Sensitivity, specificity, and accuracy of molecular profiling on circulating cell-free DNA in refractory or relapsed multiple myeloma patients, results of MM-EP1 study

As a promising alternative to bone marrow aspiration (BMA), mutational profiling on blood-derived circulating cell-free tumor DNA (cfDNA) is a harmless and simple technique to monitor molecular response and treatment resistance of patients with refractory/relapsed multiple myeloma (R/R MM). We evaluated the sensitivity and specificity of cfDNA compared to BMA CD138 positive myeloma plasma cells (PCs) in a series of 45 R/R MM patients using the 29-gene targeted panel (AmpliSeq) NGS. KRAS, NRAS, FAM46C, DIS3, and TP53 were the most frequently mutated genes. The average sensitivity and specificity of cfDNA detection were 65% and 97%, respectively. The concordance per gene between the two samples was good to excellent according to Cohen's κ coefficients interpretation. An increased number of mutations detected in cfDNA were associated with a decreased overall survival. In conclusion, we demonstrated cfDNA NGS analysis feasibility and accuracy in R/R MM patients who may benefit from early phase clinical trial.

Incidence, characteristics, management and outcome of patients with follicular lymphoma with tumor epidural compression, a study on 22 cases

PURPOSE

Follicular lymphoma (FL) is one of the most common lymphoma. Occasionally, FL is associated with tumoral epidural compression and management of these patients remain poorly codified. This study aims to report incidence, clinical characteristics, management and outcomes of patients with FL and tumoral epidural compression.

MATERIAL AND METHODS

Observational, retrospective cohort study of adult patients with FL and epidural tumor compression, treated in a French Institute over the last 20 years (2000-2021).

RESULTS

Between 2000 and 2021, 1382 patients with FL were followed by the haematological department. Of them, 22 (1.6%) patients (16 men and 6 women) had follicular lymphoma with epidural tumor compression. At epidural tumor compression occurrence, 8/22 (36%) patients had a neurological clinical deficit (motor, sensory or sphincter function) and 14/22 (64%) had tumor pain. All patients were treated with immuno-chemotherapy; the main regimen being used was R-CHOP plus high dose IV methotrexate in 16/22 (73%) patients. Radiotherapy for tumor epidural compression was performed in 19/22 (86%) patients. With a median follow-up of 60 months (range=[1-216]), 5 year local tumor relapse free survival was achieved in 65% (95% CI 47-90%) of patients. The median PFS was of 36 months (95% CI 24-NA) and 5 years OS estimate was 79% (95% CI 62-100%). Two patients developed a relapse at a second epidural site.

CONCLUSION

FL with tumoral epidural compression reached 1.6% of all FL patients. Management based on immuno-chemotherapy with radiotherapy appeared to produce comparable outcomes with the general FL population.

Infections occurring following IL6 blockade for the management of cytokine release syndrome in onco-hematology patients

BACKGROUND

Cytokine release syndrome (CRS) is a common adverse event of CAR T cell or bispecific antibody (bsAb) therapy. Anti-IL6/IL6R drugs are used in the management of auto-immune diseases. Some reports showed increased risk of bacterial infection in this context. In onco-hematology, there are few data about the occurrence of infection after administration of an anti-IL6/IL6R for CRS.

METHODS

We retrospectively reviewed all consecutive patients treated in Gustave Roussy Cancer Campus between 2018 and 2021, who received anti-IL6/IL6R for CRS due to bsAb in phase I clinical trials or adoptive cellular therapy (ACT). We constituted a control group including all the patients treated in the same clinical trials or standard of care ACT, naïve of anti-IL6/IL6R.

RESULTS

Fifty-two patients have been included. In the anti-IL6/IL6R group (n = 26), five patients developed a grade 2 to 5 infection within a month after anti-IL6/IL6R treatment, including two grade 5 infections. In the control group (n = 26), only one patient had a grade 3 infection. The two patients who had grade 5 infections were treated for diffuse large B cell lymphoma (DLBCL), one with bsAb and the other with CAR T cell. Fifty percent (3/6) of DLBCL patients who received an anti-IL6/IL6R presented an infection, one of which was a grade 5. In solid tumor patients treated with bsAb and anti-IL6/IL6R, only one patient (/9, 11%) developed a grade 2 viral infection.

CONCLUSION

It seems that the use of anti-IL6/IL6R in CRS secondary to bsAb administration in solid tumors patients does not significantly increase the risk of infection, as opposed to DLBCL patients where secondary infection might be a concern.

