Evaluating the Validity of a Bayesian Program for Predicting Stage in Hodgkin’s Disease

A Bayesian model that provides probabilistic information about the spread of malignancy in a Hodgkin’s disease patient has been developed at the Tufts New England Medical Center. In assessing the model’s reliability, it seemed important to use it to make predictions about patients other than those relevant to its construction. The accuracy of these predictions could then be tested statistically. This paper describes such a test, based on 243 Hodgkin’s disease patients of known pathologic stage. The results obtained were supportive of the model, and the test procedure might interest those wishing to determine whether the imperfections that attend any attempt to make probabilistic forecasts have gravely damaged their accuracy.

Relationship Between Sarcopenia and Frailty in the Toledo Study of Healthy Aging: A Population Based Cross-Sectional Study

INTRODUCTION

Frailty and sarcopenia are correlates of musculoskeletal aging that represent a state of vulnerability increasing the risk of negative health outcomes. Standardized definitions are lacking for both, and sometimes both concepts are used interchangeably. However, no large study has assessed the coexistence of these 2 entities in a cohort of older community-dwelling people.

METHODS

Data were taken from the Toledo Study of Healthy Aging (TSHA), a study of community-dwelling elderly (≥65 years). The study population consists of 1611 participants with frailty and sarcopenia assessments. For sarcopenia, we used 3 criteria: European Working Group on Sarcopenia in Older People (EWGSOP), the Foundation for the National Institutes of Health (FNIH), and the FNIH fitted to the cut-off points of our population [standardized FNIH (sFNIH)]. Frailty was assessed according to the Fried criteria with cut-off points adjusted to our population. We used logistic regression to assess the relationship between sarcopenia and frailty and measures of diagnostic accuracy to evaluate the potential use of sarcopenia as a diagnostic marker for frailty.

RESULTS

The mean age of the population was 75.42 years (±5.86). Overall, 72 (4.5%) were frail. In addition, 352 (21.8%), 332 (20.6%), and 453 (28.1%) participants were considered sarcopenic according to the EWGSOP, FNIH, and sFNIH criteria, respectively. The prevalence of frailty among those with sarcopenia was 8.2% (29/352), 15.7% (52/332), and 10.4% (47/453). Moreover, among frail people, the prevalence of sarcopenia was 40.27%, 72.2%, and 65.3% according to the used criteria. Sarcopenia showed a low sensitivity (<10%) but high specificity (>97%) for the diagnosis of frailty, with a low intercorrelation (Cramer V = 0.16, 0.40, and 0.30) between the 3 criteria and frailty. Using multivariate logistic regression, frailty was associated with sarcopenia according to EWGSOP [odds ratio (OR) = 1.67, 95% confidence interval (CI) = 0.95, 2.96], FNIH (OR = 10.61, 95% CI = 5.8, 19.4), and sFNIH (OR = 6.63, 95% CI =3.5, 12.53).

CONCLUSION

Frailty and sarcopenia are distinct but related conditions. Sarcopenia is not a useful clinical biomarker of frailty, but its absence might be useful to exclude frailty.

The Last Glacial Maximum and deglaciation in central Patagonia, 44°S–49°S

This paper reviews published geochronological data on glacier fluctuations and environmental changes in central Patagonia (44° S - 49° S) from the Last Glacial Maximum (LGM) through to the Holocene. Well-dated glacial chronologies from the southern mid-latitudes can inform on the synchronicity of glacial advances worldwide and provide insight on the drivers of southern hemisphere glaciations. In central Patagonia, two large outlet lobes of the former Patagonian Ice Sheet advanced in broad synchrony with the global LGM. In contrast to other parts of Patagonia, there is no convincing evidence for a more extensive local LGM advance during Marine Isotope Stage 3. Deglaciation initiated at ca. 19 ka, earlier than in other parts of Patagonia and regionally in the Southern Hemisphere, and rapid deglaciation saw ice margins retreat in places by at least 80-120 km within a few millennia. The Lateglacial glacier margins are poorly constrained, but an ice mass substantial enough to maintain a large regional proglacial lake must have persisted at this time. The timing of lake drainage and opening of the Río Baker drainage route to the Pacific Ocean is debated; the only directly dated shoreline suggests this occurred at the end of the Antarctic Cold Reversal at 12.7 ka. Palaeoecological evidence for cooling during the Antarctic Cold Reversal or Younger Dryas remains equivocal, which may reflect both the eurythermic nature of Patagonian vegetation and shifting Southern Westerly Winds. Eastern outlet glaciers appear to have advanced or stabilised at the Lateglacial/Holocene transition when palaeoenvironmental records indicate warmer and drier conditions, but the reason for this is unclear. Our review reveals both spatial and temporal gaps in available data that provide avenues for future research.

