Do thoracoabdominal organ boundaries differ between males and females? Implications for body armour coverage and design

To optimise fit and protection of body armour systems, knowledge of the location of thoracoabdominal organ boundaries is required. The aims of this study were (i) determine the effect of sex on essential and desirable thoracoabdominal organ boundaries, and (ii) compare essential thoracoabdominal organ boundaries with small and large hard ballistic plate sizes from the National Institute of Justice (NIJ) and determine if coverage requirements differ between sexes. 33 males and 33 females underwent supine magnetic resonance imaging of their thoracoabdominal organs. Male participants on average displayed more laterally and inferiorly positioned essential and desirable organ boundaries than females. Based on NIJ plate sizes, insufficient coverage of essential organs was identified for male and female participants. A greater range of body armour sizes and designs that better cater to the diverse anatomy of soldier populations is warranted, but must be considered in the context of ergonomic and performance implications.

Association between maternal family history of hypertension and preterm birth: modification by noise exposure and multivitamin intake

OBJECTIVE

To measure the effect of maternal family history of hypertension on preterm birth (PTB) and to identify factors that modified this association.

METHODS

A case-control study was nested in a prospective cohort of the entire pregnant population in Wuhan, China, from 2011 to 2013. Home-visit interviews were scheduled for all PTBs and their controls, to collect extensive information on maternal exposures to behavioral, environmental, and intergenerational risk factors of PTB. The effects of maternal family history of hypertension on PTB were measured by logistic regression analyses, controlling for potential confounders. Potential effect modifiers were examined using stratified analyses.

RESULTS

There were 2393 PTBs and 4263 full-term births out of all eligible births. A positive association was observed between maternal family history of hypertension and PTB, after adjusted for potential confounders (adjusted odds ratio: 1.17 [1.03, 1.33]). A higher effect was observed when mothers were exposed to certain noise during pregnancy (adjusted odds ratio: 1.37 [1.14, 1.65]) and/or when they did not take multivitamins during pregnancy (adjusted odds ratio: 1.46 [1.20, 1.78]), whereas, this association was weaker and no longer significant when mothers took multivitamins during pregnancy (adjusted odds ratio: 1.00 [0.84, 1.19]) and/or when they were not exposed to certain noise during pregnancy (adjusted odds ratio: 1.01 [0.85, 1.12]). The modification effect from maternal multivitamin intake was significant on both spontaneous and medically indicated PTBs, and the modification effect from maternal exposure to certain noise was only significant on spontaneous PTB.

CONCLUSIONS

Increased PTB risk was observed for pregnant women with a family history of hypertension in Wuhan, China. This effect was stronger when pregnant women did not take multivitamin and/or exposed to certain noise during pregnancy, than those who took multivitamin and/or unexposed to certain noise.

Association of exposure to ambient particulate matter with maternal thyroid function in early pregnancy

BACKGROUND

It is known that maternal thyroid dysfunction during early pregnancy can cause adverse pregnancy complications and birth outcomes. This study was designed to examine the association between ambient particulate matter with aerodynamic diameters ≤2.5 μm (PM2.5) and particulate matter with aerodynamic diameters ≤10 μm (PM10) exposure and maternal thyroid function during early pregnancy.

METHODS

This study was based on data from a birth cohort study of 921 pregnant women in China. We estimated associations between ambient PM2.5 and PM10 exposure during the first trimester of pregnancy (estimated with land-use regression models) and maternal thyroid hormone concentrations (free thyroxine (FT4), free tri-iodothyronine (FT3), and thyroid-stimulating hormone (TSH)) collected between weeks 10 and 17 of gestation using linear regression models adjusting for potential confounders. Ambient PM2.5 and PM10 concentrations were modeled per interquartile range (IQR) increment and as tertiles based on the distribution of the exposure levels.