Ultra-high-frequency ECG assessment of QRS fragmentation predicts sudden cardiac death risk in inherited arrhythmia syndromes

Background

Fragmentation of the QRS complex, as a surrogate for scar or functionally disrupted ventricular activation, has been postulated as a risk factor for malignant ventricular arrhythmias across a range of cardiac diagnoses including cardiomyopathies, channelopathies and myocardial infarction. Fragmentation is subtle on the conventionally filtered 12-lead ECG and can easily be missed or over-diagnosed. Isolation of high-frequency (HF) QRS components could overcome this to demonstrate easily identifiable fragmentation but this has previously been limited by technological constraints resulting in a limited range of measured frequencies (150–300Hz). Ultra-high-frequency ECG (UHF-ECG) is a novel technology that utilises amplification and signal-averaging techniques to reliably measure frequencies up to 1000Hz.

Purpose

We explored the use of UHF-ECG in arrhythmia risk stratification.

Methods

We recruited 60 participants to undergo UHF-ECG recordings, including 23 healthy volunteers and 37 patients with inherited arrhythmia syndromes: 25 hypertrophic cardiomyopathy (HCM), 5 Brugada syndrome, 4 arrhythmogenic cardiomyopathy, 3 idiopathic ventricular fibrillation, 2 long QT syndrome and 1 non-ischaemic dilated cardiomyopathy.

The arrhythmia risk status of patients with inherited disease was classified, by two independent researchers, into high or low risk based on their history of cardiac arrest, sustained ventricular arrhythmia, appropriate therapy, syncope and programmed ventricular stimulation result. A third researcher adjudicated disagreement. Two further researchers, blinded to aforementioned risk status, independently assessed the UHF-ECG recordings of all participants.

Results

40 patients were classified as low risk, and 20 as high. Healthy volunteer UHF-ECGs showed uniform ventricular activation with single HF peaks in each lead. High-risk patients' UHF-ECGs showed multiple HF peaks, representing QRS fragmentation. The maximum number of HF peaks in any lead was used to measure severity of fragmentation. Example UHF-ECGs are shown in Figure 1. Fragmentation severity (number of peaks) correlated with arrhythmia risk status (chi-square statistic = 8.95, p-value = 0.03) across all participants (Figure 2) and when comparing high to low risk patients with inherited disease.

UHF-ECG fragmentation could be observed even when the 12-lead ECG did not show any observable fragmentation. Among patients with inherited disease, patients with HCM showed the largest difference in UHF-ECG fragmentation between high and low risk. UHF-ECG fragmentation analysis showed excellent reproducibility with no difference in number of peaks identified between two independent assessors.

Conclusion

We demonstrate proof-of-concept that a novel ultra-high-frequency tool for measuring a broad range of high frequency QRS components can be used for sudden death risk stratification in patients with inherited cardiac conditions.

Funding Acknowledgement

Type of funding sources: None.

AB0652 Prevalence of Interstitial lung disease and pulmonary arterial hypertension in systemic sclerosis patients cohort at a rheumatology referral centre in the United Arab Emirates

Background

Scleroderma, also known as Systemic Sclerosis (SSc), is a connective tissue disease that affects multiple organ systems, including the cardiovascular and respiratory systems, namely, pulmonary arterial hypertension (PAH) and interstitial lung disease (ILD) as the leading causes of death in this patient population.

Objectives

The purpose of this study is to determine the prevalence of PAH and ILD in a cohort of patients diagnosed with SSc.

Methods

We performed a retrospective chart review of clinical characteristics of all patients diagnosed with SSc Cleveland Clinic Abu Dhabi between April 2015 and April 2020. PAH was estimated by echocardiographic findings and diagnosed based on right heart catheterization (RHC) using 2019 World Symposium on Pulmonary Hypertension. The CT scan of the chest was read by a board-certified radiologist in chest radiology.

Results

Fifty individuals were diagnosed with SSc, with 46% having diffuse cutaneous systemic sclerosis and 54% having limited cutaneous systemic sclerosis. The majority of the patients (88%) were female, with a mean age of 41 ±13 years. The average period from presentation to diagnosis was 5 ±5.4 years. The majority of the cohort (86%) were from the United Arab Emirates. The average BMI was 26.0 kg/m2. Patients’ most prevalent symptoms are fatigue (80%), gastrointestinal symptoms (72%) followed by shortness of breath (58%) and cough (50%). Twenty-six out of fifty patients (52%) underwent a CT chest scan, with 19 (38%) having ILD. Eight patients had more than 30% fibrotic alterations, four patients had 10-30% fibrotic changes, and seven patients had less than 10% fibrotic abnormalities. Patients with more than 10% fibrotic changes were more likely to have usual interstitial pneumonia, whereas those with less than 10% fibrotic changes were more likely to have none specific fibrosis. The majority of patients (92%) had echocardiogram. All except one patient had a normal ejection fraction, and five had grade 1 left ventricular diastolic dysfunction. Five patients were described as having mild, 1 moderate and 2 severe PAH. Only 4 patients underwent RHC. One patient had group II PAH based on elevated wedge pressure. One had group 1 PAH with systemic sclerosis as the only cause for her PAH and two patients had group III PAH due to having more than 30 % pulmonary fibrosis and severe restrictive defect on spirometry. Therefore, the precapillary PAH prevalence was 6% (3/50).

