Impact of gout on the risk of atrial fibrillation

Objectives. To examine the risk of atrial fibrillation (AF) at the time of first diagnosis of gout compared with matched controls and to follow incident gout patients and their matched controls after diagnosis to compare their subsequent risk of AF.

Methods. From the UK Clinical Practice Research Data-link, 45 378 incident gout patients and 45 378 age-, sex-, practice-, registration year- and index year-matched controls were identified. Index dates were initial diagnosis date for gout patients and their matched controls. The risk of AF at diagnosis [odds ratios (ORs), using conditional logistic regression] and after the diagnosis of gout [hazard ratios (HRs), using Cox proportional models] were estimated, adjusted for BMI, smoking, alcohol consumption, ischaemic heart disease, heart failure, heart valve disease, hyperthyroidism and other comorbidities and medications.

Results. The prevalence of AF at index date in gout patients (male, 72.3%; mean age, 62.4 ± 15.1 years) was 7.42% (95% CI 7.18, 7.66%) and in matched controls 2.83% (95% CI 2.67, 2.98%). The adjusted OR (95% CI) was 1.45 (1.29, 1.62). The cumulative probability of AF at 1, 2, 5 and 10 years after index date was 1.08, 2.03, 4.77 and 9.68% in gout patients and 0.43, 1.08, 2.95 and 6.33% in controls, respectively (log-rank test, P < 0.001). The adjusted HR (95% CIs) was 1.09 (1.03, 1.16).

Conclusion. This population-based study indicates that gout is independently associated with a higher risk of AF at diagnosis and the risk is also higher after the diagnosis.

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Real-life effectiveness of canakinumab in cryopyrin-associated periodic syndrome

Objective. Cryopyrin-associated periodic syndrome (CAPS) is a heterogeneous group of diseases characterized by excessive IL-1β release resulting in severe systemic and organ inflammation. Canakinumab targets IL-1β and is approved at standard dose for children and adults with all CAPS phenotypes. Limited data are available for the real-life effectiveness of canakinumab in patients living with CAPS. Therefore the aim of the study was to evaluate the real-life dosing and effectiveness of canakinumab in CAPS.

Methods. A multi-centre study of consecutive children and adults with CAPS treated with canakinumab was performed. Demographics, CAPS phenotype and disease activity, inflammatory markers and canakinumab treatment strategy were recorded. Treatment response was assessed using CAPS disease activity scores, CRP and/or serum amyloid A levels. Comparisons between age groups, CAPS phenotypes and centres were conducted.

Results. A total of 68 CAPS patients at nine centres were included. All CAPS phenotypes were represented. Thirty-seven (54%) patients were females, the median age was 25 years and 27 (40%) were children, and the median follow-up was 28 months. Overall, complete response (CR) was seen in 72% of CAPS patients, significantly less often in severe (14%) than in mild CAPS phenotypes (79%). Only 53% attained CR on standard dose canakinumab. Dose increase was more commonly required in children (56%) than in adults (22%). Centres with a treat-to-target approach had significantly higher CR rates (94 vs 50%).

Conclusion. Real-life effectiveness of canakinumab in CAPS was significantly lower than in controlled trials. Treat-to-target strategies may improve the outcome of children and adults living with CAPS.

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Finding specific 10-joint Juvenile Arthritis Disease Activity Score (JADAS10) and clinical JADAS10 cut-off values for disease activity levels in non-systemic juvenile idiopathic arthritis: a Finnish multicentre study

Objectives. To establish the cut-off values for inactive disease, as well as low disease activity (LDA), moderate disease activity (MDA) and high disease activity (HDA) in non-systemic JIA based on the Juvenile Arthritis Disease Activity Score (JADAS) and assessed with the 10-joint JADAS (JADAS10) and clinical JADAS10 (cJADAS10).

Methods. In a multicentre cross-sectional study consisting of ~20% of all patients with JIA in Finland (n = 509), we obtained data on their most recent registered visits between January 2013 and January 2014. We calculated the JADAS10 and cJADAS10 and established the cut-off values of both of these scores using two different receiver operating characteristics–based statistical methods.

Results. Of the 509 patients studied, 65.8% were females and 53.8% had polyarticular disease. The most suitable method for determining cut-off values was the Youden index. In oligoarticular patients, a JADAS10 score of 0–0.5 represented inactive disease, 0.6–2.7 LDA and ≥2.8 MDA. In polyarticular disease, a JADAS10 score of 0–0.7 represented inactive disease, 0.8–3.9 LDA and ≥4.0 MDA. The cut-off values for HDA were not possible to establish because only two visits fulfilled HDA criteria.

Conclusion. We established cut-off values for LDA and MDA. A reliable definition for HDA will require more patients. In the clinical setting, both the cJADAS10 and JADAS10 serve equally well both for research and quality control purposes. In the future, uniform clinical disease activity levels should be established. We also suggest revising and validating the criteria for HDA. Valid and robust cut-off values for disease activity levels can guide both clinicians and researchers and equip them for quality control.

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ROUTINE–a prospective, multicentre, non-interventional, observational study to evaluate the safety and effectiveness of intravenous tocilizumab for the treatment of active rheumatoid arthritis in daily practice in Germany

Objective. To evaluate the tolerability, effectiveness and utilization of tocilizumab for the treatment of RA in a usual care setting.

Methods. ROUTINE was a prospective, non-interventional, observational 52-week study performed at 174 sites throughout Germany. RA patients were selected and treated according to label. Study objectives included the targeted documentation of infections, other adverse events, and various effectiveness outcomes (e.g. DAS28, clinical disease activity). Statistical analyses were performed primarily based on the data as observed.

Results. A total of 850 patients (75% women, mean age: 56 ± 13 years, mean RA duration: 10.3 ± 8.6 years) were enrolled. Most patients (79%) were pretreated with TNF-inhibitors, whereas 21% were pretreated with conventional DMARDs only. Most common DMARD pretreatments were MTX (79%), LEF (68%), adalimumab (53%) and etanercept (50%). At baseline, 60.5% of patients received tocilizumab in combination with any other RA drugs, while 39.5% were treated in monotherapy. Mean baseline DAS28 was 5.5 ± 1.3, and this decreased to 2.6 ± 1.6 at week 52. At week 52, good EULAR response was achieved in 62.3%, low disease activity state in 66.4%, and DAS28 remission in 55.1% of patients (adjusted relative frequencies). 35.3% of patients discontinued the study prematurely; common reasons were lack of effectiveness (10.5%) and intolerability (7.3%). Any infections and severe infections occurred in 37.6% and 7.2% of patients, respectively (N = 836); serious infections were seen in 5.3% (N = 850). Event rates of any, severe and serious infections were 70.3, 9.8 and 4.4 events/100 patient-years, respectively.

Conclusion. Tocilizumab administered in a real-life setting showed clinically meaningful improvements and a safety profile that was consistent with data reported from pre-approval Phase III studies.

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Do we need to lower the cut point of the 2010 ACR/EULAR classification criteria for diagnosing rheumatoid arthritis?

Objective. In this study we aimed to evaluate the effect of lowering the cut point of the 2010 criteria to identify more patients with RA among early inflammatory arthritis patients.

Methods. We included early arthritis patients from the Rotterdam Early Arthritis Cohort with at least one joint with clinical synovitis and symptoms for <1 year, with no other explanation for their symptoms. The demographic and clinical characteristics of each patient were recorded at baseline. Patients were classified as case or non-case at the 1-year follow-up by the definition used in the development of the 2010 criteria (MTX initiation). To assess the diagnostic performance of the 2010 criteria, the sensitivity and specificity at each cut point were determined.