RESULTS

An IQR increment (68 μg/m3) in PM2.5 exposure was associated with a significant decrease in maternal FT4 levels (β = -0.60, 95% CI: -1.07, -0.12); and a significant decrease in FT4/FT3 ratio (β = -0.13, 95% CI: -0.25, -0.02). Further analyses showed that, relative to the lowest tertile, women in both the middle and highest tertiles of PM2.5 had significantly lower concentrations of maternal FT4 and FT4/FT3 ratio. No significant associations were found between PM2.5 and FT3 or TSH levels. PM10 exposure was not significantly associated with maternal thyroid function.

CONCLUSIONS

Our study suggested that higher ambient PM2.5, not PM10, exposed during the first trimester of pregnancy were associated with a significant decrease in maternal serum FT4 concentrations and FT4/FT3 ratio. Studies in populations with different exposure levels are needed to replicate our study results.

Outcomes of patients after repeat heart transplantation – insights from the UNOS database

Background

Cardiac graft failure may require repeat heart transplantation (HTx). Outcomes of patients that undergo repeat HTx have not been well described.

Methods

We compared patients that received repeat HTx with patients that received initial HTx by inquiring the United Network for Organ Sharing database between 2015–2021. The primary endpoint was all-cause mortality.

Results

A total of 19,805 HTx patients were included in the study. Patients that underwent repeat HTx (n=578, 3%) were younger (43.8±15.3 vs. 53.7±12.7 years, p<0.001) with lower body mass index (26.8±5.3 vs. 27.6±4.9 kg/m2, p<0.001) and worse renal function (Cr 1.8±1.4 vs. 1.4±0.9 mg/dl). Patients with repeat HTx had increased risk for 1-year mortality (hazard ratio 1.49 [1.16–1.90], p=0.002) compared to patients with initial HTx after adjusting for age, ethnicity, use of left ventricular assist device, UNOS recipient status, diabetes, ischemic time, donor age and predicted heart mass mismatch (Figure 1). Results did not change with the new allocation system (10/2018).

Conclusion

Repeat HTx occurred in 3% of a contemporary UNOS cohort and carried an increased and independent risk for mortality.

Funding Acknowledgement

Type of funding sources: None.

Prenatal metal mixture exposure and birth weight: A two-stage analysis in two prospective cohort studies

The understanding of the impact of prenatal exposure to metal mixtures on birth weight is limited. We aimed to identify metal mixture components associated with birth weight and to determine additional pairwise interactions between metals showing such associations. Concentrations of 18 metals were measured using inductively coupled plasma mass spectrometry in urine samples collected in the 3rd trimester from a prenatal cohort (discovery; n = 1849) and the Healthy Baby Cohort (replication; n = 7255) in Wuhan, China. In the discovery set, we used two penalized regression models, i.e., elastic net regression for main effects and a lasso for hierarchical interactions, to identify important mixture components associated with birth weight, which were then replicated. We observed that 8 of the 18 measured metals were retained by elastic net regression, with five metals (vanadium, manganese, iron, cesium, and barium) showing negative associations with Z-scores for birth weight and three metals (cobalt, zinc, and strontium) showing positive associations. In replication set, associations remained significant for vanadium (β = -0.035; 95% confidence interval [CI], -0.059 to -0.010), cobalt (β = 0.073; 95% CI, 0.049 to 0.097), and zinc (β = 0.040; 95% CI, 0.016 to 0.065) after Bonferroni correction. We additionally identified and replicated a single pairwise interaction between iron and copper exposure on birth weight (P < 0.001). Using a two-stage analysis, we identified and replicated individual metals and additional pairwise interactions-associated birth weight. The approach could be used in other studies estimating the effect of complex mixtures on human health.

