Clinical, environmental and histological distribution of BRAF, NRAS and TERT promoter mutations among patients with cutaneous melanoma: a retrospective study of 563 patients

BACKGROUND

The distinct somatic mutations that define clinical and histopathological heterogeneity in cutaneous melanoma could be dependent on host susceptibility to exogenous factors like ultraviolet radiation.

OBJECTIVES

Firstly, to characterize patients with cutaneous melanoma clinically and pathologically based on the mutational status of BRAF, NRAS and TERT promoter. Secondly, to elucidate the modified features due to the presence of TERT promoter mutations over the background of either BRAF or NRAS mutations.

METHODS

We performed a retrospective study on 563 patients with melanoma by investigating somatic mutations in BRAF, NRAS and TERT promoter.

RESULTS

We observed co-occurrence of TERT promoter mutations with BRAF and NRAS mutations in 26.3% and 6.9% of melanomas, respectively. Multivariate analysis showed an independent association between BRAF mutations and a decreased presence of cutaneous lentigines at the melanoma site, and an increased association with the presence of any MC1R polymorphism. We also observed an independent association between TERT promoter mutations and increased tumour mitotic rate. Co-occurrence of BRAF and TERT promoter mutations was independently associated with occurrence of primary tumours at usually sun-exposed sites, lack of histological chronic sun damage in surrounding unaffected skin at the melanoma site, and increased tumour mitotic rate. Co-occurrence of NRAS and TERT promoter mutations was independently associated with increased tumour mitotic rate. The presence of TERT promoter together with BRAF or NRAS mutations was associated with statistically significantly worse survival.

CONCLUSIONS

The presence of TERT promoter mutations discriminates BRAF- and NRAS-mutated tumours and indicates a higher involvement of ultraviolet-induced damage and tumours with worse melanoma-specific survival than those without any mutation. These observations refine classification of patients with melanoma based on mutational status.

Vipera snakebite in Europe: a systematic review of a neglected disease

In 2009, snakebites were included in the list of the World Health Organization (WHO) neglected diseases. Dermatological literature lacks current and up-to-date articles about snakebites and their management, despite the fact that dermatologists, especially from rural hospitals, can be called into the emergency room to consult the management of suspected snakebites. In this systematic review, we highlighted the main clinical and laboratory aspects of snakebites from Vipera spp. in Europe, by reviewing 3574 studies initially retrieved from PubMed, Embase and Cochrane CENTRAL databases. Of these, 78 were finally included in the systematic review. We found that the most involved taxon was V. berus in 63.3% and the most involved anatomic site of the bite was the upper limbs 53.1% with fang marks reported in 90.5%. The mean age of the patients was 32.9 years, and bites were slightly more common among males (58.2%). A wound washing was performed in 86.9% of cases before the hospitalization. The most frequently reported grade of envenomation was G2 (42.2%). In addition to local dermatological symptoms (extended erythema, oedema, cutaneous necrosis, hives, purpura, petechiae, acute compartment syndrome), numerous systemic symptoms have also been reported, including fatigue (14.4%), pain (75.3%), fever (49.2%), direct anaphylactoid reaction (5.3%), anxiety (60.8%), cranial nerve neurotoxicity (14.8%), dysesthesia/paraesthesia (7.9%), vomiting (33.7%), abdominal pain (23.3%), diarrhoea (15.4%), dyspnoea (6.3%), proteinuria (10.6%) and haematuria (9.3%). Secondary infections were present in 3.5% and disseminated intravascular coagulation in 3.1% of cases, and fasciotomy was performed in 4.2% cases, while an amputation in 6.9%. Only 0.9% of patients died. Antivenom was administered in 3053 cases. In conclusion, there is a pressing need for robust multi-centre randomized control trials, standardized protocol for snakebite management and antivenom administration across Europe and a National snakebite register for each European country.

Soft & Hard Tissue Assessment around Immediate & Delayed Implants: A Clinico-Radiographical Study

The aim of the modern dentistry is to provide the predictable treatment in short duration. Replacement of missing teeth in shorter duration helps in fulfilling patient's aesthetics and functional demands. Endosseous dental implants are predictable method for replacing missing dentition. The evolution in implant surgical techniques is focused on decreasing treatment duration, e.g. implants can be placed in fresh extraction socket. Therefore, this non-randomized clinical controlled study was designed to determine that whether the treatment outcomes obtained by short treatment duration (immediate implant) are comparable with conventional treatment options (delayed implant) by evaluating the peri-implant soft and hard tissue level, clinically and radiographically {by Cone beam computed tommography (CBCT)}. Total of 30 implants were placed in 13 patients, according to Type 1 ITI protocol (Group 1; 15 implants) and Type 4 ITI protocol (Group 2; 15 implants). Implants in each group were loaded with definitive restoration after 3 months of placement. Hard tissue parameters (marginal bone width and height and probing depth) and soft tissue parameters (width of keratinised gingiva and papillary index) were evaluated at baseline, 3 months post implant insertion and 3 months post prosthetic loading. The results showed statistically significant reduction in width of marginal bone in delayed implants as compared to immediate implants. In contrast, significant reduction in marginal bone height and width of keratinised gingiva was evident in immediate implants. Significant reduction in pocket depth (after 2nd stage surgery and 3 months post prosthetic loading) was noted around delayed implants (p<0.05). Moreover, esthetic results showed regeneration of interproximal papillae in both the groups till the end of study period. This study was concluded that both the groups showed similar results but in some aspects delayed implants was superior to immediate implants. Careful evaluation of implant placement sites before implant installation promotes optimal implant esthetics and survival outcomes.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Low-cost IoT framework for irrigation monitoring and control

Purpose

The purpose of this work is to make an IoT-based low-cost and power-efficient portable system to control irrigation using a threshold value algorithm and to measure soil-irrigation-related parameters such as soil moisture, soil temperature, humidity and air temperature.