Results. We included 557 patients in our analysis. At the 1-year follow-up, 253 patients (45%) were classified as case (MTX use). In the group of patients who scored 0–5 points (n = 328), 98 patients (30%) were classified as case (MTX use). The sensitivity and specificity of the 2010 criteria using the cut point of 6 were 61% and 76%, respectively. With the cut point of 5, the sensitivity would increase to 76% and the specificity would decrease to 68%.

Conclusion. By lowering the cut point of the 2010 criteria from 6 to 5 points, we were able to identify 15% more RA patients at the cost of 8% more false-positive patients.

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Pulsed electromagnetic fields in knee osteoarthritis: a double blind, placebo-controlled, randomized clinical trial

Objectives. This trial aimed to test the effectiveness of a wearable pulsed electromagnetic fields (PEMF) device in the management of pain in knee OA patients.

Methods. In this randomized [with equal randomization (1:1)], double-blind, placebo-controlled clinical trial, patients with radiographic evidence of knee OA and persistent pain higher than 40 mm on the visual analog scale (VAS) were recruited. The trial consisted of 12 h daily treatment for 1 month in 60 knee OA patients. The primary outcome measure was the reduction in pain intensity, assessed through VAS and WOMAC scores. Secondary outcomes included quality of life assessment through the 36-item Medical Outcomes Study Short-Form version 2 (SF-36 v2), pressure pain threshold (PPT) and changes in intake of NSAIDs/analgesics.

Results. Sixty-six patients were included, and 60 completed the study. After 1 month, PEMF induced a significant reduction in VAS pain and WOMAC scores compared with placebo. Additionally, pain tolerance, as expressed by PPT changes, and physical health improved in PEMF-treated patients. A mean treatment effect of –0.73 (95% CI – 1.24 to – 0.19) was seen in VAS score, while the effect size was –0.34 (95% CI – 0.85 to 0.17) for WOMAC score. Twenty-six per cent of patients in the PEMF group stopped NSAID/analgesic therapy. No adverse events were detected.

Conclusion. These results suggest that PEMF therapy is effective for pain management in knee OA patients and also affects pain threshold and physical functioning. Future larger studies, including head-to-head studies comparing PEMF therapy with standard pharmacological approaches in OA, are warranted.

Trial registration: ClinicalTrials.gov, http://ift.tt/PmpYKN, NCT01877278

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Defining criteria for disease activity states in juvenile idiopathic arthritis

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Effectiveness and long-term retention of anti-tumour necrosis factor treatment in juvenile and adult patients with juvenile idiopathic arthritis: data from Reuma.pt

Objectives. Assess the effectiveness and safety of biologic therapy as well as predictors of response at 1 year of therapy, retention rate in biologic treatment and predictors of drug discontinuation in JIA patients in the Portuguese register of rheumatic diseases.

Methods. We prospectively collected patient and disease characteristics from patients with JIA who started biological therapy. Adverse events were collected during the follow-up period. Predictors of response at 1 year and drug retention rates were assessed at 4 years of treatment for the first biologic agent.

Results. A total of 812 JIA patients [65% females, mean age at JIA onset 6.9 years (s.d. 4.7)], 227 received biologic therapy; 205 patients (90.3%) were treated with an anti-TNF as the first biologic. All the parameters used to evaluate disease activity, namely number of active joints, ESR and Childhood HAQ/HAQ, decreased significantly at 6 months and 1 year of treatment. The mean reduction in Juvenile Disease Activity Score 10 (JADAS10) after 1 year of treatment was 10.4 (s.d. 7.4). According to the definition of improvement using the JADAS10 score, 83.3% respond to biologic therapy after 1 year. Fourteen patients discontinued biologic therapies due to adverse events. Retention rates were 92.9% at 1 year, 85.5% at 2 years, 78.4% at 3 years and 68.1% at 4 years of treatment. Among all JIA subtypes, only concomitant therapy with corticosteroids was found to be univariately associated with withdrawal of biologic treatment (P = 0.016).

Conclusion. Biologic therapies seem effective and safe in patients with JIA. In addition, the retention rates for the first biologic agent are high throughout 4 years.

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Multibiomarker disease activity score and C-reactive protein in a cross-sectional observational study of patients with rheumatoid arthritis with and without concomitant fibromyalgia

Objectives. To examine the association between a multibiomarker disease activity (MBDA) score, CRP and clinical disease activity measures among RA patients with and without concomitant FM.

Methods. In an observational cohort of patients with established RA, we performed a cross-sectional analysis comparing MBDA scores with CRP by rank correlation and cross-classification. MBDA scores, CRP and clinical measures of disease activity were compared between patients with RA alone and RA with concomitant FM (RA and FM) by univariate and multivariate analyses.

Results. CRP was <=1.0 mg/dl for 184 of 198 patients (93%). MBDA scores correlated with CRP (r = 0.755, P < 0.001), but were often discordant, being moderate or high for 19%, 55% and 87% of patients with CRP <=0.1, 0.1 to <=0.3, or 0.3 to <=1.0 mg/dl, respectively. Among patients with CRP <=1.0 mg/dl, swollen joint count (SJC) increased linearly across levels of MBDA score, both with (P = 0.021) and without (P = 0.004) adjustment for CRP, whereas CRP was not associated with SJC. The 28-joint-DAS-CRP, other composite measures, and their non-joint-count component measures were significantly greater for patients with RA and FM (n = 25) versus RA alone (n = 173) (all P <= 0.005). MBDA scores and CRP were similar between groups.

Conclusion. MBDA scores frequently indicated RA disease activity when CRP did not. Neither one was significantly greater among patients with RA and FM versus RA alone. Thus, MBDA score may be a useful objective measure for identifying RA patients with active inflammation when CRP is low (<=1.0 mg/dl), including RA patients with concomitant FM.

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Impact of pre-existing co-morbidities on mortality in granulomatosis with polyangiitis: a cohort study

Objective. To assess the impact of pre-existing co-morbidities on mortality among patients affected by granulomatosis with polyangiitis (GPA).

Methods. By means of the Danish National Hospital Register, we identified a cohort of patients hospitalized for GPA during 1994–2010 (n = 308). The burden of pre-existing co-morbidities among the patients was quantified according to the Charlson Comorbidity Index (CCI). Each patient was matched with five age- and gender-matched population controls with no pre-existing co-morbidities captured by the CCI (CCI score = 0). The study subjects were followed throughout 2010. Cox regression analyses were used to calculate mortality rate ratios (MRRs).

Results. The median duration of follow-up in the GPA cohort was 5.8 years (interquartile range 2.3–10.0). Compared with their matched population controls, the MRR for patients presenting with a CCI score of 0 (n = 246) was 3.9 (95% CI 2.0, 7.5) during years 0–2 and 1.4 (95% CI 0.9, 2.0) from the second year of follow-up onwards. The corresponding MRRs were 13.3 (95% CI 5.8, 31) and 1.9 (95% CI 1.1, 3.6) for patients with a CCI score >=1 (n = 62). In a direct comparison, GPA patients with a CCI score >=1 were found to have significantly higher mortality than GPA patients with a CCI score of 0 during years 0–2 [adjusted MRR 3.4 (95% CI 1.6, 7.0)] but not after >2 years of follow-up [adjusted MRR 1.3 (95% CI 0.7, 2.6)].

