Effect of inulin on breath hydrogen, postprandial glycemia, gut hormone release, and appetite perception in RYGB patients: a prospective, randomized, cross-over pilot study

BACKGROUND AND OBJECTIVE

Large intestinal fermentation of dietary fiber may control meal-related glycemia and appetite via the production of short-chain fatty acids (SCFA) and the secretion of glucagon-like peptide-1 (GLP-1) and peptide YY (PYY). We investigated whether this mechanism contributes to the efficacy of the Roux-en-Y gastric bypass (RYGB) by assessing the effect of oligofructose-enriched inulin (inulin) vs. maltodextrin (MDX) on breath hydrogen (a marker of intestinal fermentation), plasma SCFAs, gut hormones, insulin and blood glucose concentrations as well as appetite in RYGB patients.

METHOD

Eight RYGB patients were studied on two occasions before and ~8 months after surgery using a cross-over design. Each patient received 300 ml orange juice containing 25 g inulin or an equicaloric load of 15.5 g MDX after an overnight fast followed by a fixed portion snack served 3 h postprandially. Blood samples were collected over 5 h and breath hydrogen measured as well as appetite assessed using visual analog scales.

RESULTS

Surgery increased postprandial secretion of GLP-1 and PYY (P ≤ 0.05); lowered blood glucose and plasma insulin increments (P ≤ 0.05) and reduced appetite ratings in response to both inulin and MDX. The effect of inulin on breath hydrogen was accelerated after surgery with an increase that was earlier in onset (2.5 h vs. 3 h, P ≤ 0.05), but less pronounced in magnitude. There was, however, no effect of inulin on plasma SCFAs or plasma GLP-1 and PYY after the snack at 3 h, neither before nor after surgery. Interestingly, inulin appeared to further potentiate the early-phase glucose-lowering and second-meal (3-5 h) appetite-suppressive effect of surgery with the latter showing a strong correlation with early-phase breath hydrogen concentrations.

CONCLUSION

RYGB surgery accelerates large intestinal fermentation of inulin, however, without measurable effects on plasma SCFAs or plasma GLP-1 and PYY. The glucose-lowering and appetite-suppressive effects of surgery appear to be potentiated with inulin.

Closure of Post-thrombotic Iliac Arteriovenous Fistulas by Iliac Vein Recanalization

PURPOSE

The purpose of this study was to report the closure of iliac arteriovenous fistulas associated with a post-thrombotic iliac vein occlusion by iliac venous stent recanalization.

CASE REPORT

An 80-year-old woman presented with a worsening painful swelling of her left leg after an iliofemoral deep vein thrombosis 6 months ago. Duplex ultrasound and magnetic resonance venography revealed a post-thrombotic obstruction of her iliac veins as well as several arteriovenous fistulas between branches of her left external and internal iliac arteries and adjacent diseased venous segments. In a first attempt, coil embolization did not sustainably close these iliac arteriovenous fistulas. Direct stent recanalization of the chronically diseased iliofemoral venous segment, however, resulted in an immediate closure of arteriovenous shunt flow and subsequent improvement of clinical symptoms. Six months after iliac vein stent recanalization, still no fistulas could be detected any more, venous stents were fully patent, and the patient was free of symptoms.

CONCLUSION

Post-thrombotic iliofemoral obstructions might be associated with the development of arteriovenous fistulas. Direct stent recanalization of the chronically occluded veins results in closure of related arteriovenous fistulas.

CLINICAL IMPACT

This case suggests that the combined occurrence of post-thrombotic venous obstructions with arteriovenous fistulas, which are related to aforementioned venous lesions, should be evaluated for primary venous stent recanalization rather than fistula embolization.

Environmental impacts of earth observation data in the constellation and cloud computing era

