Genotype Hemophilia Screening Program Identified 2 Novel Variants Including a Novel Variant (c.5816-2A > G) Causing a Pathogenic Variant of the Factor 8 Gene

Establishing a national screening program for hemophilia patients is highly encouraged by the World Health Organization and the World Federation of Hemophilia. Hence, this study aimed to analyze the variant spectrum of F8 and F9 genes in Arab hemophilia patients. Molecular genetic and sequencing studies were performed on a cohort of 135 Saudi hemophilia patients. Out of all screened hemophilia patients (97 hemophilia A and 39 hemophilia B), 15 (11.1%) were positive for inversion 22 and 4 (3%) for inversion 1. Out of a total of 32 (23.7%) substitution/deletion mutations, 2 novel variants were identified: a novel splice acceptor site missense mutation (c.5816-2A > G) causing a pathogenic variant of the F8 gene and another splicing site point mutation in intron/exon 23 (g.164496G > A). The frequent F8 variants were (c.409A > C, p.T137P) in exon 4, (c.760A > G) in exon 6, and (c.1835G > C, p.R612P) in exon 12, while the frequent F9 variants were (c.580A > G) in exon 6 and (c.880C > T) in exon 8. These study data will enrich the spectrum of the genetic databases in the Arab population that could be applied in the future for national genetic counseling.

Clinical and laboratory presentation of von Willebrand disease: Experience from a single center in KSA

Objectives

This study was aimed at assessing the clinical presentations and laboratory findings among patients diagnosed with vWD at a Saudi tertiary care unit.

Methods

This retrospective study included 189 patients with vWD who were followed up in our unit over 4 years. Clinical and laboratory data were collected and analyzed in SPSS.

Results

The median age of the study cohort was 30 years (range 11 months-56 years). The cohort had a female preponderance, with 32.30% males and 66.70% females. Bleeding from different sites was observed, mostly from the joints and muscles (23.90%), followed by the mucus membranes (14.60%), genitourinary areas (7.70%), ecchymoses (2.80%), and gastrointestinal areas (2.80%). A total of 48% of participants presented with more than one type of bleeding. A total of 105 (58.01%) participants had type 1; 29 (16.02%) had type 2; and 47 (25.96%) had type 3 vWD. Blood tests indicated the following mean value: hemoglobin, 116 ± 25.60 gm/L; ferritin, 75.80 ± 166.80 μg/L (median 28.5); vWAg, 0.40 ± 0.27IU/ml; and vWD:RCo, 0.32 ± 0.20IU/dL. The partial thromboplastin time was prolonged in 49.20% and normal in 50.80% of participants. Platelet function analysis values were prolonged in 92.90% and normal in 7.10% of participants. Comparative analysis of the O-type and non-O blood type showed that blood type O was significantly correlated with factor VIII (p-value = 0.013), vWF:RCo (p-value = 0.004), and vWF:Ag (p-value = 0.019).

Conclusion

Joint and muscle bleeds were the most common clinical presentations in our cohort. Although type 1 vWD was most prevalent in our cohort, we observed a comparatively higher prevalence of type 3, possibly because of ethnic differences or referral bias. We found a significant difference between O and non-O blood type regarding FVIII and vWF:Ag, and observed a more pronounced difference for vWD activity measuresd by vWF:RCo with blood type O being the systematic factor.

Аssessment of E-learning readiness among different levels of Nursing Learners in KING SAUD MEDICAL CITY

Aim: Nurses’ and students’ willingness to increase information and practical skills through electronic platforms may help in setting up hundreds of timesaving and economical e-learning programs. The aim of this study is to evaluate the readiness of e-learning among different levels of nurses and nursing students. Methods: In this quantitative research, 425 participants from King Saud Medical City in Riyadh, Saudi Arabia were included. The study population included nurses and nursing students. Results: With p < 0.042 the research indicated that there are statistically significant differences between nursing groups with respect to e-Learning readiness. Conclusions: The nursing staff and students in King Saud Medical City demonstrated significant readiness levels towards e-learning, while the level of readiness and experience towards e-learning vary for different nursing groups

