Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis

BACKGROUND

Social determinants of health (SDH) greatly influence outcomes during the first year of treatment in rheumatoid arthritis, a disease similar to polyarticular juvenile idiopathic arthritis (pJIA). We investigated the correlation of community poverty level and other SDH with the persistence of moderate to severe disease activity and functional disability over the first year of treatment in pJIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry.

METHODS

In this cohort study, unadjusted and adjusted generalized linear mixed effects models analyzed the effect of community poverty and other SDH on disease activity, using the clinical Juvenile Arthritis Disease Activity Score-10, and disability, using the Child Health Assessment Questionnaire, measured at baseline, 6, and 12 months.

RESULTS

One thousand six hundred eighty-four patients were identified. High community poverty (≥20% living below the federal poverty level) was associated with increased odds of functional disability (OR 1.82, 95% CI 1.28-2.60) but was not statistically significant after adjustment (aOR 1.23, 95% CI 0.81-1.86) and was not associated with increased disease activity. Non-white race/ethnicity was associated with higher disease activity (aOR 2.48, 95% CI: 1.41-4.36). Lower self-reported household income was associated with higher disease activity and persistent functional disability. Public insurance (aOR 1.56, 95% CI 1.06-2.29) and low family education (aOR 1.89, 95% CI 1.14-3.12) was associated with persistent functional disability.

CONCLUSION

High community poverty level was associated with persistent functional disability in unadjusted analysis but not with persistent moderate to high disease activity. Race/ethnicity and other SDH were associated with persistent disease activity and functional disability.

Wide-field mid-infrared single-photon upconversion imaging

Frequency upconversion technique, where the infrared signal is nonlinearly translated into the visible band to leverage the silicon sensors, offers a promising alternation for the mid-infrared (MIR) imaging. However, the intrinsic field of view (FOV) is typically limited by the phase-matching condition, thus imposing a remaining challenge to promote subsequent applications. Here, we demonstrate a wide-field upconversion imaging based on the aperiodic quasi-phase-matching configuration. The acceptance angle is significantly expanded to about 30°, over tenfold larger than that with the periodical poling crystal. The extended FOV is realized in one shot without the need of parameter scanning or post-processing. Consequently, a fast snapshot allows to facilitate high-speed imaging at a frame rate up to 216 kHz. Alternatively, single-photon imaging at room temperature is permitted due to the substantially suppressed background noise by the spectro-temporal filtering. Furthermore, we have implemented high-resolution time-of-flight 3D imaging based on the picosecond optical gating. These presented MIR imaging features with wide field, fast speed, and high sensitivity might stimulate immediate applications, such as non-destructive defect inspection, in-vivo biomedical examination, and high-speed volumetric tomography.

The authors present a simple yet effective solution to dramatically boost the performances of an upconversion imaging system, which leads to unprecedented mid-infrared imaging features with large field of view, single-photon sensitivity and a MHz-level frame rate.

Polarization control of plasmon-induced transparency in metamaterials with reversibly convertible bright and dark modes

We numerically demonstrate a Z-shaped metal-based metamaterial to realize an active polarization-controlled plasmon-induced transparency (PIT). The metamaterial unit cell contains two horizontal Au bars and a vertical Au bar. Simply by varying the incident light polarization, a tunable PIT can be achieved due to the reversible conversion of bright and dark modes between the horizontal and vertical Au bars. Moreover, a switchable PIT window modulation can be accomplished via changing the geometrical parameters, and the theoretical fittings according to the coupled Lorentz oscillator model display consistency with the simulated results. Our proposed metamaterials provide a promising strategy for fabricating compact PIT devices such as optical switching, sensing, and selective filters.

1370 Classifying Morbidity and Error in Oral and Maxillofacial Trauma Using the Clavien-Dindo Classification: A Prospective Pilot Study

Introduction

The collection of morbidity outcomes following surgery was recommended by the Royal College of Surgeons of England in 2014. They suggest a structure to stratify complications into groupings but do not include a classification this limits comparison. Our unit, a regionalised maxillofacial trauma service, introduced a standardised morbidity and error classification to be applied at M&M meetings.

Method

Prospective collection of data from March 2019 to February 2020. All patients discussed at our M&M meeting were then classified according to the Clavien-Dindo Classification (2004), assigned an error type and recommended action determined through a panel of between 5-10 consultants.

