Does the Keele STarT MSK tool predict the risk of poor outcome in non-specific shoulder complaints in primary care in a Dutch population?

OBJECTIVES

The Keele STarT MSK tool is a questionnaire to identify the prognostic factors for musculoskeletal conditions, such as shoulder complaints, developed by Keele University, UK. This study assessed whether the Keele STarT MSK tool can predict the risk of poor outcome in non-specific shoulder complaints in a Dutch population.

DESIGN

Multicentre prospective cohort study.

SETTING

Fourteen primary care physiotherapy clinics in the Netherlands participated in this study.

PARTICIPANTS

In total, 180 patients with non-specific shoulder complaints with complete data from the Keele STarT MSK tool (baseline), Short-Form 12 Health Survey (SF-12), Shoulder Pain and Disability Index (SPADI), Numeric Pain Rating Score (NPRS) and Global Perceived Effect (GPE) scale at week 6, week 12 or endpoint were included. Data were collected from January 2019 to January 2020. Of these, 180 patients were eligible for the study. Of these, 139 completed the study and were included in the analysis.

MAIN OUTCOME MEASURES

Poor outcome was defined as: SF-12 score ≤33 (physical health), SPADI score ≥30% (disability in activity), NPRS score ≥3 (pain intensity) and GPE scale score ≥3 (patient-reported recovery).

RESULTS

The area under the receiver operating characteristic curves for prediction of outcome were excellent for the SF-12, acceptable for the SPADI and NPRS, and showed no discrimination for the GPE scale. The optimal cut-off value for the Keele STarT MSK score to discriminate between low and medium/high risk groups was ≥5.

CONCLUSIONS

The Keele STarT MSK tool is able to predict the risk of poor outcome in patients with non-specific shoulder complaints in primary care physiotherapy clinics. Further research is needed to establish whether stratified care (subgrouping and targeted treatment) is more efficient. CONTRIBUTION OF PAPER.

Evaluating caregiver-child interactions in low- and middle-income countries: a systematic review of tools and methods

AIMS/BACKGROUND

The United Nations Sustainable Development Goals (SDGs) has placed emphasis on improving early child development globally. This is supported through the Nurturing Care Framework which includes responsive caregiving. To evaluate responsive caregiving, tools to assess quality of caregiver-child interactions are used, however there is little information on how they are currently employed and/or adapted particularly in low- and middle-income countries (LMICs) where children have a greater risk of adverse outcomes. The aim of this review is to provide a comprehensive guide on methodologies used to evaluate caregiver-child interaction - including their feasibility and cultural adaptation.

DESIGN/METHODS

We conducted a systematic review of studies over 20years in LMICs which assessed caregiver-child interactions. Characteristics of each tool, their validity (assessed with COSMIN Risk of Bias checklist), and the quality of the study (Mixed Methods Appraisal Tool) are reported.

RESULTS

We identified 59 studies using 34 tools across 20 different LMICs. Most tools (86.5%) employed video-recorded observations of caregiver-child interactions at home (e.g. Ainsworth's Sensitivity Scale, OMI) or in the laboratory (e.g. PICCOLO) with a few conducting direct observations in the field (e.g. OMCI, HOME); 13.5% were self-reported. Tools varied in methodology with limited or no mention of validity and reliability. Most tools are developed in Western countries and have not been culturally validated for use in LMIC settings.

CONCLUSION

There are limited caregiver-child interaction measures used in LMIC settings, with only some locally validated locally. Future studies should aim to ensure better validity, applicability and feasibility of caregiver-child interaction tools for global settings.

Evaluating the psychometric properties of the Grit scale in Marine recruits using Rasch analysis

INTRODUCTION

Successful completion of initial military training has been suggested to be predicted by physical abilities, cognitive abilities and non-cognitive abilities such as hardiness and grit. This study aimed to assess the psychometric properties of a Dutch version of a grit measurement scale: the NL-Grit scale.

METHODS

We assessed the factor structure, unidimensionality of the subscales, discriminative quality of the rating scale and investigated to what extend the items together can reliably measure the entire range of grit levels in Dutch Marine recruits. We used data of Marine recruit training platoons of the Royal Netherlands Marine Corps.

RESULTS

Principal component analysis reflected two subscales: 'consistency of interests' and 'perseverance of effort'. Rasch analysis confirmed the unidimensionality of the intended subscales. Rasch rating scale analysis indicated that the five-point response scale was not used as intended by respondents. Disordered rating scale categories were collapsed to obtain ordered rating categories. The item and person parameters (grit levels) largely overlapped, indicating that the item spread was sufficient for measuring the entire range of grit trait levels. However, larger gaps between item location parameters suggested a low discriminative capacity of the NL-Grit scale for respondents with trait levels within the gaps.

CONCLUSION

Our evaluation of the NL-Grit scale suggests sound psychometric quality of the NL-Grit in Dutch Marine recruits. Reliability could be improved by adding items to fill the observed gaps in item content.

Direct comparison between Grade Group assessed on systematic and MRI/ultrasound fusion targeted biopsies correlated to the radical prostatectomy specimens in patients with prostate cancer

OBJECTIVES

To compare the correlation of Gleason score (GS) and ISUP grade determined by prostate biopsies (PBx) and radical prostatectomy (RP) specimens according to the biopsy technique: ultrasound randomised (RBx) vs. MRI/ultrasound fusion targeted (TBx).

MATERIALS AND METHODS

Between March 2013 and June 2018, we retrospectively included patients who underwent RP for prostate cancer (PCa) histopathologically proven by RBx and/or TBx. All patients had a prebiopsy MRI by a single radiologist (using PI-RADS score), then transrectal RBx (12cores, blinded to MRI lesions) and TBx (2-4 cores/target) with elastic MRI/ultrasound fusion (UroStation™, Koelis, Grenoble, France). Histological findings were compared: PBx vs. RP.

RESULTS

One hundred and four patients underwent RP after RBx and/or TBx. ISUP concordance rate was better with the association RBx+TBx 49% (51/104) vs. 43.3% with TBx (P=0.07) and 43.3% with RBx (P=0.13). With RBx, 50% of the patients were downgraded (52/104) against 42.3% (44/104) with TBx (P=0.088). The association RBx+TBx significantly decreased the rate of downgrading of the ISUP score compared to the ISUP score of RP 35.6% (37/104) vs. RBx (50%, P=0.0001) and vs. TBx (42.3%, P=0.016).

CONCLUSION

In half of cases, the ISUP score was underestimated in RBx compared to RP specimens. Adding TBx to RBx significantly reduced downgrading. The combination of both biopsy techniques appeared to be the best protocol to get closer to ISUP score and GS of the RP specimens.

LEVEL OF EVIDENCE

C.

Human and animal botulism surveillance in France from 2008 to 2019

Botulism is a human and animal neurological disease caused by the action of bacterial neurotoxins (botulinum toxins) produced by bacteria from the genus Clostridium. This disease induces flaccid paralysis that can result in respiratory paralysis and heart failure. Due to its serious potential impact on public health, botulism is a closely monitored notifiable disease in France through a case-based passive surveillance system. In humans, this disease is rare, with an average of 10 outbreaks reported each year, mainly due to the consumption of contaminated foods. Type B and to a lesser extend type A are responsible for the majority of cases of foodborne botulism. Each year, an average of 30 outbreaks are recorded on poultry farms, about 20 cases in wild birds and about 10 outbreaks in cattle, involving a large number of animals. Mosaic forms C/D and D/C in birds and cattle, respectively, are the predominant types in animals in France. Types C and D have also been observed to a lesser extent in animals. With the exception of botulinum toxin E, which was exceptionally detected throughout the period in wild birds, the types of botulism found in animal outbreaks are different from those identified in human outbreaks over the last ten years in France and no human botulism outbreaks investigated have been linked to animal botulism. In line with the One Health concept, we present the first integrative approach to the routine surveillance of botulism in humans and animals in France.