Design/methodology/approach

This paper presents a threshold value algorithm to optimize power consumption and to control irrigation process.

Findings

The system uses ESP-12F 8266 as the main microcontroller unit to monitor and control irrigation system. The system also consists of an actuator system that triggers automatically based on a threshold value algorithm. An open-source cloud platform is used to monitor and store all the data for future perspective. To make the system run for a long time without any human intervention, a solar panel is used as an alternate source of energy for charging the 12V lithium-ion battery. The battery takes 2.64 h for full charging considering peak intensity of sunlight. A capacitive moisture sensor is included using less expensive 555 timer and calibrated to measure water content in the soil. The 555 timer is used in astable mode of configuration to generate a signal of 572 KHz. The calibrated sensor data when compared with a standard SEN0193 moisture sensor shows an error of 3.4%. The prototype model is made to optimize the power consumption. This can be achieved by utilizing sleep mode of ESP-12F 8266. The total cost involved to make the system is 3900.55 Indian rupees and around US$54.90.

Practical implications

The device is tested in a flower garden during winter season of Nagaland, India, for 75 days to collect all the data and to automate the irrigation process.

Originality/value

The proposed threshold value algorithm optimizes the power consumption of the device, and wastage of water is reduced up to 60% as compared to the traditional method of irrigation.

THU0046 A PIPELINE TO STUDY ANTIGEN-SPECIFIC CD4+ T CELLS IN RHEUMATOID ARTHRITIS

Background:

Autoimmunity to citrullinated autoantigens forms a critical component of disease pathogenesis in rheumatoid arthritis (RA). Presence of anti-citrullinated protein antibodies (ACPAs) in patients has high diagnostic value. Recently, several citrullinated antigen specific CD4+T cells have been described. However, detailed studies of their T-cell receptor usage and in-vivo profile suffer from the disadvantage that these cells are present at very low frequencies. In this context, we here present a pipeline for TCR repertoire analysis of antigen-specific CD4+T cells from RA patients, including both citrulline and influenza (control) specificities using in-vitro peptide challenge induced-cell expansion.

Objectives:

To enable studies of the T cell repertoire of citrullinated antigen-specific CD4+T cells in rheumatoid arthritis

Methods:

Peripheral blood mononuclear cells (PBMCs) (n=7) and synovial fluid mononuclear cells (SFMCs) (n=5) from HLA-DR*0401-postive RA patients were cultured in the presence of citrullinated Tenascin C peptide cocktails or influenza peptides (positive control). Citrulline reactive cells were further supplemented with recombinant human IL-15 and IL-7 on day 2. All cultures were replenished with fresh medium on day 6 and rIL-2 was added every 2 days from then. Assessment of proportion of peptide-HLA-tetramer positive cells was performed using flow cytometry whereby individual antigen-specific CD4+T cells were sorted into 96-well plates containing cell lysis buffer, followed by PCR-based alpha/beta TCR sequencing. TCR sequencing data was demultiplexed and aligned for TCR gene usage using MiXCR. Some tetramer positive cells were sorted into complete medium containing human IL-2 and PHA for expansion of antigen-specific cells. Cells were supplemented with irradiated allogenic PBMCs (30 times number of antigen specific cells). Clones of antigen specific CD4+T cells were further subjected to tetramer staining to confirm expansion of cells.

Results:

As evidenced by increase in frequency of tetramer positive CD4+T cells, in vitro peptide stimulation resulted in expansion of both influenza specific (Fig. 1a) and citrullinated antigen specific (Fig. 1b) CD4+T cells. Polyclonal in-vitro expansion of tenascin C tetramer positive sorted cells followed by tetramer staining further confirmed antigen specificity and enrichment for antigen specific CD4+T cells after polyclonal stimulation (Fig.1c). TCR repertoire analysis in PB and SF dataset from the first patient showed clonal expansion of influenza specific cells in both sites. Synovial fluid had more diversity of expanding clones as compared to paired PB, with few expanded clones being shared among SF and PB. We observed a more diverse TCR repertoire in citrulline specific CD4+T cells. We also observed sharing of TCR alpha chains among different citrulline specific CD4+T cell clones.

Fig. 1

In-vitroexpansion of antigen specific CD4+T cells:

Conclusion:

This method provides a highly suitable approach for investigating TCR specificities of antigen specific CD4+T cells under conditions of low cell yields. Building on this dataset will allow us to assess specific features of TCR usage of autoreactive T cells in RA.

