Day-case unicompartmental knee arthroplasty: a literature review and development of a novel hospital pathway

INTRODUCTION

We have seen unparalleled changes in our healthcare systems globally as a result of the COVID-19 pandemic. As we strive to regenerate our full capacity elective services in order to contest the increasing demand for lower limb arthroplasty, this pandemic has allowed us a rare opportunity to revise and develop novel elective arthroplasty pathways intended to improve patient care and advance healthcare efficiency. We present an extensive evidence-based review of the approaches used to achieve day-case unicompartmental arthroplasty (UKA) as well as the development of a day-case UKA care pathway in a UK NHS institution based on the evidence provided in the literature.

METHODS

An extensive search of the literature was performed for articles that reported on readmission or complication rates ≥30 days postoperatively following day-case UKA.

FINDINGS

Fifteen manuscripts reporting the results of day-case UKA, defined as discharged on the same calendar day of surgery, were included in our review. Mean reported complication rates for day-case and inpatient UKA within the follow-up periods were 4.05% and 6.52%, respectively. Mean readmission rates were 2.71% and 4.36% for day-case and inpatient UKA, respectively. The mean rate of successful same-day discharge was 92.45%.

CONCLUSION

We introduce our institutional Elective Day Surgery Arthroplasty Pathway (EDSAP) founded upon the evidence presented in the literature. Stringent patient selection complimented by a well-defined day-case arthroplasty pathway is fundamental for successful commencement of day-case UKA in the NHS.

Changing susceptibility pattern of Neisseria Gonorrhoeae: A threat to management of sexually transmitted infections - Case series

Gonorrhoea is a sexually transmitted infection (STI) that increases the risk of infection with human immunodeficiency virus (HIV) and causes infertility and urethral stricture. We describe three cases of sexually active men, otherwise stable, who presented with a history of painful micturition and creamy white, urethral discharge. A clinical diagnosis of gonococcal urethritis was made and confirmed by microscopy, culture and 16SrRNA. Antimicrobial susceptibility revealed resistance to all the antimicrobial agents tested including ceftriaxone. A dual therapy was initiated using ceftriaxone and azithromycin, but at a higher dose for the patient with multi-drug resistant (MDR) Neisseria gonorrhoeae. Patients did well and were followed up for 5 months. Contact tracing was done for their sexual partners. While it is also important for healthcare workers to familiarize themselves with current treatment guidelines for gonococcal urethritis, the place of clinical laboratory in the management of STIs, with molecular techniques and the need for surveillance for MDR Neisseria gonorrhoeae cannot be overemphasized.

Evaluation of mare endometrial cytology using the novel cytotape technique

The cytobrush is considered the method of choice to obtain endometrial samples. Rigid brush fibers, however, may induce endometrial irritation and bleeding, or cell fragmentation, decreasing quality and diagnostic value of the samples. It was hypothesized that samples collected using a novel cytotape would provide sample smears of greater quality and less blood contamination than the cytobrush. Endometrial samples were collected with a cytotape and a cytobrush from ten mares without endometritis. Endometritis was then induced with artificial insemination, and samples were again collected 6 h after insemination. A cytology smear and bacterial culture were prepared from each sample. The collection methods and times were compared in terms of number and integrity of endometrial cells; number, integrity, and percentage of neutrophils; number of red blood cells, and number of colony-forming units. Frequency of positive cytology and culture was compared when there was use of each technique. The sensitivity, specificity, positive predictive value, and negative predictive value of cytology and culture for each technique was calculated using endometrial biopsy as the gold standard. While all samples had adequate and comparable cellularity and cell integrity, cytotape samples had less red blood cell contamination compared to cytobrush samples (P < 0.05). The number and percentage of PMNs, frequency of positive cytology diagnosis, number of colony-forming units and frequency of positive cultures did not differ between collection methods. In conclusion, the cytotape is a rapid, easy, and practical technique that can provide endometrial samples with similar diagnostic value to the cytobrush, but with less blood contamination.

Recovery from COVID-19 Pneumonia in a Heart Transplant Recipient

Introduction

Solid-organ transplant patients have a high risk of severe infection related to Severe Acute Respiratory Syndrome Coronavirus-2. There are limited data on COVID-19 presentation and clinical outcome in a cardiac transplant recipient.

Case Report

A 54-year old woman a heart transplant recipient presented with symptoms of fatigue, excessive sleepiness and cough with phlegm for one week. She did not report any fever or shortness of breath. She had a heart transplant six months prior complicated by antibody-mediated rejection. She was treated with plasmapheresis, intravenous immune globulin, and high dose methylprednisolone. She could not have further scheduled RV biopsies due to the lockdown. She remained on a high dose of immune suppressive medication till her current presentation. Her medication included Prednisolone 20mg daily, Mycophenolate Mofetil (MMF) 1g bid, Tacrolimus 7 mg bid for a target FK level 10-15. On her current presentation to the hospital, she was found to be hypoxic, tachypnic, tachycardic with a BP 130/70. Her chest x-ray showed bilateral infiltrates. She had leukopenia 3.5 and lymphopenia 0.2, CRP 25, ferritin 1106, LDH 632, and IL6 87. She was started empirically on oseltamivir, vancomycin and piperacillin/tazobactam. Her COVID-19 PCR result was positive. Subsequently, she was started on Favipiravir loading of 1600 mg for two doses and a maintenance dose of 600 mg twice daily for 7 days. The MMF and tacrolimus were discontinued. The prednisone was switched to hydrocortisone 50mg IV q6h. Despite treatment, she had reduced level of consciousness and progressive bilateral lung infiltrates requiering mechanical ventilation. The multidisciplinary team discussed enrolling patients in the convalescent plasma study. The patient's family was informed and they agreed and consented to proceed with plasma therapy. Two units of compatible ABO plasma therapy was given for two consecutive days. Intravenous dexamethasone was started. She was extubated successfully after ten days. Given her marked clinical improvement, she was started on MMF 1g bid, and tacrolimus adjusted to the target FK level of 5. The patient was discharged home after three weeks of admission.

Summary

This case represents a recent heart transplant recipient who presented with COVID-19 pneumonia. Her treatment involved convalescent plasma transfusion, Favipiravir, dexamethasone, and reduction of immune suppression.

Assessment of pentraxin 3 in a systemic inflammatory response occurring with neonatal bacterial infection

INTRODUCTION

In the developing countries, neonatal sepsis is the most common complication in neonatal period. It is as a systemic inflammatory response because of infection. Laboratory indicators, do not have satisfactory sensitivity. Thus, early identification of sepsis is still needed. Because PTX3 may be a faster acute-phase protein that is not liver-dependent, it is probable that it is superior to traditional biomarkers for mirroring rapid inflammatory courses.

METHODS

A prospective case control study design was used to determine the sensitivity of pentraxin 3 in the diagnosis of neonatal sepsis to allow early diagnostic tool. This study was carried out on neonatal ICU unit in Suez Canal University Hospital and the studied population were divided into two groups, including patients diagnosed with neonatal sepsis, based on clinical, laboratory and positive blood culture results, and control groupRESULTS:The study found that there was statistically significant differences between both groups in serum CRP values in diseased and control group (Mean = 49.3±37.4 mg/L, 26.8±17.2 mg/L, p < 0.05), and pentraxin values in diseased and control group (Mean = 5.2±3.7 mg/L, 2.3±0.78 mg/L, p < 0.0001). In addition, there were statistically significant correlations between pentraxin and serum CRP concentrations (p < 0.05) in diseased group. ROC curve showed that serum CRP demonstrated good diagnostic accuracy in predicting neonatal sepsis AUC = 0.875 with sensitivity of 100% and specificity of 92.3%.