Numbers of Earth Observation (EO) satellites have increased exponentially over the past decade reaching the current population of 1193 (January 2023). Consequently, EO data volumes have mushroomed and data storage and processing have migrated to the cloud. Whilst attention has been given to the launch and in-orbit environmental impacts of satellites, EO data environmental footprints have been overlooked. These issues require urgent attention given data centre water and energy consumption, high carbon emissions for computer component manufacture, and difficulty of recycling computer components. Doing so is essential if the environmental good of EO is to withstand scrutiny. We provide the first assessment of the EO data life-cycle and estimate that the current size of the global EO data collection is ~807 PB, increasing by ~100 PB/year. Storage of this data volume generates annual CO2 equivalent emissions of 4101 t. Major state-funded EO providers use 57 of their own data centres globally, and a further 178 private cloud services, with considerable duplication of datasets across repositories. We explore scenarios for the environmental cost of performing EO functions on the cloud compared to desktop machines. A simple band arithmetic function applied to a Landsat 9 scene using Google Earth Engine (GEE) generated CO2 equivalent (e) emissions of 0.042-0.69 g CO2e (locally) and 0.13-0.45 g CO2e (European data centre; values multiply by nine for Australian data centre). Computation-based emissions scale rapidly for more intense processes and when testing code. When using cloud services such as GEE, users have no choice about the data centre used and we push for EO providers to be more transparent about the location-specific impacts of EO work, and to provide tools for measuring the environmental cost of cloud computation. The EO community as a whole needs to critically consider the broad suite of EO data life-cycle impacts.

Multivariate analysis and digital twin modelling: Alternative approaches to evaluate molecular relaxation in photoacoustic spectroscopy

A comparative analysis of two different approaches developed to deal with molecular relaxation in photoacoustic spectroscopy is here reported. The first method employs a statistical analysis based on partial least squares regression, while the second method relies on the development of a digital twin of the photoacoustic sensor based on the theoretical modelling of the occurring relaxations. Methane detection within a gas matrix of synthetic air with variable humidity level is selected as case study. An interband cascade laser emitting at 3.345 µm is used to target methane absorption features. Two methane concentration ranges are explored targeting different absorptions, one in the order of part-per-million and one in the order of percent, while water vapor absolute concentration was varied from 0.3 % up to 2 %. The results achieved employing the detection techniques demonstrated the possibility to efficiently retrieve the target gas concentrations with accuracy > 95 % even in the case of strong influence of relaxation effects.

Accessory and cavitated uterine masses: a case series and review of the literature

Objectives

The purpose of this study is to report nine patients of young women who underwent a surgical treatment of an accessory and cavitated uterine mass (ACUM) in our hospital between 2014 and 2022 and review all cases described in the literature.

Material and methods

The principal outcomes measured are the imaging techniques used to determine the diagnosis, the type of surgery used and the post-operative evolution of symptoms. We also report and analyse the 79 patients found in the literature since 1996 in addition to our 9 patients.

Results

Surgical excision is the only long-lasting treatment. Small invasive surgery with laparoscopic access is the gold standard and most widely used (83.0%). Some new therapeutic procedures have been recently described of which ethanol sclerotherapy seems very promising. Post-operatively, 54.5% of patients have a complete relief of symptoms. MRI is the best imaging technique to identify ACUM. Finally, we refine the description of this pathology and give a more precise definition of it.

Conclusion

Through our literature review and the analysis of our cases, we want to underline an important diagnostic criterion of this pathology: the fallopian tube on the homolateral side of the ACUM never communicates with the latter. It is a capital element for differential diagnosis.

Water in the terrestrial planet-forming zone of the PDS 70 disk

Terrestrial and sub-Neptune planets are expected to form in the inner (less than 10 AU) regions of protoplanetary disks1. Water plays a key role in their formation2-4, although it is yet unclear whether water molecules are formed in situ or transported from the outer disk5,6. So far Spitzer Space Telescope observations have only provided water luminosity upper limits for dust-depleted inner disks7, similar to PDS 70, the first system with direct confirmation of protoplanet presence8,9. Here we report JWST observations of PDS 70, a benchmark target to search for water in a disk hosting a large (approximately 54 AU) planet-carved gap separating an inner and outer disk10,11. Our findings show water in the inner disk of PDS 70. This implies that potential terrestrial planets forming therein have access to a water reservoir. The column densities of water vapour suggest in-situ formation via a reaction sequence involving O, H2 and/or OH, and survival through water self-shielding5. This is also supported by the presence of CO2 emission, another molecule sensitive to ultraviolet photodissociation. Dust shielding, and replenishment of both gas and small dust from the outer disk, may also play a role in sustaining the water reservoir12. Our observations also reveal a strong variability of the mid-infrared spectral energy distribution, pointing to a change of inner disk geometry.

Real-world observational cohort study of treatment patterns and safety outcomes of infliximab biosimilar CT-P13 for the treatment of inflammatory bowel disease (CONNECT-IBD)

BACKGROUND

The objective of this non-interventional, observational prospective cohort study (CONNECT-IBD) was to assess the use of CT-P13 (Inflectra®) in the treatment of patients with Crohn's disease (CD) and ulcerative colitis (UC) in the context of treatment with reference infliximab (IFX; Remicade®).