Results

301 surgical procedures were carried out with a 7% complication rate. 26 cases were discussed at M&M. The commonest error type was ‘nature of the disease’ (48%) followed by ‘error in judgement’ (37%). Clavien-Dindo Classification IIIb (intervention under GA) was the most frequent morbidity (74%)

Conclusions

Standardised national data collection of morbidity and error can be used to analyse a single institution or between institutions to improve patient care. To our knowledge, this is the first standardised classification of morbidity in maxillofacial trauma and was of educational and service benefit. However, there was discussion of the appropriateness of the classification systems to facial fractures. We would therefore recommend further development of both a morbidity classification and an error type classification specific to treatment of facial fractures so that it can be used to improve outcomes for our patients in the future.

Plasmon Enhanced Second Harmonic Generation from ZnO Nanofilms on Vertical Au Nanorod Arrays

Vertically aligned gold nanorod arrays have attracted much attention for their fascinating optical properties. Different from longitudinal surface plasmon wavelength (LSPW) and edge-to-edge spacing of gold nanorods, the role of gold nanorod diameter in plasmonic enhancement ability of vertical gold nanorod arrays has rarely been explored. In this work, we selected gold nanorods with similar LSPW but two different diameters (22 and 41 nm), the optical properties of which are dominated by absorption and scattering cross sections, respectively. The vertically aligned arrays of these gold nanorods formed by evaporation self-assembly are coupled with nonlinear ZnO nanocrystal films spin-coated on their surfaces. It was found that the gold nanorod array with a larger diameter can enhance the second harmonic generation (SHG) of ZnO nanofilm by a factor of 27.0, while it is about 7.3 for the smaller gold nanorod array. Theoretical simulations indicate that such stronger enhancement of the larger vertical gold nanorod array compared with the smaller one is due to its stronger scattering ability and greater extent of near-field enhancement at SHG fundamental wavelength. Our work shows that the diameter of gold nanorods is also an important factor to be considered in realizing strong plasmon enhancement of vertically aligned gold nanorod arrays.

Distance-Dependent Plasmon-Enhanced Fluorescence of Submonolayer Rhodamine 6G by Gold Nanoparticles

We investigate the fluorescence from submonolayer rhodamine 6G molecules near gold nanoparticles (NPs) at a well-controlled poly (methyl methacrylate) (PMMA) interval thickness from 1.5 to 21 nm. The plasmonic resonance peaks of gold NPs are tuned from 530 to 580 nm by the PMMA spacer of different thicknesses. Then, due to the plasmonic resonant excitation enhancement, the emission intensity of rhodamine 6G molecules at 562 nm is found to be enhanced and shows a decline as the PMMA spacer thickness increases. The variation of spectral intensity simulated by finite-difference time-domain method is consistent with the experimental results. Moreover, the lifetime results show the combined effects to rhodamine 6G fluorescence, which include the quenching effect, the barrier effect of PMMA as spacer layer and the attenuation effect of PMMA films.

[Correlation analysis between type 2 diabetes and core gut microbiota]

OBJECTIVE

To analyze the species, abundance and structure differences of intestinal flora between patients with type 2 diabetes mellitus (T2D) and healthy individuals and explore the correlation between intestinal flora changes and T2D.

OBJECTIVE

We collected a total of 133 clinical fecal samples from 78 healthy individuals and 55 patients with T2D. Hiseq2500 was used for high-throughput sequencing of the V3+V4 regions of the 16S rRNA gene. Usearch and QIIME were used for data splicing and filtering, classification and species annotation. The Alpha diversity index and Beta diversity index of the samples were analyzed using R language data packets to compare the richness and diversity of the sample flora. The flora differences were compared between the two groups and the disease marker flora was screened after correction of the relevant factors. PICRUST software was used to predict the function of different flora.

OBJECTIVE

There was significant difference in the intestinal flora diversity between the two groups. Cluster analysis showed that Fimicutes and Bacteroidetes were the dominant species at the phylum level. LefSe analysis showed that significant differences in the relative abundance between the two groups in 2 phyla, 3 classes, 3 orders, 4 families and 10 genera. After correction for the influence of related factors, the markers of T2Drelated bacteria groups were identified, including Bifidobacterium, Bifidobacteriales, Bifidobacteriaceae, Actinobacteria, Bacilli, Lactobacillales, Lactobacillaceae and Lactobacillus. On this basis, analysis of KEGG metabolic pathways of the differential flora revealed significant differences in 36 KEGG metabolic pathways between the two groups, and the citric acid cycle, lipopolysaccharide biosynthesis and other metabolic pathways were all up-regulated in T2D group.

OBJECTIVE

The composition and abundance of intestinal flora were different between T2D group and the normal group, and T2D group showed the characteristics of ecological imbalance.