PBMCs were cultured in presence of (a) influenza (HA, MP54) and (b) citrullinated tenascin peptides. The proportion of antigen specific CD4+T cells was assessed using HLA-class II tetramer staining. We observed an increase in frequency of (a) Infleunza specific cells (red dots in upper left and lower right quadrants) and (b) citrullinated tenascin C specific cells (red dots in lower right quadrant), at day 13 post culture as compared to day 3. (c) Sorting of citrullinated tenascin specific CD4+T cells, followed by PHA expansion resulted in visible increase in proportion of citrullinated tenascin specific CD4+T cells.

Disclosure of Interests:

Ravi kumar: None declared, Niyaz Yoosuf: None declared, Christina Gerstner: None declared, Sara Turcinov: None declared, Karine Chemin: None declared, Vivianne Malmström Grant/research support from: VM has had research grants from Janssen Pharmaceutica

Trans Fatty Acid Analysis of Frying Oil Using ATR-FTIR Spectroscopy: A Study on Indian Traditional Snack Foods

Background: Trans Fatty Acid (TFA) content in oil is an important quality parameter due to its adverse health effect. This study was aimed to examine the TFA content in the frying oil used by street food vendors in India for two traditional snack foods. Methods: Totally, 143 oil samples were collected at different frying times (0, 2, and 4 h) from five different vendors for Samosa and Jalebi. TFA levels of the oil samples were analyzed by Attenuated Total Reflection-Fourier Transform Infrared Spectroscopy (ATRFTIR). Statistical analyses were carried out using SPSS software version 23.0. Results: ATR-FTIR spectra exhibited an increase in peak intensity at 966 cm-1 with different frying time in both frying oil samples, indicating the formation of TFA. The TFA content in oils fried at 4 h was significantly higher than the ones at 0 and 2 intervals. It was found that 3 out of 74 (4%) Samosa fried oils and 12 out of 69 (17.4%) Jalebi fried oils were over the maximum allowed regulatory limit of TFA (5%). Jalebi fried oils had significantly higher TFA content than Samosa fried oils. Conclusion: The increase in frying time decreased the peroxide values and increased saturated fatty acids and TFA values of oils used for both food items. The local vendors and consumers should be educated by national authorities regarding health risk of TFA in street fried snacks.

0438 Automatic Nighttime Agitation and Sleep Disruption Detection Using a Wearable Ankle Device and Machine Learning

Introduction

Nighttime agitation behavior such as wandering and restlessness during awake and sleep in people with Alzheimer’s disease (AD) is expensive to manage and adversely affects sleep. Nighttime agitation is mostly noted by subjective caregiver reports. An automated process for this assessment would improve clinical management. Here we report on the RestEaZeTM system that uses an ankle band and machine learning to automatically classify sleep status and nighttime agitation behaviors in older adults with AD.

Methods

We collected data on 7 adults (mean: 81 years, SD: 10.6) with AD. They wore the RestEaZeTM ankle band with a 3-axis accelerometer, a 3-axis gyroscope, and three textile capacitive sensors. A trained Research Assistant (RA) continuously observed for wandering, restlessness, wake, and sleep between 5pm and 7am using the Cohen Mansfield Agitation Inventory (CMAI). We merged, and band-pass filtered the data and divided it into 10-second non-overlapping windows. CMAI labels and time-series features (scaled using StandardScaler) extracted from the RestEaZeTM data were used to train a Random Forest binary classifier. The significant features were extracted based on the impact on the p-value for the classifier. We used the Synthetic Minority Oversampling Technique (SMOTE) to balance the dataset and performed 5-fold cross-validation with a 67-33 train-test split.

Results

We report the sensitivity, specificity, accuracy, and Area-under-the Curve (AUC) for the ROC curve for the classifiers: (1) Sleep/Awake: sensitivity=0.95, specificity=0.87, accuracy=0.92, AUC=0.97; (2) Wandering/Non-Wandering: sensitivity=0.85, specificity=0.99, accuracy=0.98, AUC=0.99; and (3) Restless/Non-Restless: sensitivity=0.84, specificity=0.84, accuracy=0.84, AUC=0.92. The significant features were related to the intensity of movements.

Conclusion

Our preliminary results show the feasibility of using RestEaZeTM for quantitatively measuring nighttime agitation. These can provide clinically useful objective measures of agitation that can be automatically transmitted to clinical or research records with minimal staff time requirements.

Support

The authors acknowledge the funding support from the National Institute on Aging under award R01AG051588 and Arbor Pharmaceuticals for support for Horizant and the matching placebo.

Risk factors for the development of a second melanoma in patients with cutaneous melanoma

BACKGROUND

Cutaneous melanoma patients have an increased risk of developing other neoplasms, especially cutaneous neoplasms and other melanomas. Identifying factors associated with an increased risk might be useful in the development of melanoma guidelines.

OBJECTIVES

To identify risk factors related to the development of a second primary melanoma in a series of patients diagnosed with sporadic melanoma and to establish the estimated incidence rate.

METHODS

A longitudinal study based on prospective follow-up information of patients diagnosed with sporadic cutaneous melanoma at our centre from 2000 to 2015 was performed. Cumulative incidence was estimated based on competing risk models, and the association of characteristics with the risk of a second melanoma was performed by Cox proportional hazard models.