Conclusion. During early follow-up periods, the mortality among GPA patients with pre-existing co-morbidities is markedly higher than that among GPA patients with no pre-existing illnesses. Our analyses identify an increased CCI score for pre-existing co-morbidities as an important risk factor for a fatal outcome in GPA.

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Abatacept (CTLA-4Ig) treatment reduces T cell apoptosis and regulatory T cell suppression in patients with rheumatoid arthritis

Objective. Abatacept (CTLA-4Ig) blocks CD28-mediated T cell activation by binding to the costimulatory B7 ligands CD80/CD86 on antigen presenting cells. Costimulatory molecules, however, can also be expressed on T cells upon activation. Therefore, the aim of our study was to investigate direct effects of CTLA-4Ig on distinct T cell subsets in RA patients.

Methods. Phenotypic and functional analyses of CD4+ T cells, including CD4+ FoxP3+ CD25+ regulatory T cells (Treg), from RA patients were performed before and during CTLA-4Ig therapy. In addition T cells from healthy volunteers were analysed on in vitro culture with CTLA-4Ig or anti-CD80 and anti-CD86 antibodies. Apoptotic DNA fragmentation in CD4+ and CD4+ FoxP3+ T cells was measured by TUNEL staining.

Results. We observed an increase in T cells, including Treg cells, after initiation of CTLA-4Ig therapy, which was linked to a downregulation of activation-associated marker molecules and CD95 on CD4+ T cells and Treg cells. CTLA-4Ig decreased CD95-mediated cell death in vitro in a dose-dependent manner. Functional analysis of isolated Treg cells from RA patients further revealed a diminished suppression of responder T cell proliferation. This was found to be due to CTLA-4Ig-mediated blocking of CD80 and CD86 on responder T cells that led to a diminished susceptibility for Treg cell suppression.

Conclusion. CTLA-4Ig therapy in RA patients exerts effects beyond the suppression of T cell activation, which has to be taken into account as an additional mechanism of CTLA-4Ig treatment.

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Intestinal pseudo-obstruction in patients with systemic sclerosis: an analysis of the Nationwide Inpatient Sample

Objective. Intestinal pseudo-obstruction is a rare gastrointestinal complication in patients with SSc without large studies examining its prevalence or outcomes. We aimed to compare outcomes in SSc patients with intestinal pseudo-obstruction to patients with intestinal pseudo-obstruction secondary to other causes, and SSc patients without intestinal pseudo-obstruction.

Methods. This is a case-control study using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample for the period 2002–2011. We included patients with the previously validated International Classification of Diseases–Clinical Modification-9 code 710.1 for SSc in combination with codes for intestinal pseudo-obstruction, and determined length of hospitalization and the risks for surgical procedures, use of total parenteral nutrition (TPN) and in-hospital mortality.

Results. A total of 193 610 SSc hospitalizations occurred in the USA between 2002 and 2011, of which 5.4% (n = 10 386) were associated with a concurrent intestinal pseudo-obstruction diagnosis (cases). In-hospital mortality was 7.3%. In multivariate analyses, cases were more likely to die during the inpatient stay and to receive TPN than patients with idiopathic intestinal pseudo-obstruction (control group 1), patients with intestinal pseudo-obstruction and diabetes (control group 2), and SSc patients without intestinal pseudo-obstruction (control group 3). Cases had longer in-hospital stay than control groups 2 and 3, and were less likely to undergo surgical procedures than control groups 1 and 2.

Conclusion. Intestinal pseudo-obstruction is a rare cause of hospitalization in patients with SSc, but is associated with high in-hospital mortality in comparison with other SSc patients and those with intestinal pseudo-obstruction secondary to other causes.

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On the Conventionalization of Mouth Actions in Australian Sign Language

This study investigates the conventionalization of mouth actions in Australian Sign Language. Signed languages were once thought of as simply manual languages because the hands produce the signs which individually and in groups are the symbolic units most easily equated with the words, phrases and clauses of spoken languages. However, it has long been acknowledged that non-manual activity, such as movements of the body, head and the face play a very important role. In this context, mouth actions that occur while communicating in signed languages have posed a number of questions for linguists: are the silent mouthings of spoken language words simply borrowings from the respective majority community spoken language(s)? Are those mouth actions that are not silent mouthings of spoken words conventionalized linguistic units proper to each signed language, culturally linked semi-conventional gestural units shared by signers with members of the majority speaking community, or even gestures and expressions common to all humans? We use a corpus-based approach to gather evidence of the extent of the use of mouth actions in naturalistic Australian Sign Language–making comparisons with other signed languages where data is available–and the form/meaning pairings that these mouth actions instantiate.

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Best Teaching Practices in Anatomy Education: A critical review

Publication date: Available online 17 March 2016
Source:Annals of Anatomy – Anatomischer Anzeiger
Author(s): Mohamed Estai, Stuart Bunt
In this report we review available teaching resources and strategies being used in anatomy education with the aim of coming up with suggestions about the best teaching practices in this area. There is much debate about suitable methods of delivering anatomical knowledge. Competent clinicians, particularly surgeons, need a deep understanding of anatomy for safe clinical procedures. However, because students have had very limited exposure to anatomy during clinical training, there is a concern that medical students are ill-prepared in anatomy when entering clerkships and residency programs. Therefore, developing effective modalities for teaching anatomy is essential to safe medical practice. Cadaver-based instruction has survived as the main instructional tool for hundreds of years, however, there are differing views on whether full cadaver dissection is still appropriate for a modern undergraduate training. The limitations on curricular time, trained anatomy faculty and resources for gross anatomy courses in integrated or/and system-based curricula, have led many medical schools to abandon costly and time-consuming dissection-based instruction in favor of alternative methods of instruction including prosection, medical imaging, living anatomy and multimedia resources. To date, no single teaching tool has been found to meet curriculum requirements. The best way to teach modern anatomy is by combining multiple pedagogical resources to complement one another, students appear to learn more effectively when multimodal and system-based approaches are integrated. Our review suggests that certain professions would have more benefit from certain educational methods or strategies than others. Full body dissection would be best reserved for medical students, especially those with surgical career intentions, while teaching based on prosections and plastination is more suitable for dental, pharmacy and allied health science students. There is a need to direct future research towards evaluation of suitability of the new curriculum and student perceptions to integrated and multimodal teaching paradigms, and the ability of these to meet a set of learning outcomes.

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The number of Purkinje neurons and their topology in the cerebellar vermis of normal and reln haplodeficient mouse

Publication date: Available online 17 March 2016
Source:Annals of Anatomy – Anatomischer Anzeiger
Author(s): Chiara Magliaro, Carolina Cocito, Stefano Bagatella, Adalberto Merighi, Arti Ahluwalia, Laura Lossi
The Reeler heterozygous mice (reln+/−) are haplodeficient in the gene (reln) encoding for the reelin glycoprotein (RELN) and display reductions in brain/peripheral RELN similar to autistic or schizophrenic patients. Cytoarchitectonic alterations of the reln+/− brain may be subtle, and are difficult to demonstrate by current histological approaches. We analyzed the number and topological organization of the Purkinje neurons (PNs) in five vermal lobules – central (II-III), culmen (IV-V), tuber (VIIb), uvula (IX), and nodulus (X) – that process different types of afferent functional inputs in reln+/+ and reln+/− adult mice (P60) of both sexes (n=24). Animals were crossed with L7GFP mice so that the GFP-tagged PNs could be directly identified in cryosections. Digital images from these sections were processed with different open source software for quantitative topological and statistical analyses. Diversity indices calculated were: maximum caliper, density, area of soma, dispersion along the XZ axis, and dispersion along the YZ axis. We demonstrate: i. reduction in density of PNs in reln+/− males (14.37%) and reln+/− females (17.73%) compared to reln+/+ males; ii. that reln+/− males have larger PNs than other genotypes, and females (irrespective of the reln genetic background) have smaller PNs than reln+/+ males; iii. PNs are more chaotically arranged along the YZ axis in reln+/− males than in reln+/+ males and, except in central lobulus, reln+/− females. Therefore, image processing and statistics reveal previously unforeseen gender and genotype-related structural differences in cerebellum that may be clues for the definition of novel biomarkers in human psychiatric disorders.