METHODS

Patients (recruited April 2015 to October 2018) at 150 sites across 13 European countries were followed for up to 2 years. Primary outcomes were safety, population characteristics, and drug utilization patterns. Secondary outcomes included clinical assessment of disease activity. Data were analyzed descriptively.

RESULTS

Overall, 2543 patients (CD, n = 1676; UC, n = 867) were included. In the CT-P13 cohort (n = 1522), median disease duration was 63 (0-579) months and 30% of patients were IFX naïve; median duration of prior IFX treatment was 5 months. During the observation period, median duration of drug exposure was 14 (0-28) months. 41% of patients reported 912 all-causality treatment-emergent adverse events (TEAEs); 24% experienced treatment-related TEAEs. Most TEAEs were of mild-to-moderate severity. Treatment-emergent serious adverse events were reported by 17% of patients.

CONCLUSION

Safety information for CT-P13 in this large study was consistent with the known safety profile for IFX and did not alter the established benefit-risk profile of CT-P13.

Associations between nailfold capillary aberrations and autoantibodies in children and adults with Raynaud's phenomenon

OBJECTIVE

To characterise associations between individual nailfold capillary aberrations with autoantibodies in a cross-sectional study on children and adults with Raynaud's phenomenon (RP).

METHODS

Consecutive children and adults with RP and without previously known connective tissue disease (CTD) systemically underwent nailfold capillaroscopy and laboratory tests for the presence of antinuclear antibodies (ANA). The prevalence of individual nailfold capillary aberrations and ANA was assessed, and the associations between individual nailfold capillary aberrations and ANA were analysed separately in children and adolescents.

RESULTS

In total, 113 children (median age 15 years) and 2858 adults (median age 48 years) with RP and without previously known CTD were assessed. At least one nailfold capillary aberration was detected in 72 (64%) of included children and in 2154 (75%) of included adults with RP (children vs adults p<0.05). An ANA titre ≥1:80, ≥1:160 or≥1:320 was observed in 29%, 21% or 16% of included children, and in 37%, 27% or 24% of screened adults, respectively. While the occurrence of individual nailfold capillary aberrations was related to the presence of an ANA titre of ≥1:80 in adults (reduced capillary density, avascular fields, haemorrhages, oedema, ramifications, dilations and giant capillaries: each p<0.001), no comparable association between nailfold capillary aberrations and ANA was observed in children with RP without previously known CTD.

CONCLUSION

In contrast to adults, the association between nailfold capillary aberrations and ANA might be less pronounced in children. Further studies are warranted to validate these observations in children with RP.

A case of occupational transmission of mpox

INTRODUCTION

Between May 2022 and January 2023, a global mpox outbreak affected more than 84,000 patients across all continents. Transmission of mpox occurs through large respiratory droplets and direct contact with skin lesions.

CASE PRESENTATION

We present the case of a 31-year-old previously healthy male with mpox-Infection following occupational exposure to mpox from a needle stick injury with a sterile needle through a contaminated glove. The patient presented with a three-day history of fever, malaise, and an increasing erythema and swelling of one fingertip. The patient works as a medical doctor with regular exposure to patients infected with mpox. Mpox-PCR from a swab of the lesion and an oro-pharyngeal swab were positive. The lesion on his finger evolved into a necrotic skin lesion finally healing, leaving a scar. He did not develop any secondary pox on his skin and recovered fully.

DISCUSSION

Only a minority of patients with mpox infection develop illness with pronounced local complications as in this case.

CONCLUSION

Mpox can potentially be transmitted in an occupational context. Medical personnel should be informed about this possible route of transmission.

Arterial stiffness in acute coronary syndrome as a potential triage tool: a prospective observational study

BACKGROUND

Diagnosis and percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) are time-sensitive. Triage and algorithms identify patients at high-risk. However, additional prediction tools are warranted for prioritized care based on predicted coronary pathologies and PCI complexity. Pulse-wave velocity (PWV) is a non-invasive measurement related to cardiovascular morbidity, and their exact value in ACS evaluation is unclear.

METHODS

In patients undergoing coronary angiography (CA) and - if warranted - PCI for ACS evaluation at a tertiary university hospital in Vienna, Austria, brachial-ankle (ba)PWV and carotid-femoral (cf)PWV were prospectively measured from January 2020 to January 2021.