A reply to "Relevant factors in the eutrophication of the Uruguay River and the Río Negro"

A recent paper by Beretta-Blanco and Carrasco-Letelier (2021) claims that agricultural eutrophication is not one of the main causes for cyanobacterial blooms in rivers and artificial reservoirs. By combining rivers of markedly different hydrological characteristics e.g., presence/absence and number of dams, river discharge and geological setting, the study speculates about the role of nutrients for modulating phytoplankton chlorophyll-a. Here, we identified serious flaws, from erratic and inaccurate data manipulation. The study did not define how erroneous original dataset values were treated, how the variables below the detection/quantification limit were numerically introduced, lack of mandatory variables for river studies such as flow and rainfall, arbitrary removal of pH > 7.5 values (which were not outliers), and finally how extreme values of other environmental variables were included. In addition, we identified conceptual and procedural mistakes such as biased construction/evaluation of model prediction capability. The study trained the model using pooled data from a short restricted lotic section of the (large) Uruguay River and from both lotic and reservoir domains of the Negro River, but then tested predictability within the (small) Cuareim River. Besides these methodological considerations, the article shows misinterpretations of the statistical correlation of cause and effect neglecting basic limnological knowledge of the ecology of harmful algal blooms (HABs) and international research on land use effects on freshwater quality. The argument that pH is a predictor variable for HABs neglects overwhelming basic paradigms of carbon fluxes and change in pH because of primary productivity. As a result, the article introduces the notion that HABs formation are not related to agricultural land use and water residence time and generate a great risk for the management of surface waterbodies. This reply also emphasizes the need for good practices of open data management, especially for public databases in view of external reproducibility.

Effect of transcutaneous electrical nerve stimulation (TENS) on knee pain and physical function in patients with symptomatic knee osteoarthritis: the ETRELKA randomized clinical trial

OBJECTIVE

To determine the effectiveness of TENS at relieving pain and improving physical function as compared to placebo TENS, and to determine its safety, in patients with knee osteoarthritis.

METHODS

Multi-centre, parallel, 1:1 randomized, double-blind, placebo-controlled clinical trial conducted in six outpatient clinics in Switzerland. We included 220 participants with knee osteoarthritis recruited between October 15, 2012, and October 15, 2014. Patients were randomized to 3 weeks of treatment with TENS (n = 108) or placebo TENS (n = 112). Our pre-specified primary endpoint was knee pain at the end of 3-weeks treatment assessed with the WOMAC pain subscale. Secondary outcome measures included WOMAC physical function subscale and safety outcomes.

RESULTS

There was no difference between TENS and placebo TENS in WOMAC pain at the end of treatment (mean difference -0.06; 95%CI -0.41 to 0.29; P = 0.74), nor throughout the trial duration (P = 0.98). Subgroup analyses did not indicate an interaction between patient/treatment characteristics and treatment effect on WOMAC pain at the end of treatment (P-interaction ≥0.22). The occurrence of adverse events was similar across groups, with 10.4% and 10.6% of patients reporting events in the TENS and placebo TENS groups, respectively (P = 0.95). No relevant differences were observed in secondary outcomes.

CONCLUSIONS

TENS does not improve knee osteoarthritis pain when compared to placebo TENS. Therapists should consider other potentially more effective treatment modalities to decrease knee osteoarthritis pain and facilitate strengthening and aerobic exercise. Our findings are conclusive and further trials comparing TENS and placebo TENS in this patient population are not necessary.

Multimodal imaging assessment of left atrial strain in cardiac amyloidosis and hypertrophic cardiomyopathies

Funding Acknowledgements

Type of funding sources: None.

Background

Despite the increasing number of studies concerning Left Atrial Strain (LAS), few data are available comparing LAS patients with cardiac amyloidosis (CA) and sarcomeric hypertrophic cardiomyopathies (HCM).

Purposes

We aimed to perform a comparative multimodal imaging analysis of LAS of a prospective cohort of patients with CA and HCM.

Methods

For each enrolled patient, we performed same-day two and three-dimension echocardiography (TTE) and cardiac magnetic resonance imaging (CMR) to blindly measure the peak atrial longitudinal strain (PALS) and the peak atrial contraction strain (PACS). Patients with acute atrial fibrillation were excluded.

Results

  Between January 2020 and July 2021, 67 patients were included: 31 patients with CA (age 75.1 ± 10 years, left ventricular ejection fraction 60.6 ± 10.4%, maximum left ventricular thickness 17.8 ± 3.9 mm) and 36 with HCM (age 50.8 ± 15.5 years, left ventricular ejection fraction 66.1 ± 9.8%, maximum left ventricular thickness 20.7 ± 4.5 mm). Left atrial volume was similar in the 2 groups (42.5 ± 15.6 mL/m2 in HCM vs 47.9 ± 15 in CA, P = 0.1557).

Concerning PALS, its values for CA and for CMH were on 2D TTE manual (10.9 ± 5.8% vs 21.4 ± 9.4%, P < 0.001), 2D TTE automatic (11.5 ± 7.3% vs 22.9 ± 10.2%, P < 0.001), 3D TTE (10 ± 6.8% vs 18.1 ± 6.7%, P < 0.001), and CMR (11.3 ± 8 vs 24.4 ± 17.1, P < 0.001) respectively.

Concerning PACS, its values for CA and for CMH were on 2D TTE manual (5.2 ± 3.4% vs 10 ± 4%, P < 0.001), 2D TTE automatic (4.9 ± 3.9% vs 10.2 ± 5.1%, P < 0.001), 3D TTE (3.6 ± 3.8% vs 7.9 ± 4%, P = 0.001) and CMR (6.2 ± 5.8% vs 11.9 ± 9%, P = 0.004) respectively.

Multivariate analysis adjusted on main factors influencing LAS (left ventricular (LV) mass, LV ejection fraction, LV global longitudinal strain, renal function and history of hypertension) found that the differences between the two groups remained significant for PALS and PACS for almost all technics.

Furthermore, although concordance between the 3 echocardiographic technics was excellent (the interclass correlation coefficient (ICC) was higher than 0.80 between each TTE methods), ICC was poor between TTE and CMR technics: 0.40 (0.18-0.59) for manual 2D TTE and CMR, 0.46 (0.24-0.63) for auto 2D TTE and CMR, 0.40 (0.14-0.60) for 3D TTE and CMR.