Different plastics ingestion preferences and efficiencies of superworm (Zophobas atratus Fab.) and yellow mealworm (Tenebrio molitor Linn.) associated with distinct gut microbiome changes

Larvae of superworms (Zophobas atratus Fab.) and yellow mealworms (Tenebrio molitor Linn.) can survive on sole plastic diets. However, no side-by-side comparison of plastics degradation by both species is available yet. Here, superworms and yellow mealworms were fed with polystyrene (PS) or polyurethane (PU) foam plastics as sole diets for 35 days with bran as control. Superworms survived 100% on all diets but decreased weights were observed after 20 days with sole plastic diets. In contrast, yellow mealworms survived 84.67% or 62.67% with PS or PU diet, respectively, both plastics diet groups showed increased weights. Cumulative consumption of plastics by superworms were 49.24 mg-PS/larva and 26.23 mg-PU/larva, which were 18 and 11 folds of that of yellow mealworms, respectively. When converted into mg/g-larvae, superworms had a higher PS consumption rate but both species had similar PU consumption rates. Similar changes of the plastic chemical functional groups in frass indicated occurrences of oxidation and biodegradation of plastics in the guts of both species. Changes of gut microbial communities were found associated with plastics feedstocks and larvae species. The increased relative abundances of unclassified Enterobacteriaceae, Klebsiella, Enterococcus, Dysgonomonas and Sphingobacterium were strongly associated with PS diet in superworms, while Hafnia was strongly associated with PS diet in yellow mealworms. Enterococcus and Mangrovibacter were dominant in PU-fed superworm guts, while unclassified Enterobacteriaceae and Hafnia were strongly associated with PU feeding in yellow mealworms. The results demonstrated that different plastics ingestion preferences and efficiencies of both species were associated with distinct dominant microbiomes although similar changes of chemical groups in plastics were observed.

876 Veriset Haemostatic Patch, Indications, Benefits and Complications: A Systematic Review

Aim

Achieving haemostasis intraoperatively is important for minimising blood loss, complications, and operation time. Suturing, cauterisation, fibrin glues and patches are used for this purpose. We explore Veriset, a patch consisting of polyethylene glycol and oxidised cellulose, to determine and compare its safety and effectiveness.

Method

Medline, Embase, Web of Science, Scopus, Cinahl and Cochrane databases were searched. Data points collected were Study/subject characteristics/demographics, surgery/specialty, time to haemostasis, proportion of haemostasis achieved, intraoperative adverse events, post operative complications, follow up time, and biochemical/histological analysis. Risk of Bias was assessed by Newcastle-Ottawa Scale

Results

Six studies were included; four human trials (3 RCTs, 1 case series) and two animal trials.

The human trials combined had 250 patients, with 147 using Veriset. In two RCTs, Veriset showed faster time to haemostasis and higher proportion of haemostasis achieved vs suturing and Tachosil haemostatic patch. In all three RCTs, no significant differences in adverse events and complications were seen between Veriset and suturing/Tachosil. Vascular, nephrectomy and hepatic surgery were investigated.

In the animal studies, the pig trial showed similar effectiveness and safety as the human trials. The rat study compared novel experimental patches to Veriset, and showed similar effectiveness to Veriset, at reduced costs.

Conclusions

Although current literature is scarce, Veriset is more effective than alternatives for haemostasis, with similar safety, although there are now other experimental patches that could have better health economic implications. Further clinical trials would be necessary to determine the breadth of applicable surgical fields for Veriset.

180 Retrograde Hindfoot Nailing for the Treatment of Acute Ankle Fractures in the Elderly - a Systematic Review and Meta-Analysis

Aim

Fragility ankle fractures are traditionally managed conservatively or with open reduction internal fixation (ORIF). Tibiotalocalcaneal (TTC) nailing is an alternative option for the geriatric patient. This meta-analysis provides the most detailed analysis of hindfoot nailing for fragility ankle fractures.

Method

A systematic search was performed on MEDLINE, EMBASE, Cochrane Library, Scopus, Web of Science, identifying fourteen studies for inclusion. Studies including patients over 60 with a fragility ankle fracture, treated with TTC nail were included. Patients with a previous fracture of the ipsilateral limb, fibular nails, and pathological fractures were excluded.

Meta-regression analyses were performed to explore sources of heterogeneity, and publication bias was assessed using Egger's test.

