Association between osteoarthritis-related serum biochemical markers over 11 years and knee MRI-based imaging biomarkers in middle-aged adults

OBJECTIVE

To describe the associations between osteoarthritis (OA)-related biochemical markers (COMP, MMP-3, HA) and MRI-based imaging biomarkers in middle-aged adults over 10-13 years.

METHODS

Blood serum samples collected during the Childhood Determinants of Adult Health (CDAH)-1 study (year:2004-06; n = 156) and 10-13 year follow-up at CDAH-3 (n = 167) were analysed for COMP, MMP-3, and HA using non-isotopic ELISA. Knee MRI scans obtained during the CDAH-knee study (year:2008-10; n = 313) were assessed for cartilage volume and thickness, subchondral bone area, cartilage defects, and BML.

RESULTS

In a multivariable linear regression model describing the association of baseline biochemical markers with MRI-markers (assessed after 4-years), we found a significant negative association of standardised COMP with medial femorotibial compartment cartilage thickness (β:-0.070; 95%CI:-0.138,-0.001), and standardised MMP-3 with patellar cartilage volume (β:-141.548; 95%CI:-254.917,-28.179) and total bone area (β:-0.729; 95%CI:-1.340,-0.118). In multivariable Tobit regression model, there was a significant association of MRI-markers with biochemical markers (assessed after 6-9 years); a significant negative association of patellar cartilage volume (β:-0.001; 95%CI:-0.002,-0.00004), and total bone area (β:-0.158; 95%CI-0.307,-0.010) with MMP-3, and total cartilage volume (β:-0.001; 95%CI:-0.001,-0.0001) and total bone area (β:-0.373; 95%CI:-0.636,-0.111) with COMP. No significant associations were observed between MRI-based imaging biomarkers and HA.

CONCLUSION

COMP and MMP-3 levels were negatively associated with knee cartilage thickness and volume assessed 4-years later, respectively. Knee cartilage volume and bone area were negatively associated with COMP and MMP-3 levels assessed 6-9 years later. These results suggest that OA-related biochemical markers and MRI-markers are interrelated in early OA.

Evaluation of dentinal crack propagation, amount of gutta percha remaining and time required during removal of gutta percha using two different rotary instruments and hand instruments - An In vitro study

Background

One of the most important goal of non surgical endodontic retreatment is the successful removal of gutta percha and sealers from the root canal system. A variety of techniques have been recommended for retreatment procedures for the removal of gutta-percha and sealers with or without the help of adjunctive chemical solvents, by using stainless steel hand files or nickel-titanium rotary files, gate glidden burs, heated instruments, ultrasonic instruments, and lasers 1,3. The current advancements in the design of NiTi instruments have proved efficacious in the removal of filling materials from the root canal wall and various studies have also confirmed their cleaning ability and efficacy 4,5. Nevertheless, the use of rotary instrumentation can lead to the formation of dentinal cracks in the root canal dentin. Many researchers have reported the incidence of crack formation and propagation after the procedure with manual, rotary and reciprocating instruments. The behavior of rotary instruments in the generation of defects have been the point of greatest interest during many years 6. These dentinal cracks can be defined as defects with a complete crack line extending from inner root canal space up to the outer surface of the root when the tensile stress in the root canal wall exceeds the tensile stress of dentin 7.

Aim

This study was conducted to investigate and to compare the amount of dentinal microcracks formation with various new instrumentation methods and conventional hand filing method. It also looks into amount of gutta-percha removed after retreatment from the canal and the time required for all the instrumentation technique.

Methodology

Sixty extracted human maxillary first molars with curved roots were mounted on addition silicone impression material incorporated in an aluminium hollow block, then instrumented using step-back preparation with 35 size K files. Obturation was done using gutta-percha with AH plus sealer. These were stored for 14 days and divided into three groups Mani GPR, Endostar Re Endo and H file and were subjected to retreatment procedures. Retreatment was considered complete when no filling material was observed on the canal wall and the canal was smooth and free of visible debris. The samples were examined under scanning electron microscope and the number of cracks were calculated. The percentage of root canal filling material and time taken was recorded.