RESULTS

PWV was measured in 58 patients (60.3% male; 65 [61-69] years). Risk prediction scores (GRACE, CRUSADE, TIMI), cardiac enzymes, and fraction of patients with a three-vessel disease were significantly higher in the pathological PWV ranges. Adjusted for age and comorbidities, baPWV independently predicted the LAD being relevantly stenotic (crude OR=1.416 [1.143-1.755], P=0.001; adjusted OR=1.340 [1.039-1.727], P=0.024; cut-off 15.5 m/s in CART-analysis), being the culprit lesion (crude OR=1.320 [1.094-1.594], P=0.004; adjusted OR=1.311 [1.037-1.657], P=0.024; cut-off 15.5 m/s), and being totally occluded (crude OR=1.422 [1.113-1.818], P=0.005; adjusted OR=1.677 [1.189-2.366], P=0.003; cut-off 19.6 m/s). Moreover, CA or PCI complexity were associated with higher PWV.

CONCLUSIONS

Pathological PWV as a surrogate for arterial stiffness, polyvascular disease and a larger atherosclerotic burden was associated with GRACE, CRUSADE, and TIMI scores, and PCI duration and complexity. BaPWV independently predicted relevant LAD pathologies, and is suggested as a potential novel triage and prioritization tool for suspected NSTE-ACS in emergency departments.

Genome sequencing reveals underdiagnosis of primary ciliary dyskinesia in bronchiectasis

BACKGROUND

Bronchiectasis can result from infectious, genetic, immunological and allergic causes. 60-80% of cases are idiopathic, but a well-recognised genetic cause is the motile ciliopathy, primary ciliary dyskinesia (PCD). Diagnosis of PCD has management implications including addressing comorbidities, implementing genetic and fertility counselling and future access to PCD-specific treatments. Diagnostic testing can be complex; however, PCD genetic testing is moving rapidly from research into clinical diagnostics and would confirm the cause of bronchiectasis.

METHODS

This observational study used genetic data from severe bronchiectasis patients recruited to the UK 100,000 Genomes Project and patients referred for gene panel testing within a tertiary respiratory hospital. Patients referred for genetic testing due to clinical suspicion of PCD were excluded from both analyses. Data were accessed from the British Thoracic Society audit, to investigate whether motile ciliopathies are underdiagnosed in people with bronchiectasis in the UK.

RESULTS

Pathogenic or likely pathogenic variants were identified in motile ciliopathy genes in 17 (12%) out of 142 individuals by whole-genome sequencing. Similarly, in a single centre with access to pathological diagnostic facilities, 5-10% of patients received a PCD diagnosis by gene panel, often linked to normal/inconclusive nasal nitric oxide and cilia functional test results. In 4898 audited patients with bronchiectasis, <2% were tested for PCD and <1% received genetic testing.

CONCLUSIONS

PCD is underdiagnosed as a cause of bronchiectasis. Increased uptake of genetic testing may help to identify bronchiectasis due to motile ciliopathies and ensure appropriate management.

Besoins non satisfaits en soins de soutien chez les survivants du cancer de la prostate à un stade avancé : exploration par méthodes mixtes

But : Les hommes souffrant d’un cancer avancé de la prostate connaissent un large éventail d’effets secondaires découlant du cancer et de ses traitements qui nuisent à leur qualité de vie (QDV). Peu d’études ont évalué les besoins de soins de soutien chez ces personnes. Cette étude a été réalisée pour effectuer une évaluation globale des besoins en soins de soutien chez ces survivants en se fondant sur un cadre de soins de soutien en oncologie (Supportive Care Framework for Cancer Care, ou SCFCC). Méthodes : Dans le cadre d’une recherche menée selon une approche mixte, parallèle et convergente, des survivants du cancer de la prostate à un stade avancé (n = 188) ont répondu à un questionnaire d’enquête transversale. Quelques-uns de ces survivants (n = 20) ont participé à un entretien afin de mieux évaluer leurs besoins non satisfaits. Résultats : Les survivants ont déclaré des besoins non satisfaits de soins de soutien dans tous les domaines du cadre d’évaluation utilisé. Pas moins de 95,2 % des survivants avaient au moins un besoin non satisfait, avec une moyenne de 14,9 besoins (fourchette : 0–42). Plusieurs domaines de convergence entre les données quantitatives et qualitatives (fatigue, dysfonctionnement sexuel, domaines pratique et émotionnel/psychologique) et de divergence (domaines informationnel et spirituel, dépression, dysfonctionnement urinaire) ont été trouvés durant le processus d’intégration. Conclusion : Cette étude confirme que les survivants du cancer de la prostate à un stade avancé présentent des taux élevés de besoins non satisfaits en soins de soutien. Les résultats soulignent également une grande diversité dans ces besoins non satisfaits. Ces résultats pourraient contribuer au développement de plans de soins de soutien centrés sur le patient, adaptés aux besoins particuliers de ce groupe vulnérable de survivants du cancer. Mots-clés : cancer de la prostate; stade avancé; survivants; soins de soutien; besoins non satisfaits; qualité de vie; méthodes mixtes

