Impaired amygdala astrocytic signaling worsens neuropathic pain-associated neuronal functions and behaviors

Introduction: Pain is a clinically relevant health care issue with limited therapeutic options, creating the need for new and improved analgesic strategies. The amygdala is a limbic brain region critically involved in the regulation of emotional-affective components of pain and in pain modulation. The central nucleus of amygdala (CeA) serves major output functions and receives nociceptive information via the external lateral parabrachial nucleus (PB). While amygdala neuroplasticity has been linked causally to pain behaviors, non-neuronal pain mechanisms in this region remain to be explored. As an essential part of the neuroimmune system, astrocytes that represent about 40-50% of glia cells within the central nervous system, are required for physiological neuronal functions, but their role in the amygdala remains to be determined for pain conditions. In this study, we measured time-specific astrocyte activation in the CeA in a neuropathic pain model (spinal nerve ligation, SNL) and assessed the effects of astrocyte inhibition on amygdala neuroplasticity and pain-like behaviors in the pain condition. Methods and Results: Glial fibrillary acidic protein (GFAP, astrocytic marker) immunoreactivity and mRNA expression were increased at the chronic (4 weeks post-SNL), but not acute (1 week post-SNL), stage of neuropathic pain. In order to determine the contribution of astrocytes to amygdala pain-mechanisms, we used fluorocitric acid (FCA), a selective inhibitor of astrocyte metabolism. Whole-cell patch-clamp recordings were performed from neurons in the laterocapsular division of the CeA (CeLC) obtained from chronic neuropathic rats. Pre-incubation of brain slices with FCA (100 µM, 1 h), increased excitability through altered hyperpolarization-activated current (Ih) functions, without significantly affecting synaptic responses at the PB-CeLC synapse. Intra-CeA injection of FCA (100 µM) had facilitatory effects on mechanical withdrawal thresholds (von Frey and paw pressure tests) and emotional-affective behaviors (evoked vocalizations), but not on facial grimace score and anxiety-like behaviors (open field test), in chronic neuropathic rats. Selective inhibition of astrocytes by FCA was confirmed with immunohistochemical analyses showing decreased astrocytic GFAP, but not NeuN, signal in the CeA. Discussion: Overall, these results suggest a complex modulation of amygdala pain functions by astrocytes and provide evidence for beneficial functions of astrocytes in CeA in chronic neuropathic pain.

Oral Health Advice for Looked-After-Children: A pilot care pathway in Buckinghamshire, UK

INTRODUCTION

Looked-After-Children (LAC) frequently are more likely to have untreated dental caries, periodontal diseases or dental trauma (McMahon et al., 2018). The COVID-19 pandemic reduced the availability of dental appointments, including for LAC. This initiative piloted the inclusion of a dental pathway into the existing LAC care pathway in Buckinghamshire. The key principle was providing oral health messaging around maintaining good oral health and preventing disease in these children by training those involved with their care.

METHODS

A working group was convened, which included dental public health, clinical and training expertise. A care pathway was developed with resources drawn from existing programmes including mini Mouth Care Matters (mMCM). The care pathways were designed to identify children who needed care urgently due to pain or discomfort, signpost them to the relevant/most appropriate providers and provide oral health improvement advice for everyone. Local partners were engaged to ensure that the processes and training were appropriate. A pilot training session was then carried out for a range of staff engaged in the care of LAC within Buckinghamshire.

RESULTS

The pilot dental pathway, launched in March 2022, initiative was welcomed by all stakeholders, including dental commissioners. The pilot training session received positive feedback from participants, with requests for more sessions. Training sessions were subsequently translated into video sessions, accessible when needed, for new staff or as refresher sessions.

CONCLUSION

There are opportunities to reduce future inequalities for these children by inculcating positive behaviours early in their care journey. This will reduce their need for care. Identifying and implementing the most appropriate initiatives requires collaboration and commitment from all stakeholders.

Arterial Oxygen Saturation: A Vital Sign?