Statistical Analysis

The data obtained were analyzed by using descriptive statistics, ANOVA (Analysis of Variance), chi-square test and Scheffe's post hoc test through SPSS for window (version 22.0).

Result

All the techniques showed similar amount of crack propagation, with no statistical difference between the group. Retreatment done using H Files required more time and removed less material. The coronal third showed less amount of gutta-percha remnants than the apical third in all groups.

Conclusion

All the groups showed a similar amount of crack propagation. Less number of cracks were observed in the coronal one third and more amount of cracks were found at the apical third. Endostar RE Endo rotary instrument proved to be most effective and least time-consuming. Hedstrom Files required more time and removed less material.

Textbook outcome following oesophagectomy for cancer: international cohort study

Background

Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.

Methods

Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).

Results

Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter ‘no major postoperative complication’ had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome.

Conclusion

Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.

Textbook outcome following oesophagectomy for cancer: international cohort study

BACKGROUND

Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.

METHODS

Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).

RESULTS

Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter 'no major postoperative complication' had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome.

CONCLUSION

Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.

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Sakulin H, Salfeld-Nebgen J, Scarfi S, Schäfer C, Schwick C, Selvaggi M, Sharma A, Silva P, Snoeys W, Sphicas P, Summers S, Tavolaro VR, Treille D, Tsirou A, Van Onsem GP, Vartak A, Verzetti M, Wozniak KA, Zeuner WD, Caminada L, Erdmann W, Horisberger R, Ingram Q, Kaestli HC, Kotlinski D, Langenegger U, Rohe T, Backhaus M, Berger P, Calandri A, Chernyavskaya N, De Cosa A, Dissertori G, Dittmar M, Donegà M, Dorfer C, Gadek T, Espinosa TAG, Grab C, Hits D, Lustermann W, Lyon AM, Manzoni RA, Meinhard MT, Micheli F, Nessi-Tedaldi F, Pauss F, Perovic V, Perrin G, Pigazzini S, Ratti MG, Reichmann M, Reissel C, Reitenspiess T, Ristic B, Ruini D, Becerra DAS, Schönenberger M, Stampf V, Steggemann J, Olsson MLV, Wallny R, Zhu DH, Amsler C, Botta C, Brzhechko D, Canelli MF, Burgo RD, Heikkilä JK, Huwiler M, Jofrehei A, Kilminster B, Leontsinis S, Macchiolo A, Meiring P, Mikuni VM, Molinatti U, Neutelings I, Rauco G, Reimers A, Robmann P, Schweiger K, Takahashi Y, Adloff C, Kuo CM, Lin W, Roy A, Sarkar T, Yu SS, Ceard L, Chang P, Chao Y, Chen KF, Chen PH, Hou WS, Li YY, Lu RS, Paganis E, Psallidas A, Steen A, Yazgan