Effects of sex on carcass composition and physicochemical, textural and rheological properties of meat from grey partridge

The study aimed to determine the effects of sex on bodyweight (BW) and dimensions, carcass weight, dressing percentage, percentage of carcass components, chemical composition, mineral content, acidity and electrical conductivity of the breast and leg muscles of grey partridges (Perdix perdix L.). The experiment also determined the colour attributes, textural and rheological characteristics, and mineral content in the liver of the grey partridge. Fifteen males and 15 females were examined. Carcasses were weighed on electronic scales, then dissected. The chemical compounds in the breast and leg muscles were determined with a near-infrared spectrophotometer. To ascertain the contents of minerals, the meat samples were analysed by spectrometry. The textural and rheological properties were established with the TPA double compression test, Warner-Bratzler (WB) test, and the relaxation test. At 36 weeks, males had significantly longer keels and shanks than females. Males and females did not differ significantly in the weight of the eviscerated carcass, dressing percentage, and percentage of carcass components. There were no significant differences between males and females in the chemical composition of meat from breasts and legs, and in the mineral contents of the breast and leg muscles and the liver. Bird sex had no significant effect on acidity and electrical conductivity of the breast and leg muscles or on the lightness (L*), redness (a*), and yellowness (b*) of the Pectoralis major muscle. No significant differences were established between 36-week-old males and females in textural and rheological characteristics. Thus, there was scant evidence for sexual dimorphism in this species.

741 Restarting Elective Orthopaedic Surgery During The COVID-19 Pandemic: Experiences and Patient Outcomes

Aim

The COVID-19 pandemic resulted in postponing all non-urgent elective surgeries from April 2020. As we emerged from the first peak, restarting non-urgent services such as elective orthopaedic surgery was important for patients with chronic debilitating conditions. Our hospital successfully restarted orthopaedic surgery during the pandemic to help improve the quality of life of patients. This study describes the development of local protocols and pathways to allow for a safe restart of elective orthopaedic surgery in a COVID-19 free site. It presents the morbidity and mortality outcomes of those patients.

Method

This is a prospective cohort study evaluating all patients undergoing non-emergency orthopaedic procedures through a COVID-19 free pathway in a DGH from 18th May – 10th July 2020. 104 patients were identified, and their outcomes analysed during the 2 weeks following their surgery.

Results

No patients developed COVID-19 in the 2-weeks post-operative period. There were no ITU admissions or in-hospital deaths. 22(21.15%) out of 104 patients developed 23 complications within 2 weeks of surgery. These included: TIA, PE, AF, superficial wound infection, oozy wound and post-operative anaemia. They all made full recovery. There was no statistical difference in the development of complications for age (&lt; 70; &gt;70), gender, BMI, or ASA grades.

Conclusions

This study describes a roadmap to setting up a protocolised elective operating service for orthopaedic surgery. It has shown that standardised protocols in a COVID-19 free site, pre-operative COVID-19 testing and adherence to national guidelines on self-isolation prior to surgery can help prevent COVID-19 infection and its related risks post-operatively.

Changes in Hematological, Clinical and Laboratory Parameters for Children with COVID-19: Single-Center Experience

Background

COVID-19 wreaked havoc on the healthcare system, with more than 36 million cases reported globally. Although the pediatric population makes up a lesser proportion of total COVID-19 patients than adults, the clinical status, age and comorbidities warrant identifying possible prognostic factors associated with disease severity in this group. The current study aimed to explore the incidence of thrombosis, overall outcome, and different hematological and coagulation markers in children with COVID-19.

Methods

This is a single-center prospective study of 43 patients (age < 14 years) with confirmed COVID-19 diagnosis recruited from April to August 2020. Data for clinical presentation were collected and analyzed. The samples were tested for different hematological and coagulation markers.