Conclusion

Our study is the first to describe and compare, both on TTE and CMR, LAS on a prospective cohort of patients with CA and HCM. Although they have same mean left atrial volume, we found significant differences on PALS and PACS between these two groups of patients on all the studied technics. These findings may be used in future multi-modality imaging studies dealing with diagnosis or prognosis of these hypertrophic cardiopathies. Abstract Figure. LAS 2D TTE manual  Abstract Figure. LAS comparison between CA and HCM

Migraine with aura

Around 15% to one-third of migraineurs experience aura. Aura is a fully reversible focal neurological phenomenon involving visual, sensory, speech, and/or motor symptoms that develops gradually and usually precedes the headache phase. The pivotal role of cortical spreading depression (CSD) as a mechanism underlying aura has been widely supported by a large body of studies. The diagnosis is based on the International Headache Classification Disorders III edition criteria. Aura is characterized by gradual development, duration of each symptom no longer than one hour, a mix of positive and negative features, and complete reversibility. Visual aura is the most common type of aura, occurring in over 90% of patients. When aura symptoms are multiple, they usually follow one another in succession, beginning with visual, then sensory, then aphasic; but the reverse and other orders have been noted. The accepted duration for most aura symptoms is one hour, but motor symptoms, which are rare, are often longer lasting. When a patient experiences for the first time a possible aura phase it's sometimes difficult to know if there was gradual or brutal onset of the symptoms. If the patient has no visual aura symptoms or simultaneous neurological symptoms, or presents neurological symptoms corresponding to a cerebral vascular territory, emergency exploration of a possible transient ischemic attack is necessary. Long duration (greater than one hour) of what may or may not be an aura phase, late onset of aura, or a dramatic increase in aura attacks should also be explored. The relative risk of ischemic stroke is significantly increased in migraine with aura. Combined hormonal contraception with estrogens significantly increases the risk of stroke in women with migraine with aura. It is recommended to start non-steroidal anti-inflammatory drugs (NSAIDs) or aspirin as soon as possible during the aura phase, not to treat the aura, but to avoid or to diminish the headache phase. In case of failure of NSAIDs or aspirin it is recommended to use a triptan when the headache begins. The prophylactic treatments for migraine with aura are those used in migraine without aura based on very few randomized clinical trials specifically dedicated to migraine with aura.

Revised guidelines of the French Headache Society for the diagnosis and management of migraine in adults. Part 1: Diagnosis and assessment

The French Headache Society proposes updated French guidelines for the management of migraine. The first part of these recommendations is focused on the diagnosis and assessment of migraine. First, migraine needs to be precisely diagnosed according to the currently validated criteria of the International Classification of Headache Disorders, 3d version (ICHD-3). Migraine-related disability has to be assessed and we suggest to use the 6 questions of the headache impact test (HIT-6). Then, it is important to check for risk factors and comorbidities increasing the risk to develop chronic migraine, especially frequency of headaches, acute medication overuse and presence of depression. We suggest to use a migraine calendar and the Hospital Anxiety and Depression scale (HAD). It is also necessary to evaluate the efficacy and tolerability of current migraine treatments and we suggest to systematically use the self-administered Migraine Treatment Optimization Questionnaire (M-TOQ) for acute migraine treatment. Finally, a treatment strategy and a follow-up plan have to be proposed. Guidelines for pharmacological and non-pharmacological treatments are presented in the second and third part of the recommendations.

Revised guidelines of the French headache society for the diagnosis and management of migraine in adults. Part 3: Non-pharmacological treatment

The French Headache Society proposes updated French guidelines for the management of migraine. This article presents the third part of the guidelines, which is focused on the non-pharmacological treatment of migraine, including physical exercise, dietary supplements and plants, diets, neuromodulation therapies, acupuncture, behavioral interventions and mindfulness therapy, patent foramen ovale closure and surgical nerve decompression.

Revised guidelines of the French headache society for the diagnosis and management of migraine in adults. Part 2: Pharmacological treatment

The French Headache Society proposes updated French guidelines for the management of migraine. This article presents the second part of the guidelines, which is focused on the pharmacological treatment of migraine, including both the acute treatment of attacks and the prophylaxis of episodic migraine as well as chronic migraine with and without medication overuse. The specific situations that can be encountered in women with migraine are also discussed, including pregnancy, menstrual migraine, contraception and hormonal replacement therapy.

Medication overuse headache: Updating of the French recommendations regarding the treatments strategies

Regular and frequent use of analgesics and acute antimigraine drugs can increase the frequency of headache, and induce the transition from episodic to chronic migraine or medication-overuse headache (MOH). The one-year prevalence of this condition is between 1% and 2% in Europe, provoking substantial burden. MOH is more prevalent in people with comorbid depression, anxiety, and other chronic pain conditions. This paper aims at presenting an updating of French recommendations regarding treatments strategies. Prior French recommendations, published in 2014, were written in French. A literature search in the major medical databases including the terms "medication overuse headache", "symptomatic medication overuse", published between 2010 and 2020 was carried out. Three main strategies can be recommended and conducted in parallel: education and explanations about the negative consequences of overusing acute antimigraine drugs, discontinuation of the overused medication, and finally, preventive drug therapy and non-pharmacological prevention. Medication overuse headache remains a debated problem and evidence for the most effective treatment strategy is needed.

Identifying prognostic factors to determine the level of recovery in servicemembers with chronic low back pain: A prospective cohort study

OBJECTIVE

The main objective of this study was to identify general and military-related factors that are associated with the level of recovery in Dutch service members with chronic low back pain (CLBP) who followed a rehabilitation program.

MATERIAL AND METHOD

One hundred five consecutive service members with CLBP were included in this study. The level of disability, was used to distinguish a recovered and non-recovered group. Level of pain and self-perceived recovery were used as secondary outcome measurements. Differences were evaluated within and between the groups using the Student's t-test Bivariate logistic regression analyses were used for identifying the prognostic factors related to various outcomes of recoveryRESULTS: After following the rehabilitation program, 64.8% of the service members recovered from CLBP. The recovered group, demonstrated significant effect sizes in disability and in pain The non-recovered group showed on disability a non-significant effect and in pain a significant effect. The self-perceived recovery in the recovered group was "much improved" and the non-recovered group "slightly improved". The results of the bivariate regression analyses showed no significant independent prognostic factors related to recovery.

CONCLUSIONS

In this study, no significant independent prognostic factors could be identified that were associated to the various outcomes of recovery in service members with CLBP who followed a rehabilitation program.

POS0403 RISK FACTORS FOR PROGRESSION OF RHEUMATOID ARTHRITIS-ASSOCIATED INTERSTITIAL LUNG DISEASE: REASSURING IMPACT OF METHOTREXATE

Background:

Factors associated with rheumatoid arthritis-associated interstitial lung disease (RA-ILD) progression and prognosis are not well identified, especially the impact of methotrexate.

Objectives:

Identify risk factors of ILD progression in RA-ILD patients in a longitudinal study.

Methods:

RA patients with ILD confirmed in 2 high resolution computed tomography (HRCT) chest scans spaced at least 6 months apart (T0: date of the first HRCT chest scan describing ILD; Tx: date of the last HRCT chest scan available) were consecutively included in this retrospective multi-centric study from 2010 to 2020. HRCT chest scans were analyzed for each patient at T0 and Tx by 2 independent radiologists to determinate ILD pattern (definite UIP, probable UIP, indeterminate UIP, non-UIP) and progression during the follow-up including variation of the fibrosis score (aggravated or non-aggravated). Characteristics of patients (demographic-clinical-biological findings, respiratory function tests, and treatments exposure) at ILD diagnosis and during the follow-up (T0-Tx) were analyzed as potential determinants of ILD progression through multivariable logistic regression analysis. Overall survival was analyzed using Kaplan-Meier method.