ABSTRACT

The physical examination is a key part of a continuum that extends from the history of the present illness to the therapeutic outcome. An understanding of the pathophysiological mechanism behind a physical sign is essential for arriving at the correct diagnosis. Early detection of deteriorating physical/vital signs and their appropriate interpretation is thus the key to achieve correct and timely management. By definition, vital signs are "the signs of life that may be monitored or measured, namely pulse rate, respiratory rate, body temperature, and blood pressure." Vital signs are the simplest, cheapest and probably the most inexpensive information gathered bedside in outpatient or hospitalized patients. The pulse oximeter was introduced in the 1980s. It is an accurate and non-invasive method for the measurement of arterial hemoglobin oxygen saturation (SaO2). Pulse oximetry-based arterial oxygen saturation can be effectively used bedside in in-hospital and ambulatory patients with diagnosed or suspected lung disease. The present pandemic of COVID-19 should be considered as a wake-up call. Articles related to arterial oxygen saturation and its importance as a vital sign in patient care were searched online especially in PubMed. Available studies were studied in full length and data was extracted. Discussion: A. Clinical Utility of Oxygen Saturation Monitoring: There are many studies reporting the clinical applicability and usefulness of pulse oximetry in the early detection of hypoxemic events during intraoperative and postoperative periods. B. Role of clinical expertise accompanied by knowledge of physiology: A diagnostic sign is useful only if it is interpreted accurately and applied appropriately while evaluating a patient. The World Health Organisation also appreciates these facts and published "The WHO Pulse Oximetry Training Manual." Understanding the physiology behind and overcoming limitations of the diagnostic sign by clinical expertise is important. While using pulse oximetry, a clinician needs to keep in mind the sigmoidal nature of the oxygen-Hb dissociation curve. Considering these benefits of SaO2 measurement, there have been several references in the past to consider oxygen saturation as the fifth vital sign. In the present pandemic oxygen saturation i.e., SpO2 (arterial oxygen saturation) measured by pulse oxymeter, has been the single most important warning and prognostic sign be it for households, offices, street vendors, hospitals or governments. Measurement of trends of SaO2 added with respiratory rate will provide clinicians with a holistic overview of respiratory functions and multidimensional conditions associated with hypoxemia.

Cryostorage of human ovarian tissue: evaluating the storage and disposal pattern over a 22-year period in 2475 patients

RESEARCH QUESTION

What are the parameters of age, indications for ovarian tissue cryopreservation, storage characteristics and reasons for tissue disposal in a large cohort of individuals undertaking cryopreservation?

DESIGN

The relevant parameters in a single university centre were revised and digitalized in the period from 2019 to 2021. To assess patients' motivation at the end of storage, patients were contacted by letter, e-mails and telephone calls.

RESULTS

A group of 2475 patients with stored ovarian tissue were analysed in the time period between 2000 and 2021; the response rate for contact calls and letters was 28.8% (224/777). Where storage had ended (n = 1155), patients had on average stored for 3.8 years and begun storing at age 30 years; the main indications were breast cancer (53%) and lymphoma (17.5%). Of these participants, 2.5% had a transplantation on site, 10.3% transferred their tissue to another cryobank and 11.5% were deceased. The majority of the group (75.7%) ended their storage due to pregnancy (49.1%), a lack of desire to have children (25.9%), storage fees that were too expensive (8.9%), death (8.5%), recurrence of cancer (8.5%), lack of a partner (4%) and fear of surgery in the future (3.1%); 6.7% retrospectively regretted ending storage.

CONCLUSIONS

The pregnancy rate of 49.1%, resulting from ovarian tissue that was not removed during surgery for scheduled ovarian tissue cryopreservation supports the clinical approach of removing and cryopreserving only 25-50% of one ovary. It is proposed that interdisciplinary counselling should be implemented not only prior to fertility preservation, but also when intending to end storage.

Comparison of angiogenic potential in vitrified vs. slow frozen human ovarian tissue

Vitrification of ovarian tissue is a promising alternative approach to the traditional slow freezing method. Few empirical investigations have been conducted to determine the angiogenic profiles of these two freezing methods. In this study we aimed to answer the question whether one of the cryopreservation methods should be preferred based on the secretion of angiogenic factors. Tissue culture with reduced oxygen (5%) was conducted for 48 h with samples of fresh, slow frozen/thawed and vitrified/rapid warmed ovarian cortex tissue from 20 patients. From each patient, tissue was used in all three treatment groups. Tissue culture supernatants were determined regarding cytokine expression profiles of angiogenin, angiopoietin-2, epidermal growth factor, basic fibroblast growth factor, heparin binding epidermal growth factor, hepatocyte growth factor, Leptin, Platelet-derived growth factor B, placental growth factor and vascular endothelial growth factor A via fluoroimmunoassay. Apoptotic changes were assessed by TUNEL staining of cryosections and supplemented by hematoxylin and eosin and proliferating cell nuclear antigen staining. Comparing the angiogenic expression profiles of vitrified/rapid warmed tissue with slow frozen/thawed tissue samples, no significant differences were observed. Detection of apoptotic DNA fragmentation via TUNEL indicated minor apoptotic profiles that were not significantly different comparing both cryopreservation methods. Vitrification of ovarian cortical tissue does not appear to impact negatively on the expression profile of angiogenic factors and may be regarded as an effective alternative approach to the traditional slow freezing method.