Unmet supportive care needs in prostate cancer survivors with advanced disease: A mixed-methods exploration

Purpose: Men with advanced prostate cancer experience a wide range of side effects from the cancer and its therapies, which have a negative effect on their quality of life (QOL). Few studies have evaluated supportive care needs in these individuals. The purpose of this study was to conduct a holistic supportive care needs assessment among these survivors guided by the Supportive Care Framework for Cancer Care. Methods: Using a convergent parallel mixed-methods approach, prostate cancer survivors with advanced disease (n = 188) completed a cross-sectional survey. A subset of these survivors (n = 20) participated in an interview to further explore their experience of unmet needs. Results: Survivors reported unmet supportive care needs in every domain of the framework. Up to 95.2% of the survivors had at least one unmet need, with a mean of 14.9 (range: 0–42). Several areas of convergence among the quantitative and qualitative data (fatigue, sexual dysfunction, practical, and emotional/psychological domains), as well as divergence (informational and spiritual domains, depression, urinary dysfunction) were found through the integration process. Conclusions: This study confirms that prostate cancer survivors with advanced disease experience high rates of unmet supportive care needs. The findings also highlight the diversity of those unmet needs. These results may assist with future development of patient-centered supportive care interventions that better meet the specific needs of this vulnerable group of cancer survivors. Keywords: prostate cancer; advanced disease; survivors; supportive care; unmet needs; quality of life; mixed-methods

Decrease of RNA editing in the failing heart leads to induction of circRNAs

Background and purpose

Adenosine-to-Inosine (A-to-I) RNA editing is a post-transcriptional modification process that affects the secondary structure of RNAs. Changes in RNA editing have been associated with human diseases. We therefore aimed to analyze editing in the healthy and failing human heart.

Methods and results

Transcriptome sequencing of human heart samples of heart failure (HF) patients (n=20) and controls (n=10) revealed A-to-I editing as the major type of editing (&gt;80%). In HF patients, RNA editing was reduced, which was primarily attributable to Alu elements in introns of protein-coding genes. We identified 166 upregulated circRNAs in HF, with the majority showing reduced RNA editing in their parental host gene (88.3%). CircRNA expression did not correlate with their corresponding host gene (R=0.07, P&lt;0.05), suggesting that an alternative splicing mechanism gives rise to the elevated circRNA levels in HF. The RNA editing enzyme ADAR2, which binds to RNA regions that are edited from adenosine to inosine, was decreased in failing human hearts (−68.2%). In vitro, reduction of ADAR2 increased circRNA levels suggesting a causal effect of reduced ADAR2 levels on increased circRNAs in the failing human heart. To gain mechanistic insight, we examined the formation of circRNAs on one exemplary candidate. AKAP13 was among the top edited mRNAs in the human heart and gave rise to a circular transcript, which was elevated in HF. ADAR2 reduced the formation of double-stranded structures in AKAP13 pre-mRNA, thereby reducing the stability of Alu elements and the circularization of the resulting circRNA. Overexpression of circAKAP13 impaired the sarcomere regularity of human induced pluripotent stem cell-derived cardiomyocytes (−31.0%).

Conclusion

Our study shows that ADAR2 mediates A-to-I RNA editing in the human heart. We describe an alternative splicing mechanism of circRNAs in the human heart. In the healthy human heart, A-to-I RNA editing represses the formation of dsRNA structures of Alu elements thereby favoring linear mRNA splicing. Our results contribute to a better mechanistic understanding into the human-specific regulation of circRNA formation and are relevant to diseases with reduced RNA editing and increased circRNA levels.

Funding Acknowledgement

Type of funding sources: None.