Results:

74 RA-ILD patients were included. During a mean duration between T0-Tx of 2.8 years ± 2.4, 26 patients (35%) had ILD progression. Thirty-three patients (45%) were treated by methotrexate at ILD diagnosis (T0) and 29 of them (39%) continued methotrexate during T0-Tx. Logistic regression in multivariate analysis revealed that a treatment by methotrexate at ILD diagnosis was protective against ILD progression (OR=0.14 [0.04-0.52]; p=0.0031). Non-UIP pattern at ILD diagnosis was also protective against ILD progression (OR=0.09 [0.02-0.36]; p=0.0005). The follow-up for survival analysis was 5.1 years ± 2.9. Thirty-three patients (31%) died, and the 3-year survival rate was 80%. Survival was better for non-aggravated ILD patients (HR=3.5 [1.46-8.4]; p=0.004) and for patients treated by methotrexate during T0-Tx (HR= 0.36 [0.15-0.84]; p=0.018) and worse for definite UIP patterns (HR=2.570 [1.078-6.128]; p=0.0332).

Conclusion:

In RA-ILD patients, non-UIP pattern and methotrexate treatment are associated with better ILD evolution and prognosis.

Disclosure of Interests:

None declared

Gender and gut microbiota composition determine hepatic bile acid, metabolic and inflammatory response to a single fast-food meal in healthy adults

BACKGROUND & AIMS

Regular consumption of fast-food (FF) as a form of typical Western style diet is associated with obesity and the metabolic syndrome, including its hepatic manifestation nonalcoholic fatty liver disease. Currently, it remains unclear how intermittent excess FF consumption may influence liver metabolism. The study aimed to characterize the effects of a single FF binge on hepatic steatosis, inflammation, bile acid (BA), glucose and lipid metabolism.

METHODS

Twenty-five healthy individuals received a FF meal and were asked to continue eating either for a two-hour period or until fully saturated. Serum levels of transaminases, fasting BA, lipid profile, glucose and cytokine levels as well as transient elastography and controlled attenuation parameter (CAP; to assess hepatic steatosis) were analyzed before (day 0) and the day after FF binge (day 1). Feces was collected prior and after the FF challenge for microbiota analysis.

RESULTS

The FF meal induced a modest increase in CAP, which was accompanied by a robust increase of fasting serum BA levels. Surprisingly, levels of cholesterol and bilirubin were significantly lower after the FF meal. Differentiating individuals with a relevant delta BA (>1 μmol/l) increase vs. individuals without (delta BA ≤1 μmol/l), identified several gut microbiota, as well as gender to be associated with the BA increase and the observed alterations in liver function, metabolism and inflammation.

CONCLUSION

A single binge FF meal leads to a robust increase in serum BA levels and alterations in parameters of liver injury and metabolism, indicating a novel metabolic aspect of the gut-liver axis.

Dietary fish hydrolysate supplementation containing n-3 LC-PUFAs and peptides prevents short-term memory and stress response deficits in aged mice

Brain aging is characterized by a decline in cognitive functions, which can lead to the development of neurodegenerative pathologies. Age-related spatial learning and memory deficits are associated with a chronic low-grade inflammation. Anxiety disorders and stress response alterations, occurring for a part of the elderly, have also been linked to an increased neuroinflammation and thus, an accelerated cognitive decline. Nutrition is an innovative strategy to prevent age-related cognitive impairments. Among the nutrients, n-3 long chain polyunsaturated fatty acids (LC-PUFAs) and low molecular weight peptides from proteins, especially those from marine resources, are good candidates for their immunomodulatory, anxiolytic and neuroprotective properties. The aim of this study is to determine the combined effect of n-3 LC-PUFAs and low molecular weight peptides on cognitive functions, and their mechanism of action. We are the first to show that a dietary supplementation with a fish hydrolysate containing n-3 LC-PUFAs and low molecular weight peptides prevented the age-related spatial short-term memory deficits and modulated navigation strategies adopted during spatial learning. In addition, the fish hydrolysate displayed anxiolytic activities with the reduction of anxiety-like behaviour in aged mice, restored the plasmatic corticosterone levels similar to adult animals following an acute stress and modulated the hypothalamic stress response. These effects on behaviour can be explained by the immunomodulatory and neuroprotective properties of the fish hydrolysate that limited microgliosis in vivo, decreased LPS-induced expression of pro-inflammatory cytokines and increased the expression of growth factors such as BDNF and NGF in vitro. Thus, n-3 LC-PUFAs and low molecular weight peptides contained in the fish hydrolysate can play an important role in the limitation of neuroinflammation and stress response alterations during aging and represent a potential strategy for the prevention of age-related cognitive decline.

Despite an improved aerobic endurance, still high attrition rates in initially low-fit recruits-results of a randomised controlled trial

Background

Low baseline fitness of recruits entering basic military training (BMT) is associated with an increased risk of musculoskeletal injuries (MSIs) and attrition from training.

Objective

To determine the effects of a pre-training conditioning program (PCP) on aerobic endurance, incidence of musculoskeletal injuries (MSIs), and attrition rates in BMT of a special infantry unit of the Netherlands Armed Forces.

Participants

Recruits were considered eligible for this study when they were ‘low-fit’ at the start of BMT (time to complete a 2.7-km run ≥ 12′23″).

Interventions

‘Low-fit’ recruits were deferred to a seven to twelve week—depending on the time between two consecutive training platoons—PCP consisting of functional training to improve several fitness domains. The control (CON) group started regular BMT without delay.

Results

Forty-nine recruits were included in this study; 26 in the PCP-group and 23 in the CON-group. Recruits who followed the PCP started BMT with better aerobic endurance than the CON-group who started BMT immediately (2.7 km run timings: PCP 11′32″, CON 13′16″). The risk of dropout was lower in the PCP-group (incidence density ratio (IDR) 0.63, 95%CI 0.32; 1.26), but dropout due to training-related MSIs was more frequent (IDR 1.23, 95%CI 0.32; 4.76 (per-protocol 0.94, 95%CI 0.24; 3.63), without statistically significant differences between the groups.

Conclusion

Although a PCP was effective to improve aerobic endurance in low-fit recruits to return to meet pre-enlistment fitness criteria, we could not demonstrate an effect on dropout from military training.

Trial registration

Dutch trial register Trial NL6791 (NTR6977) https://www.trialregister.nl/trial/6791.

•

Low baseline fitness of recruits is associated with musculoskeletal injuries and dropout from military training.

•

A pre-training conditioning program was capable of improving physical fitness in low-fit recruits.

•

However, dropout from training remained high, perhaps due to common other causes.

•

Future research should focus on identifying these physical, social and mental factors, and their interactions.