E, Asavapibhop B, Asawatangtrakuldee C, Srimanobhas N, Boran F, Damarseckin S, Demiroglu ZS, Dolek F, Dozen C, Dumanoglu I, Eskut E, Gokbulut G, Guler Y, Guler EG, Hos I, Isik C, Kangal EE, Kara O, Topaksu AK, Kiminsu U, Onengut G, Ozdemir K, Polatoz A, Simsek AE, Tali B, Tok UG, Turkcapar S, Zorbakir IS, Zorbilmez C, Isildak B, Karapinar G, Ocalan K, Yalvac M, Atakisi IO, Gülmez E, Kaya M, Kaya O, Özçelik Ö, Tekten S, Yetkin EA, Cakir A, Cankocak K, Komurcu Y, Sen S, Sen FA, Cerci S, Kaynak B, Ozkorucuklu S, Cerci DS, Grynyov B, Levchuk L, Bhal E, Bologna S, Brooke JJ, Clement E, Cussans D, Flacher H, Goldstein J, Heath GP, Heath HF, Kreczko L, Krikler B, Paramesvaran S, Sakuma T, Nasr-Storey SSE, Smith VJ, Stylianou N, Taylor J, Titterton A, Bell KW, Belyaev A, Brew C, Brown RM, Cockerill DJA, Ellis KV, Harder K, Harper S, Linacre J, Manolopoulos K, Newbold DM, Olaiya E, Petyt D, Reis T, Schuh T, Shepherd-Themistocleous CH, Thea A, Tomalin IR, Williams T, Bainbridge R, Bloch P, Bonomally S, Borg J, Breeze S, Buchmuller O, Bundock A, Cepaitis V, Chahal GS, Colling D, Dauncey P, Davies G, Negra MD, Fedi G, Hall G, Iles G, Langford J, Lyons L, Magnan AM, Malik S, Martelli A, Milosevic V, Nash J, Palladino V, Pesaresi M, Raymond DM, Richards A, Rose A, Scott E, Seez C, Shtipliyski A, Stoye M, Tapper A, Uchida K, Virdee T, Wardle N, Webb SN, Winterbottom D, Zecchinelli AG, Cole JE, Hobson PR, Khan A, Kyberd P, Mackay CK, Reid ID, Teodorescu L, Zahid S, Abdullin S, Brinkerhoff A, Call K, Caraway B, Dittmann J, Hatakeyama K, Kanuganti AR, Madrid C, McMaster B, Pastika N, Sawant S, Smith C, Wilson J, Bartek R, Dominguez A, Uniyal R, Hernandez AMV, Buccilli A, Charaf O, Cooper SI, Gleyzer SV, Henderson C, Rumerio P, West C, Akpinar A, Albert A, Arcaro D, Cosby C, Demiragli Z, Gastler D, Rohlf J, Salyer K, Sperka D, Spitzbart D, Suarez I, Yuan S, Zou D, Benelli G, Burkle B, Coubez X, Cutts D, Duh YT, Hadley M, Heintz U, Hogan JM, Kwok KHM, Laird E, Landsberg G, Lau KT, Lee J, Narain M, Sagir S, Syarif R, Usai E, Wong WY, Yu D, Zhang W, Band R, Brainerd C, Breedon R, De La BarcaSanchez MC, Chertok M, Conway J, Conway R, Cox PT, Erbacher R, Flores C, Funk G, Jensen F, Ko W, Kukral O, Lander R, Mulhearn M, Pellett D, Pilot J, Shi M, Taylor D, Tos K, Tripathi M, Yao Y, Zhang F, Bachtis M, Cousins R, Dasgupta A, Hamilton D, Hauser J, Ignatenko M, Lam T, Mccoll N, Nash WA, Regnard S, Saltzberg D, Schnaible C, Stone B, Valuev V, Burt K, Chen Y, Clare R, Gary JW, Hanson G, Karapostoli G, Long OR, Manganelli N, Negrete MO, Paneva MI, Si W, Wimpenny S, Zhang Y, Branson JG, Chang P, Cittolin S, Cooperstein S, Deelen N, Duarte J, Gerosa R, Gilbert D, Krutelyov V, Letts J, Masciovecchio M, May S, Padhi S, Pieri M, Sharma V, Tadel M, Würthwein F, Yagil A, Amin N, Campagnari C, Citron M, Dorsett A, Dutta V, Incandela J, Marsh B, Mei H, Ovcharova A, Qu H, Quinnan M, Richman J, Sarica U, Stuart D, Wang