Camostat Mesylate Versus Lopinavir/Ritonavir in Hospitalized Patients With COVID-19—Results From a Randomized, Controlled, Open Label, Platform Trial (ACOVACT)

Background: To date, no oral antiviral drug has proven to be beneficial in hospitalized patients with COVID-19.

Methods: In this randomized, controlled, open-label, platform trial, we randomly assigned patients ≥18 years hospitalized with COVID-19 pneumonia to receive either camostat mesylate (CM) (considered standard-of-care) or lopinavir/ritonavir (LPV/RTV). The primary endpoint was time to sustained clinical improvement (≥48 h) of at least one point on the 7-category WHO scale. Secondary endpoints included length of stay (LOS), need for mechanical ventilation (MV) or death, and 29-day mortality.

Results: 201 patients were included in the study (101 CM and 100 LPV/RTV) between 20 April 2020 and 14 May 2021. Mean age was 58.7 years, and 67% were male. The median time from symptom onset to randomization was 7 days (IQR 5–9). Patients in the CM group had a significantly shorter time to sustained clinical improvement (HR = 0.67, 95%-CI 0.49–0.90; 9 vs. 11 days, p = 0.008) and demonstrated less progression to MV or death [6/101 (5.9%) vs. 15/100 (15%), p = 0.036] and a shorter LOS (12 vs. 14 days, p = 0.023). A statistically nonsignificant trend toward a lower 29-day mortality in the CM group than the LPV/RTV group [2/101 (2%) vs. 7/100 (7%), p = 0.089] was observed.

Conclusion: In patients hospitalized for COVID-19, the use of CM was associated with shorter time to clinical improvement, reduced need for MV or death, and shorter LOS than the use of LPV/RTV. Furthermore, research is needed to confirm the efficacy of CM in larger placebo-controlled trials.

Systematic Review Registration: [https://clinicaltrials.gov/ct2/show/NCT04351724, https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-001302-30/AT], identifier [NCT04351724, EUDRACT-NR: 2020–001302-30].

Nonlinear pulse compression to 51-W average power GW-class 35-fs pulses at 2-µm wavelength in a gas-filled multi-pass cell

We report on the generation of GW-class peak power, 35-fs pulses at 2-µm wavelength with an average power of 51 W at 300-kHz repetition rate. A compact, krypton-filled Herriott-type cavity employing metallic mirrors is used for spectral broadening. This multi-pass compression stage enables the efficient post compression of the pulses emitted by an ultrafast coherently combined thulium-doped fiber laser system. The presented results demonstrate an excellent preservation of the input beam quality in combination with a power transmission as high as 80%. These results show that multi-pass cell based post-compression is an attractive alternative to nonlinear spectral broadening in fibers, which is commonly employed for thulium-doped and other mid-infrared ultrafast laser systems. Particularly, the average power scalability and the potential to achieve few-cycle pulse durations make this scheme highly attractive.

25 Tender Is the Spine: Thoracolumbar Fractures and Patterns of Referrals

Introduction

This study investigates the pattern of referrals of thoracolumbar fractures between trauma and orthopaedic department in a district general trauma unit (TU) and the affiliated Major Trauma Centre (MTC). Our TU has got no out of hour emergency spinal surgeons on site. Patients who are admitted with thoracolumbar fractures get referred to MTC for advice on management. The TLICS score and the AO Thoracolumbar fracture classification system are two well recognized classification systems for thoracolumbar fractures. The main aim of this project is to evaluate current practice and its effectiveness.

Method

Data was retrospectively collected from the trauma board for patients referred to the orthopaedic on call services for thoracolumbar fractures over a 16-month period. Patients’ demographics, mechanism of injury, TLICS scores and AO classification were recorded, and outcome registered.

Results

From 92 patients identified most had low energy trauma and the majority had low TLICS score (&lt;2) and AO class (A1,2,3). 24 of the patients were referred to MTC of whom 10 required a follow-up appointment. 39 were discussed with the local spinal consultants. 91 were treated conservatively and locally.

Conclusions

Most thoracolumbar fractures are treated locally. It can be argued that the emergency spinal services at MTC are unnecessarily burdened for advice and reassurance. A change of the current pathway can possibly be put in place for patients with low AO classification (A1,2,3), that can be treated with local spinal surgeon input. This calls for a follow-on multi-centre study.

Biosimilar-to-Biosimilar Switching: What is the Rationale and Current Experience?