RESULTS

Out of 1447 patients included in the study, after a median follow-up of 61 months, 55 patients (3.8%) developed a second melanoma. Fair hair colour, more than 100 common melanocytic nevi and the presence of more than 50 cherry angiomas were independently associated with the development of a second melanoma. The site and the histological subtype of the first and second melanomas were not consistent. The second melanomas were thinner than the first ones.

CONCLUSIONS

Fair-haired and multiple-nevi patients might benefit from more intensive prevention measures. The finding of cherry angiomas as a risk factor suggests that these lesions could be markers of skin sun damage in the setting of certain degree of genetic susceptibility.

Obstacle-avoiding intelligent algorithm for quad wheel robot path navigation

Purpose

The purpose of this work is to propose quad wheel robot with path navigation using an intelligent novel algorithm named as obstacle-avoiding intelligent algorithm (OAIA).

Design/methodology/approach

The paper proposes OAIA algorithm, which is used to minimize the path distance and elapsed time between source and goal.

Findings

The hardware implementation of the Quad Wheel Robot design includes a global positioning system (GPS) module for path navigation. An ultrasonic module (HC SR04) is mainly used as the sensing unit for the system. In the proposed scheme, the GPS locator (L80) is used to obtain the current location of the robot, and the ultrasonic sensor is utilized to avoid the obstacles. An ARM processor serves as the heart of the Quad Wheel Robot.

Practical implications

This paper includes real-time implementation of quad wheel robot for various coordinate values, and the movement of the robot is captured and analysed.

Originality/value

The proposed OAIA is capable of estimating the mobile robot position exactly under ideal circumstances. Simulation and hardware implementation are carried out to evaluate the performance of the proposed system.

Split bolus dual-energy CT urography after urine dilution: a one-stop shop for detection and characterisation of urolithiasis

AIM

To determine the diagnostic performance of split-bolus dual-energy computed tomography (CT) urography (SBDECTU) in the detection and characterisation of urolithiasis.

MATERIALS AND METHODS

This single-centre Institute Ethics Committee (IEC)-approved prospective study was conducted from April 2014 to November 2015. One hundred and thirty consenting adults with microscopic haematuria underwent dual-energy true non-enhanced CT (DETNE) of the whole abdomen followed by a SBDECTU. The SBDECTU protocol consisted of synchronous nephrogram-urogram acquisition following urine dilution by oral hydration and normal saline injection. Calculi were detected and characterised using virtual non-enhanced (VNE) images derived from SBDECT were compared with DETNE (the reference standard). The subjective image quality and radiation dose were compared.

RESULTS

Twenty-six participants had one or more calculi (total 129 calculi) detected on DETNE CT. The sensitivity and specificity of VNE on a per-patient basis were 100%. Of the 129 calculi, 118 were detected on VNE, with a sensitivity of 91.47% and an accuracy of 91.47%. Of the calculi, 83.9% (99/118) could be characterised on SBDECTU images. On VNE images, complete iodine subtraction was seen in 73.1% (19/26). By omitting DETNE CT, the mean dose-length product of 537.6±152.9 mGy and volume CT dose index of 10.9±2.9 mGy•cm² could have been saved.

CONCLUSION

SBDECTU has high diagnostic accuracy in the detection and characterisation of clinically significant urinary calculi at potentially half the radiation dose.

Measurement of R(D) and R(D^{*}) with a Semileptonic Tagging Method

The experimental results on the ratios of branching fractions R(D)=B(B[over ¯]→Dτ^{-}ν[over ¯]_{τ})/B(B[over ¯]→Dℓ^{-}ν[over ¯]_{ℓ}) and R(D^{*})=B(B[over ¯]→D^{*}τ^{-}ν[over ¯]_{τ})/B(B[over ¯]→D^{*}ℓ^{-}ν[over ¯]_{ℓ}), where ℓ denotes an electron or a muon, show a long-standing discrepancy with the standard model predictions, and might hint at a violation of lepton flavor universality. We report a new simultaneous measurement of R(D) and R(D^{*}), based on a data sample containing 772×10^{6}  BB[over ¯] events recorded at the ϒ(4S) resonance with the Belle detector at the KEKB e^{+}e^{-} collider. In this analysis the tag-side B meson is reconstructed in a semileptonic decay mode and the signal-side τ is reconstructed in a purely leptonic decay. The measured values are R(D)=0.307±0.037±0.016 and R(D^{*})=0.283±0.018±0.014, where the first uncertainties are statistical and the second are systematic. These results are in agreement with the standard model predictions within 0.2, 1.1, and 0.8 standard deviations for R(D), R(D^{*}), and their combination, respectively. This work constitutes the most precise measurements of R(D) and R(D^{*}) performed to date as well as the first result for R(D) based on a semileptonic tagging method.