Finding the "sweet spot" of smartphone use: Reduction or abstinence to increase well-being and healthy lifestyle?! An experimental intervention study

The present experimental study compared the impact of a total abstinence from smartphone use and of a reduction of daily smartphone use by 1 hr on well-being and healthy lifestyle. Participants (N_total = 619) were smartphone users in Germany. The first experimental group (N = 200) waived smartphone use for 7 days, the second experimental group (N = 226) reduced its daily use by 1 hr, and the control group (N = 193) used smartphone as usual. Variables of smartphone use (time, intensity, problematic tendencies), life satisfaction, depressive symptoms, anxiety symptoms, physical activity, and smoking behavior were assessed via online surveys at four measurement time points (baseline; postintervention; 1 and 4 months after postintervention). Both interventions reduced smartphone use intensity, problematic use tendencies, depressive, and anxiety symptoms. In both groups, life satisfaction and physical activity increased. Most effects were stronger and remained more stable over 4 months in the reduction group than in the abstinence group. Moreover, in the reduction group only, the number of daily smoked cigarettes decreased. Thus, less time spent on the smartphone leads to more well-being and a healthier lifestyle; a complete smartphone abstinence is not necessary. Programs that focus on the increase of well-being and a healthier lifestyle could benefit from the integration of controlled reduction of smartphone use. A potential "sweet spot" of smartphone use is discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The effect of high-throughput vitrification of human ovarian cortex tissue on follicular viability: a promising alternative to conventional slow freezing?

BACKGROUND

The standard procedure most frequently used for ovarian tissue cryopreservation (OTC) is slow freezing, while vitrification has been proposed as promising alternative and has built an impressive catalog of success in fertility laboratories regarding cryopreservation of oocytes and embryos.

METHODS

We developed and evaluated a high-throughput protocol for vitrification of human ovarian tissue suitable for clinical processing. Follicular viability was assessed via calcein staining prior and after cryopreservation analyzing ovarian tissue of a cohort of 30 patients.

RESULTS

We found no significant differences regarding follicular viability between slow frozen and vitrified cortex tissue samples 24 h after thawing and rapid warming. Follicular viability of thawed and rapid warmed samples was not significantly different in comparison to fresh samples, indicating high proportions of follicular survival rates with both methods.

CONCLUSIONS

High-throughput vitrification is a promising option in a clinical setting. More research is required to determine the status of other tissue-specific quality indicators potentially influencing on autotransplantation.

Novel in-home COVID-19 vaccination program for vulnerable populations using public-private collaboration

Background

The continued emergence of new COVID-19 variants highlights the importance of vaccination in the effort to reduce disease transmission and burden. The objective of this study is to evaluate the processes and outcomes associated with a novel in-home COVID-19 vaccination program aimed at vaccinating high-risk populations in New York, USA.

Methods

To evaluate program processes, we described the program itself and reflected on some key lessons learned. To evaluate program outcomes, we analyzed data reported by vaccine recipients. These outcomes included the percentage of vaccine recipients that successfully received the full course of vaccinations, and the demographic and health characteristics of vaccine recipients. We additionally assessed demographic differences in motivations for receiving in-home care, using chi-squared tests to assess statistical significance. Data were collected and reported via dynamic online intake forms.

Results

The median age of vaccine recipients was 79 ± SD 9.0 years. The oldest vaccine recipient was 107 years old. Of those with non-missing data, more than half of vaccine recipients were female (63%), identified as part of a racial/ethnic minority (66%), reported an annual income of < $25,000 (58%), and received a high school degree or less (68%). Most vaccine recipients reported having one or more health conditions associated with increased risk of severe COVID-19 disease (72%). Vaccine recipients were most likely to report receiving in-home vaccination because they were home-bound due to disability. Motivations for receiving in-home vaccination differed by demographic subgroup.

Conclusion

The population receiving vaccinations from this in-home care delivery program comprised seniors who were mostly female and non-white, indicated socioeconomic vulnerability, and reported one or more COVID-related health conditions; this signified that the program met its goal of vaccinating those most at risk for severe COVID-19 disease.

Small bowel intussusception caused by a metastatic testicular germ cell tumour

Intussusception from a testicular germ cell tumour is extremely rare. Metastatic gastrointestinal implants outgrow their blood supply leading to central necrosis. This results in erosions and ulcerations, which can be visualised as submucosal polypoid masses. These masses can then serve as a lead point for intussusception. We report a case of a 25-year-old patient with small bowel obstruction due to an intussuscepted choriocarcinoma in the absence of any other apparent retroperitoneal disease. Urologists must exclude gastrointestinal tract (GIT) involvement in testicular cancers, and similarly, surgeons need to exclude testicular tumours in young men with unexplained GIT haemorrhage, bowel obstruction or intussusception.

Post-load glucose spike: a better predictor of post-MI prognosis than post-load glucose in patients without known diabetes

Funding Acknowledgements

Type of funding sources: None.

Background

In non-diabetic population, number of deaths increase as the post-challenge glucose spike (PGS) i.e. difference between the fasting and 2h-PG increases in the DECODE study.

Purpose

To assess whether PGS is a better predictor of post-ACS prognosis in patients without known diabetes.