Results

312 ankle fractures were included. The mean age was 77.3 (32–101) years. 26.9% were male, and 41.9% were diabetics. The pooled proportion of superficial infection, deep infection, implant failure, malunion, and all-cause mortality was 0.10 (95%CI:0.06–0.16; I2=44%), 0.08 (95%CI:0.06–0.11, I2=0%), 0.11 (95%CI:0.07–0.15,I2=0%), 0.11 (95%CI:0.06–0.18; I2=51%), and 0.27 (95%CI:0.20–0.34; I2=11%), respectively. The pooled mean post-operative OMAS score was 54.07 (95%CI:48.98–59.16; I2=85%). The best-fitting meta-regression model included age and percentage of male patients as covariates (p=0.0263), and were inversely correlated with higher OMAS scores. Egger's test (p=0.56) showed no significant publication bias.

Conclusions

TTC nailing is an adequate alternative option for fragility ankle fracture management. However, current evidence includes mainly case series with inconsistent outcome measures reported and post-operative rehabilitation protocols. Prospective RCTs with long follow-up times and large cohort sizes are needed to clearly guide the use of TTC nailing for ankle fractures.

893 Predictors for Infection Severity in Open Tibial Fractures

Aim

Open tibial fractures can be difficult to manage - many factors could affect treatment and outcome, including being complicated by infection. We present a cohort of 244 patients and analyse which factors are significantly associated with infection outcome.

Method

Open tibia fractures treated at a major trauma centre between 2015–2021 were included.

Infection status was categorized into no infection, superficial infection, osteomyelitis. Data collected were Age, mode of injury, polytrauma, fibula status, Gustilo-Anderson (GA) classification, wound contamination, time to first procedure. time to definitive plastics procedure, time to definitive fixation, type of definitive fixation, smoking/diabetic status, and BMI.

Multicollinearity was calculated, with highly correlated factors removed. Multinomial logistic regression was performed. Chi-Squared test, with Post-Hoc Bonferroni correction was performed for complex categorical factors.

Results

244 patients were included. Polytrauma and fibula status, and type of definitive fixation were excluded from the multivariate model due to strong multicollinearity. Compared to non-infected outcome, patients with superficial infection had higher BMI (p&lt;0.01), higher GA grade (p&lt;0.01), and osteomyelitis patients had longer time to definitive fixation (p=0.049) and longer time to definitive plastics procedure (p=0.013), higher GA grade, and wound contamination.

Post-hoc analysis showed “no infection” was positively associated with GA-I (p=0.029) and GA-II (p&lt;0.01), and negatively associated with GA-IIIC (p&lt;0.01). Osteomyelitis was positively associated with GA-IIIc (p&lt;0.01)

Conclusions

This study investigated associations between injury and presentation factors that may have been associated with infection. We suggest clinicians should give extra consideration to the factors highlighted during management and take preventative measures to mitigate the infection risk.

245 Ankle Fusion with Tibiotalocalcaneal Retrograde Nail for Fragility Ankle Fractures: Outcomes at a Major Trauma Centre

Aim

Fragility ankles fractures in the geriatric population are challenging to manage, due to fracture instability, soft tissue compromise, and patient co-morbidities. Traditional management options include open reduction internal fixation, or conservative treatment, both of which are fraught with high complication rates. We aimed to present functional outcomes of elderly patients with fragility ankle fractures treated with retrograde ankle fusion nails.

Method

171 patients received a tibiotalocalcaneal nail over a six-year period, but only twenty met the inclusion criteria of being over sixty and having poor bone stock. Primary outcome was mortality risk from co-morbidities according to Charlson co-morbidity index (CCI), and patients’ post-operative mobility status compared to pre-operative mobility. Secondary outcomes include intra-operative and post-operative complications, six-month mortality rate, time to mobilisation and union.