Conclusion

While the prevalence of pulmonary fibrosis in our SSc patients reflects what has been reported in the literature, the prevalence of PAH is significantly lower than the reported 15-20%.1 This is likely due to underdiagnosis of PAH considering the number of years of systemic sclerosis diagnosis on presentation to our clinic. A systematic approach is needed to assess for the presence and severity of PAH using tools as in Detect algorithm which has been validated and commonly used in Europe and North America to screen for PAH.2 Validation of such algorithm is likely needed in middle eastern population before it is universally adopted.

References

[1]Screening for pulmonary arterial hypertension in an unselected prospective systemic sclerosis cohort. Vandecasteele E, Eur Respir J. 2017;49(5) Epub 2017 May 11.

[2]Evidence-based detection of pulmonary arterial hypertension in systemic sclerosis: the DETECT study, Coghlan et al. Ann Rheum Dis 2014;73:1340–1349. doi:10.1136/annrheumdis-2013-203301.

Disclosure of Interests

None declared

Risk Factors for Complicated Mohs Surgery in the South Sweden Mohs Cohort

BACKGROUND

Mohs micrographic surgery (MMS) is a precise, tissue-sparing surgical technique that offers superior cure rates compared to traditional surgical excision. However, the degree of difficulty of MMS depends on many variables and, consequently, the number of surgical stages required for each case is quite unpredictable.

OBJECTIVES

To identify risk factors for complicated MMS, defined as MMS requiring ≥3 stages.

METHODS

In a cohort study design, data was prospectively collected from 612 patients that underwent MMS for basal cell carcinoma (BCC) at the Department of Dermatology, Skåne University Hospital, Lund, between 2009 and 2020. Univariate and multivariate logistic regression were used to estimate risk of MMS requiring ≥3 stages. Due to risk of multicollinearity between recurrent or incompletely excised BCC and previous treatments, a partially and a fully adjusted multivariate logistic regression model were constructed.

RESULTS

In fully adjusted multivariate analyses, age (odds ratio (OR) 1.02; confidence interval (CI) 95% 1.00-1.04), previous cryotherapy (OR 2.3; CI 95% 1.1-4.8) and >1 previous surgery (OR 3.4; CI 95% 1.5-7.7) were significantly associated with risk of complicated MMS. Recurrent BCC was associated with risk of complicated MMS in partially adjusted multivariate analyses, but not in the fully adjusted analyses. In this highly selected cohort, histopathological subtype and tumour localisation were not associated with risk of complicated MMS.

CONCLUSIONS

Older age and tumours previously treated with cryotherapy or multiple prior surgeries increased risk of MMS requiring ≥3 stages. Whether recurrent BCC is an independent risk factor for complicated MMS needs further evaluation. Knowledge of these risk factors may ameliorate planning of Mohs surgeries.

C45. Exercise-Induced Ventricular Tachycardia in Normal Coronary Artery Patient with Incidental Finding of COVID-19 : a case report

Background

Exercised-induced ventricular tachycardia is associated with pre-existing ischemia or structural heart disease. However, exercise-induced ventricular tachycardia in asymptomatic patient without evident of coronary artery disease or structural heart disease needs further investigation.

Case Description

A 53-year-old woman with suspected coronary artery disease underwent an Exercise Stress Test. During recovery phase, the patient developed monomorphic ventricular tachycardia accompanied by drowsiness, which lasted eight minutes before resolving. The patient was tested positive on COVID-19 screening, a mandatory testing before hospital admission. Subsequent evaluation with transthoracic echocardiography and coronary angiography revealed absence of coronary artery stenosis and significant structural heart disease. Twenty-four hours Holter monitoring results were low-grade premature ventricular contractions.

Discussion

Exercise-induced ventricular tachycardia in normal coronary artery patient may be associated with an increased risk of sudden cardiac death, thus required careful examinations and establishment of underlying pathology. COVID-19 was reported to be associated with and might trigger episodes of ventricular tachycardia through sympathetic hyperactivity or re-entry in myocarditis. This case is noteworthy due to the absence of typical cause of exercise-induced ventricular tachycardia and the possible relation with COVID-19 infection. However electrocardiogram monitoring should be taken periodically to observe recurrences and to determine prognosis.

C45. Exercise-Induced Ventricular Tachycardia in Normal Coronary Artery Patient with Incidental Finding of COVID-19 : a case report

Background

Exercised-induced ventricular tachycardia is associated with pre-existing ischemia or structural heart disease. However, exercise-induced ventricular tachycardia in asymptomatic patient without evident of coronary artery disease or structural heart disease needs further investigation.