Over time, clinicians have become increasingly comfortable embracing the prescription of biosimilars-highly similar versions of innovator or reference biological agents-for their patients with inflammatory diseases. Although a switch from a reference product to a licensed biosimilar version (or vice versa) is a medical decision robustly supported by the stepwise accumulation of clinical trial evidence concerning comparable safety, immunogenicity, and efficacy between these products, a switch from one biosimilar to another biosimilar of the same reference product, or a cross-switch, is not. Similarity among biosimilars of a reference product is not a regulatory agency concern and therefore is unlikely to be investigated in randomized controlled trials in the foreseeable future. Yet in clinical practice, across a diverse range of patients, the option to cross-switch from one biosimilar to another can and does arise for valid reasons such as convenience or tolerability issues, or driven by third parties (e.g., payers). In the absence of clinical trial data, clinicians must attempt to objectively evaluate the emerging real-world cross-switching evidence within the context of what is known about the science underpinning a designation of biosimilar. That knowledge then needs to be integrated with what clinicians know about their patients and their disease on a case-by-case basis. This review aims to consolidate relevant emerging real-world data and other key information about biosimilar-to-biosimilar cross-switching for prescribing clinicians. In the absence of clear clinical guidelines addressing this topic at present, this review may serve to facilitate discretionary and educated treatment decision making.

Reduced RNA editing in the failing human heart mediates alternative circular RNA splicing

Background and purpose

Post-transcriptional RNA editing is an important mechanism in the development of human diseases. RNA editing can affect RNA stability and alternative splicing. The aim of our study was to characterize RNA editing and its impact on alternative RNA splicing in the healthy and failing human heart.

Methods and results

Human heart samples of heart failure (HF) patients (n=20) and controls (n=10) were analyzed using RNA sequencing with subsequent analysis of RNA editing. We identified adenosine-to-inosine (A-to-I) editing as the major form of RNA editing in human hearts, being reduced in HF patients. Consistently, we found the editing enzyme ADAR2 reduced in HF patients. A-to-I RNA editing predominantly occurred in intronic regions of protein-coding genes, specifically in repetitive, primate-specific Alu elements which can affect RNA splicing. Indeed, we found 173 circular RNAs (circRNAs) regulated by alternative mRNA splicing in the failing heart.

Loss of ADAR2 led to reduced RNA editing concomitant with an increase of circRNA, while overexpression reduced circRNA expression and enhanced RNA editing.

Conclusion

A-to-I editing is the major type of RNA editing in the human heart, being reduced in HF. We demonstrate a primate-specific alternative RNA splicing mechanism mediated by RNA editing in human hearts. The findings may be relevant to diseases with reduced RNA editing such as cancer, neurological and cardiac diseases.

Funding Acknowledgement

Type of funding sources: None.

Point-of-care testing in out-of-hospital cardiac arrest: a retrospective analysis of relevance and consequences

Background

Metabolic and electrolyte imbalances are some of the reversible causes of cardiac arrest and can be diagnosed even in the pre-hospital setting with a mobile analyser for point-of-care testing (POCT).

Methods

We conducted a retrospective observational study, which included analysing all pre-hospital resuscitations in the study region between October 2015 and December 2016. A mobile POCT analyser (Alere epoc®) was available at the scene of each resuscitation. We analysed the frequency of use of POCT, the incidence of pathological findings, the specific interventions based on POCT as well as every patient’s eventual outcome.

Results

N = 263 pre-hospital resuscitations were included and in n = 98 of them, the POCT analyser was used. Of these measurements, 64% were performed using venous blood and 36% using arterial blood. The results of POCT showed that 63% of tested patients had severe metabolic acidosis (pH < 7.2 + BE <  − 5 mmol/l). Of these patients, 82% received buffering treatment with sodium bicarbonate. Potassium levels were markedly divergent normal (> 6.0 mmol/l/ < 2.5 mmol/l) in 17% of tested patients and 14% of them received a potassium infusion. On average, the pre-hospital treatment time between arrival of the first emergency medical responders and the beginning of transport was 54 (± 20) min without POCT and 60 (± 17) min with POCT (p = 0.07). Overall, 21% of patients survived to hospital discharge (POCT 30% vs no POCT 16%, p = 0.01, Φ = 0.16).

Conclusions

Using a POCT analyser in pre-hospital resuscitation allows rapid detection of pathological acid–base imbalances and potassium concentrations and often leads to specific interventions on scene and could improve the probability of survival.