Results

Mean age was 77.82 years old. The average CCI was 5.05. Thirteen patients returned to their pre-operative mobility state. Patients with low CCI are more likely to return to pre-operative mobility status (p=0.16;OR=4.00).

Average time to bone union and mobilisation were 92.5 days and 7.63 days, respectively. Mean post-operative AOFAS ankle-hindfoot and Olerud-Molander scores were 53.0 and 50.9, respectively. There were four cases of superficial infection. Patients with high CCI were more likely to acquire superficial infections (p=0.264,OR=3.857). There were no deep infections, periprosthetic fractures, nail breakages, non-unions. Average follow-up time was 499.3 days.

Conclusions

Tibiotalocalcaneal nailing is an effective and safe option for managing fragility ankle fractures in the elderly. This technique leads to lower complication rates and earlier mobilisation than traditional fixation methods.

Application of coal fly ash in pavement subgrade stabilisation: A review

Expansive clays are found in many countries worldwide, and they exhibit inherent volume change during the seasonal moisture variation causing cracks, heaves, and damages to the overlying pavements. Chemical stabilisation is one of the most used approaches to treat the expansive clay subgrades. Cement, Lime and Fly ash are the most commonly used stabilisers, in which fly is cheaper and a by-product obtained from the coal power plant. This paper reviews fly ash stabilisation on various clay types, including low plasticity clays, high plasticity clays, silty clays, organic clays, and peats. The review begins with the properties of fly ash, followed by the characteristics of fly ash stabilised subgrades. The micro-level mechanism, physical, mechanical, and hydraulic characteristics of stabilised pavements are presented graphically for the Class C, and F fly ashes. The micro-level studies reveal that the pozzolanic reaction is stronger than the cation exchange during the fly ash stabilisation. The unconfined compressive strength (UCS), California bearing ratio (CBR) and resilient modulus (M_r) increased with the fly ash addition and curing time for most soft soils except peat clays. Based on the mechanical and hydraulic characteristics, using 15% class C fly ash with 7 days of curing is recommended for optimum performance. Although few research studies confirm that the leachate limit of stabilised soil is within the acceptable limit, further studies are required to investigate the uptake of heavy metals and other certain carcinogenic contaminants. This study will provide key information for researchers and Engineers on the selection of fly ash stabilisation measures for expansive subgrades.

Impact of early term and late preterm birth on infants' neurodevelopment: evidence from a cohort study in Wuhan, China

Background

The incidences of early term and late preterm birth have increased worldwide during recent years. However, there is a lack of prospective study about the influence of early term and late preterm birth on infants’ neurodevelopment, especially at the early stage. Therefore, we conducted this cohort study to investigate the impact of early term and late preterm birth on infants’ neurodevelopment within 6 months.

Methods

This cohort study was conducted in Wuhan, China, between October 2012 and September 2013. A total of 4243 singleton infants born within 34-41 weeks of gestation at Wuhan Children’s Hospital were included. The Gesell Developmental Scale (GDS) was utilized to evaluate the neurodevelopment of infants.

Results

Among the 4243 included participants, 155 (3.65%) were late preterm infants, 1288 (30.36%) were early term infants, and 2800 (65.99%) were full term infants. After adjusted for potential confounders, significant negative relationship was shown between late preterm birth and development quotient (DQ) in all domains of neurodevelopment: gross motor (β = − 17.42, 95% CI: − 21.15 to − 13.69), fine motor (β = − 23.61, 95% CI: − 28.52 to − 18.69), adaptability (β = − 10.10, 95% CI: − 13.82 to − 6.38), language (β = − 6.28, 95% CI: − 9.82 to − 2.74) and social behavior (β = − 5.99, 95% CI: − 9.59 to − 2.39). There was a significant negative trend for early term birth in DQ of fine motor (β = − 2.01, 95% CI: − 3.93 to − 0.09). Late preterm infants had a significantly elevated risk of neurodevelopmental delay in domains of gross motor (adjusted OR = 3.82, 95% CI: 2.67 to 5.46), fine motor (adjusted OR = 3.51, 95% CI: 2.47 to 5.01), and adaptability (adjusted OR = 1.60, 95% CI: 1.12 to 2.29), whereas early term birth was significantly associated with neurodevelopmental delay of fine motor (adjusted OR = 1.22, 95% CI: 1.05 to 1.42).