Search for an Invisibly Decaying Z^{'} Boson at Belle II in e^{+}e^{-}→μ^{+}μ^{-}(e^{±}μ^{∓}) Plus Missing Energy Final States

Theories beyond the standard model often predict the existence of an additional neutral boson, the Z^{'}. Using data collected by the Belle II experiment during 2018 at the SuperKEKB collider, we perform the first searches for the invisible decay of a Z^{'} in the process e^{+}e^{-}→μ^{+}μ^{-}Z^{'} and of a lepton-flavor-violating Z^{'} in e^{+}e^{-}→e^{±}μ^{∓}Z^{'}. We do not find any excess of events and set 90% credibility level upper limits on the cross sections of these processes. We translate the former, in the framework of an L_{μ}-L_{τ} theory, into upper limits on the Z^{'} coupling constant at the level of 5×10^{-2}-1 for M_{Z^{'}}≤6  GeV/c^{2}.

Efficacy of influenza vaccine (Fluvax) in cancer patients on treatment: a prospective single arm, open-label study

PURPOSE

Influenza virus infection has significant morbidity and mortality in patients with medical co-morbidities who are also immunosuppressed. The efficacy of the seasonal influenza vaccine has not been well studied in patients receiving chemotherapy. We assessed the efficacy of seasonal influenza vaccine in patients with non-haematological malignancy on active treatment (chemotherapy and targeted therapy).

METHODS

A prospective single arm, open label study with 53 patients with non-haematological cancers recruited during the 2011 and 2012 influenza seasons. Participants had one dose of 2011/2012 trivalent vaccine containing strains A/California/7/2009(H1N1), A/Perth/16/2009 (H3N2) and B/Brisbane/60/2008 (Fluvax) prior to or in-between treatment cycles. Haemagglutination inhibition antibody (HIA) titres in serum were measured at baseline 3, 6 and 24 weeks. Primary endpoint: seroconversion rate (SCR) at 3 weeks. Secondary endpoints: late SCR at 6 weeks. rate of sustained sero-protection titres (SPR) at 24 weeks. Seroconversion was defined as postvaccination ≥ 4-fold increase in HIA titre and sero-protection defined as a HIA ≥ 1:40.

RESULTS

The SCR at 3 weeks were 35%, 30% and 22.5% to the H1N1, H3N2 and B/Bris strains, respectively. There were no new cases of late SC at 6 weeks or 24 weeks. The SPR at 3 weeks were 72.5%, 65% and 40%, respectively, to H1N1, H3N2 and B/Bris. The SPR at 24 weeks to H1N1, H3N2 and B/Bris were 40%, 52.5% and 17.5%, respectively.

CONCLUSIONS

Patients on various solid tumour treatments achieve sero-protection rate congruent with the general population. The sero-protection HIA titres were not sustained at 24 weeks postvaccination.

Carotid artery ultrasound image analysis: A review of the literature

Stroke is one of the prominent causes of death in the recent days. The existence of susceptible plaque in the carotid artery can be used in ascertaining the possibilities of cardiovascular diseases and long-term disabilities. The imaging modality used for early screening of the disease is B-mode ultrasound image of the person in the artery area. The objective of this article is to give a widespread review of the imaging modes and methods used for studying the carotid artery for identifying stroke, atherosclerosis and related cardiovascular diseases. We encompass the review in methods used for artery wall tracking, intima-media, and lumen segmentation which will help in finding the extent of the disease. Due to the characteristics of the imaging modality used, the images have speckle noise which worsens the image quality. Adaptive homomorphic filtering with wavelet and contourlet transforms, Levy Shrink, gamma distribution were used for image denoising. Learning-based neural network approaches for denoising give better edge preservation. Domain knowledge-based segmentation approaches have proved to provide more accurate intima-media thickness measurements. There is a requirement of useful fully automatic segmentation approaches, 3D, 4D systems, and plaque motion analysis. Taking into consideration the image priors like geometry, imaging physics, intensity and temporal data, image analysis has to be performed. Encouragingly more research has focused on content-specific segmentation and classification techniques. With the evaluation of machine learning algorithms, classifying the image as with or without a fat deposit has gained better accuracy and sensitivity. Machine learning-based approaches like self-organizing map, k-nearest neighborhood and support vector machine achieve promising accuracy and sensitivity in classification. The literature reveals that there is more scope in identifying a patient-specific model in a fully automatic manner.

Genome sequence and description of Blautia brookingsii SG772 sp. nov., a novel bacterial species isolated from human faeces

An anaerobic isolate SG772 belonging to the genus Blautia was isolated from a healthy human faecal sample. When compared using 16s rRNA sequence identity, SG772 showed only 94.46% similarity with its neighbour species Blautia stercoris. As strain SG772 showed both phenotypic and genomic differences from other members of the type species within the genus Blautia, we propose the designation of SG772 as novel species 'Blautia brookingsii SG772^T'.