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Dermoscopic Findings of Jellyfish Stings Caused by Pelagia noctiluca

Publication date: Available online 16 March 2016
Source:Actas Dermo-Sifiliográficas
Author(s): L.J. del Pozo, N. Knöpfel, A. Martín-Santiago, M.M. Escudero-Góngora, C. Saus, N. Izquierdo-Herce, A. Bauzà-Alonso
Background and objectivesJellyfish are free-living members of the phylum Cnidaria who share a specialized stinging cell, the cnidocyte. Pelagia noctiluca is the most frequent and toxic jellyfish species found in the Balearic beaches and cnidocytes are arranged in pigmented clusters called "warts". Dermoscopy continues to expand its use much beyond the pigmentary lesions and to date, there is no data regarding dermoscopic findings in jellyfish stings. The aim of the present work was to study the dermoscopic findings of jellyfish stings in the island of Mallorca.Patients and methodsWe retrospectively reviewed the clinical and dermoscopic images of 25 episodes of jellyfish stings caused by P. noctiluca that occurred between 2009 and 2015.ResultsOverall, the following dermoscopic features were found: brown dots (84%), pinkish hue (56%), pinpoint brown crusts (44%), scale-crust (40%), brown "Chinese characters pattern" (32%), "serpentine" ulceration (28%), linear purpura (20%), and whitish-yellow crusts (15%). Vessels were mainly dotted (36%) or reticular (16%). Scale-crust, serpentine ulceration and pinkish hue were significantly more frequent in lesions older than 2 days.Conclusions and limitationsOur study identifies 4 dermoscopic features that may represent the contact with P. noctiluca cnidocytes: brown dots, brown "Chinese characters pattern", pinpoint brown crusts and whitish-yellow crusts. A peculiar finding of "serpentine ulceration" with brown dots would be very suggestive of P. noctiluca sting. We believe dermoscopy is a valuable tool in the diagnosis of jellyfish stings when a clear history of contact is lacking. Further studies are needed to validate our findings in other jellyfish species.

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Utilidad de la azitromicina en la hiperplasia gingival inducida por ciclosporina

Publication date: Available online 17 March 2016
Source:Actas Dermo-Sifiliográficas
Author(s): J.M. Martín, E. Mateo, E. Jordá

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How to use immunoglobulin levels in investigating immune deficiencies

Children are often referred to immunologists for the evaluation of reduced serum immunoglobulins. Knowledge of the immunoglobulin levels in healthy children of different ages is necessary when estimating immunological deficiency states of various kinds. After the measurement of the serum levels of the three major isotypes, examination of the capacity of the child to form antibodies to several antigens is a reasonable next step in the evaluation. We can rely on vaccine responses to make the distinction between significant primary immunodeficiency diseases and transiently low immunoglobulin levels. On the other hand, normal values of IgM, IgG and IgA are not always enough to exclude a more serious condition. Regardless of immunoglobulin concentrations, if a child's history indicates that further evaluation is warranted, a complete humoral immunity study should be carried out, including IgG subclasses, specific antibody responses and identification of B lymphocyte populations.

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Statutory prevention of work injuries in Italy: an effectiveness evaluation with interrupted time series analysis in a sample of 5000 manufacturing plants from the Veneto region

Objectives

According to Italian law, prevention of injuries in the workplace falls under the National Health System Service of Prevention, Health and Safety at Work (SPISAL). In a sample of about 5000 industrial firms in the Veneto region (North-Eastern Italy), the study examines the impact of SPISAL safety programmes on injuries.

Methods

The study is based on the before-and-after comparison of injury rates in 795 industrial settings that were subject to SPISAL interventions and 4186 reference firms, which were all manufacturing industries with >10 employees; construction companies were excluded. The time window (2001–2007) was chosen in order to have 8 quarters of observation before and 8 after the intervention. The National Institute for Workers' Compensation provided data on injuries and plants, while SPISAL gave information on interventions carried out. The preintervention and postintervention rates of injuries were compared by means of interrupted time series analyses, estimating the rate ratio (RR) with a 95% CI.

Results

Inspection after injury reduced by 24% (RR=0.76; 95% CI 0.65 to 0.90; p=0.001) all injuries, and by 36% (RR=0.64; 95% CI 0.50 to 0.83; p=0.001) severe injuries (fatalities, lost workdays >30, degree of permanent disability >0). These changes occurred immediately and persisted for 2 years. The effects of programmed inspections were never significant.

Conclusions

It can be presumed that, after a severe injury, the employees raised their standard of what they considered good work safety and, at the same time, the employers were pushed to improve the work environment as a result of the sudden attention from the workplace hygiene and safety authority and court authority. Inspection after injury was an effective strategy; however, confirmatory evidence is needed.

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Author response: letter on ‘Does cadmium exposure contribute to depressive symptoms in the elderly population?

We thank Dr Tomoyuki Kawada1 for his interest in our manuscript entitled 'Does cadmium exposure contribute to depressive symptoms in the elderly population?'.2 In the letter, Dr Kawada depicted three possible reasons for the inconsistent results of our study: limited statistical power, use of blood cadmium as marker of cadmium exposure and the presence of other potential confounding variables.

First, we agree with Dr Kawada's opinion on the limited statistical power of the study regarding the small number of depression patients in the second and the third visit data. In our study, the point estimates for the association between blood cadmium levels and elderly depressive symptoms were not consistent across the three visits. The direction of the point estimate at the second and the third visit should be consistent as long as depression patients are similarly distributed across the quartile group as their distribution at the first…

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Antidifferentiation Noncoding RNA Regulates the Proliferation of Osteosarcoma Cells

Cancer Biotherapy & Radiopharmaceuticals Mar 2016, Vol. 31, No. 2: 52-57.

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Neuroplastic Response following Radiotherapy for Pediatric Brain Tumors: A Pilot Study

Publication date: Available online 17 March 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Carol L. Armstrong, Michael J. Fisher, Yimei Li, Robert A. Lustig, Jean B. Belasco, Jane E. Minturn, Christine E. Hill-Kayser, Sonny Batra, Peter C. Phillips
Purpose/ObjectivesClinically effective measurement of cognitive toxicity from photon radiotherapy (XRT) should be accurate, sensitive, and specific. This pilot study tests translational findings on phasic changes in children's memory systems that are sensitive and insensitive to toxic XRT effects, to identify a possible neuroplastic effect.Methods and MaterialsMemory processes were prospectively tested pre-XRT and at three later time points up to two years in 35 non-recurred children with mixed primary brain tumors. Memory processes were verbal-semantic, visual-semantic, and visual-perceptual, including accuracy, speed to recall, encoding, retrieval, and recognition. The mixed effects model included time (to estimate slope), covariates (age, tumor locus, XRT field, and medications) as fixed effects, and individual random intercepts. A sensitivity analysis examined the influence of XRT dose to the hippocampi on memory.ResultsRetrieval from long-term verbal-semantic memory declined two months after completing XRT, as seen in adults, and was lowest at one year, which was delayed in comparison to adults. Double dissociation from visual-perceptual memory at baseline and two months was found, consistent with adults. Recovery was demonstrated two years after XRT. Patterns were unchanged when dose to hippocampus was included in the model.ConclusionsVerbal and semantic long-term retrieval is specifically sensitive to XRT-related cognitive dysfunction, without effect on visual-perceptual memory. Children reached nadir in XRT-sensitive memory one year post-XRT, and recovered by two years, which is later than that observed in adults. The protracted period of post-XRT injury may represent the maturation of the human hippocampus and white matter into late adolescence.