CONCLUSION

Serum PTX3 may be a promising acute-phase protein for interpretation of affected newborns with symptoms and signs of sepsis.

Development of a machine vision system for rice seed inspection system

Rice seed production in Malaysia is greatly dependent on the purity of the cultivated paddy seed produced through the government certified paddy seed program. The seeds to be marketed by the seed processors must undergo quality control protocol where the seed lots are sampled from the seed farms and seed processing plants for purity analysis by the enforcing agency at the Seed Testing Laboratory of the Department of Agriculture (DoA). The current inspection conducted by the laboratory is based on a manual process, which is laborious and time-consuming. Therefore, a prototype (Patent ID: PI2018500018) of a machine vision-based rice seed inspection system (RiSe-IViS) was developed to explore the possibility of replacing the existing manual method in distinguishing the weedy rice and cultivated rice seeds under the Standard Jabatan Pertanian Malaysia (SJPM) standard protocol with a modern, effective and efficient technique using an image processing approach. The developed RiSe-IViS prototype consists of two parts i) hardware configuration and ii) software development. This paper discussed the criteria to be established, challenges and limitation encountered in developing the hardware prototype involving the image acquisition setup, lighting configuration and seed plate design. The importance of each criterion to ensure its reproducibility are also discussed. A software programme was developed to assist the user for image acquisition and analysis. The image processing steps undertaken in the programme are also discussed. The RiSe-IViS is expected to classify major rice seed varieties available in Malaysia against the weedy rice variants with superior accuracy.

Cancer-related lymphedema: clinical pearls for providers

Lymphedema is a chronic inflammatory condition that results from damage to the lymphatic system. Lymphedema is classified as either primary or secondary, the former being caused by a malformation of lymph vessels or nodes, and the latter resulting from trauma, chronic lymphatic system overload, or the sequelae of cancer treatments. In the present article, we focus on secondary cancer-related lymphedema (crl), a potential survivorship treatment-related effect. Treatments for breast, gynecologic, prostate, and head-and-neck cancers, and melanoma and other skin cancers are most frequently associated with crl. The incidence of crl varies widely based on cancer location and treatment modalities, with estimates ranging from 5% to 83% in various cancers. Given the lack of a universal definition and diagnostic criteria, the prevalence of crl is difficult to ascertain; current estimates suggest that more than 300,000 Canadians are affected by crl. Here, we present an overview of crl, divided into 5 subtopics: lymphedema risk factors; early identification and intervention; diagnosis and staging; management, with emphasis on the volume reduction and maintenance phases, plus patient support and education; and clinical pearls to help providers integrate knowledge about crl into their practice.

Safety and efficacy of hysteroscopic resection of uterine leiomyoma embedded at the base of a uterine septum

BACKGROUND

To determine the safety and efficacy of hysteroscopic resection of uterine leiomyoma embedded at the base of a uterine septum.

METHODS

This case series included 11 patients with infertility or recurrent pregnancy loss who were found to have a uterine septum (one septate and 10 sub-septate) and a uterine leiomyoma embedded at the base of the uterine septum. All patients underwent a hysteroscopic division of the uterine septum and hysteroscopic resection of the uterine leiomyoma. Safety was determined by any intra-operative complications, and any immediate or late postoperative complications. Efficacy was determined based on the findings on a postoperative trans-vaginal 3D ultrasound (TV 3D US) with a saline infusion sonohysterogram (SIH) and reproductive outcomes.

RESULTS

There were no reported intra-operative complications, or immediate or late postoperative complications. Eleven patients underwent TV 3D US with SIH; findings were normal in 8 (72.7%); 3 patients underwent a second operative hysteroscopy and subsequent TV 3D US with SIH were also normal. The analysis of reproductive outcomes was limited to patients who were < 40 years (9 patients). Seven patients conceived (77.8%), six delivered (66.7%) and one miscarried (14.3%).

CONCLUSIONS

Hysteroscopic myomectomy of a leiomyoma, which is embedded at the base of a uterine septum, can be safely performed at the same session of hysteroscopic division of the uterine anomaly. Improvement in reproductive outcomes is to be expected after such procedures.

Anti-CD20-Mediated B Cell Depletion Is Associated With Bone Preservation in Lymphoma Patients and Bone Mass Increase in Mice

Immunotherapy with anti-CD20-specific antibodies (rituximab), has become the standard of care for B cell lymphoproliferative disorders and many autoimmune diseases. In rheumatological patients the effect of rituximab on bone mass yielded conflicting results, while in lymphoma patients it has not yet been described. Here, we used cross-sectional X-ray imaging (CT/PET-CT) to serially assess bone density in patients with follicular lymphoma receiving rituximab maintenance therapy. Remarkably, this treatment prevented the decline in bone mass observed in the control group of patients who did not receive active maintenance therapy. In accordance with these data, anti-CD20-mediated B cell depletion in normal C57BL/6J female mice led to a significant increase in bone mass, as reflected by a 7.7% increase in bone mineral density (whole femur), and a ~5% increase in cortical as well as trabecular tissue mineral density. Administration of anti-CD20 antibodies resulted in a significant decrease in osteoclastogenic signals, including RANKL, which correlated with a reduction in osteoclastogenic potential of bone marrow cells derived from B-cell-depleted animals. Taken together, our data suggest that in addition to its anti-tumor activity, anti-CD20 treatment has a favorable effect on bone mass. Our murine studies indicate that B cell depletion has a direct effect on bone remodeling.

Differential impact of life-long lower LDL-C levels on ischaemic stroke subtypes and coronary heart disease risk among 1 million individuals

Background

The relative impact of low density lipoprotein cholesterol (LDL-C) lowering on risk of ischaemic stroke [IS] and coronary heart disease [CHD] has been debated. The relevance of aetiologically distinct IS subtypes may contribute to this complex relationship, but the causal relationship and relative importance of LDL-C for risk of large artery, cardioembolic and small vessel stroke and CHD remains unclear.

Purpose

To disentangle the relative impact and quantify the causal effects of life-long differences in LDL-C on risk of cardioembolic, small vessel, and large artery stroke, and CHD.

Methods

We undertook a multi-ethnic Mendelian randomization (MR) study of 1,008,662 individuals including 66,218 IS cases (with TOAST subtyping available in 3 times more cases than previously available), and 103,536 CHD cases. IS results were based on a meta-analysis of summary and individual participant data from the MEGASTROKE Consortium and UK Biobank respectively, and CHD results on data from the CARDIoGRAMplusC4D Consortium and UK Biobank. We created a weighted genetic risk score based on 175 independent variants identified in previous genome-wide studies of LDL-C that included individuals of multiple ethnicities. This genetic instrument was used to estimate the causal effects of life-long differences in LDL-C for risk of IS, IS subtypes and CHD. In addition, the associations between functionally informed genomic regions representing LDL-lowering drug targets including HMGCR (for statins), NPC1L1 (for ezetimibe), and PCSK9 (for PCSK9-inhibitors) and the disease outcomes were examined.