Results

Twenty-nine (67.4%) were symptomatic at presentation, with fever being the most common symptom (n = 23, 53.5%), followed by respiratory (n = 5, 11.6%) and gastrointestinal symptoms (n = 3, 7%). Co-morbid conditions were recorded in 26 (60.5%) patients, with malignancy being the commonest (n = 9, 20.9%). In this cohort of patients with age <14 years, hypertension, respiratory symptoms and ABO group-A were significantly associated with pediatric intensive care unit (PICU) admission during the course of treatment. Patients with elevated FVIII and fibrinogen levels at presentation were more likely to have an extended length of hospital stay (LOS) (P-value =0.036 and 0.032 respectively). No thrombotic event was observed in our cohort. D-dimer values were higher (above 0.5 µg/mL) in 24 (55.8%) patients at admission. We found an association between high D-dimer and PICU admission and LOS.

Conclusion

Although we did not observe thrombosis in our cohort, serial measurements of D-dimer and elevated FVIII bear a prognostic value in predicting the need for critical care in children with COVID-19. Further studies with larger sample size can aid in the establishment of prognostic factors for the pediatric COVID-19 population.

Essential Thrombocythemia in Children: A Retrospective Study

Background

Essential thrombocythemia (ET) is one of the “classic” Philadelphia chromosome negative (Ph-) myeloproliferative neoplasms characterized by sustained thrombocytosis, increased megakaryopoiesis and high risk of vascular complications. ET is very rare in childhood. The annual incidence is approximately 1 per 10,000,000 in children less than 14 years, and about 60 times lower than adults. The genetic landscape and clonal features in childhood ET has not been well defined. There is no evidence-based guidance on the diagnosis of childhood ET.

Methods

Medical records of 28 pediatric patients (age ≤ 14 years at diagnosis) with ET were reviewed and evaluated to characterize the different mutation profiles and to evaluate the treatment modalities used and the potential long-term outcome.

Results

More than half of the patients were found to have positive history of parental consanguinity (57.1%) whereas positive family history was documented for more than a quarter of our patients (28.6%). Janus kinase 2 gene (JAK2) V617F mutation was positive in two of 26 patients (7.7%). Myeloproliferative leukemia virus oncogene (MPL) exon 10 and calreticulin (CALR) mutations were tested in eight patients, which were negative for all of them. Treatment included low-dose aspirin (LDA) in seven patients (50%), combination of LDA with hydroxyurea in three patients (21.4%), hydroxyurea in two patients (14.3%), combination of platelets apheresis with LDA and anagrelide in one patient each (7.1%). During the treatment, two patients experienced stroke (7.1%), one patient developed Budd-Chiari syndrome (3.6%) and one patient developed azoospermia (3.6%).

Conclusions

The incidence of ET in children is extremely low in Saudi Arabia. Most of the children with ET were asymptomatic, and thrombocytosis was often discovered incidentally. JAK2 V617F mutation has no known impact on the prognosis or on the outcome of the disease in the pediatric age group that is in contrast to the adult ET. Children less than 1 year are at high risk for complications particularly during acute precipitating infectious episode. The potential complications and clinical course of pediatric ET are unpredictable.

Incidence of lupus anticoagulant in hospitalized covid-19 patients

BACKGROUND

Procoagulant profile of 2019-nCoV/SARS-CoV-2 has been well documented over the last year. Perturbance in coagulating factors has also been reported in Covid-19 patients, including increased d-dimers and reports of lupus anticoagulant (LA).

METHODS

The current study aimed to identify the incidence of positivity of lupus anticoagulant in Covid-19 patients and analyze the association between LA and D-dimer in predicting thrombosis and mortality in one-hundred and five hospitalized adult (age >14 years) patients and forty-three hospitalized pediatric (age <14 years) patients with a confirmed diagnosis of Covid-19 between June 2020 and September 2020.

RESULTS

Twenty-one (20%) adult patients were tested positive for PTT LA, of which nine (8.6%) turned out to be confirmed positive for LA through StaClot and DRVVT Ratio tests. Six (14%) pediatric patients were positive for PTT LA, and only one (2.3%) had positive StaClot. Median D-dimer at admission was positively correlated with age and CRP among adult patients and was significantly higher in expired cases (P=0.001). No association between any of the coagulation tests and thrombosis or mortality was observed in the pediatric cohort.