Diversity of Escherichia coli strains isolated from day-old broiler chicks, their environment and colibacillosis lesions in 80 flocks in France

Avian colibacillosis is the most common bacterial disease affecting broilers. To better evaluate the diversity and the origin of the causative Escherichia coli strains infecting birds, we conducted a study on 80 broiler flocks. Just before the arrival of chicks on the farm, samples were collected in the farm environment (walls, feeders, air inlets, etc.) and, upon delivery, day-old chicks (DOCs) and the transport boxes were also sampled. Isolates were obtained from these samples, and from organs of chickens exhibiting typical colibacillosis symptoms. The isolates were characterized using high-throughput qPCR to detect a range of genetic markers (phylogroups, main serogroups virulence markers, etc.). A total of 967 isolates were studied, including 203 from 28 colibacillosis episodes, 484 from DOCs, 162 from transport boxes and 118 from the farm environment. These isolates yielded 416 different genetic profiles, of which 267 were detected in single isolates, and the others were observed in up to 44 isolates from nine farms. The distributions of isolates across phylogroups and the main serogroups varied with the origin of isolation. The isolates obtained from colibacillosis cases either shared a single genetic profile or were different. In a few cases, we observed the same profile for isolates obtained from DOCs and colibacillosis lesions in the same flock or different flocks. However, some flocks receiving DOCs contaminated with isolates bearing the genetic profile of colibacillosis cases identified in other flocks remained healthy. This study highlights the huge diversity among avian E. coli isolated from diseased and non diseased birds.

Practice recommendations for neurovascular ultrasound investigations of acute stroke patients in the setting of the COVID-19 pandemic: an expert consensus from the European Society of Neurosonology and Cerebral Hemodynamics

Background and purpose

Patients with acute ischemic stroke are at high‐risk for contracting COVID‐19 infection. Additionally, healthcare professionals including neurovascular ultrasound providers are also at risk of being infected by SARS‐CoV‐2 virus. Yet, preparedness to continue to guarantee hyperacute treatment is vital for patients outcome. In light of this situation, the European Society of Neurosonology and Cerebral Hemodynamic (ESNCH) appointed a task force to provide consensus recommendations for the performance of neurovascular ultrasound investigations in acute ischemic stroke during the COVID‐19 pandemic with the aim of protecting both patients and ultrasound providers.

Methods

The “ultrasound in acute stroke working group” of the ESNCH examined literature articles and reviews using the following key words: “corona virus” or “COVID‐19” or “SARS‐CoV‐2 virus”, and “acute stroke” or “cerebrovascular disease”, and “ultrasound”. Thereafter, a thorough discussion was conducted with the “education and guidelines working group” of the ESNCH.

Results

We propose rapid up‐to‐date recommendations for healthcare personnel involved in the pre‐hospital and intra‐hospital assessment of stroke patients, with a particular attention to neurovascular ultrasound performance.

Conclusion

The ESNCH provides a guidance summary for the performance of neurovascular ultrasound investigations in acute ischemic stroke in the time of COVID‐19.

AB0034 EARLY IMMUNIZATION AGAINST TREATMENT IS ASSOCIATED TO POOR CLINICAL RESPONSE AT 6 MONTHS AND LOW NUMBER OF TRANSITIONAL B CELLS AT BASELINE IN RHEUMATOID ARTHRITIS PATIENTS TREATED BY ADALIMUMAB

Background:

Circulating anti-drug antibodies (ADAs) are detectable approximatively in 33% of adalimumab treated rheumatoid arthritis (RA) patients, often within the first 6 months of therapy1-2. Classically, circulating ADAs associate with their specific drugs to form immune complexes, increasing drug clearance, and by this mechanism reducing therapeutic effect3. B cell involvement leading to ADAs production is not yet well established.

Objectives:

To study early ADAs formation according to clinical response to an adalimumab therapy in RA patients and the relationship between ADAs and circulating B cell subsets.

Methods:

28 RA patients and 13 healthy controls were included. Patients all presented inadequately controlled RA under conventional treatment, were naive of biotherapies, and started an adalimumab treatment at baseline (M0). Responder status was determined according to the DAS28CRP score (<or>3.2) at 3 (M3) and 6 months (M6). ADAs plasma concentration >10pg/mL at M3 defined the immunized patient group. Circulating B cell subsets were quantified by flow cytometry at M0 and M3.

Results:

11 (42.3%) patients were immunized at M3. Among them, 4 (36.4%) were responders at M6 and 7 (63.6%) were non-responders. Presence and concentration of ADAs at M3 was associated to non-responder status at M6 (p=0.043; p=0.042). Immunized patients had lower transitional B cells count at M0 compared to non-immunized patients (p=0.031).

Conclusion:

A high but classical proportion of RA patients developed ADAs after only 3 months of adalimumab treatment. This immunization was associated to non-responder status at M6 and to a low blood transitional B cells count at baseline. Our results suggest transitional B cells implication in

RA activity and biotherapy resistance due to immunization. Low concentrations of transitional B cells could be an early biomarker of immunization process against adalimumab.

References:

[1]Bartelds GM et al. JAMA. 2011

[2]Moots RJ et al. PLoS ONE. 2017

[3]Van Schouwenburg PA et al. Ann Rheum Dis. 2013

Table.

Patients characteristics at baseline

CharacteristicsAll RA patients (n=28)M6 responders(n=16)M6 non-responders(n=10)Age (years)60.5 [47-78]65.5 [47-76]54 [47-78]Sex ratio M/F (% of F)0.4 (71,4%)0.5 (68.8%)0.3 (80.0%)Disease duration, (years)5.6 [0.7-43.0]6.8 [1.0-43.0]2.9 [0.7-31.0]Oral steroid use, (%)18 (64,3%)9 (56.2%)8 (80.0%)Oral steroids, dose (mg/day)5.0 [2.0-15]5.0 [4.0-12.5]8.5 [2.5-15.0]Methotrexate use, (%)24 (50.9%)14 (87.5%)8 (80.0%)Methotrexate, dose (mg/week)20 [10-25]20 [10-25]15 [10-20]*Leflunomide use, (%)3 (10.7)1 (6.3%)2 (20.0%)Leflunomide, dose (mg/day)20 [20-20]20 [20-20]20 [20-20]CRP, (mg/dL)5.5 [1.0-57.0]6.6 [1.0-46.8]3.6 [1.0-57.0]DAS28CRP score4.3 [3.3-5.7]4.1 [3.3-5.2]4.5 [3.4-5.7]RF positive, (%)20 (71.4%)12 (75.0%)6 (60.0%)RF, (U/mL)116 [19-640]88 [21-640]181 [19-336]ACPA positive, (%)25 (89.3%)15 (93.8%)8 (80.0%)ACPA, (U/mL)340 [11-340]340 [14-340]340 [11-340]

Values are medians with ranges and frequencies with percentages. *p=0.050.

Figure 1.

Graph 1Immunization against treatment at 3 months and clinical response at 6 months in RA patients (n=26). Presence of ADAs at 3 months is associated to non-responder status at 6 months. Fisher exact test. R, responders at 6 months; NR, non-responders at 6 months; ADA+, immunized patients at 3 months; ADA-, non-immunized patients at 3 months.

Figure 2.

Graph 2Absolute number of transitional B cells at baseline in RA patients (n=28) according to immunized status at 3 months. Immunized patients at 3 months had lower transitional B cells at baseline than non-immunized patients. ADA+, immunized patients at 3 months; ADA-, non-immunized patients at 3 months. Data represent the mean; *p<0.05 by Mann-Whitney U test.

Disclosure of Interests:

None declared

One out of four recruits drops out from elite military training due to musculoskeletal injuries in the Netherlands Armed Forces

Introduction

Musculoskeletal injuries (MSIs) are among the main causes of dropout from military training. The main purpose of this study was to provide an overview of dropout rates and MSI incidence rates during elite military training. Second, this study aimed to explore restricted training days due to MSIs and to describe MSI-care by military physicians.