Attenuation-free non-diffracting Bessel beams

We report on a versatile method to compensate the linear attenuation in a medium, independently of its microscopic origin. The method exploits diffraction-limited Bessel beams and tailored on-axis intensity profiles, which are generated using a phase-only spatial light modulator. This technique for compensating one of the most fundamental limiting processes in linear optics is shown to be efficient for a wide range of experimental conditions (modifying the refractive index and the attenuation coefficient). Finally, we explain how this method can be advantageously exploited in applications ranging from bio-imaging light sheet microscopy to quantum memories for future quantum communication networks.

P2682Long-term effects of enhanced external counterpulsation treatment on symptom burden, usage of nitrates, physical capacity and health-related quality of life in patients with refractory angina pectoris

Background

Patients with refractory angina pectoris (RAP) suffer from debilitating symptoms with considerable limitation of functional capacity and impaired health-related quality of life (HRQoL) despite optimized medical therapy. Recurrent angina symptoms are strongly associated with psychological distress and cardiac anxiety (i.e., a subtype of anxiety related to cardiac sensations). Enhanced external counterpulsation (EECP) is an alternative non-invasive treatment for these patients. An EECP course includes 35 1-hour sessions over 7 weeks. No previous study has explored long-term EECP effects on cardiac anxiety in patients with RAP.

Objective

To evaluate the effects of EECP treatment in patients with RAP regarding usage of nitrates, physical capacity, cardiac anxiety and HRQoL.

Methods

A quasi experimental design with long-term follow-up (6 months) involving 50 patients (men=37, 47–91 years) who had finished one course of EECP. Assessment of average use of nitrates, six-minute walk test, functional class with Canadian Cardiovascular Society (CCS) classification and questionnaires for cardiac anxiety and HRQoL were collected pre and post treatment. In addition, the questionnaires were collected 6 months after completion of EECP.

Results

Patients used significantly less nitrates (p<0.001) compared to at the start of treatment. They enhanced the walking distance on average by 46 m after EECP (p<0.001) and CCS class also improved (p<0.001). All subscales except for one in cardiac anxiety were significantly reduced (p<0.05). All dimensions in HRQoL improved significantly (p<0.01). The positive effects in both cardiac anxiety and HRQoL were maintained 6 months after the treatment.

Conclusions

Patients with RAP received beneficial effects from EECP. Reduced symptom burden and improved physical capacity enable engagement in physical activities. Furthermore, less cardiac anxiety and improved HRQoL may enhance life satisfaction for these patients. EECP treatment should be considered to a greater extent to improve the life situation for these patients.

dc Magnetometry with Engineered Nitrogen-Vacancy Spin Ensembles in Diamond

The exquisite optical and spin properties of nitrogen-vacancy (NV) centers in diamond have made them a promising platform for quantum sensing. The prospect of NV-based sensors relies on the controlled production of these atomic-scale defects. Here we report on the fabrication of a preferentially oriented, shallow ensemble of NV centers and their applicability for sensing dc magnetic fields. For the present sample, the residual paramagnetic impurities are the dominant source of environmental noise, limiting the dephasing time (T₂^*) of the NVs. By controlling the P1 spin-bath, we achieve a 4-fold improvement in the T₂^* of the NV ensemble. Further, we show that combining spin-bath control and homonuclear decoupling sequence cancels NV-NV interactions and partially protects the sensors from a broader spin environment, thus extending the ensemble T₂^* up to 10 μs. With this decoupling protocol, we measure an improved dc magnetic field sensitivity of 1.2 nT μm^3/2 Hz^-1/2. Using engineered NVs and decoupling protocols, we demonstrate the prospects of harnessing the full potential of NV-based ensemble magnetometry.

Reducing off target viral delivery in ovarian cancer gene therapy using a protease-activated AAV2 vector platform