CONCLUSION

We report an increased incidence of LA in Covid-19 patients, yet we didn't find any association between thrombotic events or mortality, probably due to the small sample size.

AB0637 THE STATE OF GOUT MANAGEMENT IN WALES RHEUMATOLOGY UNITS

Background:

Gout is the most common inflammatory arthritis with both the prevalence and incidence showed significant rise in the UK in recent years1.

The most frequent reasons for referral from primary care were diagnostic uncertainty 54%, failure to respond to primary care management 28%, and complex comorbidity 25%2.

From primary care perspective, increased urate level (p=0.0001), young age (p=0.009), fewer comorbidities (p=0.039) constituted the most common risk for gout General Practice consultations and in addition to poor compliance to urate lowering treatment ULT (p=0.004) and lower CVS risk scores (p=0.038) these all factors comprised the independent risk factors for Gout flares3.

Objectives:

To compare the management of gout in the rheumatology services in Wales against the 2017 British Society for Rheumatology (BSR) Guidelines.

Methods:

•A descriptive study over an 8-week period from January to February 2019, used Simple Analysis in calculating the frequency (%).

•Data were collected from notes of 79 patients referred to rheumatology departments across Wales using the British Society for Rheumatology (BSR) 2017 Gout Guidelines Audit Tool.

•The audit cohort comprised 62% of chronic gout patients and 38% of acute admissions.

Results:

Conclusion:

•Gout management by rheumatologists across Wales concords well with the recent BSR guidelines for most audit standards and showed an improvement in percentage of patients who achieved a target serum uric acid level <300 and <360 umol/L according to the BSR and EULAR guidelines, respectively.

•Areas for improvement include documentation of Patient Education, improvement of audit tool (Age, Alcohol, current ULT).

•To spread the message to primary care setting, where gout is predominantly managed, to ensure that ULT is optimized to achieve target serum uric acid level to benefit patients.

References:

[1]Kuo C, Grainge MJ, Mallen C, et al Rising burden of gout in the UK but continuing suboptimal management: a nationwide population study, Annals of the Rheumatic Diseases 2015;74:661-667.

[2]*Management of gout by UK rheumatologists: a British Society for Rheumatology national audit.Roddy E, Packham J, Obrenovic K, Rivett A, Ledingham JM.Rheumatology (Oxford). 2018 May 1; 57(5):826-830.

[3]Callear J, Blakey G, Callear A, et al Gout in primary care: Can we improve patient outcomes? BMJ Open Quality 2017;6:u210130.w4918. doi: 10.1136/bmjquality.u210130.w4918

Acknowledgements:

Dr Martin Bevan for supervising the work and Rheumatology Units across Wales for collecting data and the British Society for Rheumatology in formulating the audit tool.

Disclosure of Interests:

None declared.

A participatory and systemic training approach for IPC improvement in Nigerian health facilities

Background

Health care-associated infections (HAI) are one of the most common adverse events in care delivery and a major public health problem. A large percentage of HAI in hospitals are preventable through effective infection prevention and control (IPC) measures. IPC trainings for health care personnel based only on technical content do not lead to sustainable improvement of IPC standard precautions. To address this problem, the Nigeria Centre for Disease Control (NCDC) in collaboration with the Robert Koch Institute (RKI) developed a multimodal training approach to facilitate the transfer of IPC competences into working routine in Nigerian health facilities.

Objectives

The training should foster the ability of health care workers to act and communicate participatory, analyze IPC problems systemically and to develop and perform tailored IPC activities in their health facilities. It should empower health care workers to initiate and promote sustainable IPC improvement locally.

Results

We developed a participatory training approach which focusses on the relational and organizational dimension of IPC. It addresses the human and infrastructural factors for IPC compliance in daily working routine. A variety of training methods offers practice tools in communication, systemic thinking and team work, and allows experiencing a participatory attitude. The training program consists of two face to face workshops and an interjacent field project. 28 Health care workers of 14 health facilities in Lagos State participated the first implementation of the training program in 2018. The training evaluation showed the high relevance of the training to the HCW. The field projects showed that the participants could apply the participatory approach for IPC improvement.

