrum of naphthalene dimer cations, we propose a tentative simple analytical model based on effective Morse potentials. These effective potentials are expected to "average" temperature effects that would apparently result in a smaller energy difference between the fundamental and dissociation states due to the twisting vibration modes of the naphthalene dimer cations.

Faraday-Talbot effect: Alternating phase and circular arrays

A hydrodynamic analog to the optical Talbot effect may be realized on the surface of a vertically shaken fluid bath when a periodic array of pillars protrudes from the fluid surface. When the pillar spacing is twice or one and a half times the Faraday wavelength, we observe repeated images of the pillars projected in front of the array. Sloshing inter-pillar ridges act as sources of Faraday waves, giving rise to self-images. Here, we explore the emergence of Faraday-Talbot patterns when the sloshing ridges between pillars have alternating phases. We present a simple model of linear wave superposition and use it to calculate the expected self-image locations, comparing them to experimental observations. We explore how alternating phase sources affect the Faraday-Talbot patterns for linear and circular arrays of pillars, where curvature allows for magnification and demagnification of the self-imaging pattern. The use of an underlying wavefield is a subject of current interest in hydrodynamic quantum analog experiments, as it may provide a means to trap walking droplets.

Time-resolved photoion imaging spectroscopy: Determining energy distribution in multiphoton absorption experiments

We propose an approach to determine the excitation energy distribution due to multiphoton absorption in the case of excited systems following decays to produce different ion species. This approach is based on the measurement of the time-resolved photoion position spectrum by using velocity map imaging spectrometry and an unfocused laser beam with a low fluence and homogeneous profile. Such a measurement allows us to identify the species and the origin of each ion detected and to depict the energy distribution using a pure Poisson's equation involving only one variable which is proportional to the absolute photon absorption cross section. A cascade decay model is used to build direct connections between the energy distribution and the probability to detect each ionic species. Comparison between experiments and simulations permits the energy distribution and accordingly the absolute photon absorption cross section to be determined. This approach is illustrated using C₆₀ as an example. It may therefore be extended to a wide variety of molecules and clusters having decay mechanisms similar to those of fullerene molecules.

Does hip joint positioning affect maximal voluntary contraction in the gluteus maximus, gluteus medius, tensor fasciae latae and sartorius muscles?

BACKGROUND

Minimally invasive total hip arthroplasty (THA) is presumed to provide functional and clinical benefits, whereas in fact the literature reveals that gait and posturographic parameters following THA do not recover values found in the general population. There is a significant disturbance of postural sway in THA patients, regardless of the surgical approach, although with some differences between approaches compared to controls: the anterior and anterolateral minimally invasive approaches seem to be more disruptive of postural parameters than the posterior approach. Electromyographic (EMG) study of the hip muscles involved in surgery [gluteus maximus (GMax), gluteus medius (GMed), tensor fasciae latae (TFL), and sartorius (S)] could shed light, the relevant literature involves discordant methodologies. We developed a methodology to assess EMG activity during maximal voluntary contraction (MVC) of the GMax, GMed, TFL and sartorius muscles as a reference for normalization. A prospective study aimed to assess whether hip joint positioning and the learning curve on an MVC test affect the EMG signal during a maximal voluntary contraction.

HYPOTHESIS

Hip positioning and the learning curve on an MVC test affect EMG signal during MVC of GMax, GMed, TFL and S.

METHODS

Thirty young asymptomatic subjects participated in the study. Each performed 8 hip muscle MVCs in various joint positions recorded with surface EMG sensors. Each MVC was performed 3 times in 1 week, with the same schedule every day, controlling for activity levels in the preceding 24h. EMG activity during MVC was expressed as a ratio of EMG activity during unipedal stance. Non-parametric tests were applied.

RESULTS

Statistical analysis showed no difference according to hip position for abductors or flexors in assessing EMG signal during MVC over the 3 sessions. Hip abductors showed no difference between abduction in lateral decubitus with hip straight versus hip flexed: GMax (19.8±13.7 vs. 14.5±7.8, P=0.78), GMed (13.4±9.0 vs. 9.9±6.6, P=0.21) and TFL (69.5±61.7 vs. 65.9±51.3, P=0.50). Flexors showed no difference between hip flexion/abduction/lateral rotation performed in supine or sitting position: TFL (70.6±45.9 vs. 61.6±45.8, P=0.22) and S (101.1±67.9 vs. 72.6±44.6, P=0.21). The most effective tests to assess EMG signal during MVC were for the hip abductors: hip abduction performed in lateral decubitus (36.7% for GMax, 76.7% for GMed), and for hip flexors: hip flexion/abduction/lateral rotation performed in supine decubitus (50% for TFL, 76.7% for S).

DISCUSSION

The study hypothesis was not confirmed, since hip joint positioning and the learning curve on an MVC test did not affect EMG signal during MVC of GMax, GMed, TFL and S muscles. Therefore, a single session and one specific test is enough to assess MVC in hip abductors (abduction in lateral decubitus) and flexors (hip flexion/abduction/lateral rotation in supine position). This method could be applied to assess muscle function after THA, and particularly to compare different approaches.