Methods

In a retrospective observational study, we collected dropout rates and injury surveillance data from the electronic patient records of two elite units of the Netherlands Armed Forces (NAF): the Royal Netherlands Marine Corps (RNLMC) and the Airmobile Brigade (AMB), from 1 January 2015 until 31 December 2017.

Results

In the RNLMC, total dropout rate was 53.9% and dropout due to MSIs was 23%. The most frequently affected locations were foot, knee and leg. In the AMB total dropout rate was 52.6% and dropout due to MSIs was 25%. In the AMB, the most frequently affected locations were back, knee and leg. Average restricted training days due to MSIs ranged between 8.3 and 20.8 days/injury. MSI-care by military physicians consisted mostly of the provision of injury-specific information and (self-)management options, imposing a specific activity restriction and referral to physiotherapy.

Conclusion

Our study findings showed that one out of four recruits who dropout from elite military training in the NAF, do so due to MSIs. Redesigning training programmes with the objective to reduce MSIs should be given high priority, as this may reduce dropout substantially.

Agreement between physical therapists and radiologists of stratifying patients with shoulder pain into new treatment related categories using ultrasound; an exploratory study

STUDY DESIGN

A systematic overview of the literature and an agreement study.

OBJECTIVES

The aim of this study is to explore the inter-professional agreement of diagnostic musculoskeletal ultrasound (DMUS) between physical therapists (PT) and radiologists, using a new classification strategy based upon the therapeutic consequences in patients with shoulder pain.

BACKGROUND

DMUS is frequently used by PTs, although the agreement regarding traditional diagnostic labels between PTs and radiologists is only fair. Nevertheless, DMUS could be useful when used as a stratifying-tool.

METHODS

First, a systematic overview of current evidence was performed to assess which traditional diagnostic labels could be recoded into new treatment related categories (referral to secondary care, corticosteroid injections, physical therapy, watchful waiting). Next, kappa values were calculated for these categories between PTs and radiologists.

RESULTS

Only three categories were extracted, as none of the traditional diagnostic labels were classified into the 'corticosteroid injection' category. Overall, we found moderate agreement to stratify patients into treatment related categories and substantial agreement for the category 'referral to secondary care'. Both categories 'watchful waiting' and 'indication for physical therapy' showed moderate agreement between the two professions.

CONCLUSION

Our results indicate that the agreement between radiologists and PTs is moderate to substantial when labelling is based on treatment consequences. DMUS might be able to help the PT to guide treatment, especially for the category 'referral to secondary care' as this showed the highest agreement. However, as this is just an explorative study, more research is needed, to validate and assess the consequences of this stratification classification for clinical care.

A pre-training conditioning program to increase physical fitness and reduce attrition due to injuries in Dutch Airmobile recruits: Study protocol for a randomised controlled trial

Background

Low baseline fitness of recruits entering basic military training is shown to be associated with an increased risk of musculoskeletal injuries (MSIs) and attrition of military training. This in turn leads to an increased demand for health care, increased health care costs and decreased personnel occupancy rate of military units.

Design

Study protocol for a randomised controlled trial.

Objective

To determine the effects of a pre-training conditioning program on cardiovascular endurance, incidence of overuse injuries, and attrition rates in Dutch Airmobile recruits undertaking initial military training.

Setting

Royal Netherlands Army, Air Assault Brigade military training course.

Participants

Recruits are considered eligible for this study when they are ‘low-fit’ at the start of the initial military training. Time to complete a 2700 m run test in ≥12′23’’ is used as selection criteria.

Interventions

We use a complex system approach to cover multiple domains of MSI prevention and optimise intervention circumstance; a pre-training conditioning program, training staff support, process-focused culture and health accountability. The pre-training conditioning program contains functional training to improve mobility, power, agility, lower and upper body strength and cardiovascular endurance. Cardiovascular endurance will be targeted both by endurance training and high intensity interval training.

Main outcome measurements

Outcome measures include cardiovascular endurance, injury incidence, attrition rates, lost training days due to injuries, and implementation fidelity of the PCP.

Trial status

Recruitment of participants commenced April 18, 2018 and final results are expected in August 2019.

Trial registration

Dutch trial register www.trialregister.nl/=trial/6791.

On the emerging relationship between the stratospheric Quasi-Biennial oscillation and the Madden-Julian oscillation

A strong relationship between the quasi-biennial oscillation (QBO) of equatorial stratospheric winds and the amplitude of the Madden-Julian oscillation (MJO) during the boreal winter has recently been uncovered using observational data from the mid-1970s to the present. When the QBO is in its easterly phase in the lower stratosphere, it favors stronger MJO activity during boreal winter, while the MJO tends to be weaker during the westerly phase of the QBO. Here we show using reconstructed indices of the MJO and QBO back to 1905 that the relationship between enhanced boreal winter MJO activity and the easterly phase of the QBO has only emerged since the early 1980s. The emergence of this relationship coincides with the recent cooling trend in the equatorial lower stratosphere and the warming trend in the equatorial upper troposphere, which appears to have sensitized MJO convective activity to QBO-induced changes in static stability near the tropopause. Climate change is thus suggested to have played a role in promoting coupling between the MJO and the QBO.

"Two heads are better than one"- pharmacy and nursing students' perspectives on interprofessional collaboration utilizing the RIPE model of learning

BACKGROUND

Simulation is an effective strategy for enhancing interprofessional education (IPE) and collaboration (IPC).

OBJECTIVES

A novel interprofessional learning model, The RIPE Model (Reflective Interprofessional Education Model) was applied for a pilot study during a simulation laboratory aimed to (i) enhance pharmacy and nursing students' understanding of the roles and responsibilities of professions within the multidisciplinary healthcare team; and (ii) enhance the importance of working collaboratively in team-based care.

METHODS

The pilot study using a mixed-methods approach, including the administration of a 6-item student survey on a 6-point Likert-type scale as a pre-test (prior to participation in the simulation laboratory) and post-test (after participation in the simulation laboratory), and a debriefing session eliciting a follow up written reflective statement.

RESULTS

Sixty-four students (n = 56 pharmacy; n = 8 nursing) participated in the study which resulted n = 52 pharmacy students and n = 8 nursing students matched data to a pre-test and post-test survey, analyzed via paired t-tests. Statistically significant results (p < 0.05) reported a positive increase in pharmacy students' perceptions from the pre-test and post-test survey for all six items indicating the extent of agreement of IPC; and for one item on the nursing student survey. Qualitative analysis of reflective statements (n = 62) was conducted via thematic analysis utilizing Braun and Clarke's 6-phase process. Thematic analysis generated one overarching theme: IPC: Developing appreciation and respect for healthcare team members to improve patient outcomes; and three subthemes: (i) Enhanced decision-making; (ii) Communication and collaboration; (iii) New understandings of roles and responsibilities.

CONCLUSIONS

Students perceived that utilizing the RIPE Model of learning involving simulation to enhance interprofessional collaboration assisted their understanding of the roles, functions and responsibilities of other healthcare professionals involved the patient care team. Effective collaboration was perceived to be beneficial to enhancing confidence with engagement and communication, appreciation and respect for the expertise of other healthcare professions.

The effect of functional-task training on activities of daily living for people with Parkinson`s disease, a systematic review with meta-analysis

OBJECTIVE

To evaluate the effect of functional-task training on activities of daily living (ADL) in people with Parkinson`s Disease.