Conclusions

A participatory and systemic approach for IPC trainings enables health care workers to take action for IPC improvement locally.

Key messages

We developed and implemented a participatory training approach that addresses the relational and organizational dimension of IPC. Health care workers took tailored actions for IPC improvement locally.

Carcass, physicochemical and sensory characteristics of meat from genetic reserve ducks after two reproductive seasons

The aim of the study was to compare carcass composition and meat quality of i) Pekin ducks of French origin (P9), ii) crosses of wild mallard and Pekin duck (K2), and iii) crosses of Khaki Campbell drakes and Orpington Fauve ducks (KhO1). Twenty carcasses from 110-week-old ducks of each genetic group were used. Carcass weight of P9 was significantly higher than that of K2 and KhO1. Carcasses of K2 ducks had a significantly lower percentage of neck and leg muscles and giblet weight compared with P9 and KhO1 ducks, while carcasses of KhO1 ducks had a significantly higher percentage of wing meat compared with K2 and P9, and a significantly lower percentage of breast muscles compared with P9 ducks. Breast and leg muscles of P9 contained significantly more water than those of K2 and KhO1, and the breast muscles of P9 ducks had more protein and less fat than those of KhO1 birds. The leg muscles of KhO1 contained significantly more protein, and those of K2 had significantly more fat than the other duck groups. Breast muscles of P9 and KhO1 ducks had significantly more collagen but had less in leg muscles compared with K2. Breast fillets from P9 ducks showed higher L*, a*, and b* colour values and shear force than K2 and KhO1 ducks. Keywords: carcass composition, conservation flocks, meat quality, spent duck

[Placoid pigment epitheliopathy and serpiginous choroiditis]

Placoid pigment epitheliopathy and serpiginous choroiditis are among the white dot retinal syndromes and possess similarities that can cause confusion between these two diseases. However, they are very different in terms of their progression and prognosis, which requires a diagnosis of certainty in order to better manage the patients with the diseases and identify potentially serious progressive complications. The clinical presentation, results of testing, differential diagnoses and treatment of these two pathologies are discussed in this article.

Placoid pigment epitheliopathy and serpiginous choroiditis

Placoid pigment epitheliopathy and serpiginous choroiditis are among the white dot retinal syndromes and possess similarities that can cause confusion between these two diseases. However, they are very different in terms of their progression and prognosis, which requires a diagnosis of certainty in order to better manage the patients with the diseases and identify potentially serious progressive complications. The clinical presentation, results of testing, differential diagnoses and treatment of these two pathologies are discussed in this article.

P963Coronary orbital atherectomy manufacturers and user facility device experience (MAUDE) database: a 5-year analysis of real-world complications

Background

Coronary Orbital Atherectomy System was approved by the United States FDA (food and Drug Administration) on October 21st, 2013. The initial safety data were published in the ORBIT I trial.

Purpose

Evaluation of the reported real-life complications related to utilization of orbital coronary atherectomy system since its approval in the United States using the online FDA database.

Methods

The Manufacturer and User facility Device Experience (MAUDE) database was queried for all complication reports involving the orbital atherectomy (OA) “Diamondback 360 coronary orbital atherectomy system” from 1/1/2013 through 12/31/2018. All reports were searched for complications; mortality, perforation, dissections, device fragmentation, and the need for surgical intervention among reported procedures. Duplicate entries and data with no reporting on final procedure outcome were excluded.

Results

Over the allocated interval519 reports were identified. Seven reports were excluded (according to exclusion criteria).

Over the period of slightly more than five years, coronary perforation was the most commonly reported complication mounting to 44.14% of all the reports (226 reports). Device fragmentation was reported in 18.94% of the reports (97 reports). Surgery was needed to retrieve device fragments in 13 cases (13.4% of all device fragmentation reports). Coronary dissection represented 16.21% of the reports (83 reports) and total surgical interventions were needed in 14.25% of the cases (73 reports). Finally, total reported deaths were 121 cases (23.63% of the total reports).