Methods

Retrospective cohort analysis of post-MI survivors (n=1056) without known diabetes undergoing pre-discharge oral glucose tolerance test. A standardised dataset was collected for the Myocardial Infarction National Audit Project. MACE (death or non-fatal re-infarction) over 5 (median 3.4) years was collected from notes review. Predictors of MACE were determined from Cox proportional hazard regression (stepwise) models adjusted for several variables (tested for collinearity) including GRACE score (GRS), fasting (FG) and 2-hour post-load glucose (2hG) and PGS as % of the 2hG (%PGS) (VIF=3.12). Incremental predictive value of PGS over 2hG was tested using probabilities of MACE calculated from logistic regression models using the same covariates and FG, 2hG and PGS individually and in combination applying c-statistics, continuous net reclassification improvement (cNRI) and integrated discrimination improvement (IDI).

Results

Of the patients 469 (44.4%) had normal glucose tolerance, 378(35.8%) preDM and 209 (19.8%) had new DM. In the whole cohort, MACE was predicted by %PGS (HR 1.02 (1.01-1.03), p&lt;0.0001), GRS (HR 1.01, (1.01-1.02), p&lt;0.0001), discharge with betablockers (HR 1.50 (1.14-1.98), p=0.0037), previous history of MI (HR 1.44 (1.02-2.03), p=0.039) but neither FG nor 2hG were included in the final model. MACE was predicted by %PGS (HR 1.04 (1.02-1.06), p&lt;0.0001) in the non-diabetic group but not in the new DM patients (HR 1.02 (0.99-1.05), p=0.296). Addition of PGS to models containing FG and 2hG improved reclassification by 22.6% for events and 5.0% for non-events (NRI&gt;0 0.275, p&lt;0.001) and discrimination (IDI 0.0076, p=0.033). However the c-statistics did not change significantly (ΔAUC 0.0094, p=0.099).

Conclusion

PGS is a better predictor of post-MI prognosis than FG or 2hG in patients without known diabetes.

A study of spectrum of sickle cell anemia and thalassemia in a teaching institute of South India

Background and Aim

Sickle cell syndrome is a group of inherited hematological disorders with varying degrees of anemia, jaundice, fatiguability along with hepatomegaly and splenomegaly. The clinical presentations can be may vary and therefore require thorough investigations. We tried to evaluate the spectrum of sickle cell anemia and thalassemia in pediatric patients of our hospital.

Patients and Methods

In this cross-sectional study, A total of n = 200 consecutive cases were detected during the period of study. A thorough history and detailed clinical examination were done. Hb electrophoresis was done in the present study using HYDRASYS ® Electrophoresis Systems from Sebia.

Results

The overall prevalence of SCD in our study was 6.83% the existence of this is found to be greater in the males as compared to females which is in agreement with prevalence across India with more male than female. Thalassemia was prevalent at the rate of 3.96%, sickle cell anemia had a prevalence of 1.98% sickle thalassemia was 0.89%. N = 20 pairs of Parents recognized genetic counseling i.e., with a single child or who wanted further children readily underwent HPLC analysis.

Conclusion

The existence of SCD in our study group is lesser as compared to the South India average. Preventive programs consisting of public education, population screening, genetic counseling, and prenatal diagnosis have been very effective in reducing both rates of β-Thalassemia major. Sickle cell anemia is of prime importance because of its high prevalence, morbimortality and the absence of curative treatments.

Intrathecal morphine in combination with bupivacaine as pre-emptive analgesia in posterior lumbar fusion surgery: a retrospective cohort study

Background

The purpose of this study was to evaluate the efficacy of intrathecal morphine (ITM) in combination with bupivacaine as pre-emptive analgesia in patients undergoing posterior lumbar fusion surgery. This is in comparison with traditional opioid analgesics such as intravenous (IV) morphine.

Methods

Two groups were identified retrospectively. The first (ITM group) included patients who had general anaesthesia (GA) with low-dose spinal anaesthesia prior to induction using 1–4 mls of 0.25% bupivacaine and 0.2 mg ITM. 1 ml of 0.25% bupivacaine was administered per hour of predicted surgery time, up to a maximum of 4 ml. The insertion level for the spinal anaesthetic corresponded to the spinal level of the iliac crest line and the level at which the spinal cord terminated. The control group had GA without any spinal anaesthesia. Patients were instead administered opioid analgesia in the form of IV morphine or diamorphine. The primary outcome was the consumption of opioids administered intraoperatively and in recovery, and over the first 48 h following discharge from the post-anaesthesia care unit (PACU). Total opioid dose was measured, and a morphine equivalent dose was calculated. Secondary outcomes included visual analogue scale (VAS) pain scores in recovery and at day two postoperatively, and the length of stay in hospital.

Results

For the ITM group, the median total amount of IV morphine equivalent administered intraoperatively and in recovery, was 0 mg versus 17 mg. The median total amount morphine equivalent, administered over the first 48 h following discharge from PACU was 20 mg versus 80 mg. Both are in comparison with the control group. The median length of stay was over 1 day less and the median VAS for pain in recovery was 6 points lower. No evidence was found for a difference in the worst VAS for pain at day two postoperatively.