Results

Life-long lower genetically determined LDL-C was associated with a 25% lower risk of CHD per standard deviation of the genetic score (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.73–0.77; p=2×10–91), but had a significantly weaker effect on IS (OR 0.92, 95% CI 0.88–0.95, p=8x10–6, p for heterogeneity=7.3x10–18). Underlying the relationship with IS was a strong association with large artery stroke (OR 0.75, 95% CI 0.68–0.83; p=2×10–8), comparable to that for CHD, but no significant effects on cardioembolic (OR 1.02, 95% CI 0.95–1.10; p=0.60) or small vessel strokes (OR 0.95, 95% CI 0.88–1.03; p=0.23). Results from multivariable MR analyses that accounted for potential pleiotropy with HDL-C and triglycerides showed no material difference. Additional analyses to examine sensitivity of these findings to the genetic risk score, ethnicity, and wider sources of pleiotropy were performed, and effects of genetic proxies for individual LDL-lowering drug targets assessed.

Conclusion

This study, the largest of its type to date, demonstrates that life-long lower genetically determined LDL-C levels have a materially weaker effect on IS than on CHD, and differences in the relative importance of life-long lower LDL-C for aetiologically distinct IS subtypes contribute to the differences observed.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): British Heart Foundation

Assiri M, Thind S, Bilal M, Irfan A, G. Al-Sehemi A. Biochemical studies on protein, phenolic contents and antioxidant activities of Sida cordifolia extracts

The study aimed to characterize the antioxidant properties regarding the Sida cordifolia with special reference to its detailed biochemical analysis. The study revealed that chlorophyll A (0.9 ± 0.3 mg/g), total chlorophyll content (3.0 ± 0.7 mg/g), total carotenoid content (0.3 ± 0.1 mg/g), total soluble proteins (7.5 ± 0.1 mg/g), and total phenolic contents (5.6 ± 1.3 mg/g) were found highest in flower tissue of S. cordifolia. However, peroxidase (POD) contents (118 ± 31 units/g), superoxide dismutase (SOD)  activity (64 ± 1.5 units/g) were maximum in the leaf tissues, while catalase (CAT)  contents (133 ± 25 units/g), ascorbate peroxidase (APX)  contents (145 ± 44 units/g) were also found more in the flowers of S. cordifolia rather than other parts. Our results conclude that leaves, stem, flower of S. cordifolia could be exploited in pharmacology due to presence of different antioxidants reflected in flower and leaf extract make them potent and profound therapeutic agents.                     KEY WORDS: Alkaloids, Flavonoids, Phenolics, Antioxidant, Sida cordifolia   Bull. Chem. Soc. Ethiop. 2020, 34(2), 427-434 DOI: https://dx.doi.org/10.4314/bcse.v34i2.18

Male Infertility: Evaluation and Treatment

Globally, 48.5 million couples are suffering from infertility. One of six couples in United Kingdom is categorized as infertile. In developing countries, infertility affects one of four couples. Male infertility constitutes about 40-50% of the incidence. A minimum of 30 million men worldwide are infertile. Mortality rate is higher in men with impaired semen quality than those who have normal semen quality. The initial evaluation of a male partner of an infertile couple should be done if there is a delay in the pregnancy in the female partner for one year or more from unprotected sexual intercourse. It can be done earlier if there is a predisposing factor for infertility. Identification of the underlying aetiology of infertility is the guide for treatment course which could be medical, surgical or through assisted reproductive technology. The aim of this review is to highligh the main courses of evaluation and treatment of male infertility.

Effect of Trihoney (A Mixture of Trigona, Mellifera and Tualang) on Male Reproductive Hormones and Insulin Resistance in Hypercholesterolaemic Rabbits

Introduction: Hypercholesterolaemia affects Sertoli and Leydig cells secretory functions, impairs steroidhormone biosynthesis, and disrupts the hypothalamic-pituitary-gonadal axis. The use of honey in previousstudies resulted in an improvement of male reproductive hormonal disturbances. This study aimed toinvestigate the protective effects of Trihoney on hypercholesterolemia-induced male reproductive hormonalchanges in male rabbits and compare its effects with atorvastatin. Materials and methods: Forty-eight maleNew Zealand white rabbits were assigned into 6 groups as follows; Control: commercial pellet; CH:commercial pellet with 0.6 g/kg/day Trihoney; HCD: 1% cholesterol diet; DH1: 1% cholesterol diet with 0.3g/kg/day Trihoney; DH2: 1% cholesterol diet with 0.6 g/kg/day Trihoney and DAt: 1% cholesterol diet with2mg/kg/day atorvastatin. After 12 weeks, the rabbits were sacrificed and blood samples were collected foranalysis of hormones and pro-inflammatory cytokines and calculation of HOMA-IR. The testes werehomogenized for intra-testicular testosterone measurement. Results: Serum testosterone reducedsignificantly in HCD (p<0.05) and DAt (p<0.05) groups. Likewise, intra-testicular testosterone reducedsignificantly in HCD (p<0.01) and DAt (p<0.01) groups. Serum FSH increased significantly in HCD (p<0.001)and DAt (p<0.01). Trihoney particularly at the dose of 0.6 g/kg/day improved serum and intra-testiculartestosterone (p<0.05) and FSH (p<0.05). Trihoney and atorvastatin improved serum pro-inflammatorycytokines. Trihoney and atorvastatin did not affect HOMA-IR. Conclusion: Trihoney attenuated thedetrimental effects of hypercholesterolaemia on male reproductive hormones which probably through alocal effect on testicular tissue and Trihoney anti-inflammatory effect independent of insulin resistance.Atorvastatin did not counteract the impact of hypercholesterolaemia on the reproductive hormones.

Population-based prevalence and associated risk factors of hypertension among adults in Benue State, Nigeria

Background

The increasing prevalence of hypertension in low- and middle-income countries is associated with increased morbidity and mortality.

Aim

To determine the prevalence of hypertension and associated risk factors in Benin state, Nigeria.

Materials and Methods

A population-based cross-sectional study was conducted among 1265 adults selected by multistage sampling technique. The World Health Organization (WHO) STEPwise approach was used to collect data. Data were analyzed using Statistical Package for the Social Sciences (SPSS) software program, version 23.0 (IBM). We estimated prevalence and odds of hypertension at 5% level of significance.

Results

The prevalence of hypertension was 35.6%. The odds of hypertension was higher among age 30-39 (aOR: 2.0; 95% CI: 1.3-3.1) compared to age 18-29 years, males (aOR: 1.4; 95% CI: 1.1-2.0) compared to females, overweight (aOR: 2.3; 95%CI: 1.6-3.2), and obesity (aOR: 4.9; 95%CI: 3.2-7.7) compared to normal weight, and high cholesterol (aOR: 1.6; 95% CI: 1.1-2.3) compared to normal cholesterol.

Conclusion

The prevalence of hypertension was high among young adults in Benue State. The associated risk factors for hypertension were age, sex, overweight, obesity, and high total cholesterol.