Case Description

A 53-year-old woman with suspected coronary artery disease underwent an Exercise Stress Test. During recovery phase, the patient developed monomorphic ventricular tachycardia accompanied by drowsiness, which lasted eight minutes before resolving. The patient was tested positive on COVID-19 screening, a mandatory testing before hospital admission. Subsequent evaluation with transthoracic echocardiography and coronary angiography revealed absence of coronary artery stenosis and significant structural heart disease. Twenty-four hours Holter monitoring results were low-grade premature ventricular contractions.

Discussion

Exercise-induced ventricular tachycardia in normal coronary artery patient may be associated with an increased risk of sudden cardiac death, thus required careful examinations and establishment of underlying pathology. COVID-19 was reported to be associated with and might trigger episodes of ventricular tachycardia through sympathetic hyperactivity or re-entry in myocarditis. This case is noteworthy due to the absence of typical cause of exercise-induced ventricular tachycardia and the possible relation with COVID-19 infection. However electrocardiogram monitoring should be taken periodically to observe recurrences and to determine prognosis.

CdO/CdCO3 nanocomposite physical properties and cytotoxicity against selected breast cancer cell lines

Cadmium Oxide nanoparticles have the lowest toxicity when compared to nanoparticles of other semiconductors and they are not detrimental to human and mammalian cells, thereby making them candidates for targeting cancer cells. Synadenium cupulare plant extracts were used to synthesize CdO/CdCO3 nanocomposite using cadmium nitrate tetrahydrate 98% as a precursor salt. The resultant nanoparticles were characterized using scanning electron microscopy (SEM), transmission electron microscopy (TEM), X-ray diffraction (XRD), X-ray photoelectron spectroscopy, ultraviolet visible spectroscopy, and Fourier transform infrared spectroscopy (FTIR). The nanoparticles were then screened for effect on breast cancer cell lines (MCF-7 and MDA MB-231) and Vero cell line to determine their growth inhibition effect. Cytotoxicity effect was evaluated using 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. XRD showed the peaks of monteponite CdO and otavite CdCO3 nanoparticles. TEM results showed irregular and spherical particles of varying sizes, whilst SEM revealed a non-uniform morphology. FTIR results showed peaks of functional groups which are present in some of the phytochemical compounds found in S. cupulare, and point to the presence of CdO. Annealed CdO/CdCO3 NPs showed selectivity for MCF7 and MDA MB231 in comparison to Vero cell line, thereby supporting the hypothesis that cadmium oxide nanoparticles inhibit growth of cancerous cells more than non-cancerous cells.

AB0176 RISK OF ANTI-CITRULLINATED PEPTIDE ANTIBODIES AND RHEUMATOID FACTOR IN MALE SMOKERS: DATA FROM KUWAIT REGISTRY FOR RHEUMATIC DISEASES (KRRD)

Background:

Smoking has been proposed to be associated with the development of anti-citrullinated peptide antibodies (ACPA) in rheumatoid arthritis (RA) patients.

Objectives:

To study the relationship between smoking and ACPA as well as smoking and RF in patients with RA in Kuwait Registry for Rheumatic Diseases (KRRD).

Methods:

Data on RA patients were extracted from KRRD from four major hospitals from February 2013 through December 2019. As females rarely smoke in Kuwait with a smoking prevalence of 3% in female RA patients in KRRD, females were excluded from the study population to reach the minimum statistical percentage needed to perform chi square test and assess the association between smoking and other variables. Statistical tests were applied where appropriate. Logistic regression was conducted to adjust for possible confounders including age, disease duration, comorbidities, family history of a rheumatic disease, ANA, treatment agents and disease activity and quality of life assessment tools.

Results:

A total of 863 RA male patients were studied with a mean age of 53.9±12.5 years and a mean disease duration 7.3±5.5 years. 652 (75.6%) had positive RF and 624 (72.3%) had positive ACPA. 431 (50%) had at least one comorbidity. 640 (74.2%) were on conventional disease modifying agents (cDMARD’s) and 223 (25.8%) were on biologic therapy. 183 (21.2%) were smokers. After adjustment of other factors, logistic regression showed that smokers were significantly different than non-smokers in terms of a positive ACPA (β=-1.051,p<0.001, odds=4.019) and a positive RF (β=-0.804,p=0.019, odds=2.517).

Conclusion:

Smokers have a higher risk of expressing a positive RF and a positive ACPA in a male population. Smoking should be considered as a possible risk factor for RA and efforts should be done to educate the population to cease smoking to possibly lower that risk.

References:

[1]Benowitz, N.L., 2009. Pharmacology of nicotine: addiction, smoking-induced disease, and therapeutics. Annual review of pharmacology and toxicology, 49, pp.57-71.

[2]Firestein, G.S., 2003. Evolving concepts of rheumatoid arthritis. Nature, 423(6937), p.356.