Turbulence in the Local Interstellar Medium and the IBEX Ribbon

The effects of turbulence in the very local interstellar medium (VLISM) have been proposed by Giacalone & Jokipii (2015) to be important in determining the structure of the Interstellar Boundary Explorer (IBEX) ribbon via particle trapping by magnetic mirroring. We further explore this effect by simulating the motion of charged particles in a turbulent magnetic field superposed on a large-scale mean field, which we consider to be either spatially-uniform or a draped field derived from a 3D MHD simulation. We find that the ribbon is not double-peaked, in contrast to Giacalone & Jokipii (2015). However, the magnetic mirror force still plays an important role in trapping particles. Furthermore, the ribbon's thickness is considerably larger if the large-scale mean field is draped around the heliosphere. Voyager 1 observations in the VLISM show a turbulent field component that is stronger than previously thought, which we test in our simulation. We find that the inclusion of turbulent fluctuations at scales ≳100 au and power consistent with Voyager 1 observations produces a ribbon whose large-scale structure is inconsistent with IBEX observations. However, restricting fluctuations to <100 au produces a smoother ribbon structure similar to IBEX observations. Different turbulence realizations produce different small-scale features (≲10°) in the ribbon, but its large-scale structure is robust if the maximum fluctuation size is ≲50 au. This suggests that the magnetic field structure at scales ≲50 au is determined by the heliosphere-VLISM interaction and cannot entirely be represented by pristine interstellar turbulence.

Prospects for observing and localizing gravitational-wave transients with Advanced LIGO, Advanced Virgo and KAGRA

We present our current best estimate of the plausible observing scenarios for the Advanced LIGO, Advanced Virgo and KAGRA gravitational-wave detectors over the next several years, with the intention of providing information to facilitate planning for multi-messenger astronomy with gravitational waves. We estimate the sensitivity of the network to transient gravitational-wave signals for the third (O3), fourth (O4) and fifth observing (O5) runs, including the planned upgrades of the Advanced LIGO and Advanced Virgo detectors. We study the capability of the network to determine the sky location of the source for gravitational-wave signals from the inspiral of binary systems of compact objects, that is binary neutron star, neutron star-black hole, and binary black hole systems. The ability to localize the sources is given as a sky-area probability, luminosity distance, and comoving volume. The median sky localization area (90% credible region) is expected to be a few hundreds of square degrees for all types of binary systems during O3 with the Advanced LIGO and Virgo (HLV) network. The median sky localization area will improve to a few tens of square degrees during O4 with the Advanced LIGO, Virgo, and KAGRA (HLVK) network. During O3, the median localization volume (90% credible region) is expected to be on the order of 10 5 , 10 6 , 10 7 Mpc 3 for binary neutron star, neutron star-black hole, and binary black hole systems, respectively. The localization volume in O4 is expected to be about a factor two smaller than in O3. We predict a detection count of 1 - 1 + 12 ( 10 - 10 + 52 ) for binary neutron star mergers, of 0 - 0 + 19 ( 1 - 1 + 91 ) for neutron star-black hole mergers, and 17 - 11 + 22 ( 79 - 44 + 89 ) for binary black hole mergers in a one-calendar-year observing run of the HLV network during O3 (HLVK network during O4). We evaluate sensitivity and localization expectations for unmodeled signal searches, including the search for intermediate mass black hole binary mergers.

A prospective randomized controlled trial comparing conventional Intuitive® procedure card recommended port placement with the modified Indian (Manipal) technique

Introduction

The da Vinci^® X hybrid systems (Intuitive Surgical^®, Sunnyvale CA) provides standard sites recommendations for port placement during robotic surgery; including that for colorectal procedures. The author's encountered challenges while adhering to the provided instructions, such as clash of instruments and arms and need for additional ports, and hence to overcome these challenges attempted a few innovative technical modifications. The surgical results as well as merits of the revised Indian (Manipal) port placement with single docking technique are presented here.

Methods

Twenty patients underwent robotic rectal resection at the Department of Surgical Oncology and Robotic Surgery, Manipal Comprehensive Cancer Centre, Bengaluru, India, between December 2017 and June 2018. A randomised controlled study was conducted to compare the two techniques. Ten patients were operated using hybrid da Vinci^® 'X' system using the manufacturer's recommendations and 10 by the modified Indian (Manipal) port placement with a single docking technique.

Result and Conclusions

The Indian (Manipal) modifications of port placements are optimal for colorectal procedures such as low anterior resection as well as for ultralow anterior resections. The intraoperative parameters compared between the recommendations of the Intuitive^® (da Vinci^® systems) and attempted modifications demonstrated statistically significant advantages with the use of the revised techniques. The improvements offered by this modification include no additional requirements of ports or staplers, lesser clash amongst instruments as well as arms, better mobilisation of splenic flexure amongst others.

Development of a biomarker of efficacy in second-line treatment for lymphangioma of the tongue: a pilot study

Lymphangioma of the tongue is a rare lymphatic malformation, and various authors have reported the successful use of sirolimus for its treatment. However, the safety of sirolimus in children needs further evaluation so that those who do not respond are not necessarily exposed to its potential adverse effects. We hypothesised that assessment of lymphangiogenesis can be used to predict whether the patient will respond to sirolimus, so we organised a prospective study after ethics committee approval had been given. After clinical and histological diagnoses of lymphangioma of the tongue had been confirmed, 16 patients were given sirolimus 0.8mg/day in three divided doses. Clinical response was assessed and compared with lymphatic microvessel density (LMVD), which was calculated immunohistochemically using the monoclonal antibody D2-40 as the lymphatic endothelial marker. Nine patients responded well, five partially, and two failed to respond. Mean (SD) LVD among the good responders was 21.00 (3.74), whereas among non-responders it was 8.00 (4.24). There was a significant difference in mean LVD between good responders, partial responders, and non-responders (p=0.04). Sirolimus is effective in treating children with lymphangioma of the tongue, and lymphangiogenesis is a useful therapeutic predictive marker.