Utilization and Outcomes of Single and Dual Kidney Transplants from Older Deceased Donors in the United Kingdom

BACKGROUND AND OBJECTIVES

Kidneys from elderly deceased donors are often discarded after procurement if the expected outcomes from single kidney transplantation are considered unacceptable. An alternative is to consider them for dual kidney transplantation. We aimed to examine the utilization of kidneys from donors aged ≥60 years in the United Kingdom and compare clinical outcomes of dual versus single kidney transplant recipients.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Data from the United Kingdom Transplant Registry from 2005 to 2017 were analyzed. We examined utilization rates of kidneys retrieved from deceased donors aged ≥60 years, and 5-year patient and death-censored graft survival of recipients of dual and single kidney transplants. Secondary outcomes included eGFR. Multivariable analyses and propensity score analysis were used to correct for differences between the groups.

RESULTS

During the study period, 7841 kidneys were procured from deceased donors aged ≥60 years, of which 1338 (17%) were discarded; 356 dual and 5032 single kidneys were transplanted. Donors of dual transplants were older (median, 73 versus 66 years; P<0.001) and had higher United States Kidney Donor Risk Indices (2.48 versus 1.98; P<0.001). Recipients of dual transplants were also older (64 versus 61 years; P<0.001) and had less favorable human leukocyte antigen matching (P<0.001). After adjusting for confounders, dual and single transplants had similar 5-year graft survival (hazard ratio, 0.81; 95% CI, 0.59 to 1.12). No difference in patient survival was demonstrated. Similar findings were observed in a matched cohort with a propensity score analysis method. Median 12-month eGFR was significantly higher in the dual kidney transplant group (40 versus 36 ml/min per 1.73 m²; P<0.001).

CONCLUSIONS

Recipients of kidneys from donors aged ≥60 years have similar 5-year graft survival and better graft function at 12 months with dual compared with single deceased donor kidney transplants.

Erythropoietin receptor in B cells plays a role in bone remodeling in mice

Erythropoietin (EPO) is a key regulator of erythropoiesis. However, EPO receptors (EPO-Rs) are also expressed on non-erythroid cell types, including myeloid and bone cells. Immune cells also participate in bone homeostasis. B cells produce receptor activator of nuclear factor kappa-Β ligand (RANKL) and osteoprotegerin (OPG), two pivotal regulators of bone metabolism. Here we explored the ability of B cells to transdifferentiate into functional osteoclasts and examined the role of EPO in this process in a murine model.

Methods: We have combined specifically-designed experimental mouse models and in vitro based osteoclastogenesis assays, as well as PCR analysis of gene expression.

Results: (i) EPO treatment in vivo increased RANKL expression in bone marrow (BM) B cells, suggesting a paracrine effect on osteoclastogenesis; (ii) B cell-derived osteoclastogenesis occured in vivo and in vitro, as demonstrated by B cell lineage tracing in murine models; (iii) B-cell-derived osteoclastogenesis in vitro was restricted to Pro-B cells expressing CD115/CSF1-R and is enhanced by EPO; (iv) EPO treatment increased the number of B-cell-derived preosteoclasts (β3⁺CD115⁺), suggesting a physiological rationale for B cell derived osteoclastogenesis; (v) finally, mice with conditional EPO-R knockdown in the B cell lineage (cKD) displayed a higher cortical and trabecular bone mass. Moreover, cKD displayed attenuated EPO-driven trabecular bone loss, an effect that was observed despite the fact that cKD mice attained higher hemoglobin levels following EPO treatment.

Conclusions: Our work highlights B cells as an important extra-erythropoietic target of EPO-EPO-R signaling and suggests their involvement in the regulation of bone homeostasis and possibly in EPO-stimulated erythropoietic response. Importantly, we present here for the first time, histological evidence for B cell-derived osteoclastogenesis in vivo.

Ottawa classification for symptomatic acetabular dysplasia assessment of interobserver and intraobserver reliability

Aims

The aim of the current study was to assess the reliability of the Ottawa classification for symptomatic acetabular dysplasia.

Methods

In all, 134 consecutive hips that underwent periacetabular osteotomy were categorized using a validated software (Hip2Norm) into four categories of normal, lateral/global, anterior, or posterior. A total of 74 cases were selected for reliability analysis, and these included 44 dysplastic and 30 normal hips. A group of six blinded fellowship-trained raters, provided with the classification system, looked at these radiographs at two separate timepoints to classify the hips using standard radiological measurements. Thereafter, a consensus meeting was held where a modified flow diagram was devised, before a third reading by four raters using a separate set of 74 radiographs took place.

Results

Intrarater results per surgeon between Time 1 and Time 2 showed substantial to almost perfect agreement among the raters (κappa = 0.416 to 0.873). With respect to inter-rater reliability, at Time 1 and Time 2 there was substantial agreement overall between all surgeons (Time 1 κappa = 0.619; Time 2 κappa = 0.623). Posterior and anterior rating categories had moderate and fair agreement at Time 1 (posterior κappa = 0.557; anterior κappa = 0.438) and Time 2 (posterior κappa = 0.506; anterior κappa = 0.250), respectively. At Time 3, overall reliability (κappa = 0.687) and posterior and anterior reliability (posterior κappa = 0.579; anterior κappa = 0.521) improved from Time 1 and Time 2.

Conclusion

The Ottawa classification system provides a reliable way to identify three categories of acetabular dysplasia that are well-aligned with surgical management. The term ‘borderline dysplasia’ should no longer be used.

Cite this article: Bone Joint Res. 2020;9(5):242–249.

128Non-invasive 3D mapping of earliest activation of premature ventricular complexes originating from intracardiac structures to guide catheter ablation

Funding Acknowledgements

Research funding from Catheter Precision, Inc.

Introduction

Catheter ablation for ventricular arrhythmias such as premature ventricular complexes and ventricular tachycardia is an established management approach.  Non-invasive mapping to localise the earliest activation (site of origin) on the myocardium may help guide ablation.  Established ECGi methods using the inverse solution to reconstruct epicardial electrograms are unable to accurately locate arrhythmias from the endocardium or from intracardiac structures.  VIVO™ (Catheter Precision) is a novel vectorcardiography based 3D mapping system that may be able to localise arrhythmias from any part of the ventricle.

Methods

We reviewed our initial experience utilising this mapping system to guide catheter ablation of ventricular ectopics from the inter-ventricular septum, coronary cusp or papillary muscle.  A patient-specific 3D heart and torso model was created using semi-automated segmentation of MRI or CT scan images.  A 3D topographic image of the patient’s torso was taken to accurately position surface ECG electrode locations onto the 3D heart-torso model.  An ECG of the PVC was imported from LabSystemPro (Bard) into VIVO™ for analysis prior to ablation.  The result was then compared with the site of earliest activation identified using invasive electro-anatomical (EA) mapping.

Results

VIVO™ was used in 12 cases where the PVC was localised to an intracardiac structure – six papillary muscle, four to the septum and two from the coronary cusp.  VIVO™ was able to accurately localise the earliest activation site when compared to the invasive map in 5/6 papillary muscle cases, 3/4 septal cases and 2/2 coronary cusp cases.  Ablation was acutely successful in all cases.  One additional patient had a PVC localised non-invasively to the postero-medial papillary muscle, however an invasive 3D electro-anatomical map or ablation was not performed.

In three cases we were able to merge the 3D geometry of the non-invasive map from VIVO™ into the Carto™ system to guide mapping and ablation in real time (see figure).

Conclusion

Our experience shows promising results for accurate non-invasive localisation of ventricular arrhythmias originating from intracardiac structures.  Non-invasive localisation is of particular value in cases where the arrhythmia is infrequent, difficult to induce or poorly tolerated haemodynamically.  The two cases where PVC localisation was inaccurate were performed using an older version of the software. With recent refinements, localisation is anticipated to be improved further.