Can laparoscopy be part of a paediatric surgery outreach service?

INTRODUCTION The aim of this study was to assess the outreach laparoscopic service delivered by four paediatric surgeons to a district general hospital (DGH). METHODS A retrospective review was carried out of all laparoscopic procedures performed in a single DGH between January 2004 and November 2014 by the four paediatric surgeons providing the outreach service. All operations were identified from the electronic theatre system and archived correspondence. Demographic and clinical details were obtained from contemporaneous records. RESULTS Over the 11-year study period, 1,339 operations were performed as part of the outreach paediatric surgery service, with 128 patients (9.6%) undergoing laparoscopy. The indications for laparoscopic surgery were impalpable unilateral or bilateral undescended testes (UDT) (n=79, 62%) or request for insertion of a feeding gastrostomy (n=49, 38%). All but six UDT cases (96%) were performed as day surgery and the median length of stay for gastrostomy patients was 3 days (interquartile range: 2-3 days). There were three UDT cases with surgical complications and one had complications related to the anaesthesia. One gastrostomy case required transfer to our tertiary centre for management of postoperative urinary retention and urethral injury. CONCLUSIONS Elective laparoscopic procedures in young children can be provided safely as components of an outreach paediatric surgery service in a DGH setting as part of an increasing volume of operations performed by specialist paediatric surgeons. This enables children to have a high quality service as close to their home as possible.

Cutting Edge: Tissue-Resident Memory T Cells Generated by Multiple Immunizations or Localized Deposition Provide Enhanced Immunity

Tissue-resident memory T cells (T_RM) have been shown to afford superior protection against infection, particularly against pathogens that enter via the epithelial surfaces of the body. Although T_RM are often concentrated at sites of prior infection, it has been shown that T_RM can disseminate throughout the body. We examined the relative effectiveness of global versus targeted CD8⁺ T_RM lodgment in skin. The site of initial T cell priming made little difference to skin lodgement, whereas local inflammation and Ag recognition enhanced T_RM accumulation and retention. Disseminated T_RM lodgment was seen with the skin, but required multiple exposures to Ag and was inferior to targeted strategies. As a consequence, active recruitment by inflammation or infection resulted in superior T_RM numbers and maximal protection against infection. Overall, these results highlight the potency of localized T_RM deposition as a means of pathogen control as well as demonstrating the limitations of global T_RM lodgment.

Preliminary Results of PTFE Patch Saphenoplasty to Prevent Neovascularization Leading to Recurrent Varicose Veins

Objective:

Recurrence is common after varicose vein surgery. Neovascularization may be one cause of recurrent veins. This was a study of PTFE patch saphenoplasty to try and prevent recurrent veins.

Design and setting:

Prospective cohort study of patients treated in a vascular surgical unit.

Patients and interventions:

Fifty patients having surgery for symptomatic long saphenous varicose veins (66 legs, 51 primary and 15 recurrent veins) had a PTFE patch sutured over the saphenous opening after flush saphenofemoral ligation.

Main outcome measures:

The rate of varicose vein recurrence and neovascularization 1 year after surgery were determined using clinical examination and venous duplex imaging.

Results:

Forty patients (80%) remained pleased with the results of their surgery. Recurrent veins were visible in 14 (21%) legs: 10 were principally due to neovascularization, two to sapheno-popliteal incompetence and two to an incompetent mid-thigh perforating vein. Three other legs had neovascularization but no recurrent veins. Both recurrent veins (47% versus 14%) and neovascularization (40% versus 14%) were significantly more common in patients having surgery for recurrent veins.

Conclusions:

PTFE patching was safe but did not abolish neovascularization. Neovascularization was the principal cause of recurrent veins in this study and perseverance with investigations into other barrier methods is worthwhile.