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Complications with allogeneic, cancellous bone blocks in vertical alveolar ridge augmentation: prospective clinical case study and review of the literature

Publication date: Available online 17 March 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): G.F. Draenert, P.W. Kämmerer, M. Berthold, A. Neff
ObjectivesVertical bone augmentation procedures in dental implantology are an indication for cancellous allogeneic bone blocks (ABB). Though, these materials may lead to adverse reactions as known well from orthopedics but rarely published. Therefore, an evaluation of ABB in vertical bone augmentation in clinical dental implantology was conducted.Material and MethodsThe prospective clinical study was designed for 20 cases with vertical augmentation using ABB and subsequent or simultaneous placement of implants in the lateral maxilla and mandible. Follow up included panoramic X-ray, tissue healing and periimplantitis. Due to limited patients number, observation was planned to be descriptive only. A loss of ABB or periimplantitis of more than 30% of the intraosseous implant length was considered as failure.ResultsThe study was cancelled after 6 cases due to an unexpected high number of complications (5/6; 83%). The average surveillance time was1460 days. Three types of unsatisfying outcome were observed: type I: early complete loss of the augmentation with soft tissue defects after 3-8 weeks (n=2); type II: early soft tissue maceration (up to 8 weeks) without loss of coverage and complete early bony healing with later periimplantitis and bone loss after prosthetic loading (6 months or later; n=2); type III: complication-free bony healing with subsequent periimplantitis after prosthetic loading (6 months or later; n=1).ConclusionsComplications were observed in vertical augmentation with ABB and implant placement. Literature data support these results after careful consideration and also suggest that tissue level implants may be advantageous in vertical bone augmentation with ABB.

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Complete Remission of Unresectable Hepatocellular Carcinoma After Combined Sorafenib and Adjuvant Yttrium-90 Radioembolization

Cancer Biotherapy & Radiopharmaceuticals Mar 2016, Vol. 31, No. 2: 65-69.

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Pulsed-dose-rate vs. high-dose-rate intracavitary radiotherapy for locally advanced carcinoma of cervix: A prospective randomized study

Publication date: Available online 17 March 2016
Source:Brachytherapy
Author(s): Pavnesh Kumar, Daya Nand Sharma, Sunesh Kumar, Ajeet Kumar Gandhi, Goura Kishor Rath, Pramod Kumar Julka
PurposeTo compare late radiation toxicities in patients with carcinoma of cervix treated with pulsed-dose-rate (PDR) vs. high-dose-rate (HDR) intracavitary radiotherapy (ICRT).Methods and MaterialsBetween July 2010 to April 2012, 37 patients with Stage IIB-IIIB (International Federation of Gynecology and Obstetrics 2009) squamous cell carcinoma of cervix were randomized to receive either HDR (7 Gy each in three fractions, repeated weekly) or PDR (70 cGy hourly pulses for 39 hours, total 27 Gy) ICRT after external beam radiotherapy. Late rectal and bladder toxicities were assessed using Radiation Therapy Oncology Group criteria, and vaginal toxicity was graded as per common terminology criteria for adverse events. Overall survival and disease-free survival were estimated using Kaplan–Meier method.ResultsNineteen patients received HDR and 18 received PDR ICRT with median followup 34 and 29 months, respectively. In HDR vs. PDR arm, late rectal toxicities grade ≥2 (16.7% vs. 21.1%, p = 1.000), grade ≥3 (10.5% vs. 0%, p = 0.486), late bladder toxicities grade ≥2 (10.5% vs. 0%, p = 0.486), and late vaginal toxicities grade ≥2 (15.8% vs. 5.6%, p = 0.604) were not statistically different. For HDR and PDR ICRT groups, 4-year disease-free survival was 67.1% vs. 71.8% (p = 0.195) and overall survival was 77% vs. 75% (p = 0.322), respectively.ConclusionIn this small group of patients, there were fewer events in form of late radiation toxicities in PDR arm, although statistically not significant. Further studies are required to define role of PDR compared to HDR ICRT in cervical carcinoma.

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The NPC2 protein

Publication date: Available online 17 March 2016
Source:Annals of Allergy, Asthma & Immunology
Author(s): Taruna Khurana, Shoshana Newman-Lindsay, Philip R. Young, Jay E. Slater
BackgroundDogs are an important source of indoor allergens that cause rhinoconjunctivitis, urticaria, and asthma in sensitized individuals. Can f 1 is reported as a major dog allergen, but other allergens have also been identified. Identification of immunologically important allergens is important for both the diagnosis and treatment of dog allergy.ObjectiveTo identify and characterize the canine NPC2 protein, a novel dog allergen.MethodsWe screened commercial and laboratory-generated aqueous dog extracts by 2-dimensional polyacrylamide gel electrophoresis with IgE immunoblotting using human serum samples from 71 dog-allergic individuals. A target of interest was excised from the gel and sequenced. Canine NPC2 sequence was generated, and recombinant proteins expressed in yeast and bacteria were used to determine allergenicity. An IgE enzyme-linked immunosorbent assay was used for screening 71 dog-positive and 30 dog-negative serum samples.ResultsA 16-kDa protein (pK = 8.5) in dog allergen extracts was recognized by specific IgE. The protein was identified by sequencing as a CE1 protein or NPC2 protein. Human IgE bound to recombinant protein was expressed in both yeast and bacteria. Ten (14%) of 71 individuals had specific IgE to NPC2 protein from bacteria, and 12 (17%) had IgE to NPC2 protein from yeast. Binding of pooled dog-allergic serum IgE to the dust mite protein Der p 2 was partially inhibited by recombinant NPC2 protein.ConclusionsNPC2 protein, a member of the MD-2–related lipid recognition family, is identified as a dog allergen (Can f 7), with an apparent seroprevalence of 10% to 20%.