LEVEL OF EVIDENCE

III, case-matched study.

Fragmentation dynamics of meso-tetraphenyl iron (III) porphyrin chloride dication under energy control

Meso-tetraphenyl iron (III) porphyrin chloride dications (FeTPPCl²⁺)^* were prepared in collisions with F⁺ and H⁺ at 3 keV. The dominant fragmentation channels were observed to involve the loss of the Cl atom and the successive loss of neutral phenyl groups for both collisional systems. The mass spectra in correlation with the deposited excitation energy distributions of the parent ions for the main fragmentation channels were measured by using the collision induced dissociation under energy control method. The global excitation energy distribution was found to be shifted to lower energies in collisions with H⁺ compared to collisions with F⁺ showing a noteworthy change of the excitation energy window using different projectile ions. Partial excitation energy distributions of the parent ions FeTPPCl²⁺ were obtained for each fragmentation group. In a theoretical work, we have calculated the dissociation energies for the loss of one and two phenyl groups, including phenyl and (phenyl ± H). The energy barrier for the hydrogen atom transfer during the loss of (phenyl-H) has been also calculated. The measured energy difference for the successive loss of two phenyl groups was compared with the theoretical values.

Cooling of isolated anthracene cations probed with photons of different wavelengths in the Mini-Ring

We report on a direct measurement of the Internal Energy Distribution (IED) shift rate of an initially hot polycyclic aromatic hydrocarbon (PAH) molecular ensemble, anthracene cations (C₁₄H₁₀⁺). The ions were produced in an electron cyclotron resonance (ECR) ion source and stored in an electrostatic ion storage ring, the Mini-Ring. Laser pulses of two wavelengths were sent successively to merge the stored ion bunch at different storage times to enhance the neutral fragment yield due to fast laser induced dissociation. Using this technique, we have been able to determine directly the energy shift rate of the IED, without involving any theoretical simulation or any assumption on dissociation rates, cooling rates, or the initial IED. Theoretical energy shift rates have been estimated from the evolution of simulated IEDs by taking into account the effects of the unimolecular dissociation and two radiative decay mechanisms: the Poincaré fluorescence and the infrared vibrational emission. The comparison between the experimental results and the model provides new evidence of the important role of the Poincaré fluorescence in the overall cooling process of anthracene cations. Although in the short time range the commonly accepted intuition says that the cooling would result mostly from the dissociation of the hottest ions (depletion cooling), we demonstrate that the Poincaré fluorescence is the dominant contribution (about 85%) to the net cooling effect.

Temporal variation in major trauma admissions

INTRODUCTION

Trauma is a significant cause of morbidity and mortality in the UK. Since the inception of the trauma networks, little is known of the temporal pattern of trauma admissions.

METHODS

Trauma Audit and Research Network data for 1 April 2011 to 31 March 2013 were collated from two large major trauma centres (MTCs) in the South East of England: Brighton and Sussex University Hospitals NHS Trust (BSUH) and St George's University Hospitals NHS Foundation Trust (SGU). The number of admissions and the injury severity score by time of admission, by weekdays versus weekend and by month/season were analysed.

RESULTS

There were 1,223 admissions at BSUH and 1,241 at SGU. There was significant variation by time of admission; there were more admissions in the afternoons (BSUH p<0.001) and evenings (SGU p<0.001). There were proportionally more admissions at the weekends than on weekdays (BSUH p<0.001, SGU p=0.028). There was significant seasonal variation in admissions at BSUH (p<0.001) with more admissions in summer and autumn. No significant seasonal variation was observed at SGU (p=0.543).

CONCLUSIONS

The temporal patterns observed were different for each MTC with important implications for resource planning of trauma care. This study identified differing needs for different MTCs and resource planning should be individualised to the network.

Fragmentation of doubly charged HDO, H2O, and D2O molecules induced by proton and monocharged fluorine beam impact at 3 keV

Doubly charged ions HDO(2+), H2O(2+), and D2O(2+) were prepared selectively to triplet or singlet excited states in collisions with F(+) or H(+) projectiles at 3 keV. Excitation energies of dications following two-body or three-body dissociation channels were measured and compared with recent calculations using ab initio multi-reference configuration interaction method [Gervais et al., J. Chem. Phys. 131, 024302 (2009)]. For HDO(2+), preferential cleavage of O-H rather than O-D bond has been observed and the ratio between the populations of the fragmentation channels OD(+)_H(+) and OH(+)_D(+) were measured. The kinetic energy release has been measured and compared with previous experiments.

Triethylene glycol-based poly(1,2,3-triazolium acrylate)s with enhanced ionic conductivity

A well-defined triethylene glycol-based poly(1,2,3-triazolium acrylate) having a bis(trifluoromethane)sulfonimide anion and an anhydrous ionic conductivity of 10⁻⁵ S cm⁻¹ at 30 °C is reported.