Year 2013 2014 2015 2016 2017 2018 Number of reported complications 4 28 46 81 113 247

Percentage of reported complications

Discussion

The current analysis, representing data from real world reported complications to the FDA over a period of 5 years, shows that the most common reported complication during coronary orbital atherectomy was coronary perforations, followed by device breakings and fragmentation (which necessitated surgical intervention in almost 13.4% of those device fragmentation cases reported). It is hard to compare these data with published safety trials since the FDA database is involved in reporting complications and not total number of procedures. However the most striking complication involved device fragmentation, which was not seen or reported among the pivotal trials evaluating device safety. The current analysis may shed some light on a non reported complication among patients undergoing orbital atherectomy which might represent a gap between the device performance in real world as opposed to a well-designed study world.

[Screening for diabetic retinopathy by non-mydriatic fundus photography: First national campaign in Lebanon]

INTRODUCTION

Diabetic retinopathy (DR) is a leading cause of blindness worldwide. Non-mydriatic fundus photography (NMFP) has been adopted as a screening tool for this disease. We aim to determine the prevalence of DR through this method in Lebanese diabetic patients and to evaluate the impact of such screening in this population.

MATERIALS AND METHODS

This study explores data from an awareness and screening campaign conducted in Lebanon. Diabetic patients from multiple regions were referred by their endocrinologists to undergo NMFP using the Optomed SmartScope^® handheld fundus camera. Photographs were interpreted by a remote observer, and recommendations were given accordingly. The prevalence of DR was calculated, and statistical analyses were performed on the clinical characteristics, fundus findings and number of referrals to ophthalmologists.

RESULTS

The campaign lasted 11 months, during which 2205 patients were examined in 37 screening locations. Out of the 97.41% of patients with type 2 diabetes mellitus, 12.56% had signs of DR, with no significant difference between the regions. 6.28% of the photos were uninterpretable. Positive results were associated with a longer duration of diabetes (P<0.01), treatment with insulin (P<0.01), as well as the presence and chronicity of systemic hypertension (P=0.01). 25% of patients with positive testing were retrospectively asked about their follow-up; only one third had an ophthalmologic examination as per the recommendation, among whom 68.18% underwent treatment for proliferative DR and/or diabetic macular edema.

CONCLUSION

Tele-ophthalmology is useful in mass screening for DR. The importance of dilated fundus examinations still needs to be highlighted for diabetic patients, and better collaboration between endocrinologists and ophthalmologists is required to improve screening outcomes.

Molecular yield of targeted sequencing for Glanzmann thrombasthenia patients

Glanzmann thrombasthenia (GT) is a rare autosomal recessive bleeding disorder. Around 490 mutations in ITGA2B and ITGB3 genes were reported. We aimed to use targeted next-generation sequencing (NGS) to identify variants in patients with GT. We screened 72 individuals (including unaffected family members) using a panel of 393 genes (SHGP heme panel). Validation was done by Sanger sequencing and pathogenicity was predicted using multiple tools. In 83.5% of our cohort, 17 mutations were identified in ITGA2B and ITGB3 (including 6 that were not previously reported). In addition to variants in the two known genes, we found variants in ITGA2, VWF and F8. The SHGP heme panel can be used as a high-throughput molecular diagnostic assay to screen for mutations and variants in GT cases and carriers. Our findings expand the molecular landscape of GT and emphasize the robustness and usefulness of this panel.

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

BACKGROUND

The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications.

METHODS

ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery.

RESULTS

The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784.

CONCLUSIONS

This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance.

CLINICAL TRIAL REGISTRATION

NCT03044899.

High-resolution imaging of photoreceptors in healthy human eyes using an adaptive optics retinal camera

PURPOSE

To determine the effects of age on perifoveal cone density in healthy subjects using adaptive optics.