We also present the first experience of combining the VIVO™ geometry with the real-time invasive EA map.  This has potential to significantly speed up mapping time and reduce the need for expensive multi-polar catheters by allowing the operator to see their target in real time 3D.  Further work is ongoing to validate the accuracy of VIVO™ prospectively and quantitatively.

Abstract Figure. VIVO map merged with Carto LV geometry

FRI0649-HPR HYDROXYCHLOROQUINE PRESCRIBING AND OPHTHALMOLOGY SCREENING WITHIN RHEUMATOLOGY DEPARTMENTS IN THE NORTH-WEST OF THE UNITED KINGDOM: A PROSPECTIVE REGIONAL AUDIT

Background:

Hydroxychloroquine (HCQ) is widely used in the management of rheumatoid arthritis and connective tissue disease. The prevalence of retinopathy in patients taking long-term HCQ is approximately 7.5%, increasing to 20-50% after 20 years of therapy. Hydroxychloroquine prescribed at ≤5 mg/kg poses a toxicity risk of <1% up to five years and <2% up to ten years, but increases sharply to almost 20% after 20 years. Risk factors for retinopathy include doses >5mg/kg/day, concomitant tamoxifen or chloroquine use and renal impairment. The UK Royal College of Ophthalmologists (RCOphth) 2018 guidelines for HCQ screening recommend optimal treatment dosage and timing for both baseline and follow-up ophthalmology review for patients on HCQ, with the aim of preventing iatrogenic visual loss. This is similar to recommendations made by the American Academy of Ophthalmology (2016).

Objectives:

To determine adherence to the RCOphth guidelines for HCQ screening within the Rheumatology departments in the North-West of the UK.

Methods:

Data for patients established on HCQ and those initiated on HCQ therapy were collected over a 7 week period from 9 Rheumatology departments.

Results:

473 patients were included of which 56 (12%) were new starters and 417 (88%) were already established on HCQ. 79% of the patients were female, with median ages of 60.5 and 57 years for new and established patients respectively. The median (IQR) weight for new starters was 71 (27.9) kg and for established patients, 74 (24.7) kg.

20% of new starters exceeded 5mg/kg daily HCQ dose. 16% were identified as high risk (9% had previously taken chloroquine, 5% had an eGFR <60ml/min/m2and 2% had retinal co-pathology). Of the high-risk group, 44% were taking <5mg/kg. In total, 36% of new starters were referred for a formal baseline Ophthalmology review.

In the established patients, 74% were taking ≤5mg/kg/day HCQ dose and 16% were categorized as high risk (10% had an eGFR less than 60ml/min/m2, 3% had previous chloroquine or tamoxifen use and 2% had retinal co-pathology). In the high-risk group, 75% were not referred for spectral domain optical coherence tomography (SD-OCT). 41% of patients established on HCQ for <5 years, and 33% of patients on HCQ for >5 years were not referred for SD-OCT. Reasons for not referring included; awaiting 5 year review, previous screening already performed and optician review advised.

Since the introduction of the RCOphth guidelines, 29% patients already established on HCQ had an alteration in the dosage of HCQ in accordance with the guidelines. In the high-risk group, 16% were not on the recommended HCQ dose.

Conclusion:

This audit demonstrates inconsistencies in adherence to the RCOphth guidelines for HCQ prescribing and ophthalmology screening within Rheumatology departments in the North-West of the UK for both new starters and established patients. Plans to improve this include wider dissemination of the guidelines to Rheumatology departments and strict service level agreements with ophthalmology teams to help optimize HCQ prescribing and screening for retinopathy.

Acknowledgments:

Drs. S Jones, E MacPhie, A Madan, L Coates & Prof L Teh. Co-1st author, T David.

Disclosure of Interests:

None declared

An international comparison of deceased donor kidney utilization: What can the United States and the United Kingdom learn from each other?

In transplant, meaningful international comparisons in organ utilization are needed. This collaborative study between the United Kingdom (UK) and the United States (US) aimed to develop a kidney utilization metric allowing for legitimate intercountry comparisons. Data from the UK and US transplant registries, including all deceased donor kidneys recovered from 2006 to 2017, were analyzed. To identify a potentially comparable kidney utilization rate (UR), several denominators were assessed. We discovered that the proportion of transplanted kidneys from elderly donors in the UK (10.7%) was 18 times greater than that in the US (0.6%). Conversely, en bloc pediatric kidney transplant was more common in the US. Donation after circulatory death utilization has risen in both countries but is twice as prevalent in the UK (39% of transplants) vs the US (20%). In addition, US and UK URs are not directly comparable due to fundamental system differences. However, using a suite of URs revealed practice areas likely to yield the most benefit if improved, such as efforts to increase kidney offer acceptance in the US and to reduce postacceptance discard in the UK. Methods used in this study, including novel intracountry risk-adjusted UR trend logistic regression analyses, can be translated to other international transplant registries in pursuit of further global learning opportunities.

Infrared Spectroscopy and Density Functional Theory Investigations of the Reactivity of Titanium Atoms with Carbon Monoxide and Water Isolated in Solid Argon: Sequential Evolution from Triplet to Singlet State

Thermally evaporated titanium atoms reacted with carbon monoxide and water in solid argon at 12 K to produce the HTiOH-CO and HTiOH-(CO)₂ molecules, which were characterized using infrared spectroscopy on the basis of CO, Ti, and water concentration variations and of isotopic substitutions. The insertion product, HTiOH, resulting from the reaction of a titanium atom with a water molecule reacts with CO spontaneously to give the HTiOH-CO molecule, which in turn reacts with a second CO molecule to give HTiOH-(CO)₂ The density functional theory calculations were performed to elucidate the geometrical and electronic structures and support the spectral assignments. The topological analysis of the charge density within the experimentally observed molecules allowed us to rationalize the coordination sphere as well as the electron pairing on the titanium center.

Temperature-dependent transport properties of CVD-fabricated n-GaN nanorods/p-Si heterojunction devices

We report on the structural, electrical, and transport properties of high quality CVD-fabricated n-GaN nanorods (NRs)/p-Si heterojunction diodes.