Positron emission tomography/computed tomography guided percutaneous biopsies of Ga-68 avid lesions using an automated robotic arm

PURPOSE

The purpose of this prospective study was to evaluate the feasibility of positron emission tomography/computed tomography (PET/CT)-guided biopsy of Ga-68 avid lesions using an automated robotic arm and determine the diagnostic yield of this technique.

MATERIAL AND METHODS

Patients who underwent Ga-68 labelled tracers imaging followed by PET/CT-guided biopsies of tracer-avid lesions were prospectively included. Biopsies were performed using a dedicated automated-robotic-arm assisted PET/CT-guided biopsy device on the same-day of diagnostic PET/CT-imaging. The tissue samples were retrieved after confirming the position of needle-tip in the target lesion. Procedure-related complications and radiation exposure of the interventionist were recorded. Histopathological reports were reviewed for diagnostic yield.

RESULTS

A total of 25 patients (19 men, six women) with a mean age of 50.8±17.3 (SD) years (range: 17-83 years) were included. The biopsies were performed after PET/CT using Ga-68 DOTANOC (n=16) or Ga-68 PSMA (n=8) and Ga-68 chemokine-analogue (n=1). The biopsy samples were obtained from the liver (n=9), bone (n=8), lymph-nodes (n=3), lung (n=1), pancreas (n=1), anterior mediastinal lesion (n=1), peritoneal-deposit (n=1) and thigh-lesion (n=1). No immediate or delayed procedure-related complications were documented in any patient. PET/CT-guided molecular sampling was technically successful in all the patients. Histopathology revealed malignancies in all the biopsied specimens without the need for repeat sampling or further invasive-diagnostic workup, with a diagnostic yield of 100%. The estimated absorbed-radiation dose was 566.7μSv/year for the interventionist.

CONCLUSION

PET/CT-guided molecular biopsy using Ga-68 labelled radiotracers is feasible and can be performed safely and accurately with a high-diagnostic yield. It is helpful in accurately staging the disease when tracer-avid isolated distant lesion evident on imaging and highly practical in patients with previous inconclusive sampling.

Carbapenemase and ESBL genes with class 1 integron among fermenting and nonfermenting bacteria isolated from water sources from India

The present study was aimed to detect the carbapenemase, extended-spectrum β-lactamase (ESBL), and intI1 gene of class 1 integron among fermenting (n = 61) and nonfermenting (n = 10) bacterial isolates recovered from water samples (n = 128). Isolates were identified by 16S rRNA sequencing. These isolates showed reduced-susceptibility to third-generation cephalosporins and carbapenems. The isolates varied in number and size of plasmids (2 kb to >20 kb). Plasmid DNA screening showed 5·6, 7, 11·2 and 26·7% prevalence of bla_KPC , bla_NDM , bla_SHV and bla_TEM genes respectively. Diverse bla_NDM (bla_NDM-1 and bla_NDM-4 ) and bla_SHV subtypes (bla_SHV-2 and bla_SHV-11 ) were recorded, unlike the single allelic bla_KPC (bla_KPC-2 ) and bla_TEM (bla_TEM-1 ) gene. Of the total 27 bla-gene-producing bacterial isolates, seven isolates co-harboured the carbapenemase genes (bla_NDM or bla_KPC or the both) along with the ESBL genes (bla_SHV or bla_TEM ). The intI1 gene of class 1 integron was detected among 12 (44·4%) of ESBL- and/or carbapenemase-harbouring isolates. Gene transferability was seen among four of the 10 Enterobacteriaceae donors. Carbapenemases and ESBLs with class 1 integron among aquatic environmental isolates raise the serious issue of the biosecurity and health of the ecosystem. SIGNIFICANCE AND IMPACT OF THE STUDY: Anthropologically affected and polluted environment harbours the resistance threats, where a diverse bacterial species maintain, develop and exchange genetic determinants that constitute a risk to human and ecological health. The antimicrobial resistance (AMR) in Enterobacteriaceae and non-Enterobacteriaceae bacteria caused the failure of the therapy of last resort (carbapenems) and thus lead to life-threatening infections affecting public health. Surveillance and monitoring of AMR could be important for epidemiological, diagnostic testing and control of pathogens. This is a point-prevalence study reporting the comparative occurrence and co-occurrence of carbapenemase and extended-spectrum β-lactamase genes among fermenting and nonfermenting bacteria isolated from the aquatic environment in India.

Hypereosinophilia: A rare presentation of acute lymphoblastic leukaemia

Acute lymphoblastic leukaemia (ALL) presenting as peripheral blood hypereosinophilia is very rare and the incidence is <1%. The characteristic feature of patients with ALL and hypereosinophilia is the absence of blasts in peripheral blood, and this might lead to misdiagnosis of ALL. It is important for clinicians and pathologists to be aware of this uncommon initial presentation of ALL to avoid delay in diagnosis. We report a 37-year-old man who presented with fever and respiratory symptoms and was found to have hypereosinophilia in peripheral blood. His bone marrow and lymph node biopsies were diagnostic of ALL.