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Clinical trial on tonal tinnitus with tailor-made notched music training

Tinnitus is a result of hyper-activity/hyper-synchrony of auditory neurons coding the tinnitus frequency, which has developed due to synchronous mass activity owing to the lack of inhibition. We assume that re…

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Genotyping and follow-up of HR-HPV types detected by self-sampling in women from low socioeconomic groups not participating in regular cervical cancer screening in France

Publication date: Available online 17 March 2016
Source:Journal of Clinical Virology
Author(s): Catherine Tamalet, Philippe Halfon, Laurence Le Retraite, Anne Grob, François Xavier Leandri, Patrice Heid, Helene Sancho-Garnier, Lucien Piana
BackgroundHPV vaginal self-sampling can be an alternative for women refusing cytological screening.ObjectivesTo describe HR-HPV types in 35–69 years old women from low socioeconomic groups not attending regular cytological screening in Marseille, France.Study designA cervical screening campaign using HR-HPV self-sampling including 22,702 women aged 35–69 years living in low socioeconomic districts of Marseille was organized. A cytological and/or histological follow-up was undertaken for a subset of women harboring HR-HPV types. Abbott RealTime High Risk HPV test was used for screening, while INNO-LiPA HPV Genotyping Extra assay was used for genotyping.Results4245 self-samplings were performed (participation rate, 18.7%) out of which 609 (14.3%) were HR-HPV+ by the screening test including 114HPV 16 (18.7%), 41HPV 18 (6.7%), 454HR-HPVnon-16/18 (75.4%). A sample of 260 out of the 454HR-HPVnon-16/18 were genotyped by INNO-LiPA which revealed HPV52 (35%), 66 (22.6%), 51 (19.6%), 31 (15.7%), 39 (13%), 56 (10.4%), and 53, 35, 59, 33, 58, 82, 45, 68, 73 ( < 10% each). At month 12, a 2nd self-collection kit was sent to 274 of 609HR-HPV+ women who did not have a Pap-test previously performed on them. Of these 274 women, 130 provided a sample for HPV testing; one was uninterpretable, 56 were HPV negative, and 73 were HR-HPV+ (10HPV16+, 3HPV18+, 60HR-HPVnon-16/18 + ). Of the 345 women with cytological and/or histological follow-up 19 (5.5%) had ≥CIN2 lesions, (11 were HPV16+ and 8 were HR-HPVnon-16/18).ConclusionThis study illustrates the potential efficacy of self-sampling as a cancer screening strategy for socioeconomically deprived women who do not participate in regular Pap screening programs.

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The prospective evaluation of viral loads in patients with severe fever with thrombocytopenia syndrome

Publication date: Available online 17 March 2016
Source:Journal of Clinical Virology
Author(s): Zhen-Dong Yang, Jian-Gong Hu, Qing-Bin Lu, Chen-Tao Guo, Ning Cui, Wei Peng, Li-Yuan Wang, Shu-Li Qin, Hong-Yu Wang, Xiao-Ai Zhang, Wei Liu, Wu-Chun Cao
BackgroundSevere fever with thrombocytopenia syndrome (SFTS), caused by novel bunyavirus (SFTSV) is a potentially fatal disease that was first identified in China. Person to person transmission through contact with blood or body fluids was considered as an important infection route.ObjectivesThe study is designed to investigate the longitudinal viral loads following SFTSV infection and to identify factors affecting viral shedding in SFTS patients.MethodsA prospective, observational study was performed on 208 laboratory-confirmed SFTSV infected patients in Xinyang, Henan Province. Sequential serum samples were collected on admission and during the hospitalization for quantification of SFTSV RNA by real-time RT-PCR.ResultsThe viral RNA was undetectable in 55.6% of the patients on admission into the hospital, becoming detectable in most cases until three days and attained maximum level on six days after disease onset. This was followed by an obvious decrease thereafter, but maintained detectable for over 20 days. Viral load was independently predictable of severe disease outcome throughout the hospitalization. Viral load of >107 copies/mL was predictable of fatal outcome. The serum levels of PLT, WBC, LDH, AST and CK were significantly associated with viral loads level.ConclusionsThe diagnosis of SFTSV infection based on PCR test should be performed at least three days after disease onset. Peaking viral loads were attained around six days after disease, posing a highest risk of human-to-human transmission.

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Rhombencephalitis associated with Dengue fever

Publication date: Available online 17 March 2016
Source:Journal of Clinical Virology
Author(s): Rajesh Verma, Kavita Bharti, Mannan Mehta, Amrit Bansod
Dengue infection is gradually disseminating throughout the world in alarming proportions. It is a arbovirus infection,transmitted by aedes mosquitoes.It is a multi-systemic disorder associated with varied neurological complications. There is increased trend of development of neurological complications in dengue fever. The neurological complications arising due to dengue infection can be categorized into central and neuromuscular complications. The central nervous system disorders reported with dengue fever are encephalopathy,encephalitis and myelitis.Here we report a case of rhombencephalitis associated with dengue fever. The literature does not mention rhombencephalitis occurring with dengue illness.

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Front-line intraperitoneal versus intravenous chemotherapy in stage III-IV epithelial ovarian, tubal, and peritoneal cancer with minimal residual disease: a competing risk analysis

In the analysis of survival data for cancer patients, the problem of competing risks is often ignored. Competing risks have been recognized as a special case of time-to-event analysis. The conventional techniq…

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In this issue…

Publication date: March 2016
Source:African Journal of Emergency Medicine, Volume 6, Issue 1
Author(s): Stevan R. Bruijns

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Herpes simplex virus-1 encephalitis induced by chemoradiotherapy and steroids in an esophageal cancer patient: a case report

Systemic chemotherapy combined with steroids used as prophylactic antiemetics have been reported to induce immunosuppression. Further, herpes simplex virus-1 (HSV-1) infection has been reported to occur in pat…

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Randomised controlled trial of a home-based physical activity intervention in breast cancer survivors

To improve adherence to physical activity (PA), behavioural support in the form of behavioural change counselling may be necessary. However, limited evidence of the effectiveness of home-based PA combined with…

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Complications with allogeneic, cancellous bone blocks in vertical alveolar ridge augmentation: prospective clinical case study and review of the literature

Publication date: Available online 17 March 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): G.F. Draenert, P.W. Kämmerer, M. Berthold, A. Neff
ObjectivesVertical bone augmentation procedures in dental implantology are an indication for cancellous allogeneic bone blocks (ABB). Though, these materials may lead to adverse reactions as known well from orthopedics but rarely published. Therefore, an evaluation of ABB in vertical bone augmentation in clinical dental implantology was conducted.Material and MethodsThe prospective clinical study was designed for 20 cases with vertical augmentation using ABB and subsequent or simultaneous placement of implants in the lateral maxilla and mandible. Follow up included panoramic X-ray, tissue healing and periimplantitis. Due to limited patients number, observation was planned to be descriptive only. A loss of ABB or periimplantitis of more than 30% of the intraosseous implant length was considered as failure.ResultsThe study was cancelled after 6 cases due to an unexpected high number of complications (5/6; 83%). The average surveillance time was1460 days. Three types of unsatisfying outcome were observed: type I: early complete loss of the augmentation with soft tissue defects after 3-8 weeks (n=2); type II: early soft tissue maceration (up to 8 weeks) without loss of coverage and complete early bony healing with later periimplantitis and bone loss after prosthetic loading (6 months or later; n=2); type III: complication-free bony healing with subsequent periimplantitis after prosthetic loading (6 months or later; n=1).ConclusionsComplications were observed in vertical augmentation with ABB and implant placement. Literature data support these results after careful consideration and also suggest that tissue level implants may be advantageous in vertical bone augmentation with ABB.