[3]Heliövaara, M., Aho, K., Aromaa, A., Knekt, P. and Reunanen, A., 1993. Smoking and risk of rheumatoid arthritis. The Journal of rheumatology, 20(11), pp.1830-1835.

[4]Hoy, K. W., 2009. Quantitative Research in Education: A Primer. SAGE. pp. 69-86.

[5]Kerlan-Candon, S., Combe, B., Vincent, R., Clot, J., Pinet, V. and Eliaou, J.F., 2001. HLA-DRB1 gene transcripts in rheumatoid arthritis. Clinical & Experimental Immunology, 124(1), pp.142-149.

[6]Kuada, J., 2012. Research Methodology: A Project Guide for University Students. Samfundslitteratur. pp. 45-56.

[7]Kumar, R., 2010. Research Methodology: A Step-by-Step Guide for Beginners. SAGE. pp. 148-159.

[8]Masdottir, B., Jonsson, T., Manfreðsdóttir, V., Víkingsson, A., Brekkan, Á. and Valdimarsson, H., 2000. Smoking, rheumatoid factor isotypes and severity of rheumatoid arthritis. Rheumatology, 39(11), pp.1202-1205.

[9]Neuman, W., 2009. Understanding research. Boston: Pearson. pp. 230- 255.

Disclosure of Interests:

None declared

THU0556 MISSING DATA AND MULTIPLE IMPUTATION IN RHEUMATOID ARTHRITIS REGISTRIES USING SEQUENTIAL RANDOM FOREST METHOD

Background:

Missing data in clinical epidemiological researches violate the intention to treat principle,

reduce statistical power and can induce bias if they are related to patient’s response to treatment. In multiple imputation (MI), covariates are included in the imputation equation to predict the values of missing data.

Objectives:

To find the best approach to estimate and impute the missing values in Kuwait Registry for Rheumatic Diseases (KRRD) patients data.

Methods:

A number of methods were implemented for dealing with missing data. These includedMultivariate imputation by chained equations(MICE),K-Nearest Neighbors(KNN),Bayesian Principal Component Analysis(BPCA),EM with Bootstrapping(Amelia II),Sequential Random Forest(MissForest) and mean imputation. Choosing the best imputation method was

judged by the minimum scores ofRoot Mean Square Error(RMSE),Mean Absolute Error(MAE) and

Kolmogorov–Smirnov D test statistic(KS) between the imputed datapoints and the original datapoints that were subsequently sat to missing.

Results:

A total of 1,685 rheumatoid arthritis (RA) patients and 10,613 hospital visits were included in the registry. Among them, we found a number of variables that had missing values exceeding 5% of the total values. These included duration of RA (13.0%), smoking history (26.3%), rheumatoid factor (7.93%), anti-citrullinated peptide antibodies (20.5%), anti-nuclear antibodies (20.4%), sicca symptoms (19.2%), family history of a rheumatic disease (28.5%), steroid therapy (5.94%), ESR (5.16%), CRP (22.9%) and SDAI (38.0%), The results showed that among the methods used, MissForest gave the highest level of accuracy to estimate the missing values. It had the least imputation errors for both continuous and categorical variables at each frequency of missingness and it had the smallest prediction differences when the models used imputed laboratory values. In both data sets, MICE had the second least imputation errors and prediction differences, followed by KNN and mean imputation.

Conclusion:

MissForest is a highly accurate method of imputation for missing data in KRRD and outperforms other common imputation techniques in terms of imputation error and maintenance of predictive ability with imputed values in clinical predictive models. This approach can be used in registries to improve the accuracy of data, including the ones for rheumatoid arthritis patients.

References:

[1]Junninen, H.; Niska, H.; Tuppurainen, K.; Ruuskanen, J.; Kolehmainen, M. Methods for imputation of

missing values in air quality data sets.Atmospheric Environment2004,38, 2895–2907.

[2]Norazian, M.N.; Shukri, Y.A.; Azam, R.N.; Al Bakri, A.M.M. Estimation of missing values in air pollution

data using single imputation techniques.ScienceAsia2008,34, 341–345.

[3]Plaia, A.; Bondi, A. Single imputation method of missing values in environmental pollution data sets.

Atmospheric Environment2006,40, 7316–7330.

[4]Kabir, G.; Tesfamariam, S.; Hemsing, J.; Sadiq, R. Handling incomplete and missing data in water network

database using imputation methods.Sustainable and Resilient Infrastructure2019, pp. 1–13.

[5]Di Zio, M.; Guarnera, U.; Luzi, O. Imputation through finite Gaussian mixture models.Computational

Statistics & Data Analysis2007,51, 5305–5316.

Disclosure of Interests:

None declared

Addressing cost and time barriers in chronic disease management through telemedicine: an exploratory research in select low- and middle-income countries

Background:

Despite evidence supporting telehealth provision in developed countries, there is limited evidence regarding its economic benefits for patients living in areas where access and cost present major barriers to health care, particularly in low- and middle-income countries (LMICs). This study explores the economic benefits of telemedicine for patients, in terms of cost and times savings, and its potential role in improving chronic disease outcomes.