Conclusions

This study suggested that late preterm birth mainly elevated the risk of neurodevelopmental delay of gross motor, fine motor, and adaptability, whereas early term birth was associated with the developmental delay of fine motor within 6 months. Further research is needed to determine the effectiveness and necessity of the interventions at the early stage for early term and late preterm infants who had suspected neurodevelopmental delay.

Association between early-term birth and delayed neurodevelopment at the age of 2 years: results from a cohort study in China

A growing body of evidence indicates that early-term births (37-38 weeks of gestational age) have an increased risk of short-term and long-term complications. Here, we sought to explore the association between early-term births and the risk of delayed neurodevelopment at age 2 years. Pregnant women and their live singleton birth were recruited from a single tertiary hospital between October 2013 and February 2017. Mental and Psychomotor Development Indexes (MDI and PDI) were assessed using the Bayley Scales of Infant Development (BSID). Delayed neurodevelopment was defined as scores of PDI or MDI less than -1SD relative to the mean score of the study population. In total, 1678 full-term infants and 727 early-term infants were assessed when they were 2 years old. After adjustment for potential confounders, early-term birth was related to 43% increased odds of neurodevelopmental delay in the PDI domain as compared with full-term birth (OR: 1.43; 95% CI: 1.12, 1.82). The observed associations were more prominent among those infants born by cesarean (OR: 1.44; 95% CI: 1.03, 2.00) and among males (OR: 1.66; 95% CI: 1.20, 2.28). No statistical difference in the MDI domain was found between early-term and full-term births.Conclusions: Our findings suggest that early-term birth was associated with increased odds of delayed neurodevelopment in the PDI domain as measured by BSID assessments at age 2 years. Health professionals should be aware of the influence of early-term birth on the risk of delayed neurodevelopment. What is Known: • Evidence indicates that early-term births have an increased risk of short-term and long-term complications. • The association between early-term births and delayed neurodevelopment at their early childhood has not been widely studied. What is New: • Early-term birth was associated with increased odds of delayed neurodevelopment in PDI domain as measured by BSID assessments at age 2 years. • The observed associations were more prominent among infants born by cesarean section and among male infants.

Biodegradation of foam plastics by Zophobas atratus larvae (Coleoptera: Tenebrionidae) associated with changes of gut digestive enzymes activities and microbiome

In order to uncover the plastic types that superworm Zophobas atratus can degrade and the underlying changes associated with plastics consumption, three types of plastics including polystyrene (PS), polyethylene (PE) and polyurethane (PU) foam were used as sole feedstock to feed the superworm larvae for 35 days with bran as control. Compared to the control, PS- or PU-fed larvae showed 100% survival rates, the PE-fed and starvation larvae had decreased survival rates of 81.67% and 65%, respectively. Both plastics-fed and starvation groups showed decreased larvae weight. The consumption rates of PS, PE, and PU were 1.41, 0.30, and 0.74 mg/d/larva, respectively. The attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR) and differential scanning calorimeter and thermogravimetric (DSC-TGA) analyses demonstrated the changes of functional groups and thermostability in frass compared to plastic feedstocks, indicating the partial oxidation and degradation of plastics. Among the gut digestive enzymes tested, protease showed increased activities in all plastics-fed groups. Gut microbial communities displayed significant relative abundance changes such as increased abundances of Enterococcus in all plastic-fed groups, Citrobacter in PE-fed group, Dysgonomonas and Sphingobacterium in PS-fed group, and Mangrovibacter in PU-fed group. The latter 3 genera were reported for the first time. In summary, the results demonstrated that Z. atratus could efficiently degrade both PS and PU foam plastics, and the plastic degradation was associated with changes of gut microbial communities and digestive enzyme activities.