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Neuroplastic Response following Radiotherapy for Pediatric Brain Tumors: A Pilot Study

Publication date: Available online 17 March 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Carol L. Armstrong, Michael J. Fisher, Yimei Li, Robert A. Lustig, Jean B. Belasco, Jane E. Minturn, Christine E. Hill-Kayser, Sonny Batra, Peter C. Phillips
Purpose/ObjectivesClinically effective measurement of cognitive toxicity from photon radiotherapy (XRT) should be accurate, sensitive, and specific. This pilot study tests translational findings on phasic changes in children's memory systems that are sensitive and insensitive to toxic XRT effects, to identify a possible neuroplastic effect.Methods and MaterialsMemory processes were prospectively tested pre-XRT and at three later time points up to two years in 35 non-recurred children with mixed primary brain tumors. Memory processes were verbal-semantic, visual-semantic, and visual-perceptual, including accuracy, speed to recall, encoding, retrieval, and recognition. The mixed effects model included time (to estimate slope), covariates (age, tumor locus, XRT field, and medications) as fixed effects, and individual random intercepts. A sensitivity analysis examined the influence of XRT dose to the hippocampi on memory.ResultsRetrieval from long-term verbal-semantic memory declined two months after completing XRT, as seen in adults, and was lowest at one year, which was delayed in comparison to adults. Double dissociation from visual-perceptual memory at baseline and two months was found, consistent with adults. Recovery was demonstrated two years after XRT. Patterns were unchanged when dose to hippocampus was included in the model.ConclusionsVerbal and semantic long-term retrieval is specifically sensitive to XRT-related cognitive dysfunction, without effect on visual-perceptual memory. Children reached nadir in XRT-sensitive memory one year post-XRT, and recovered by two years, which is later than that observed in adults. The protracted period of post-XRT injury may represent the maturation of the human hippocampus and white matter into late adolescence.

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The NPC2 protein

Publication date: Available online 17 March 2016
Source:Annals of Allergy, Asthma & Immunology
Author(s): Taruna Khurana, Shoshana Newman-Lindsay, Philip R. Young, Jay E. Slater
BackgroundDogs are an important source of indoor allergens that cause rhinoconjunctivitis, urticaria, and asthma in sensitized individuals. Can f 1 is reported as a major dog allergen, but other allergens have also been identified. Identification of immunologically important allergens is important for both the diagnosis and treatment of dog allergy.ObjectiveTo identify and characterize the canine NPC2 protein, a novel dog allergen.MethodsWe screened commercial and laboratory-generated aqueous dog extracts by 2-dimensional polyacrylamide gel electrophoresis with IgE immunoblotting using human serum samples from 71 dog-allergic individuals. A target of interest was excised from the gel and sequenced. Canine NPC2 sequence was generated, and recombinant proteins expressed in yeast and bacteria were used to determine allergenicity. An IgE enzyme-linked immunosorbent assay was used for screening 71 dog-positive and 30 dog-negative serum samples.ResultsA 16-kDa protein (pK = 8.5) in dog allergen extracts was recognized by specific IgE. The protein was identified by sequencing as a CE1 protein or NPC2 protein. Human IgE bound to recombinant protein was expressed in both yeast and bacteria. Ten (14%) of 71 individuals had specific IgE to NPC2 protein from bacteria, and 12 (17%) had IgE to NPC2 protein from yeast. Binding of pooled dog-allergic serum IgE to the dust mite protein Der p 2 was partially inhibited by recombinant NPC2 protein.ConclusionsNPC2 protein, a member of the MD-2–related lipid recognition family, is identified as a dog allergen (Can f 7), with an apparent seroprevalence of 10% to 20%.

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Hints of new LHC particle get slightly stronger

One fresh analysis keeps alive physicists' hope for a breakthrough, but another is disappointing.

Nature News doi: 10.1038/nature.2016.19589

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Herpes simplex virus-1 encephalitis induced by chemoradiotherapy and steroids in an esophageal cancer patient: a case report

Systemic chemotherapy combined with steroids used as prophylactic antiemetics have been reported to induce immunosuppression. Further, herpes simplex virus-1 (HSV-1) infection has been reported to occur in pat…

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Randomised controlled trial of a home-based physical activity intervention in breast cancer survivors

To improve adherence to physical activity (PA), behavioural support in the form of behavioural change counselling may be necessary. However, limited evidence of the effectiveness of home-based PA combined with…

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Pulsed-dose-rate vs. high-dose-rate intracavitary radiotherapy for locally advanced carcinoma of cervix: A prospective randomized study

Publication date: Available online 17 March 2016
Source:Brachytherapy
Author(s): Pavnesh Kumar, Daya Nand Sharma, Sunesh Kumar, Ajeet Kumar Gandhi, Goura Kishor Rath, Pramod Kumar Julka
PurposeTo compare late radiation toxicities in patients with carcinoma of cervix treated with pulsed-dose-rate (PDR) vs. high-dose-rate (HDR) intracavitary radiotherapy (ICRT).Methods and MaterialsBetween July 2010 to April 2012, 37 patients with Stage IIB-IIIB (International Federation of Gynecology and Obstetrics 2009) squamous cell carcinoma of cervix were randomized to receive either HDR (7 Gy each in three fractions, repeated weekly) or PDR (70 cGy hourly pulses for 39 hours, total 27 Gy) ICRT after external beam radiotherapy. Late rectal and bladder toxicities were assessed using Radiation Therapy Oncology Group criteria, and vaginal toxicity was graded as per common terminology criteria for adverse events. Overall survival and disease-free survival were estimated using Kaplan–Meier method.ResultsNineteen patients received HDR and 18 received PDR ICRT with median followup 34 and 29 months, respectively. In HDR vs. PDR arm, late rectal toxicities grade ≥2 (16.7% vs. 21.1%, p = 1.000), grade ≥3 (10.5% vs. 0%, p = 0.486), late bladder toxicities grade ≥2 (10.5% vs. 0%, p = 0.486), and late vaginal toxicities grade ≥2 (15.8% vs. 5.6%, p = 0.604) were not statistically different. For HDR and PDR ICRT groups, 4-year disease-free survival was 67.1% vs. 71.8% (p = 0.195) and overall survival was 77% vs. 75% (p = 0.322), respectively.ConclusionIn this small group of patients, there were fewer events in form of late radiation toxicities in PDR arm, although statistically not significant. Further studies are required to define role of PDR compared to HDR ICRT in cervical carcinoma.

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Surgical site infections following operative management of cervical spondylotic myelopathy: prevalence, predictors of occurence, and influence on peri-operative outcomes

Abstract

Purpose

Studies have examined infection rates following spine surgery and their relationship to post-operative complications and increased length of stay. Few studies, however, have investigated predictors of infection, specifically in the setting of operative intervention for cervical spondylotic myelopathy (CSM). This study aims to identify the incidence and factors predictive of infection amongst this cohort.

Methods

This study performed a retrospective review of the prospectively collected American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Patients included those treated surgically for CSM (ICD-9 code 721.1) from 2010 to 2012. Patient demographics and surgical data were collected with outcome variables including the occurrence of one of the following surgical site infections (SSIs) within 30 days of index operation: superficial SSI, deep incisional SSI, and organ/space SSI.

Results

3057 patients were included in this analysis. Overall infection rate was 1.15 % (35/3057), of which 54.3 % (19/35) were superficial SSIs, 28.6 % (10/35) were deep incisional SSI, and 20 % (7/35) were peri-spinal SSI. Logistic regression revealed factors associated with SSI included: higher BMI [OR 1.162 (CI 1.269–1.064), p = 0.001] and operative time ≥208 min [OR 4.769 (CI 20.220–1.125), p = 0.034].

Conclusions

The overall SSI rate for the examined CSM cohort was 1.15 %. This study identified increased BMI and operative time ≥208 min as predictors of infection in surgical CSM patients. This information should be carefully considered in delivering patient education and future efforts to optimize risk in CSM patients indicated for surgical intervention.