Methods:

This retrospective cross-sectional study compared telemedicine services with hypothetical in-person consultations, with a focus on patient travel time and travel cost savings. A database containing teleconsultation visits (N = 25,182) conducted at health facilities in remote regions of Afghanistan, Pakistan, Tajikistan, and the Kyrgyz Republic, was analyzed. A two-sample homoscedastic t test was used to determine differences between the two groups. A one-way sensitivity analysis was also conducted, presuming in-person teleconsultations at 90%, 75%, and 50%.

Results:

The study extracted data from 25,182 teleconsultation visits (12,814 males; 12,368 females). The cumulative patient savings through the program amounted to USD 9,175,132, and 1,876,146 h, or 213.1 years. A significant difference was seen between the two groups in terms of mean time savings (p-value <0.05), and a nearly significant difference was observed in terms of mean cost savings (p-value = 0.05).

Conclusions:

This study suggests that considerable economic benefits imparted to patients in low-resource settings of LMICs via accessing telemedicine. Telemedicine has great potential to improve chronic disease outcomes in low-resource areas by reducing socioeconomic barriers related to cost and access, and increasing uptake of services, thereby enabling early intervention and long-term management.

Variability in the diagnosis of surgical-site infections after full-thickness skin grafting: an international survey

BACKGROUND

Diagnosis of a surgical-site infection (SSI) in dermatological surgery can be based entirely on a subjective assessment, according to the fourth criterion of the most common definition of an SSI, which was established by the US Centers for Disease Control and Prevention.

OBJECTIVES

To investigate the interobserver agreement between dermatologists in their diagnosis of SSI of dermatosurgical wounds.

METHODS

An international electronic photographic survey with eight photographs of wounds 1 week after full-thickness skin grafting (FTSG) was sent to dermatologists. All wounds were assessed in terms of visual criteria beforehand. Data collected from respondents included physician characteristics and experience, and SSI assessments of all wounds.

RESULTS

In total, 393 dermatologists from 27 countries enrolled. Most respondents were from the U.S.A. (25%), followed by Sweden (24%) and the U.K. (13%). There was only a slight interobserver agreement on SSI suspicion (κ = 0·19). SSI suspicion was lower for male physicians (P = 0·03), board-certified dermatologists (P = 0·001), physicians regularly assessing surgical wounds (P = 0·03) and physicians performing FTSG (P < 0·001). Swedish physicians diagnosed more SSIs than U.S. physicians (P = 0·002). Erythema was more common in cases with higher SSI suspicion.

CONCLUSIONS

This study reveals broad inter-rater variability in the diagnosis of SSI, illustrating the need for novel objective diagnostic methods that can better capture the variables that constitute an SSI.

l-phenylalanine modulates gut hormone release and glucose tolerance, and suppresses food intake through the calcium-sensing receptor in rodents

OBJECTIVE

High-protein diets (HPDs) are associated with greater satiety and weight loss than diets rich in other macronutrients. The exact mechanisms by which HPDs exert their effects are unclear. However, evidence suggests that the sensing of amino acids produced as a result of protein digestion may have a role in appetite regulation and satiety. We investigated the effects of l-phenylalanine (L-Phe) on food intake and glucose homeostasis in rodents.

METHODS

We investigated the effects of the aromatic amino-acid and calcium-sensing receptor (CaSR) agonist l-phenylalanine (L-Phe) on food intake and the release of the gastrointestinal (GI) hormones peptide YY (PYY), glucagon-like peptide-1 (GLP-1) and ghrelin in rodents, and the role of the CaSR in mediating these effects in vitro and in vivo. We also examined the effect of oral l-Phe administration on glucose tolerance in rats.

RESULTS

Oral administration of l-Phe acutely reduced food intake in rats and mice, and chronically reduced food intake and body weight in diet-induced obese mice. Ileal l-Phe also reduced food intake in rats. l-Phe stimulated GLP-1 and PYY release, and reduced plasma ghrelin, and also stimulated insulin release and improved glucose tolerance in rats. Pharmacological blockade of the CaSR attenuated the anorectic effect of intra-ileal l-Phe in rats, and l-Phe-induced GLP-1 release from STC-1 and primary L cells was attenuated by CaSR blockade.

CONCLUSIONS

l-Phe reduced food intake, stimulated GLP-1 and PYY release, and reduced plasma ghrelin in rodents. Our data provide evidence that the anorectic effects of l-Phe are mediated via the CaSR, and suggest that l-Phe and the CaSR system in the GI tract may have therapeutic utility in the treatment of obesity and diabetes. Further work is required to determine the physiological role of the CaSR in protein sensing in the gut, and the role of this system in humans.