Conclusion

ITM in combination with bupivacaine results in a significantly decreased use of perioperative opioids. In addition, length of hospital stay is reduced and so too is patient perceived pain intensity.

Trial registration The study was approved by the ethics committee at The Robert Jones and Agnes Hunt Orthopaedic Hospital as a service improvement project (Approval no. 1617_004).

Effect of mild α-chymotrypsin treatment of highly viscous semen samples on fertilization rates

Background

Highly viscous semen reduces sperm motility significantly and can contribute to infertility. When processing semen samples, few techniques exist to induce liquefaction in case of seminal hyperviscosity such as different washing steps and mechanical treatment. The use of α-chymotrypsin seems controversial due to possible negative effects on fertilisation rates after in vitro fertilization (IVF). The main objective of this study was to examine the influence of mild α-chymotrypsin treatment of semen samples on the fertilisation rate after artificial reproductive treatment (ART).

Methods

The fertilization rate of 52 ART cycles was examined following IVF using a low dose of α-chymotrypsin to induce liquefaction of highly viscous semen and was compared to a control group of 88 ART cycles.

Results

There was no significant difference in the fertilization rates of α-chymotrypsin treated semen samples compared to the control group; pregnancy rates were unaffected.

Conclusions

The use of mild α-chymotrypsin treatment of semen samples in case of hyperviscosity does not appear to impact negatively on the fertilization rates after ART and could be regarded as an additional method to induce liquefaction of highly viscous semen samples in IVF.

Post-load glucose spike is a determinant of post-MI prognosis in patients without known or newly diagnosed diabetes

Background

Post-prandial plasma glucose spikes contribute to the progression of atherosclerosis. Glycaemic variability may predict post-ACS prognosis. A third to two-thirds of these patients had diabetes mellitus (DM). Post-ACS prognosis is worse in DM than in those without. This has not been tested in patients without DM.

Purpose

To test whether post-load spike in plasma glucose in patients without known or newly diagnosed DM adversely affects prognosis.

Methods

Retrospective cohort analysis of 847 MI survivors without known or newly diagnosed DM who were followed up for MACE (death and non-fatal MI). The median post-glucose spike (PGS, defined as the difference between the 2h-PG and FPG) was 2.4 mmol/l for the whole cohort and 1.5 mmol/l for the patients with normal glucose tolerance (NGT). Group 1: PGS ≤2.4 mmol/l and Group 2: PGS &gt;2.4 mmom/l were compared using Mann-Whitney test for continuous variables and chi-squared test for categorical variables. Event free survival in the two groups was estimated from the Kaplan–Meier curves and compared using log-rank test. Cox proportional hazard regression identified predictors of MACE. Continuous net reclassification improvement (NRI&gt;0) and integrated discrimination improvement (IDI) and c-statistics determined the added predictive value of glycaemic matrices

Results

MACE was higher in group 2 (OR 1.99, 95% CI 1.36 to 2.91, p=0.0004) compared to group 1. In patients with NGT, MACE was higher in patients with PGS ≥1.5 mmol/l vs those below (OR 2.37, 95% CI 1.31 to 4.26, p=0.0041). Event free survival was worse in pre-diabetes than in the NGT groups (HR 1.57, 95% CI 1.17 to 2.12, p=0.003). and in group 2 than 1 (HR 2.01, 95% CI 1.49 to 2.71, p&lt;0.001). Amongst the patients with NGT, event free survival was worse in patients with PGS ≥1.5 mmol/l (HR 2.09, 95% CI 1.35 to 3.25, p&lt;0.001). PGS independently predicted MACE in the whole cohort (HR 1.16, 95% CI 1.06 to 1.26, p=0.002) and NGT group (HR 2.06, 95% 1.51 to 2.79, p&lt;0.000). Group 2 independently predicted MACE in the whole cohort (HR 1.75, 95% CI 1.26 to 2.42, p&lt;0.001). In the NGT group, PGS &gt;median, independently predicted of MACE (HR 2.67, 95% CI 1.54 to 4.61, p&lt;0.001). The c-statistic a model containing GRS only increased on addition of PGS (δAUC 0.0134, p=0.046) but not on addition of FPG. Within the whole cohort, PGS improved the net reclassification by 28% when added to the model containing GRS only. NGT cohort had higher net improvement at 46.6%. Addition of PGS to the model containing GRS and FPG resulted in NRI&gt;0 of 25.5% in the whole cohort and 56.3% in the NGT cohort. Similar changes were seen in the IDI.

Conclusion(s)

PGS predicts post MI prognosis in patients without known or newly diagnosed DM including in patients with NGT. This suggests that PGS is a more powerful indicator of post-MI prognosis than FPG

Funding Acknowledgement

Type of funding source: None

Does high-normal 2-hour post load plasma glucose after myocardial infarction in patients with normal glucose tolerance adversely affect prognosis?