169 Comparison of pregnancy outcomes in dairy heifers artificially inseminated with sexed semen deposited in the uterine horns versus the uterine body

The use of sexed semen (SS) for AI of cattle has resulted in lower pregnancy per timed AI (P/TAI) compared with conventional semen. This has been attributed to lower sperm dose and cell damage during the cell sorting-freezing process. Horn AI is a common practice in equines and canines to improve pregnancy rate when using low sperm doses. The objective was to compare P/TAI and pregnancy loss (PL) in dairy heifers inseminated with SS deposited in the uterine horn (UH) ipsilateral to the ovary containing the preovulatory follicle (POF) versus TAI in the uterine body (UB). This study was performed on two dairy farms in Georgia (A and B). On farm A, 74 Holstein heifers (12 months old) received a 5-day Cosynch + controlled internal drug release (CIDR) protocol including an intravaginal insert (Eazi-Breed CIDR, Zoetis Animal Health) containing 1.38g of progesterone for 5 days and a dose of gonadotrophin-releasing hormone (GnRH) intramuscularly (100µg, 2mL of Factrel, Zoetis Animal Health). At CIDR removal, heifers received a dose of prostaglandin F2α (PGF2α) intramuscularly (25mg, 5mL of Lutalyse, Zoetis Animal Health) and again 24h later; 72h after CIDR removal, heifers received 100µg of GnRH intramuscularly and TAI with frozen-thawed SS. On farm B, 237 Holstein×Jersey heifers (12 months old) received a modified 5-day Cosynch + CIDR. This protocol was similar to that on farm A but did not include GnRH at the time of CIDR insertion or a second dose of PGF2α 24h after CIDR removal. Immediately before TAI, heifers were examined using transrectal ultrasonography (TRUS) to determine on which ovary the POF was present. Each heifer was randomly assigned to TAI using SS in either the UH ipsilateral to the ovary containing the POF (n=150; farm A, n=32; farm B, n=118) or the UB regardless of where the POF was identified (n=161; farm A, n=42; farm B, n=119). Pregnancy was diagnosed 32 days after TAI using TRUS to determine P/TAI. Heifers diagnosed pregnant were re-examined using TRUS at 60 days of gestation to assess PL. Data were analysed using PROC LOGISTIC and the chi-square test of SAS (SAS Institute Inc.). Heifers that received SS in the UH had adequate P/TAI (50.6% (76/150); farm A: 50.0% (16/32); farm B: 50.8% (60/118)), which tended to be numerically greater (P=0.12) than that observed in heifers receiving SS in the UB (43.4% (70/161); farm A: 40.5% (17/42); farm B: 44.5% (53/119)). In addition, PL was not different between groups and was within normal ranges for dairy heifers (10.0 and 9.4% for UH and UB, respectively). In conclusion, TAI of dairy heifers with SS deposited in the UH ipsilateral to the ovary containing the POF resulted in adequate P/TAI, which was 7.2% greater than TAI in the UB. Horn AI with SS might become a valuable tool for optimising reproductive efficiency and genetic selection of dairy herds.

Effect of Heating on Compositional Characteristics and Oxidative Stability of Crude and Refined Rice Bran Oil

The compositional characteristics and oxidative stability of rice bran oil were determined by observing the formation of oxidative products and alteration in chemical composition of oils during microwave or oven heating. The values of oxidative indicators such as free acidity, peroxide, p-anisidine, total oxidation, thiobarbituric acid and color values, increased faster in refined oils compared to crude ones during heating. In gas chromatography analysis, the percentages of total saturated, monounsaturated and polyunsaturated fatty acids in the studied oils such as lab extracted crude rice bran oil, lab extracted and refined rice bran oil, crude rice bran oil from commercial mill and refined rice bran oil from commercial mill were: 23.07 to 23.56, 41.15 to 42.38 and 34.38 to 35.88, respectively. The heating caused the reduction of polyunsaturated fatty acids content with increasing saturated fatty acids content, and these changes were greater in refined rice bran oil indicating extensive lipid oxidation occurred in refined oil. The change in triacylglycerol species content as determined by High-performance liquid chromatography, was lower in crude oil; the higher stability of these species in crude oil could have contribution to reduce oxidation. During thermal treatment, the generation of hydroperoxides, their degradation and formation of secondary oxidative products evaluated by Fourier-transform infrared spectroscopy, were lower in crude oils. However, the rate of formation of oxidative products in lab prepared samples was lower compared to that in the samples collected from commercial mill. Under extreme thermal condition, the order of oxidative stability: lab extracted crude rice bran oil > crude rice bran oil from commercial mill>lab extracted and refined rice bran oil > refined rice bran oil from commercial mill. The present results will be useful to oil seed processing mills in refining of rice bran oil for economic feasibility and better marketability.

An acetylated derivative of vitexin halts MDA-MB-231 cellular progression and improves its immunogenic profile through tuning miR- 20a-MICA/B axis

The activating immune ligands, MICA/B, act as a "kill me" signal through the NKG2D receptor expressed on natural killer (NK) cells. Recently, the oncogenic miR-20a was found to mediate immune escape through repressing MICA/B levels in breast cancer (BC) cells. However, targeting miR-20a-MICA/B using natural compounds has rarely been investigated. Our group has successfully isolated 3'-O-acetylvitexin that showed cytotoxic effects against colon cancer cells but has never been evaluated in BC. Our aim is to investigate the effects of 3'-O-acetylvitexin on BC cell lines and to further elucidate its molecular mechanism of action.The results showed that 3'-O-acetylvitex depicted a more pronounced dose-dependent repression of TNBC cellular viability, colonogenicity and migration capacity than Vitexin. 3'-O-acetylvitexin treatment resulted in a marked dose-dependent repression of miR-20a with a concomitant dose-dependent increase in MICA/B expression. In conclusion, 3'-O-acetylvitexin might act as a promising therapeutic agent for TNBC patients.

P3601Association of cdkn2b rs2891168 polymorphism with wall motion index score and the development of major adverse cardiovascular events within one year following ST elevation myocardial infarction

Introduction

According to the GRACE registry the largest amount of deaths occurs in the first year after ST elevation myocardial infarction (STEMI).

Purpose

To investigate the incidence of Major Adverse Cardiovascular Events (MACE), which include cardiovascular death, nonfatal myocardial infarction, nonfatal stroke one year after STEMI and Wall Motion Index Score (WMSI) in patients with different genotypes A/G of rs2891116 polymorphism in CDKN2B gene.

Materials and methods

A total of 141 patients, diagnosed with STEMI based on the Third Universal Definition of Myocardial Infarction (ESC, 2013) were included in the study, composed of 52 females and 89 males. The study group mean age was 63.8±11.8 years. Informed consent was obtained. During hospitalization echocardiography was performed and a blood sample was taken for genetic testing. Over the one-year period MACE were recorded. 17 patients were lost to follow up. Data was analysed using Kaplan-Meier estimator; to compare differences between groups log-rank test was applied; continuous data analysis was performed by Mann-Whitney test. The measured genotype frequencies fit the Hardy-Weinberg equilibrium (p>0.05).

Results

Kaplan-Meier survival analysis revealed that in patients with AA genotype the proportion of individuals who experienced MACE over the one year period after STEMI was higher in comparison with AG genotype carriers (log rank p=0.022). Participants with GG genotype did not show significant differences compared to other genotypes carriers (Picture 1). WMSI value in patients with AA genotype was higher (Me = 1.25; Q(0.25) = 1.13; Q(0.75) = 1.56) than in AG genotype carriers (Me = 1.13; Q(0.25) = 1.13; Q(0.75) = 1.25; p=0.037). In participants with GG genotype compared to AA and AG the WMSI value was not significantly different (Me = 1.19; Q(0.25) = 1.13; Q(0.75) = 1.32).

Picture 1

Conclusions

Genotype AA in CDKN2B gene rs2891168 in patients after STEMI is associated with higher probability of the development of MACE over the one year period after the index event, compared to AG genotype carriers. Participants with AA genotype exhibited a higher WMSI value after STEMI compared to patients with AG genotype.

Risk of relapse of multiple myeloma following kidney transplantation

Background

Autologous stem cell transplantation (ASCT) and novel therapies have improved the prognosis for patients with multiple myeloma (MM). For those who undergo ASCT while on dialysis, a similar survival compared with the overall MM population has been reported. Therefore, for patients achieving remission following ASCT, kidney transplantation is an attractive option, offering an improved quality of life and significant economic advantage.