METHODS

Healthy subjects of various ages were imaged using an adaptive optics retinal camera (RTX-1^® Imagine Eyes, Orsay, France). All patients underwent a comprehensive ophthalmologic examination and retinal imaging using spectral-domain optical coherence tomography (Spectralis^®, Heidelberg Engineering, Heidelberg, Germany). Cone density together with cone spacing and cone mosaic packing were measured in the nasal and temporal area 450 µm from the fovea. A multivariate analysis was performed to determine which of the following parameters were related to a decrease in cone density: age, axial length, central macular thickness, and retrofoveal choroidal thickness.

RESULTS

One hundred and sixty-seven eyes of 101 subjects aged 6-78 years were studied. Perifoveal cone density significantly decreased with age (R² = 0.17, p<0.01). Inversely, cone spacing increased with age (R²=0.18, p<0.01). There was no change in the cone packing mosaic (p>0.05). The mean coefficient of variation between fellow eyes was 3.9%. Age and axial length were related to a cone density decrease, while choroidal and retinal thicknesses did not affect cone metrics in healthy subjects.

CONCLUSIONS

A moderate perifoveal cone loss occurs with age. The precise consequences of these findings on visual function should be investigated. In addition to a better understanding of normal retinal anatomy, these results could act as a comparative database for further studies on normal and diseased retinas.

Androgen receptor mutations in patients with castration-resistant prostate cancer treated with apalutamide

Background

Mutations in the androgen receptor (AR) ligand-binding domain (LBD), such as F877L and T878A, have been associated with resistance to next-generation AR-directed therapies. ARN-509-001 was a phase I/II study that evaluated apalutamide activity in castration-resistant prostate cancer (CRPC). Here, we evaluated the type and frequency of 11 relevant AR-LBD mutations in apalutamide-treated CRPC patients.

Patients and methods

Blood samples from men with nonmetastatic CRPC (nmCRPC) and metastatic CRPC (mCRPC) pre- or post-abiraterone acetate and prednisone (AAP) treatment (≥6 months' exposure) were evaluated at baseline and disease progression in trial ARN-509-001. Mutations were detected in circulating tumor DNA using a digital polymerase chain reaction-based method known as BEAMing (beads, emulsification, amplification and magnetics) (Sysmex Inostics' GmbH).

Results

Of the 97 total patients, 51 had nmCRPC, 25 had AAP-naïve mCRPC, and 21 had post-AAP mCRPC. Ninety-three were assessable for the mutation analysis at baseline and 82 of the 93 at progression. The overall frequency of detected AR mutations at baseline was 7/93 (7.5%) and at progression was 6/82 (7.3%). Three of the 82 (3.7%) mCRPC patients (2 AAP-naïve and 1 post-AAP) acquired AR F877L during apalutamide treatment. At baseline, 3 of the 93 (3.2%) post-AAP patients had detectable AR T878A, which was lost after apalutamide treatment in 1 patient who continued apalutamide treatment for 12 months.

Conclusions

The overall frequency of detected mutations at baseline (7.5%) and progression (7.3%) using the sensitive BEAMing assay was low, suggesting that, based on this assay, AR-LBD mutations such as F877L and T878A are not common contributors to de novo or acquired resistance to apalutamide.

ClinicalTrials.gov identifier

NCT01171898.

Development of a Cerebral Palsy Follow-up Registry in Jordan (CPUP-Jordan)

AIMS

This study aims to describe the development of a Cerebral Palsy Follow-up Registry in Jordan (CPUP-Jordan) and to provide a baseline child and parent demographic information, birth history of the child participants, and distribution of the participants based on topographical distribution of cerebral palsy (CP) and functional classification systems.

METHODS

The CPUP-Jordan was developed using a similar framework of a follow-up surveillance programme for persons with CP in Sweden (CPUP). Standard assessment forms were utilized to collect data related to child and family demographics, child birth history, and functional classifications and physiotherapy and occupational therapy assessments and interventions. Research assistants were trained to conduct the assessments. A secured web-based system was developed to store data and disseminate knowledge maintained in the registry. Children with CP were included in the registry if they have confirmed diagnosis of CP. The ascertainment age of inclusion and the minimum age of survival required are 4 years.