Background

Type 2 diabetes mellitus (DM) and pre-DM, newly diagnosed after MI in patients without known DM adversely affects prognosis. 2-hour post-load glucose (2h-PG) predicts post-MI prognosis better than fasting plasma glucose (FPG). Plasma glucose below the conventional threshold for the diagnosis of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), affects post-MI prognosis.

Purpose

To test whether high-normal post-load plasma glucose in patients with normal glucose tolerance (NGT) would affect post-MI prognosis and whether FPG or 2h-PG increases this risk.

Methods

Retrospective cohort analysis of 425 MI survivors without known DM and with NGT followed up for (death and non-fatal MI) as MACE. MACE in patients with 2h-PG &gt; median for the whole cohort (Group 2), was compared with those at or below (Group 1). Event free survival in the two groups was estimated from the Kaplan–Meier curves and compared using log-rank test. Cox proportional hazard regression identified predictors of MACE. Continuous net reclassification improvement (NRI&gt;0) and integrated discrimination improvement (IDI) and c-statistics determined the added predictive value of glycaemic matrices.

Results

Median 2h-PG was 6.3 mmol/l. 219 patients in Group 1 and 206 in Group 2. Group 2 had higher age, prevalence of hypertension, hypercholesterolaemia, ST-segment depression and higher heart rate and GRACE scores. Median follow-up was 40.6 months. MACE was more frequent in Group 2 than Group 1 (OR 2.82, 95% CI 1.55 to 5.16, p&lt;0.001). MACE-free survival was higher in Group 1 (HR 2.43, 95% CI 1.53 to 3.85, p&lt;0.001). Group 2 (HR 2.42, 95% CI 1.44 to 4.04, p&lt;0.001) predicted the MACE-free survival. 2h-PG, but not the FPG independently predicted of MACE (HR 1.73, 95% CI 1.31 to 2.30, p&lt;0.001). Addition of 2h-PG to models containing FPG and other variables improved their predictive performance (NRI&gt;0 0.5062, p&lt;0.001; IDI 0.0376, p=0.003). The c-statistic increased when 2h-PG was added to the GRACE score only model (δAUC 0.037, 95% CI 0.012 to 0.081, p=0.046).

Conclusion(s)

This study suggests that “high-normal” 2h-PG is an independent predictor of post-MI prognosis. Normoglycaemic patients with 2h-PG ≥6.4 mmol/l, had worse post-MI prognosis compared to those with 2h-PG ≤6.3 mmol/l. The risk of MACE increased with increasing 2h-PG within the normal range. FPG had no effect on prognosis.

Funding Acknowledgement

Type of funding source: None

Change in renal function post-nephrectomy for renal cell carcinoma in patients with and without hypertension and/or diabetes

BACKGROUND

The standard of care for surgically resectable disease renal cell carcinoma (RCC) is a nephrectomy. Post-nephrectomy, these patients are at risk for the development of new onset chronic kidney disease or the progression of pre-existing chronic kidney disease. We aimed to report the changes in renal function in patients who had a nephrectomy for RCC.

METHODS

This retrospective, descriptive, cross-sectional study identified 137 patients who had a nephrectomy for RCC from 1 January 2009 to 31 December 2017. The pre-nephrectomy and post-nephrectomy estimated glomerular filtration rate (eGFR) and the histological subtype of RCC on histopathological analysis of the resected specimen were recorded from the National Health Laboratory Services online results platform. All analyses were conducted using SPSS (Version 25) and the significance level was set at p < 0.05.

RESULTS

After a mean follow-up period of 26.5 ± 22 months (median = 19 months), the patients' eGFR dropped by a mean of 4.82 ± 8.67 ml/min/1.73 m2 (95% CI 3.23-6.41) post-nephrectomy. The mean eGFR fall in patients' who had hypertension and/or diabetes (n = 63) was significantly larger compared to patients who had neither of these comorbidities (n = 54; p < .001; mean = 7.30 ± 8.40 ml/min/1.73 m2 (95% CI 5.19-9.42) and 1.93 ± 8.14 ml/min/1.73 m2 (95% CI 0.30-4.15) respectively.

CONCLUSIONS

The decline in renal function in patients with hypertension and/or diabetes mellitus is more pronounced than in patients with neither of these comorbidities. In these high-risk patients, measures must be taken to prevent the development and limit the progression of chronic kidney disease.

Simulation of Copper Electrodeposition in Through-Hole Vias

Copper electrodeposition processes for filling metallized through-hole (TH) and through-silicon vias (TSV) depend on spatially selective breakdown of a co-adsorbed polyether-chloride adlayer within the recessed surface features. In this work, a co-adsorption-dependent suppression model that has previously captured experimental observations of localized Cu deposition in TSV is used to explore filling of TH features. Simulations of potentiodynamic and galvanostatic TH filling are presented. An appropriate applied potential or current localizes deposition to the middle of the TH. Subsequent deposition proceeds most rapidly in the radial direction leading to sidewall impingement at the via center creating two blind vias. The growth front then evolves primarily toward the two via openings to completely fill the TH in a manner analogous to TSV filling. Applied potentials, or currents, that are overly reducing result in metal ion depletion within the via and void formation. Simulations in larger TH features (i.e., diameter = 85 μm instead of 10 μm) indicate that lateral diffusional gradients within the via can lead to fluctuations between active and passive deposition along the metal/electrolyte interface.