[Treatment response to Conbercept of different types of diabetic macular edema classified based on optical coherence tomography]

OBJECTIVE

To compare different types of diabetic macular edema (DME) classified based on optical coherence tomography (OCT) for their responses to Conbercept injection and analyze the factors that affect the treatment responses.

METHODS

We retrospectively analyzed the clinical data of 65 patients (76 eyes) with DME diagnosed and treated with intravitreal injection of Conbercept (1+PRN) in our hospital from February, 2019 to February, 2021. According to OCT findings, DME in these patients was classified into cystic macular edema (CME; 28 eyes), serous retinal detachment (SRD; 33 eyes), and diffuse retinal thickening (DRT; 15 eyes). The best corrected visual acuity (BCVA) and central retinal thickness (CRT) were measured before and at 3 months after the first treatment. The baseline OCT characteristics of different types of DME were compared, and the correlation of these OCT characteristics with the treatment response to Conbercept was analyzed.

RESULTS

All the patients showed significant improvement of the BCVA 3 months after the treatment (P < 0.05). For all the 3 types of DME, the CRT at 3 months after the first treatment was significantly reduced as compared to the baseline (P < 0.05). The number of hyperreflective foci (HF) in the outer retina and the proportion of ellipsoid zone (EZ) interruption were the greatest in SRD group (P < 0.05). The baseline outer retinal HF was significantly correlated with the baseline CRT, CRT changes and CRT after treatment (all P < 0.05). The patients with baseline outer limiting membrane (ELM)/ EZ disruption had poorer baseline BCVA, greater baseline CRT, greater variation of CRT and poorer BCVA at 3 months after treatment (all P < 0.05).

CONCLUSION

For all the 3 types of DME, treatment with intravitreal injection of Conbercept can significantly improve the BCVA and CRT of the patients. DME of the SRD type has the best morphological response to Conbercept, while the DRT type has a relatively poor response. A greater number of HF at baseline may indicate a better morphological response to Conbercept treatment, and baseline ELM/EZ disruption may suggest a poor visual prognosis at 3 months after treatment.

33 Impact of Disruption of Tibio-Fibular Joints During Distraction Osteogenesis on Knee and Ankle Joint Function

Aim

The aim of this study is to investigate whether a disruption of proximal and/or distal tibio-fibular joint correlates to patient’s function and osteoarthritis.

Method

Retrospective analysis of 44 patients with lower limb bone defects treated by tibial corticotomy and distraction osteogenesis was conducted. Analysis of lower limb x-rays before surgery, immediately post-surgery and after frame removal permitted calculations of changes in tibial length and changes in fibula position relative to the tibia at the proximal and distal tibio-fibular joints. X-rays before and after treatment were also graded for osteoarthritis severity using Alhbäck's classification. Functional ability was scored using the American Orthopaedic Foot & Ankle Society (AOFAS) score and the Knee society score (KSS).

Results

15 patients showed a decrease in the distance between fibular tip and distal tibia, 5 showed no change and 12 showed an increase at the end of the treatment. No statistical significant association was noted with KSS or AOFAS score (p &gt; 0.05), however one patient with a large distance increase exhibited severe radiological exacerbation of knee osteoarthritis. The distal corticotomy group achieved significantly higher length of new bone (p &lt; 0.001) and were more likely to have exacerbation of knee osteoarthritis (p &lt; 0.05). Conversely, proximal corticotomy group were significantly more likely to show an exacerbation of ankle osteoarthritis (p &lt; 0.05).

Conclusions

Attempts should be made not to disrupt the tibio-fibular joints during bone transport, but disruption does not necessarily correlate to poorer outcomes. Our results show that lengthening index reduces with larger bone defects, suggesting that radical debridement/resection may not negatively affect the healing index.