Three Case Studies in Making Fair Choices on the Path to Universal Health Coverage

The goal of achieving Universal Health Coverage (UHC) can generally be realized only in stages. Moreover, resource, capacity, and political constraints mean governments often face difficult trade-offs on the path to UHC. In a 2014 report, Making fair choices on the path to UHC, the WHO Consultative Group on Equity and Universal Health Coverage articulated principles for making such trade-offs in an equitable manner. We present three case studies which illustrate how these principles can guide practical decision-making. These case studies show how progressive realization of the right to health can be effectively guided by priority-setting principles, including generating the greatest total health gain, priority for those who are worse off in a number of dimensions (including health, access to health services, and social and economic status), and financial risk protection. They also demonstrate the value of a fair and accountable process of priority setting.

An IHE-conform telecooperation platform supporting the treatment of dementia patients

Ensuring medical support of patients of advanced age in rural areas is a major challenge. Moreover, the number of registered doctors—medical specialists in particular—will decrease in such areas over the next years. These unmet medical needs in combination with communication deficiencies among different types of health-care professionals pose threats to the quality of patient treatment. This work presents a novel solution combining telemedicine, telecooperation, and IHE profiles to tackle these challenges. We present a telecooperation platform that supports longitudinal electronic patient records and allows for intersectoral cooperation based on shared electronic medication charts and other documents. Furthermore, the conceived platform allows for an integration into the planned German telematics infrastructure.

Health Care Coverage Decision Making in Low- and Middle-Income Countries: Experiences from 25 Coverage Schemes

Lessons learned by countries that have successfully implemented coverage schemes for health services may be valuable for other countries, especially low- and middle-income countries (LMICs), which likewise are seeking to provide/expand coverage. The research team surveyed experts in population health management from LMICs for information on characteristics of health care coverage schemes and factors that influenced decision-making processes. The level of coverage provided by the different schemes varied. Nearly all the health care coverage schemes involved various representatives and stakeholders in their decision-making processes. Maternal and child health, cardiovascular diseases, cancer, and HIV were among the highest priorities guiding coverage development decisions. Evidence used to inform coverage decisions included medical literature, regional and global epidemiology, and coverage policies of other coverage schemes. Funding was the most commonly reported reason for restricting coverage. This exploratory study provides an overview of health care coverage schemes from participating LMICs and contributes to the scarce evidence base on coverage decision making. Sharing knowledge and experiences among LMICs can support efforts to establish systems for accessible, affordable, and equitable health care.

Reduced expression of glucocorticoid-inducible genes GILZ and SGK-1: high IL-6 levels are associated with reduced hippocampal volumes in major depressive disorder

Neuroplasticity may have a core role in the pathophysiology of major depressive disorder (MDD), a concept supported by experimental studies that found that excessive cortisol secretion and/or excessive production of inflammatory cytokines impairs neuronal plasticity and neurogenesis in the hippocampus. The objective of this study was to examine how changes in the glucocorticoid and inflammatory systems may affect hippocampal volumes in MDD. A multimodal approach with structural neuroimaging of hippocampus and amygdala, measurement of peripheral inflammatory proteins interleukin (IL)-6 and C-reactive protein (CRP), glucocorticoid receptor (GR) mRNA expression, and expression of glucocorticoid-inducible genes (glucocorticoid-inducible genes Leucin Zipper (GILZ) and glucocorticoid-inducible kinase-1 (SGK-1)) was used in 40 patients with MDD and 43 healthy controls (HC). Patients with MDD showed smaller hippocampal volumes and increased inflammatory proteins IL-6 and CRP compared with HC. Childhood maltreatment was associated with increased CRP. Patients with MDD, who had less expression of the glucocorticoid-inducible genes GILZ or SGK-1 had smaller hippocampal volumes. Regression analysis showed a strong positive effect of GILZ and SGK-1 mRNA expression, and further inverse effects of IL-6 concentration, on hippocampal volumes. These findings suggest that childhood maltreatment, peripheral inflammatory and glucocorticoid markers and hippocampal volume are interrelated factors in the pathophysiology of MDD. Glucocorticoid-inducible genes GILZ and SGK-1 might be promising candidate markers for hippocampal volume changes relevant for diseases like MDD. Further studies need to explore the possible clinical usefulness of such a blood biomarker, for example, for diagnosis or prediction of therapy response.

Phase noise measurement of a narrow linewidth CW laser using delay line approaches

Two different laser phase noise measurement techniques are compared. One of these two techniques is based on a conventional and low-cost delay line system, which is usually set up for the linewidth measurement of semiconductor lasers. The results obtained with both techniques on a high-spectral-purity laser agree well and confirm the interest of the low-cost technique. Moreover, an extraction of the laser linewidth using computer-aided design tools is performed.