Method

This case series investigates the outcome of five patients who underwent an ASCT for MM with subsequent kidney transplantation between 2006 and 2012.

Results

Four patients presented with end-stage renal disease (ESRD) and one progressed to ESRD shortly after diagnosis. Induction chemotherapy regimens with novel agents including thalidomide and bortezomib were utilized. Following attainment of very good partial remission or complete remission, high-dose melphalan ASCTs were performed after a median of 10 months. Kidney transplantation (living donor n = 3, deceased donor n = 2) with tacrolimus-based immunosuppression regimens was completed at a median of 27 months after ASCT. Patients 1 and 3 experienced relapse of myeloma at 6 and 16 months after kidney transplantation. Patients 2, 4 and 5 remain alive at 55 months (median) after kidney transplantation with no evidence of relapse.

Conclusion

Forty percent of our cohort experienced a relapse in MM within 2 years of kidney transplantation. Death-censored graft survival and patient survival were 80% at 4 years. Our study adds to the growing literature supporting kidney transplantation following successful ASCT for MM and is useful when counselling patients regarding renal and haematological outcomes.

Marie M, Stickney K, VanBuecken D, Vellek B, Webber C, Allen L, Bollyk J, Hilderman N, Ismail H, Lamola S, Sanda S, Vendettuoli H, Tridgell D, Monzavi R, Bock M, Fisher L, Halvorson M, Jeandron D, Kim M, Wood J, Geffner M, Kaufman F, Parkman R, Salazar C, Goland R, Clynes R, Cook S, Freeby M, Pat Gallagher M, Gandica R, Greenberg E, Kurland A, Pollak S, Wolk A, Chan M, Koplimae L, Levine E, Smith K, Trast J, DiMeglio L, Blum J, Evans-Molina C, Hufferd R, Jagielo B, Kruse C, Patrick V, Rigby M, Spall M, Swinney K, Terrell J, Christner L, Ford L, Lynch S, Menendez M, Merrill P, Pescovitz M, Rodriguez H, Alleyn C, Baidal D, Fay S, Gaglia J, Resnick B, Szubowicz S, Weir G, Benjamin R, Conboy D, deManbey A, Jackson R, Jalahej H, Orban T, Ricker A, Wolfsdorf J, Zhang HH, Wilson D, Aye T, Baker B, Barahona K, Buckingham B, Esrey K, Esrey T, Fathman G, Snyder R, Aneja B, Chatav M, Espinoza O, Frank E, Liu J, Perry J, Pyle R, Rigby A, Riley K, Soto A, Gitelman S, Adi S, Anderson M, Berhel A, Breen K, Fraser K, Gerard-Gonzalez A, Jossan P, Lustig R, Moassesfar S, Mugg A, Ng D, Prahalod P, Rangel-Lugo M, Sanda S, Tarkoff J, Torok C, Wesch R, Aslan I, Buchanan J, Cordier J, Hamilton C, Hawkins L, Ho T, Jain A, Ko K, Lee T, Phelps S, Rosenthal S, Sahakitrungruang T, Stehl L, Taylor L, Wertz M, Wong J, Philipson L, Briars R, Devine N, Littlejohn E, Grant T, Gottlieb P, Klingensmith G, Steck A, Alkanani A, Bautista K, Bedoy R, Blau A, Burke B, Cory L, Dang M, Fitzgerald-Miller L, Fouts A, Gage V, Garg S, Gesauldo P, Gutin R, Hayes C, Hoffman M, Ketchum K, Logsden-Sackett N, Maahs D, Messer L, Meyers L, Michels A, Peacock S, Rewers M, Rodriguez P, Sepulbeda F, Sippl R, Steck A, Taki I, Tran BK, Tran T, Wadwa RP, Zeitler P, Barker J, Barry S, Birks L, Bomsburger L, Bookert T, Briggs L, Burdick P, Cabrera R, Chase P, Cobry E, Conley A, Cook G, Daniels J, DiDomenico D, Eckert J, Ehler A, Eisenbarth G, Fain P, Fiallo-Scharer R, Frank N, Goettle H, Haarhues M, Harris S, Horton L, Hutton J, Jeffrrey J, Jenison R, Jones K, Kastelic W, King MA, Lehr D, Lungaro J, Mason K, Maurer H, Nguyen L, Proto A, Realsen J, Schmitt K, Schwartz M, Skovgaard S, Smith J, Vanderwel B, Voelmle M, Wagner R, Wallace A, Walravens P, Weiner L, Westerhoff B, Westfall E, Widmer K, Wright H, Schatz D, Abraham A, Atkinson M, Cintron M, Clare-Salzler M, Ferguson J, Haller M, Hosford J, Mancini D, Rohrs H, Silverstein J, Thomas J, Winter W, Cole G, Cook R, Coy R, Hicks E, Lewis N, Marks J, Pugliese A, Blaschke C, Matheson D, Pugliese A, Sanders-Branca N, Ray Arce LA, Cisneros M, Sabbag S, Moran A, Gibson C, Fife B, Hering B, Kwong C, Leschyshyn J, Nathan B, Pappenfus B, Street A, Boes MA, Peterson Eck S, Finney L, Albright Fischer T, Martin A, Jacqueline Muzamhindo C, Rhodes M, Smith J, Wagner J, Wood B, Becker D, Delallo K, Diaz A, Elnyczky B, Libman I, Pasek B, Riley K, Trucco M, Copemen B, Gwynn D, Toledo F, Rodriguez H, Bollepalli S, Diamond F, Eyth E, Henson D, Lenz A, Shulman D, Raskin P, Adhikari S, Dickson B, Dunnigan E, Lingvay I, Pruneda L, Ramos-Roman M, Raskin P, Rhee C, Richard J, Siegelman M, Sturges D, Sumpter K, White P, Alford M, Arthur J, Aviles-Santa ML, Cordova E, Davis R, Fernandez S, Fordan S, Hardin T, Jacobs A, Kaloyanova P, Lukacova-Zib I, Mirfakhraee S, Mohan A, Noto H, Smith O, Torres N, Wherrett D, Balmer D, Eisel L, Kovalakovska R, Mehan M, Sultan F, Ahenkorah B, Cevallos J, Razack N, Jo Ricci M, Rhode A, Srikandarajah M, Steger R, Russell WE, Black M, Brendle F, Brown A, Moore D, Pittel E, Robertson A, Shannon A, Thomas JW, Herold K, Feldman L, Sherwin R, Tamborlane W, Weinzimer S, Toppari J, Kallio T, Kärkkäinen M, Mäntymäki E, Niininen T, Nurmi B, Rajala P, Romo M, Suomenrinne S, Näntö-Salonen K, Simell O, Simell T, Bosi E, Battaglia M, Bianconi E, Bonfanti R, Grogan P, Laurenzi A, Martinenghi S, Meschi F, Pastore M, Falqui L, Teresa Muscato M, Viscardi M, Bingley P, Castleden H, Farthing N, Loud S, Matthews C, McGhee J, Morgan A, Pollitt J, Elliot-Jones R, Wheaton C, Knip M, Siljander H, Suomalainen H, Colman P, Healy F, Mesfin S, Redl L, Wentworth J, Willis J, Farley M, Harrison L, Perry C, Williams F, Mayo A, Paxton J, Thompson V, Volin L, Fenton C, Carr L, Lemon E, Swank M, Luidens M, Salgam M, Sharma V, Schade D, King C, Carano R, Heiden J, Means N, Holman L, Thomas I, Madrigal D, Muth T, Martin C, Plunkett C, Ramm C, Auchus R, Lane W, Avots E, Buford M, Hale C, Hoyle J, Lane B, Muir A, Shuler S, Raviele N, Ivie E, Jenkins M, Lindsley K, Hansen I, Fadoju D, Felner E, Bode B, Hosey R, Sax J, Jefferies C, Mannering S, Prentis R, She J, Stachura M, Hopkins D, Williams J, Steed L, Asatapova E, Nunez S, Knight S, Dixon P, Ching J, Donner T, Longnecker S, Abel K, Arcara K, Blackman S, Clark L, Cooke D, Plotnick L, Levin P, Bromberger L, Klein K, Sadurska K, Allen C, Michaud D, Snodgrass H, Burghen G, Chatha S, Clark C, Silverberg J, Wittmer C, Gardner J, LeBoeuf C, Bell P, McGlore O, Tennet H, Alba N, Carroll M, Baert L, Beaton H, Cordell E, Haynes A, Reed C, Lichter K, McCarthy P, McCarthy S, Monchamp T, Roach J, Manies S, Gunville F, Marosok L, Nelson T, Ackerman K, Rudolph J, Stewart M, McCormick K, May S, Falls T, Barrett T, Dale K, Makusha L, McTernana C, Penny-Thomas K, Sullivan K, Narendran P, Robbie J, Smith D, Christensen R, Koehler B, Royal C, Arthur T, Houser H, Renaldi J, Watsen S, Wu P, Lyons L, House B, Yu J, Holt H, Nation M, Vickers C, Watling R, Heptulla R, Trast J, Agarwal C, Newell D, Katikaneni R, Gardner C, Del A, Rio A, Logan H, Collier C, Rishton G, Whalley A, Ali S, Ramtoola T, Quattrin L, Mastrandea A, House M, Ecker C, Huang C, Gougeon J, Ho D, Pacuad D, Dunger J, May C, O’Brien C, Acerini B, Salgin A, Thankamony R, Williams J, Buse G, Fuller M, Duclos J, Tricome H, Brown D, Pittard D, Bowlby A, Blue T, Headley S, Bendre K, Lewis K, Sutphin C, Soloranzo J, Puskaric H, Madison M, Rincon M, Carlucci R, Shridharani B, Rusk E, Tessman D, Huffman H, Abrams B, Biederman M, Jones V, Leathers W, Brickman P, Petrie D, Zimmerman J, Howard L, Miller R, Alemzadeh D, Mihailescu R, Melgozza-Walker N, Abdulla C, Boucher-Berry D, Ize-Ludlow R, Levy C, Swenson, Brousell N, Crimmins D, Edler T, Weis C, Schultz D, Rogers D, Latham C, Mawhorter C, Switzer W, Spencer P, Konstantnopoulus S, Broder J, Klein L, Knight L, Szadek G, Welnick B, Thompson R, Hoffman A, Revell J, Cherko K, Carter E, Gilson J, Haines G, Arthur B, Bowen W, Zipf P, Graves R, Lozano D, Seiple K, Spicer A, Chang J, Fregosi J, Harbinson C, Paulson S, Stalters P, Wright D, Zlock A, Freeth J, Victory H, Maheshwari A, Maheshwari T, Holmstrom J, Bueno R, Arguello J, Ahern L, Noreika V, Watson S, Hourse P, Breyer C, Kissel Y, Nicholson M, Pfeifer S, Almazan J, Bajaj M, Quinn K, Funk J, McCance E, Moreno R, Veintimilla A, Wells J, Cook S, Trunnel J, Henske S, Desai K, Frizelis F, Khan R, Sjoberg K, Allen P, Manning G, Hendry B, Taylor S, Jones W, Strader M, Bencomo T, Bailey L, Bedolla C, Roldan C, Moudiotis B, Vaidya C, Anning S, Bunce S, Estcourt E, Folland E, Gordon C, Harrill J, Ireland J, Piper L, Scaife K, Sutton S, Wilkins M, Costelloe J, Palmer L, Casas C, Miller M, Burgard C, Erickson J, Hallanger-Johnson P, Clark W, Taylor A, Lafferty S, Gillett C, Nolan M, Pathak L, Sondrol T, Hjelle S, Hafner J, Kotrba R, Hendrickson A, Cemeroglu T, Symington M, Daniel Y, Appiagyei-Dankah D, Postellon M, Racine L, Kleis K, Barnes S, Godwin H, McCullough K, Shaheen G, Buck L, Noel M, Warren S, Weber S, Parker I, Gillespie B, Nelson C, Frost J, Amrhein E, Moreland A, Hayes J, Peggram J, Aisenberg M, Riordan J, Zasa E, Cummings K, Scott T, Pinto A, Mokashi K, McAssey E, Helden P, Hammond L, Dinning S, Rahman S, Ray C, Dimicri S, Guppy H, Nielsen C, Vogel C, Ariza L, Morales Y, Chang R, Gabbay L, Ambrocio L, Manley R, Nemery W, Charlton P, Smith L, Kerr B, Steindel-Kopp M, Alamaguer D, Liljenquist G, Browning T, Coughenour M, Sulk E, Tsalikan M, Tansey J, Cabbage N. Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