METHODS

We searched five databases (Cinahl, Embase, Medline, Pedro and CENTRAL). The included studies were assessed on therapeutic validity and risk of bias. We classified the quality of evidence according to the principles of the GRADE approach. All assessments were executed independently by two researchers. The results of included studies were pooled in a meta-analyses and heterogeneity was explored by meta-regression analysis.

RESULTS

Out of 2546 identified studies, 69 full texts articles were checked for eligibility, of which ten were included in the systematic review. Moderate quality of evidence indicated that exercise interventions containing functional-task training had a positive effect on ADL performance scores on the Unified Parkinson's Disease Rating Scale (UPDRS) in people with Parkinson (pwp) directly after intervention (UPDRS=-2.62(-5.34;0.10)). This effect improved, in favor of functional-task interventions, at the first follow-up (UPDRS=-4.0(-7.56;-0.4)). A post-hoc meta-regression analysis yielded a significant relationship between intensity rate (minutes/week) and the size of the (average) effect on ADL score.

CONCLUSION

Exercise interventions containing functional-task training have a clinically important positive effect on ADL performance in pwp directly after intervention and at first follow-up, compared to no intervention or placebo. The intensity rate of the functional-task training should be as intense as possible, within the capabilities of the person with PD. Future research is necessary to determine the exact amount of effect that can be contributed to functional-task training.

Measurement of Prompt D^{0} Meson Azimuthal Anisotropy in Pb-Pb Collisions at sqrt[s_{NN}]=5.02 TeV

The prompt D^{0} meson azimuthal anisotropy coefficients, v_{2} and v_{3}, are measured at midrapidity (|y|<1.0) in Pb-Pb collisions at a center-of-mass energy sqrt[s_{NN}]=5.02  TeV per nucleon pair with data collected by the CMS experiment. The measurement is performed in the transverse momentum (p_{T}) range of 1 to 40  GeV/c, for central and midcentral collisions. The v_{2} coefficient is found to be positive throughout the p_{T} range studied. The first measurement of the prompt D^{0} meson v_{3} coefficient is performed, and values up to 0.07 are observed for p_{T} around 4  GeV/c. Compared to measurements of charged particles, a similar p_{T} dependence, but smaller magnitude for p_{T}<6  GeV/c, is found for prompt D^{0} meson v_{2} and v_{3} coefficients. The results are consistent with the presence of collective motion of charm quarks at low p_{T} and a path length dependence of charm quark energy loss at high p_{T}, thereby providing new constraints on the theoretical description of the interactions between charm quarks and the quark-gluon plasma.

Efficacy and safety of a T-type calcium channel blocker in patients with neuropathic pain: A proof-of-concept, randomized, double-blind and controlled trial

BACKGROUND

T-type calcium channels have been shown to play an important role in the initiation and maintenance of neuropathic pain and represent a promising therapeutic target for new analgesic treatments. Ethosuximide (ETX), an anticonvulsant and a T-type channel blocker has shown analgesic effect in several chronic pain models but has not yet been evaluated in patients with neuropathic pain.

METHODS

This proof-of-concept, multicentre, double-blind, controlled and randomized trial compared the efficacy and safety of ETX (given as add-on therapy) to an inactive control (IC) in 114 patients with non-diabetic peripheral neuropathic pain. After a 7-day run-in period, eligible patients aged over 18 years were randomly assigned (1:1) to ETX or IC for 6 weeks. The primary outcome was the difference between groups in the pain intensity (% of change from the baseline to end of treatment) assessed in the intention-to-treat population. This study is registered with EudraCT (2013-004801-26) and ClinicalTrials.gov (NCT02100046).

RESULTS

The study was stopped during the interim analysis due to the high number of adverse events in the active treatment group. ETX failed to reduce total pain and showed a poor tolerance in comparison to IC. In the per-protocol analysis, ETX significantly reduced pain intensity by 15.6% (95% CI -25.8; -5.4) from baseline compared to IC (-7.8%, 95% CI -14.3; -1.3; p = 0.033), but this result must be interpreted with caution because of a small subgroup of patients.

CONCLUSION

Ethosuximide did not reduce the severity of neuropathic pain and induces, at the doses used, many adverse events.

SIGNIFICANCE

This article shows that ETX is not effective to treat neuropathic pain. Nevertheless, per-protocol analysis suggests a possible analgesic effect of ETX. Thus, our work adds significant knowledge to preclinical and clinical data on the benefits of T-type calcium channel inhibition for the treatment of neuropathic pain.

Measurement of associated Z + charm production in proton-proton collisions at s = 8 TeV

A study of the associated production of a Z boson and a charm quark jet ( Z + c ), and a comparison to production with a b quark jet ( Z + b ), in p p collisions at a centre-of-mass energy of 8TeV are presented. The analysis uses a data sample corresponding to an integrated luminosity of 19.7fb - 1 , collected with the CMS detector at the CERN LHC. The Z boson candidates are identified through their decays into pairs of electrons or muons. Jets originating from heavy flavour quarks are identified using semileptonic decays of c or b flavoured hadrons and hadronic decays of charm hadrons. The measurements are performed in the kinematic region with two leptons withp T ℓ > 20 GeV ,| η ℓ | < 2.1 , 71 < m ℓ ℓ < 111 GeV , and heavy flavour jets withp T jet > 25 GeV and| η jet | < 2.5 . The Z + c production cross section is measured to be σ ( p p → Z + c + X ) B ( Z → ℓ + ℓ - ) = 8.8 ± 0.5 (stat) ± 0.6 (syst) pb . The ratio of the Z + c and Z + b production cross sections is measured to be σ ( p p → Z + c + X ) / σ ( p p → Z + b + X ) = 2.0 ± 0.2 (stat) ± 0.2 (syst) . The Z + c production cross section and the cross section ratio are also measured as a function of the transverse momentum of the Z boson and of the heavy flavour jet. The measurements are compared with theoretical predictions.

Suppression of Excited ϒ States Relative to the Ground State in Pb-Pb Collisions at sqrt[s]_{NN}=5.02 TeV

The relative yields of ϒ mesons produced in pp and Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV and reconstructed via the dimuon decay channel are measured using data collected by the CMS experiment. Double ratios are formed by comparing the yields of the excited states, ϒ(2S) and ϒ(3S), to the ground state, ϒ(1S), in both Pb-Pb and pp collisions at the same center-of-mass energy. The double ratios, [ϒ(nS)/ϒ(1S)]_{Pb-Pb}/[ϒ(nS)/ϒ(1S)]_{pp}, are measured to be 0.308±0.055(stat)±0.019(syst) for the ϒ(2S) and less than 0.26 at 95% confidence level for the ϒ(3S). No significant ϒ(3S) signal is found in the Pb-Pb data. The double ratios are studied as a function of collision centrality, as well as ϒ transverse momentum and rapidity. No significant dependencies are observed.

Study of dijet events with a large rapidity gap between the two leading jets in pp collisions at s = 7 TeV

Events with no charged particles produced between the two leading jets are studied in proton-proton collisions ats = 7 TeV . The jets were required to have transverse momentump T jet > 40 GeV and pseudorapidity1.5 < | η jet | < 4.7 , and to have values of η jet with opposite signs. The data used for this study were collected with the CMS detector during low-luminosity running at the LHC, and correspond to an integrated luminosity of 8pb - 1 . Events with no charged particles withp T > 0.2 GeV in the interval - 1 < η < 1 between the jets are observed in excess of calculations that assume no color-singlet exchange. The fraction of events with such a rapidity gap, amounting to 0.5-1% of the selected dijet sample, is measured as a function of the p T of the second-leading jet and of the rapidity separation between the jets. The data are compared to previous measurements at the Tevatron, and to perturbative quantum chromodynamics calculations based on the Balitsky-Fadin-Kuraev-Lipatov evolution equations, including different models of the non-perturbative gap survival probability.