Navigational predictors in determining the necessity for collateral ligament release in total knee replacement

The requirement for release of collateral ligaments to achieve a stable, balanced total knee replacement has been reported to arise in about 50% to 100% of procedures. This wide range reflects a lack of standardised quantitative indicators to determine the necessity for a release. Using recent advances in computerised navigation, we describe two navigational predictors which provide quantitative measures that can be used to identify the need for release. The first was the ability to restore the mechanical axis before any bone resection was performed and the second was the discrepancy in the measured medial and lateral joint spaces after the tibial osteotomy, but before any femoral resection.

These predictors showed a significant association with the need for collateral ligament release (p < 0.001). The first predictor using the knee stress test in extension showed a sensitivity of 100% and a specificity of 98% and the second, the difference between medial and lateral gaps in millimetres, a sensitivity of 83% and a specificity of 95%. The use of the two navigational predictors meant that only ten of the 93 patients required collateral ligament release to achieve a stable, neutral knee.

Effects of genetic control of subcutaneous fat deposition via using restricted selection indexes on live Performance and carcass characteristics of Pekin ducklings

Abstract. Estimates of phenotypic and genetic parameters for live Performance and detaiied dissection traits of body components and carcass tissues in Pekin ducks were calculated and used to construct selection indexes. The expected reduction in potential gain in live weight, dressing percentage and carcass characteristics resulting from restricting change in subcutaneous fat level to zero were assessed. The aggregate genotype measurements were weight at slaughter, dressing percentage and percent subcutaneous fat. The index measurements were weight at hatching, weight at slaughter, weight gain, breast width, breast length and breast circumference. The restricted indexes as compared with the unrestricted would lead to minimum reduction in potential gain of 29.4% in total net merit, 96.4% in weight at slaughter, 49.0% in dressing percentage, 74.0% in dissected side weight and 75.0% in muscle to bone ratio. The potential reduction in percent abdominal fat and percent bone in side was decreased by at least 38.5% and 80.2%, respectively. Absolute genetic response results showed that selecting for breast width alone (rTI = 0.79) would be recommended for birds with substandard levels of SCF, whereas use of the restricted index containing weight at hatching and breast width (rTI = 0.54) would be advised for individuals with Standard fatness.

Selection index alternatives for increased marketing body weight with minimum concomitant reduction in body bone percentagerecourse to tissue dissection on Japanese quail

Abstract. Live body weight, shank length, keel length and carcass dissection data taken at 6 weeks of age were available on 103 quails from 33 sires. In a principal factor analysis, the first varimax rotated factor explaining 46.1% of the total Variation, revealed that body weight had negative loading and all bone percentages positive. The implied contrast was confirmed by the finding that body weight (h,sup>2 = 0.61) was genetically correlated negatively with weight of total bone relative to body weight (−0.23) and to carcass weight (−0.58). Noticeably, shank length (SL) had large positive genetic correlation with body weight (0.90) and practically independent relationship with body bone percentage (−0.04). Selection indexes for meat production capacity were construeted. The breeding goal was defined as body weight (BW) and body bone percentage (BBP). The descending order ofthe unrestricted indexes with respect to the correlation between the index and genetic worth was: the füll index utilising body weight, shank length and keel length (0.95), indexes based on body weight and one length measurement (0.86), body weight alone (0.78). The accuracy was reduced by 17–35% upon restraining changes in BBP to zero. This study indicated that an index of considerable accuracy and remarkable usefulness would be I3 = 4.56 BW + 244.87 SL. Use of this index should result in developing birds with higher body weight and more advantageous carcass attributes than selecting for body weight alone (L) or on the restricted füll index (II(BBP)). Such three indexes were most efficient in limiting reduction in BBP.

Phenology of Stomoxyinae in a Kenyan forest

The biology of nineteen taxa of African Stomoxyinae was studied during experiments with odour-baited Vavoua traps in Nairobi National Park, Kenya. Both male and female Stomoxys were captured in similar numbers with CO2 released at 2 l/min or octenol released at 2 mg/h. Some species of Haematobosca reacted synergistically to a combination of these attractants, producing large increases in catch. Stygeromyia and Rhinomusca responded only to CO2 and Prostomoxys did not respond to either bait. Many different activity patterns were documented in these genera, but most activity was concentrated just prior to sunset. For example, at peak densities nearly 1500 Stomoxyinae representing fourteen taxa were caught in a single trap between 18.00 and 19.00 hours. The Stomoxyinae community was exceptionally diverse when compared with other biting fly communities. Using data from traps set with different odour baits in the park forest, Shannon-Wiener diversity indices (H') varied from 2.5 to 2.8, and evenness (J') varied between 0.61 and 0.68. The Stomoxys population was extremely female-biased at the start of the rainy season, with species such as S. inornatus and S. boueti consisting of nearly 100% females. Sex ratios equalized when the first rainy-season generation emerged. population doubling times estimated from trap indices were approximately 12-16 days in two habitats (forest and riverine woodland).