Serum zinc level during and after acute painful episodes in children with sickle cell anemia at the aminu kano teaching hospital, Kano, Northern Nigeria

Background

Acute painful crisis due to vaso-occlusive event is the leading cause of hospitalization in patients with sickle cell anemia (SCA). Zinc deficiency in children with SCA is associated with increased frequency and severity of acute painful events. We determined serum zinc level in children with SCA during acute painful crisis and compared the same with children with SCA who are in steady state and healthy non-sickle cell disease children.

Subjects and Methods

This was a descriptive longitudinal study, involving children with SCA age 6 months to 15 years at Aminu Kano Teaching Hospital, Kano, Northern Nigeria. Subjects were recruited into three groups, which consisted of SCA in acute painful crisis, SCA in steady state, and normal subjects with hemoglobin AA (HbAA). A total of 210 subjects were recruited, 70 subjects each for SCA in acute painful crisis, SCA in steady state, and HbAA groups, respectively. Serum zinc was analyzed with atomic absorption spectrophotometery. Serum zinc levels were repeated in children with SCA and acute painful crisis 4 weeks after resolution of painful events.

Results

The mean serum zinc level of SCA with acute painful crisis was higher than SCA in steady state, but the difference was not statistically significant (24.4 [11.0] and 23.4 [7.4]) μg/dL, respectively (t = 16.04, P = 0.54). While the HbAA control had significantly higher mean serum zinc level than SCA groups, both in acute painful and in steady state (F = 59.3, P = 0.001). Among children with SCA and acute painful crisis, repeat serum zinc level 4 weeks after resolution of acute painful events was significantly higher than during pain crisis (t = 64, P = 0.001).

Conclusion

Zinc deficiency occurs in children with SCA and the deficiency is worsened by acute painful events Therefore, it is recommended that zinc level should be assessed and any deficiency treated. Supplementation of zinc should also be enhanced as this may reduce painful crisis in SCA.