RESULTS

One hundred sixty-seven children were registered between 2013 and 2015 (mean age is 3.6 ± 3.0 years). Forty-two percent were born premature, and 48% were less than the normal birthweight. Perinatal causes were reported for 54% of the participants. The most common type of CP based on tone disturbance was spastic type, and the most common topographical distributions of motor dysfunction were quadriplegia followed by diplegia. Fifty-six percent of the participants had severe limitation in ambulation; 48% had restricted manual abilities, and 47% had limited communication abilities even with familiar family members and partners.

CONCLUSIONS

The development of CPUP-Jordan registry for children with CP proved to be both feasible and informative. The registry baseline descriptive data were similar to those reported in previous research in Jordan supporting validity of the data. The implementation of CPUP-Jordan at national level is expected to have a positive impact on children with CP, clinicians, policymakers, and researchers.

The factor V C1 domain is involved in membrane binding: identification of functionally important amino acid residues within the C1 domain of factor V using alanine scanning mutagenesis

The contribution of the factor Va C1 domain (fVa-C1) to assembly of the prothrombinase complex has not been previously investigated. The homologous fVa-C2 domain contains a binding site for phosphatidylserine (PS) that includes the indole moieties of Trp2063/Trp2064 at the apex of spike-1. In order to investigate the structure and function of fVa-C1 a molecular model was constructed based on the structure of fVa-C2. The aromatic and hydrophobic side chains of Tyr1956/Leu1957 in fVaC1 are located at the predicted apex of spike-3. Exposed charged and hydrophobic residues in fVa-C1 were changed to alanine in clusters of 1-3 mutations per construct. The resultant 20 mutants were expressed in COS cells and screened for binding to immobilized PS and prothrombinase activity on phospholipid vesicles containing either 25% or 5% PS. Two mutants, (Y1956,L1957)A, and (R2023,R2027)A showed both decreased binding to immobilized PS and a selective decrease in prothrombinase activity on membranes containing 5% PS. The interaction of purified (Y1956,L1957)A with phospholipid vesicles was studied using fluorescence resonance energy transfer and prothrombinase assays. The affinity of (Y1956,L1957)A binding to 25% PS membranes was reduced 12-fold compared to rHFVa. Prothrombin activation in the presence of (Y1956,L1957)A was markedly impaired on phospholipid vesicles containing 10% or less PS. We conclude that solvent exposed hydrophobic and aromatic amino acids in both fVa-C1 and fVa-C2 contribute to the interaction of factor V with PS membranes.

Reliable gradient search directions for kurtosis-based deflationary ICA: Application to physiological signal processing

Efficient gradient search directions for the optimisation of the kurtosis-based deflationary RobustICA algorithm in the case of real-valued data are proposed in this paper. The proposed scheme employs, in the gradient-like algorithm typically used to optimise the considered kurtosis-based objective function, search directions computed from a more reliable approximation of the negentropy than the kurtosis. The proposed scheme inherits the exact line search of the conventional RobustICA for which a good convergence property through a given direction is guaranteed. The efficiency of the proposed scheme is evaluated in terms of estimation quality, the execution time and the iterations count as a function of the number of used sensors and for different signal to noise ratios in the contexts of non-invasive epileptic ElectroEncephaloGraphic (EEG) and Magnetic Resonance Spectroscopic (MRS) analysis. The obtained results show that the proposed approach offer the best estimation performance/iterations count and execution time trade-off, especially in the case of high number of sensors.

Low cost and efficient kurtosis-based deflationary ICA method: application to MRS sources separation problem

Improving the execution time and the numerical complexity of the well-known kurtosis-based maximization method, the RobustICA, is investigated in this paper. A Newton-based scheme is proposed and compared to the conventional RobustICA method. A new implementation using the nonlinear Conjugate Gradient one is investigated also. Regarding the Newton approach, an exact computation of the Hessian of the considered cost function is provided. The proposed approaches and the considered implementations inherit the global plane search of the initial RobustICA method for which a better convergence speed for a given direction is still guaranteed. Numerical results on Magnetic Resonance Spectroscopy (MRS) source separation show the efficiency of the proposed approaches notably the quasi-Newton one using the BFGS method.