Identification and Characterization of a Germline Mutation in CARD11 From a Chinese Case of B Cell Expansion With NF-κB and T Cell Anergy

B cell expansion with NF-κB and T cell anergy (BENTA) is a rare primary immunodeficiency disorder caused by gain-of-function (GOF) mutations in the CARD11 gene. Affected patients present with persistent B cell lymphocytosis in early childhood paired with lymphadenopathy and splenomegaly. Until now only six activating mutations from 14 patients have been reported in CARD11. Here we report a patient from China with polyclonal B cell lymphocytosis and frequent infections in early life. A heterozygous mutation (c.377G>A, G126D) in exon 5 of CARD11 gene (NM_032415) was identified by whole exome sequencing. In vitro functional studies showed that the G126D mutation is associated with increased expression of CARD11 and NF-κB activation in Hela cells. Flow cytometry analysis indicated NK cell activity and CD107a degranulation of the patient were decreased. RNA sequencing analysis showed that a number of genes in NF-κB pathway increased while those involved in NK cell activity and degranulation were down-regulated. In summary, our work identified a de novo germline GOF mutation in CARD11 with functional evidence of BENTA.

Associations of prenatal exposure to vanadium with early-childhood growth: A prospective prenatal cohort study

Prenatal vanadium exposure is reported to be associated with restricted fetal growth and adverse birth outcomes. However, trimester-specific vanadium exposure in relation to early-childhood growth still remains unclear. A total of 1873 Chinese mother-infant pairs from whom a complete series of maternal urinary samples were collected over three stages of pregnancy were included from 2014 to 2016. The urinary concentrations of vanadium were analyzed. Children's anthropometric parameters were measured at birth, 6, 12 and 24 months. In boys, each doubling increase in vanadium concentrations at middle pregnancy was inversely associated with weight-for-length [- 9.07% (-17.21%, -0.93%)] and BMI z-score [- 9.66% (-18.05%, -1.28%)] at 24 months. Moreover, vanadium exposure at late pregnancy was negatively associated with weight [- 9.85% (-16.42%, -3.28%)], weight-for-length [- 11.00% (-18.40%, -3.60%)], and BMI z-scores [- 11.05% (-18.67%, -3.42%)] at 24 months in boys. However, the negative associations were not observed in girls, and we found evidence for sex difference (FDR p for interaction=0.01, 0.01 and 0.03 for weight, weight-for-length and BMI z-scores, respectively). Prenatal vanadium exposure may have an adverse effect on early-childhood growth, and the middle and late pregnancy could be windows of vulnerability for the adverse effects of vanadium exposure on growth development.

Prenatal exposure to halogenated, aryl, and alkyl organophosphate esters and child neurodevelopment at two years of age

Neurotoxicity of organophosphate esters (OPEs) has been reported in toxicological studies, but epidemiological findings are limited. We aimed to assess the associations between prenatal OPE exposures and children's neurodevelopment at 2 years old. We measured urinary concentrations of OPEs collected in the first and third trimester from 184 pregnant women in Wuhan, China. Childhood neurodevelopment was assessed using the Chinese revision of Bayley Scale of Infant Development. A two-fold increase in the average of bis (1,3-dichloro-2-propyl) phosphate (BDCIPP) was associated with 3.50 decrease in Psychomotor Development Index (PDI) score (95%CI: -5.86, -1.14) and 5.75 decrease in Mental Development Index (MDI) score (95%CI: -8.94, -2.55). Average of the molar concentrations of chlorinated-alkyl OPEs (ΣCl-OPEs) during pregnancy was inversely associated with PDI [β = -3.24 (95%CI: -5.95, -0.53)] and MDI scores [β = -5.86 (95%CI: -9.52, -2.20)]. Prenatal concentrations of BDCIPP and ΣCl-OPEs were inversely associated with neurodevelopment scores in boys, but not in girls. Our study provides evidence that elevated prenatal exposure to chlorinated-alkyl OPEs especially BDCIPP might be inversely associated with childhood neurodevelopment, and the effect seems to be sex-specific.