P2257Self-care abilities and depression symptoms linked to brain injury in heart failure

Methods

Two high-resolution T1-weighted data were collected from each 42 HF subjects (age, 55.65±7.61; 30 male; LVEF 27.74±9.40%; NYHA class II/III) using a 3.0-Tesla MRI scanner. Depression, anxiety, sleep quality, daytime sleepiness, cognition, and self-care issues were examined with Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Montreal Cognitive Assessment (MoCA), and Self-Care of Heart Failure Inventory (SCHFI) respectively. Both T1-weighted scans were realigned, averaged, and segmented into gray matter (GM), white matter, and cerebrospinal fluid tissue type. GM maps were normalized (unmodulated) to a common space and smoothed to obtain GM density maps. The smoothed GM density maps were used to examine the association of brain damage with disease symptoms (SPM 12; partial correlation; covariates, age and gender; p<0.005). Region of interest analyses were performed in prefrontal cortices, insular lobe and hippocampus to evaluate the correlation using partial correlation (SPSS, covariates, age and gender, p<0.05).

Results

The average scores for BAI 9.55±9.90, BDI 8.69±7.05, ESS 7.00±3.72, MoCA 24.64±3.48, PSQI 6.62±3.90, maintenance 73.12±13.78, management 70.28±13.98, and confidence 73.77±15.96 were calculated. Significant negative correlations was observed between GM density values and BAI (prefrontal cortices, r=−0.532, p<0.001), BDI (prefrontal cortices, r=−0.60, p<0.001; insula, r=−0.528, p<0.001, hippocampus, r=−0.432, p<0.005), ESS (prefrontal cortices, r=−0.419, p=0.007; insula, r=−0.443, p=0.004), and PSQI (prefrontal cortices, r=−0.517, p=0.001) scores, and positive correlation between GM density values, MoCA (prefrontal cortices, r=0.462, p=0.003) and SCHFI scores (maintenance: prefrontal cortices, r=0.422, p=0.007; insula, r=0.412, p=0.009, hippocampus, r=0.455, p=0.004; management: prefrontal cortices, r=0.728, p=0.001; insula, r=0.707, p=0.001, hippocampus, r=0.775, p<0.001) (Figure 1).

Figure 1

Conclusions

HF subjects show more wide-spread and significant correlations between regional GM density values and BDI as well as SCHFI management scores compared to the other disease symptom measures. The findings suggest that damage in mood, autonomic, and cognitive functions sites better correlate with BDI and SCHFI over other measures.

Acknowledgement/Funding

NIH/NINR 1R01 NR014669

P2656Real-world Outcomes for STEMI in octogenarians and nonagenarians: A 5-year review from an Irish primary PCI centre

Background

Progress made by modern healthcare has led to improved life expectancy across the globe. This progress, however, also means that individuals are living with more chronic illnesses and co-morbidities than in previous generations. Due to this aging population, we can expect increasing rates of STEMI in octogenarians and nonagenarians in the future. The challenge of older patients with STEMI is that they are particularly high-risk for complications. At present, very little is known about the outcomes of STEMI in the very old population because they were under-represented in previous studies. Many cardiologists around the world have been hesitant in performing primary percutaneous coronary intervention (PPCI) in octogenarians and nonagenarians due to fear of complications and poor outcomes.

Purpose

To review the trend of octogenarians and nonagenarians presenting with STEMI and to assess the 30-day and 1-year mortality rates.

Methods

A single-centre retrospective observational study was conducted. All patients presenting with STEMI between January 2012 and December 2017 were reviewed. Individuals aged 80 years or older were included for the purpose of this analysis. Patient level data was collected by chart review and individuals were identified using the local STEMI database. Standard Bayesian statistics were employed for analysis.

Results

1,268 patients presented with STEMI during this period. 172 (13.6%) were 80 years or older. Of this subgroup, 159/172 (92.4%) were true STEMI (figure 1). 124/159 (77.9%) patients were brought to the catheterization lab and 35/159 (22%) were managed medically on the ward.107/159 (67.29%) were treated with PPCI. Patients in the PPCI group had a 30-day mortality rate of 20.6% while those in the medically managed group had a mortality rate of 37.1%; with a trend towards statistical significance (p=0.07). The one-year mortality rate in patients treated with PPCI was 22.4% which was significantly lower than those who received medical management 48.6% (p=0.005).

Conclusions

This review demonstrates that there is a high mortality rate with STEMI in those aged 80 years or above, however, patients who are treated with PPCI tend to do better and have a significantly lower mortality rate at 1-year. The incidence of STEMI in the very old cohort is likely to continue to rise and this may prove challenging. PPCI remains the most feasible treatment approach towards STEMI and this should not be biased based on age, however, interventionists will need to take into account patient suitability on a case-by case basis. Octogenarians who undergo angiography and PPCI as required have 77.6% survival at 1 year (figure 1) with 92.4% likelihood of going home and don't require long term nursing home care.

Acknowledgement/Funding

University Hospital Limerick