Gene therapy is a promising strategy for treating metastatic epithelial ovarian cancer (EOC). However, efficient vector targeting to tumors is difficult and off-target effects can be severely detrimental. Most vector targeting approaches rely on surface receptors overexpressed on some subpopulation of cancer cells. Unfortunately, there is no universally expressed cell surface biomarker for tumor cells. As an alternative, we developed an adeno-associated virus (AAV) based "Provector" whose cellular transduction can be activated by extracellular proteases, such as matrix metalloproteinases (MMP) that are overexpressed in the tumor microenvironments of the most aggressive forms of EOC. In a non-tumor bearing mouse model, the Provector demonstrates efficient de-targeting of healthy tissues, especially the liver, where viral delivery is <1% of AAV2. In an orthotopic HeyA8 tumor model of EOC, the Provector maintains decreased off-target delivery in the liver and other tissues but with no loss in tumor delivery. Notably, approximately 10% of the injected Provector is still detected in the blood at 24 h while >99% of injected AAV2 has been cleared from the blood by 1 h. Furthermore, mouse serum raised against the Provector is 16-fold less able to neutralize Provector transduction compared to AAV2 serum neutralizing AAV2 transduction (1:200 vs 1:3200 serum dilution, respectively). Thus, the Provector appears to generate less neutralizing antibodies than AAV2. Importantly, serum against AAV2 does not neutralize the Provector as well as AAV2, suggesting that pre-existing antibodies against AAV2 would not negate the clinical application of Provectors. Taken together, we present an EOC gene delivery vector platform based on AAV with decreased off-target delivery without loss of on-target specificity, and greater immunological stealth over the traditional AAV2 gene delivery vector.

[Proper patient education improves hepatitis C patients' disease-related knowledge and antiviral treatment acceptance in rural China]

Objective: To evaluate the affect of hepatitis C virus (HCV) education in chronic hepatitis C patients' disease related knowledge and antiviral treatment acceptance in rural china. Methods: Rural HCV patients of attended CHC project of HCV education. Doctor delivered subsequent interactive lecture, and patients completed pre- and post-education questionnaires before and after taking the lectures. Results: 151 CHC patients were included. Mean age was 57.3 years old, 50.3% were male, 51.0% of the students had primary school education or illiterate, and 76.2% had a monthly income below RMB 3,000. 98.0% of patients defined their baseline HCV knowledge as "nothing" or "a little bit". A multivariate analysis reveled baseline knowledge scores were associated with age and household income. After education, mean knowledge score (range: 0-28) increased from 13.1 to 23.0 (P < 0.001) and average percent of patients with correct answers from the topic rose from 46.8% to 82.1% (P < 0.001), and patients' antiviral treatment acceptance increased from 33.9% to 65.6% (P < 0.001). Conclusion: A rural Chinese patients had less education, HCV education delivered on the preferred format of patients substantially improved hepatitis C patients' disease-related knowledge and antiviral treatment acceptance in rural china.

High-speed photon-counting laser ranging for broad range of distances

We demonstrate a high-speed photon-counting laser ranging system with laser pulses of multiple repetition rates to extend the unambiguous range. In the experiment, the laser pulses of three different repetition rates around 10 MHz were employed to enlarge the maximum unambiguous range from 15 m to 165 km. Moreover, the range of distances was increased as well, enabling the measurement on different targets of large separation distance with high depth resolution. An outdoor photon-counting laser ranging up to 21 km was realized with high repetition rate, which is beneficial for the airborne and satellite-based topographic mapping.

Postmarketing cases of eluxadoline-associated pancreatitis in patients with or without a gallbladder

BACKGROUND

Cases of pancreatitis were identified in the eluxadoline clinical development program, reflected in initial product labelling, and the subject of postmarketing reports.

AIM

To analyse postmarketing cases of eluxadoline-associated pancreatitis.

METHODS

We retrospectively analysed all US adverse event reports of pancreatitis associated with eluxadoline reported to the FDA Adverse Event Reporting System (FAERS) database from May 27, 2015 through February 15, 2017.

RESULTS

The analysis included 119 cases of pancreatitis associated with eluxadoline; one resulted in death and 75 in hospitalisation. Sixty-seven cases reported the presence (n = 12) or absence (n = 55) of the patient's gallbladder. The eluxadoline dose received in the 55 cases of patients without gallbladders was 75 mg (n = 43), 100 mg (n = 5), or not reported (n = 7). Of the 119 cases, 37 reported the patient did not abuse alcohol and 82 did not report the alcohol abuse status. The single fatal case occurred in a patient without a gallbladder who received eluxadoline 75 mg and did not abuse alcohol. Forty-seven cases reported development of pancreatitis within the first or second dose of eluxadoline initiation. The median time to onset for the development of pancreatitis (n = 83) was 1 day, ranging from 1 to 56 days of continued use of eluxadoline.

CONCLUSION

The FAERS cases suggest that patients with or without a gallbladder receiving eluxadoline are at risk for the development of pancreatitis. However, patients without a gallbladder, despite receiving the recommended lower dose of eluxadoline 75 mg and screening for alcohol abuse, appear to be overrepresented among patients who developed eluxadoline-associated pancreatitis.