The posterior epidural ligaments: a cadaveric and histological investigation in the lumbar region

Purpose. Incidental durotomy is a relatively common complication for patients undergoing posterior spinal surgery. Delineating anatomical variants in the posterior lumbar spinal canal is crucial in reducing future rates of incidental durotomy. Materials and Methods. The ligamentous attachments between the dura mater and ligamentum flavum in the lumbar region of 17 soft-fixed cadavers were investigated. The lumbar vertebral columns were removed, and cross-sectional dissection was performed at levels L1-S1. Anterior retraction of the dorsal dura mater identified attachments between the dorsal surface of the dura mater and the ligamentum flavum. Histological staining of the ligamentous attachments was carried out with hematoxylin and eosin (H&E) and elastic van Gieson (EVG). Results. Posterior epidural ligaments were present in 9 (52.9%) cadavers. Nine (9) separate ligaments were identified in these cadavers, with 3 (33.3%) at L3/L4, 5 (55.5%) at L4/L5, and 1 (11.1%) at L5/S1. Histology confirmed the presence of poorly differentiated collagen-based connective tissue, distinct from the normal anatomy. Conclusions. This study confirms the presence of multiple dorsomedial posterior epidural ligaments at the main sites for posterior spinal surgery (L3-S1). An intraoperative awareness of the variability of such connections may be an important step in reducing static rates of incidental durotomy.

Fast radiative cooling of anthracene observed in a compact electrostatic storage ring

Fast radiative cooling of anthracene was observed in a compact electrostatic storage ring by probing the evolution of the internal energy distribution of a stored (C(14)H(10))(+) molecular ensemble via laser excitation. We have measured the mean radiative decay rate to be about 120 to 250 s(-1) for internal energies in the range from 6.6 to 6.8 eV. Such a high decay rate is 2 orders of magnitude larger than the infrared emission cooling rate expected for vibrational transitions. It is attributed to fluorescence from thermally excited electrons. This fast cooling mechanism may have important implications in astrophysics concerning the lifetime and the critical size of polycyclic aromatic hydrocarbons in interstellar conditions.

High frequency of vitamin D deficiency in HIV-infected patients: effects of HIV-related factors and antiretroviral drugs

OBJECTIVES

The aim of this study was to assess 25-hydroxyvitamin D (vitamin D) status in an HIV-infected adult population and to define HIV- and antiretroviral-related factors associated with vitamin D deficiency.

METHODS

Using data from a prospective cohort of HIV-infected adult patients followed in five French centres (Dat'AIDS cohort), we evaluated the prevalence of vitamin D deficiency/insufficiency (<30 ng/mL). A multiple linear regression model was used to examine risk factors for vitamin D deficiency (≤10 ng/mL).

RESULTS

Vitamin D deficiency/insufficiency was observed in 86.7% of the 2994 patients, including 55.6% with vitamin D insufficiency and 31.1% with vitamin D deficiency. In multivariate analysis, factors associated with vitamin D deficiency were current smoking [adjusted OR (aOR) 1.55], estimated glomerular filtration rate ≥90 mL/min/1.73 m(2) (aOR 1.51), vitamin D measurement not performed in summer (aOR 0.27), CD4 <350 cells/mm(3) (aOR 1.37 for CD4 200 to <350 and 1.62 for CD4 <200 cells/mm(3)) and antiretroviral therapy (aOR 2.61). Gender, body mass index, age, coinfection and previous AIDS were not associated factors. In the antiretroviral-treated population (n = 2660), besides the same factors found in the whole population, efavirenz was the only drug to be significantly associated with deficiency, with an aOR of 1.89 (95% CI 1.45-2.47).

CONCLUSIONS

Vitamin D deficiency is frequent in this HIV-infected population. Patients on antiretroviral therapy are at higher risk of vitamin D deficiency than antiretroviral-naive patients, with an increased risk in patients receiving efavirenz. No effect of the other antiretrovirals, including the latest (etravirine, darunavir, raltegravir), was found.

Oligomerization paths of the nucleoprotein of influenza A virus

The influenza viruses contain a segmented, negative strand RNA genome. Each RNA segment is covered by multiple copies of the nucleoprotein (NP) and is associated with the polymerase complex into ribonucleoprotein (RNP) particles. Despite its importance in the virus life cycle, the interactions between the NP and the genome are not well understood. Here, we studied the assembly process of NP-RNA oligomers and analyzed how the oligomeric/monomeric status of RNA-free NP affects RNA binding and oligomerization. Recombinant wild-type NP purified in low salt concentrations and a derived mutant engineered for oligomerization deficiency (R416A) were mainly monomeric in RNA-free solutions as shown by biochemical and electron microscopy techniques. NP monomer formed with RNA a fast 1/1 complex characterized by surface plasmon resonance. In a subsequent and slow process that depended on the RNA length, oligomerization of NP was mediated by RNA binding. In contrast, preparations of wild-type NP purified in high salt concentrations as well as mutant Y148A engineered for deficiency in nucleic acid binding were partly or totally oligomeric in RNA-free solutions. These trimer/tetramer NP oligomers bind directly as oligomers to RNA with a higher affinity than that of the monomers. Both oligomerization routes we characterized could be exploited by cellular or viral factors to modulate or control viral RNA encapsidation by NP.