Emergency readmissions to paediatric surgery and urology: The impact of inappropriate coding

Introduction In England, emergency readmissions within 30 days of hospital discharge after an elective admission are not reimbursed if they do not meet Payment by Results (PbR) exclusion criteria. However, coding errors could inappropriately penalise hospitals. We aimed to assess the accuracy of coding for emergency readmissions. Methods Emergency readmissions attributed to paediatric surgery and urology between September 2012 and August 2014 to our tertiary referral centre were retrospectively reviewed. Payment by Results (PbR) coding data were obtained from the hospital's Family Health Directorate. Clinical details were obtained from contemporaneous records. All readmissions were categorised as appropriately coded (postoperative or nonoperative) or inappropriately coded (planned surgical readmission, unrelated surgical admission, unrelated medical admission or coding error). Results Over the 24-month period, 241 patients were coded as 30-day readmissions, with 143 (59%) meeting the PbR exclusion criteria. Of the remaining 98 (41%) patients, 24 (25%) were inappropriately coded as emergency readmissions. These readmissions resulted in 352 extra bed days, of which 117 (33%) were attributable to inappropriately coded cases. Conclusions One-quarter of non-excluded emergency readmissions were inappropriately coded, accounting for one-third of additional bed days. As a stay on a paediatric ward costs up to £500 a day, the potential cost to our institution due to inappropriate readmission coding was over £50,000. Diagnoses and the reason for admission for each care episode should be accurately documented and coded, and readmission data should be reviewed at a senior clinician level.

Should an increase in cerebral neurochemicals following head kicks in full contact karate influence return to play?

Background:

Cerebral neurochemicals are markers of traumatic brain injury (TBI).

Objectives:

The aim of the study was to determine whether kicks to the head (KTH) in full contact karate significantly increased serum concentrations of protein S-100B, and neurone specific enolase (NSE). Kicks to the body (KTB) were also quantified to asses muscle tissue injury. Muscle damage was assessed by analysis of serum total creatine kinase (CK).

Methods:

Twenty-four full contact karate practitioners were observed and filmed during actual competition and divided into two main groups post event: (1) Kicks to the head and body group (KTH): n = 12; mean ± SD; age, 30.4 ± 6.7 years; height, 1.74 ± 0.1 m; weight, 79.1 ± 2.1 kg; and (2): Kicks to the body group (KTB): n = 12; mean ± SD; age, 28.2 ± 6.5 years; height, 1.75 ± 0.1 m; weight, 79.2 ± 1.7 kg. The KTH group received direct kicks to the head, while group KTB received kicks and punches to the body. Blood samples were taken before and immediately post-combat for analysis of serum S-100B, NSE, CK and cardiac troponin.

Results:

Significant increases in serum concentrations of S-100B (0.12 ± 0.17 vs. 0.37 ± 0.26, µg.L−1) and NSE (11.8 ± 4.1 vs. 20.2 ± 9.1 ng.mL−1) were encountered after combat in the KTH group and CK (123 ± 53 vs. 184 ± 103 U.L−1) in the KTB group (all P <0.05).

Conclusions:

Head kicks in full contact karate cause elevation of neurochemical markers associated with damaged brain tissue. The severity of injury is related to the early post-traumatic release of protein S-100B and NSE. The early kinetics and appearance post injury can reflect intracranial pathology, and suggest S-100B and NSE are extremely sensitive prognostic markers of TBI.

A Review of Forensic Science Management Literature

The science in forensic science has received increased scrutiny in recent years, but interest in how forensic science is managed is a relatively new line of research. This paper summarizes the literature in forensic science management generally from 2009 to 2013, with some recent additions, to provide an overview of the growth of topics, results, and improvements in the management of forensic services in the public and private sectors. This review covers only the last three years or so and a version of this paper was originally produced for the 2013 Interpol Forensic Science Managers Symposium and is available at interpol.int.

Porous and strong three-dimensional carbon nanotube coated ceramic scaffolds for tissue engineering

A method to coat high-quality uniform coatings of carbon nanotubes throughout 3D porous structures is developed. Testing of their physical and biological properties demonstrate their potential for application in tissue engineering.