Development of a battery of tests to measure attitudes and intended behaviours of dental students towards people with disability or those in marginalised groups

INTRODUCTION

Recommended curricula in Special Care Dentistry (SCD) outline learning objectives that include the domain of attitudes and behaviours, but these are notoriously difficult to measure. The aims of this study were (i) to develop a test battery comprising adapted and new scales to evaluate values, attitudes and intentions of dental students towards people with disability and people in marginalised groups and (ii) to determine reliability (interitem consistency) and validity of the scales within the test battery.

MATERIALS AND METHODS

A literature search identified pre-existing measures and models for the assessment of attitudes in healthcare students. Adaptation of three pre-existing scales was undertaken, and a new scale was developed based upon the Theory of Planned Behaviour (TPB) using an elicitation survey. These scales underwent a process of content validation. The three adapted scales and the TPB scale were piloted by 130 students at 5 different professional stages, from 4 different countries.

RESULTS

The scales were adjusted to ensure good internal reliability, variance, distribution, and face and content validity. In addition, the different scales showed good divergent validity.

DISCUSSION

These results are positive, and the scales now need to be validated in the field.

CONCLUSIONS

It is hoped that these tools will be useful to educators in SCD to evaluate the impact of teaching and clinical exposure on their students.

Abstract P5-10-09: Prospective cross-sectional-study on participation in mammography screening according to immigration background and education status

Introduction

Although the health of immigrants is an important issue in national health care policy there is a serious shortage of data in many countries. Most studies lack information on educational status which is a major limitation. In this prospective cross-sectional-study we analyzed the influence of immigration background and educational status on the participation in mammography screening programs in Lower-Saxony, Germany.

Material and methods

Data collection was conducted from 2012-2016 in six certified breast cancer centers using a personal questionnaire and data from the patients' medical records. Stratification into subgroups was carried out according to first and second generation immigrants and country of origin.

Results

1547/2129 primary breast cancer cases were analyzed. The percentage of patients with a history of immigration in our study cohort was 17.7%. The majority of them were citizens of EU27 Member states. First generation immigrants (n= 146), second generation immigrants (n=129), natives (n= 1272). No significant difference was seen in sex, age, tumor stage, histology, grading, Ki-67, Her2/neu-status, and hormone receptor status. A 100% participation rate in the mammography screening program was seen in patients with no school graduation. The lowest participation rate (85.5%) was seen in the group of native Germans with a college graduation and in first generation immigrants with a high school graduation (86.7%). Detailed statistical analysis will be presented on the poster.

Conclusion

No difference was seen between immigrants and native Germans with regard to tumor biology. In first-generation immigrants mammography screening was well accepted despite cultural and linguistic differences. Participation rate decreased with higher education level in all groups. High school graduates with immigrant background participated more frequently in breast cancer screening than native high school graduates. These findings mainly relate to immigrants from EU27 Member states rather than immigrants from non EU countries.

Citation Format: Kuehnle E, Oeztuerk T, Siggelkow W, Luebbe K, Moser A, Noeding S, John J, Noesselt T, Busch C, Arfsten M, Lemster S, Hillemans P, Doerk T, Park-Simon T-W. Prospective cross-sectional-study on participation in mammography screening according to immigration background and education status [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-10-09.

Abstract P2-05-12: The ASCO-recommended prognostic factors uPA/PAI-1 in a multicenter cohort study (PiA)

Introduction

The PiA-study (Prognostic assessment in routine Application, NCT 01592825) was designed as a representative cohort of breast cancer patients to estimate the proportions of traditional and modern prognostic factors. The ASCO-recommended biomarkers uPA (urokinase-type plasminogen activator) and its inhibitor PAI-1 were used for biological risk assessment particularly for intermediate risk breast cancer patients and disease-free survival of the patients after 5 yrs of follow-up (F/U) was calculated.

Material & Methods

Between 2009 and 2011, 1,074 non-metastasized, primarily operated breast cancer patients from six centers in Germany were included. From 815 patients, fresh frozen tissue was obtained and processed for central testing uPA/PAI-1 by ELISA (FEMTELLE®, Sekisui Diagnostics GmbH). Low uPA/PAI-1 status is defined by uPA and PAI-1 concentrations below the published cut-offs, high status means one or both were higher than the corresponding cut-offs. Tumor characteristics were based on local pathology. The centers had to follow the national guidelines. In low-risk patients, adjuvant chemotherapy was spared. The median F/U is 56 months (range 0-78).