Observation of Correlated Azimuthal Anisotropy Fourier Harmonics in pp and p+Pb Collisions at the LHC

The azimuthal anisotropy Fourier coefficients (v_{n}) in 8.16 TeV p+Pb data are extracted via long-range two-particle correlations as a function of the event multiplicity and compared to corresponding results in pp and PbPb collisions. Using a four-particle cumulant technique, v_{n} correlations are measured for the first time in pp and p+Pb collisions. The v_{2} and v_{4} coefficients are found to be positively correlated in all collision systems. For high-multiplicity p+Pb collisions, an anticorrelation of v_{2} and v_{3} is observed, with a similar correlation strength as in PbPb data at the same multiplicity. The new correlation results strengthen the case for a common origin of the collectivity seen in p+Pb and PbPb collisions in the measured multiplicity range.

Measurements of the p p → Z Z production cross section and the Z → 4 ℓ branching fraction, and constraints on anomalous triple gauge couplings at s = 13 TeV

Four-lepton production in proton-proton collisions, p p → ( Z / γ ∗ ) ( Z / γ ∗ ) → 4 ℓ , where ℓ = e or μ , is studied at a center-of-mass energy of 13TeV with the CMS detector at the LHC. The data sample corresponds to an integrated luminosity of 35.9fb - 1 . The ZZ production cross section, σ ( p p → Z Z ) = 17.2 ± 0.5 (stat) ± 0.7 (syst) ± 0.4 (theo) ± 0.4 (lumi) pb , measured using events with two opposite-sign, same-flavor lepton pairs produced in the mass region 60 < m ℓ + ℓ - < 120 GeV , is consistent with standard model predictions. Differential cross sections are measured and are well described by the theoretical predictions. The Z boson branching fraction to four leptons is measured to be B ( Z → 4 ℓ ) = 4 . 83 - 0.22 + 0.23 ( s t a t ) - 0.29 + 0.32 ( s y s t ) ± 0.08 ( t h e o ) ± 0.12 ( l u m i ) × 10 - 6 for events with a four-lepton invariant mass in the range 80 < m 4 ℓ < 100 GeV and a dilepton massm ℓ ℓ > 4 GeV for all opposite-sign, same-flavor lepton pairs. The results agree with standard model predictions. The invariant mass distribution of the four-lepton system is used to set limits on anomalous ZZZ and ZZ γ couplings at 95% confidence level: - 0.0012 < f 4 Z < 0.0010 , - 0.0010 < f 5 Z < 0.0013 , - 0.0012 < f 4 γ < 0.0013 , - 0.0012 < f 5 γ < 0.0013 .

Measurements of the p p → Z Z production cross section and the Z → 4 ℓ branching fraction, and constraints on anomalous triple gauge couplings at s = 13 TeV

Four-lepton production in proton-proton collisions, p p → ( Z / γ ∗ ) ( Z / γ ∗ ) → 4 ℓ , where ℓ = e or μ , is studied at a center-of-mass energy of 13 TeV with the CMS detector at the LHC. The data sample corresponds to an integrated luminosity of 35.9 fb - 1 . The ZZ production cross section, σ ( p p → Z Z ) = 17.2 ± 0.5 (stat) ± 0.7 (syst) ± 0.4 (theo) ± 0.4 (lumi) pb , measured using events with two opposite-sign, same-flavor lepton pairs produced in the mass region 60 < m ℓ + ℓ - < 120 GeV , is consistent with standard model predictions. Differential cross sections are measured and are well described by the theoretical predictions. The Z boson branching fraction to four leptons is measured to be B ( Z → 4 ℓ ) = 4 . 83 - 0.22 + 0.23 ( s t a t ) - 0.29 + 0.32 ( s y s t ) ± 0.08 ( t h e o ) ± 0.12 ( l u m i ) × 10 - 6 for events with a four-lepton invariant mass in the range 80 < m 4 ℓ < 100 GeV and a dilepton mass m ℓ ℓ > 4 GeV for all opposite-sign, same-flavor lepton pairs. The results agree with standard model predictions. The invariant mass distribution of the four-lepton system is used to set limits on anomalous ZZZ and ZZ γ couplings at 95% confidence level: - 0.0012 < f 4 Z < 0.0010 , - 0.0010 < f 5 Z < 0.0013 , - 0.0012 < f 4 γ < 0.0013 , - 0.0012 < f 5 γ < 0.0013 .

Search for dark matter produced in association with heavy-flavor quark pairs in proton-proton collisions at s = 13 TeV

A search is presented for an excess of events with heavy-flavor quark pairs ( t t ¯ and b b ¯ ) and a large imbalance in transverse momentum in data from proton-proton collisions at a center-of-mass energy of 13TeV . The data correspond to an integrated luminosity of 2.2fb - 1 collected with the CMS detector at the CERN LHC. No deviations are observed with respect to standard model predictions. The results are used in the first interpretation of dark matter production in t t ¯ and b b ¯ final states in a simplified model. This analysis is also the first to perform a statistical combination of searches for dark matter produced with different heavy-flavor final states. The combination provides exclusions that are stronger than those achieved with individual heavy-flavor final states.

Search for Evidence of the Type-III Seesaw Mechanism in Multilepton Final States in Proton-Proton Collisions at sqrt[s]=13 TeV

A search for a signal consistent with the type-III seesaw mechanism in events with three or more electrons or muons is presented. The data sample consists of proton-proton collisions at sqrt[s]=13  TeV collected by the CMS experiment at the LHC in 2016 and corresponds to an integrated luminosity of 35.9  fb^{-1}. Selection criteria based on the number of leptons and the invariant mass of oppositely charged lepton pairs are used to distinguish the signal from the standard model background. The observations are consistent with the expectations from standard model processes. The results are used to place limits on the production of heavy fermions of the type-III seesaw model as a function of the branching ratio to each lepton flavor. In the scenario of equal branching fractions to each lepton flavor, heavy fermions with masses below 840 GeV are excluded. This is the most sensitive probe to date of the type-III seesaw mechanism.

Intralabyrinthine sporadic endolymphatic sac tumour

INTRODUCTION

Endolymphatic sac tumours are benign, slowly growing tumours that invade the temporal bone, and present clinically in the form of unilateral hearing loss. They can be sporadic or occur in the context of Von Hippel-Lindau disease (VHL).

CASE SUMMARY

The authors report a case of endolymphatic sac tumour arising in the utricle presenting histological and immunohistochemical features corresponding to endolymphatic sac tumour in a patient without VHL.

DISCUSSION

Endolymphatic sac tumours invade the posterior part of the petrous temporal bone. According to two studies concerning patients with Von Hippel-Lindau disease, endolymphatic sac tumours arise from the endolymphatic duct. This case of intralabyrinthine sporadic endolymphatic sac tumour supports this hypothesis for sporadic forms, indicating the need for labyrinthectomy associated with tumour resection to avoid recurrence.