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Clinical trial on tonal tinnitus with tailor-made notched music training

Tinnitus is a result of hyper-activity/hyper-synchrony of auditory neurons coding the tinnitus frequency, which has developed due to synchronous mass activity owing to the lack of inhibition. We assume that re...

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Diagnostic efficacy of cell block method for vitreoretinal lymphoma

Vitreoretinal lymphoma (VRL) is a life- and sight-threatening disorder. The aim of this study was to analyze the usefulness of the cell block method for diagnosis of VRL.

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Normal pressure hydrocephalus: Increase of utricular input in responders to spinal tap test

Publication date: May 2016
Source:Clinical Neurophysiology, Volume 127, Issue 5
Author(s): N. Böttcher, T. Bremova, K. Feil, C. Heinze, R. Schniepp, M. Strupp
ObjectiveTo investigate whether there is a change in ocular (oVEMP) and cervical (cVEMP) vestibular evoked myogenic potentials in patients with normal pressure hydrocephalus (NPH) before and after spinal tap test (STT).MethodsIn 25 patients (6 females, age 62–83years) c/oVEMP were measured before and after STT. Patients with an increase of >20% of walking velocity were classified as responders (n=10). VEMP were also measured in a control group of 13 non-NPH patients.ResultsAll patients had reproducible oVEMP; 68% had cVEMP. There was a significant increase of the peak-to-peak (pp) oVEMP amplitude after STT in responders (8.5±2.7 to 18.9±7.5μV (p=0.010)). No significant changes were found in non-responders (13.4±7.6 to 15.3±8.6μV) or controls (12.4±7.6 to 12.5±6.8μV). There were no significant differences in cVEMP before and after spinal tap test (STT).ConclusionOne third of patients with suspected NPH had impaired otolith function. Responders to STT only had a significant increase of oVEMP and thereby utricular input, probably due to a decrease of pressure.SignificanceBoth findings indicate that otolith dysfunction may contribute to imbalance in NPH and that increased utricular function after STT may be relevant for gait improvement.

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Maxillary Sinus Infection in a Nineteenth Century Almshouse Skeletal Sample

Abstract

In 1984, the Monroe County Parks Department in the Highland Park section of Rochester, New York, accidentally unearthed part of an unmarked cemetery while landscaping. The cemetery was in use from approximately 1826 to 1863 and was associated with the Monroe County Almshouse. Anthropological examination of dental and skeletal pathology revealed a high incidence of dental infection, known to occasionally be a causal agent of maxillary sinus infection. Therefore, maxillary sinus infections in this sample were studied to ascertain their relationship with dental infections, sex, and age-at-death. The maxillary sinuses of 99 skeletons were examined for evidence of infection. The presence, location, type, and extent of dental infections in the posterior teeth were also recorded.

Half the sample exhibited bone remodeling in the maxillary sinus (54 individuals). Dental infections were observed in 82 individuals. Forty-eight showed signs of dental infection and maxillary sinusitis. Statistical analysis revealed that dental infection and maxillary sinus infection were not statistically related. Rather, a rhinogenic method of infection seems likely, which would appear related to the squalid air quality the 19th century poor were exposed to in the almshouse and city tenements. This article is protected by copyright. All rights reserved.

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Characteristics of rumen in Naemi lamb: Morphological changes in response to altered feeding regimen

Publication date: Available online 17 March 2016
Source:Acta Histochemica
Author(s): Ibrahim Alhidary, Mutassim M. Abdelrahman, Abdullah H. Alyemni, Rifat U. Khan, Aarif H. Al-Mubarak, Hani H. Albaadani
This study sought to chart the ontogenesis of rumen in Naemi lambs through histomorphometeric evaluation subjected to alfalfa hay in total mixed rations (TMR). A total of 40 growing healthy Naemi male lambs (28.85±1.09kg), at weaning (90±3days) was randomly distributed into four groups. One group was fed on TMR (control) only, while others were supplemented with restricted amount of alfalfa hay at the rate of 100g per day (T1), 200g once per two days (T2) and 300g once per three days (T3) in addition to ad libitum TMR. The results indicated that body weight and dry matter intake increased significantly in treated groups. Significantly higher (P<0.05) pH was recorded in all the treated groups after 8h of feeding. Similarly, the brightness (L*), redness (a*) and yellowness ((b*) of rumen was significantly higher (P<0.05) in treated groups. The papillary length, width and surface area of rumen were significantly (P<0.05) high in alfalfa supplemented groups. Iron (Fe) concentration in rumen tissue decreased significantly (P<0.05) in treated groups. We concluded that a dietary plan based on ad libitum TMR with the addition of alfalfa at the rate of aforementioned protocol not only enhanced feed intake and growth rate of the growing Naemi lambs but also improved the structural characteristics of the rumen.

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Geographical Detector-Based Identification of the Impact of Major Determinants on Aeolian Desertification Risk

by Ziqiang Du, Xiaoming Xu, Hong Zhang, Zhitao Wu, Yong Liu

Arid and semi-arid areas in North China are facing the challenge of a rising aeolian desertification risk (ADR) due to the intertwined effects of complex natural processes and intensified anthropogenic activities. An accurate quantitative assessment of the relationship between ADR and its determinants is beneficial for understanding the driving mechanisms of aeolian desertification and for controlling future desertification. Previous studies have failed to quantify the relative role of determinants driving ADR and have been limited in assessing their interactive impacts. In this study, a spatial variance analysis-based geographical detector methodology is used to quantify the effects of geological, physical, and human factors on the occurrence of ADR in an area characterized by mountains and hills in northern China. It is found that soil type, precipitation, and wind velocity are the major determinants of ADR, which implies that geological and physical elements (e.g., soil attribute) and climatic factors (e.g., precipitation and wind velocity) rather than human activities have played a greater role in the incidence of ADR. Particularly, the results show that the interaction of various determinants causes significant non-linearly enhanced impacts on the ADR. The findings of our study will assist local inhabitants and policy makers in developing measures for wind prevention and sand control to mitigate the effects of desertification in the region.

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Weird and wonderful Pluto spills its secrets

Data from NASA's New Horizons mission begin to reveal the stories behind the dwarf planet's complex geology.

Nature News doi: 10.1038/nature.2016.19585

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Wild Ungulate Decision-Making and the Role of Tiny Refuges in Human-Dominated Landscapes

by Yarlagadda Chaitanya Krishna, Ajith Kumar, Kavita Isvaran

Wildlife conservation in human-dominated landscapes requires that we understand how animals, when making habitat-use decisions, obtain diverse and dynamically occurring resources while avoiding risks, induced by both natural predators and anthropogenic threats. Little is known about the underlying processes that enable wild animals to persist in densely populated human-dominated landscapes, particularly in developing countries. In a complex, semi-arid, fragmented, human-dominated agricultural landscape, we analyzed the habitat-use of blackbuck, a large herbivore endemic to the Indian sub-continent. We hypothesized that blackbuck would show flexible habitat-use behaviour and be risk averse when resource quality in the landscape is high, and less sensitive to risk otherwise. Overall, blackbuck appeared to be strongly influenced by human activity and they offset risks by using small protected patches (~3 km2) when they could afford to do so. Blackbuck habitat use varied dynamically corresponding with seasonally-changing levels of resources and risks, with protected habitats registering maximum use. The findings show that human activities can strongly influence and perhaps limit ungulate habitat-use and behaviour, but spatial heterogeneity in risk, particularly the presence of refuges, can allow ungulates to persist in landscapes with high human and livestock densities.

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