Results

In the total cohort of 1,074 patients, 166 had G1- and 237 had G3-tumors. Of the 671 patients with a G2-tumor, the following were allocated to the high-risk group: node-positive (n=371), younger than 35 yrs (n=17), and triple-negative (TN) or HER2-positive (n=118). For 253 tumors of the remaining 355 patients with an intermediate risk of recurrence (pN0, G2, HR positive, HER2-negative, ≥35 yrs), uPA/PAI-1 status was available. 126 (49.8%) were allocated to the low-risk group, one patient had a recurrence. At 5 yrs, in the total cohort 90.6% (95% CI, 89.5-91.7) of the patients were free of invasive disease. Of 114 HER2-positive tumors, 94 (82.4 %) had a high uPA/PAI-1 status, only one of the 38 HR negative/HER2 positive tumors had a low uPA/PAI-1 status. In the TN group, the majority of tumors had a high uPA/PAI-1 status (66 of 81; 81.5 %). In 30 patients lymph nodes were involved, 18.5% (n=15) had a low uPA/PAI-1 status, one event was detected. In N pos. patients with an high uPA/PAI-1 6 events were observed.

Conclusion

Testing for uPA/PAI-1 in the daily routine is feasible, fresh frozen tissue has been prepared from 76% of the tumors of the recruited patients, 37% of them had a low risk status. Using uPA/PAI-1, about half of the node-negative patients with an intermediate risk of recurrence were allocated to a group with an extremely low risk of recurrence and thus chemotherapy could be spared. Also in node-positive disease, uPA/PAI-1 has a prognostic impact.

Tab 1: Proportion of the subgroups according to IHC, grading and uPA/PAI-1-statusTumor typetotallow uPA/PAI-1 statushigh uPA/PAI-1 statusn=815 (100%)n=304 (37%)n=511 (63%)Luminal A-like tumors:HRpos., HER2neg., G1, G2515 (63.2%)240 (78.9%)275 (53.9%)Luminal B/HER2-negative-like tumors:HRpos., HER2neg., G3104 (12.8%)29 (9.5%)75 (14.7%)Luminal B/HER2-positive-like tumors:HR pos., HER2 pos., all grades77 (9.4%)19 (6.2%)58 (11.4%)HER2-positive (nonluminal) - like tumors:HRneg., HER2pos., all grades38 (4.7%)1 (0.3%)37 (7.3%)TN tumors:HRneg., HER2neg., all grades81 (9.9%)15 (4.9%)66 (12.9%)

Citation Format: Vetter M, Hartung C, Hanf V, Lantzsch T, Uleer C, Peschel S, John J, Buchmann J, Bürrig K-F, Weigert E, Thomssen C, Kantelhardt EJ. The ASCO-recommended prognostic factors uPA/PAI-1 in a multicenter cohort study (PiA) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-05-12.

Model Evaluation of Continuous Data Pharmacometric Models: Metrics and Graphics

This article represents the first in a series of tutorials on model evaluation in nonlinear mixed effect models (NLMEMs), from the International Society of Pharmacometrics (ISoP) Model Evaluation Group. Numerous tools are available for evaluation of NLMEM, with a particular emphasis on visual assessment. This first basic tutorial focuses on presenting graphical evaluation tools of NLMEM for continuous data. It illustrates graphs for correct or misspecified models, discusses their pros and cons, and recalls the definition of metrics used.

Prevalence and Visual Outcomes of Cataract Surgery in Rural South India: A Cross-Sectional Study

PURPOSE

To determine the prevalence of cataract surgery and postoperative vision-related outcomes, especially with respect to sex, socioeconomic status (SES) and site of first contact with eye care, in a rural area of South India.

METHODS

In a population-based cross-sectional survey of 5530 individuals aged 50 years or older from 10 villages selected by cluster sampling, individuals who had undergone cataract surgery in one or both eyes were identified. Consenting participants were administered a questionnaire, underwent vision assessment and ophthalmic examination. Outcomes were classified as good if visual acuity of the operated eye was 6/18 or better, fair if worse than 6/18 but better than or equal to 6/60, and poor if worse than 6/60.

RESULTS

Prevalence of cataract surgery in this age group (771 persons) was 13.9% (95% confidence interval, CI, 13.0-14.9%). In the 1112 eyes of 749 persons studied, at presentation, 53.1% (95% CI 50.1-56.1%) of operated eyes had good, 38.1% (95% CI 35.2-41.0%) had fair, and 8.8% (95% CI 7.1-10.5%) had poor outcomes. With pinhole, 75.2% (95% CI 72.6-77.8%) had good, 17.2% (95% CI 14.9-19.5%) had fair, and 7.4% (95% CI 5.8-9.0%) had poor outcomes. In 76.3% of eyes with fair and poor presenting outcomes we detected an avoidable cause for the suboptimal visual acuity. Place of surgery and duration since surgery of 3 years or more were risk factors for blindness, while SES, sex and site of first eye care contact were not.

CONCLUSION

The high prevalence of avoidable causes of visual impairment in this rural setting indicates the scope for preventive strategies.