S, Bornheim A, Cerri O, Dutta I, Lawhorn JM, Lu N, Mao J, Newman H, Ngadiuba J, Nguyen TQ, Pata J, Spiropulu M, Vlimant JR, Wang C, Xie S, Zhang Z, Zhu RY, Alison J, Andrews MB, Ferguson T, Mudholkar T, Paulini M, Sun M, Vorobiev I, Cumalat JP, Ford WT, MacDonald E, Mulholland T, Patel R, Perloff A, Stenson K, Ulmer KA, Wagner SR, Alexander J, Cheng Y, Chu J, Cranshaw DJ, Datta A, Frankenthal A, Mcdermott K, Monroy J, Patterson JR, Quach D, Ryd A, Sun W, Tan SM, Tao Z, Thom J, Wittich P, Zientek M, Albrow M, Alyari M, Apollinari G, Apresyan A, Apyan A, Banerjee S, Bauerdick LAT, Beretvas A, Berry D, Berryhill J, Bhat PC, Burkett K, Butler JN, Canepa A, Cerati GB, Cheung HWK, Chlebana F, Cremonesi M, Elvira VD, Freeman J, Gecse Z, Gottschalk E, Gray L, Green D, Grünendahl S, Gutsche O, Harris RM, Hasegawa S, Heller R, Herwig TC, Hirschauer J, Jayatilaka B, Jindariani S, Johnson M, Joshi U, Klabbers P, Klijnsma T, Klima B, Kortelainen MJ, Lammel S, Lincoln D, Lipton R, Liu M, Liu T, Lykken J, Maeshima K, Mason D, McBride P, Merkel P, Mrenna S, Nahn S, O’Dell V, Papadimitriou V, Pedro K, Pena C, Prokofyev O, Ravera F, Hall AR, Ristori L, Schneider B, Sexton-Kennedy E, Smith N, Soha A, Spalding WJ, Spiegel L, Stoynev S, Strait J, Taylor L, Tkaczyk S, Tran NV, Uplegger L, Vaandering EW, Weber HA, Woodard A, Acosta D, Avery P, Bourilkov D, Cadamuro L, Cherepanov V, Errico F, Field RD, Guerrero D, Joshi BM, Kim M, Konigsberg J, Korytov A, Lo KH, Matchev K, Menendez N, Mitselmakher G, Rosenzweig D, Shi K, Sturdy J, Wang J, Wang S, Zuo X, Adams T, Askew A, Diaz D, Habibullah R, Hagopian S, Hagopian V, Johnson KF, Khurana R, Kolberg T, Martinez G, Prosper H, Schiber C, Yohay R, Zhang J, Baarmand MM, Butalla S, Elkafrawy T, Hohlmann M, Noonan D, Rahmani M, Saunders M, Yumiceva F, Adams MR, Apanasevich L, Gonzalez HB, Cavanaugh R, Chen X, Dittmer S, Evdokimov O, Gerber CE, Hangal DA, Hofman DJ, Mills C, Oh G, Roy T, Tonjes MB, Varelas N, Viinikainen J, Wang X, Wu Z, Ye Z, Alhusseini M, Dilsiz K, Durgut S, Gandrajula RP, Haytmyradov M, Khristenko V, Köseyan OK, Merlo JP, Mestvirishvili A, Moeller A, Nachtman J, Ogul H, Onel Y, Ozok F, Penzo A, Snyder C, Tiras E, Wetzel J, Amram O, Blumenfeld B, Corcodilos L, Eminizer M, Gritsan AV, Kyriacou S, Maksimovic P, Mantilla C, Roskes J, Swartz M, Vámi TÁ, Barrera CB, Baringer P, Bean A, Bylinkin A, Isidori T, Khalil S, King J, Krintiras G, Kropivnitskaya A, Lindsey C, Minafra N, Murray M, Rogan C, Royon C, Sanders S, Schmitz E, Takaki JDT, Wang Q, Williams J, Wilson G, Duric S, Ivanov A, Kaadze K, Kim D, Maravin Y, Mitchell T, Modak A, Mohammadi A, Rebassoo F, Wright D, Adams E, Baden A, Baron O, Belloni A, Eno SC, Feng Y, Hadley NJ, Jabeen S, Jeng GY, Kellogg RG, Koeth T, Mignerey AC, Nabili S, Seidel M, Skuja A, Tonwar SC, Wang L, Wong K, Abercrombie D, Allen B, Bi R, Brandt S, Busza W, Cali IA, Chen Y, D’Alfonso M, Ceballos GG, Goncharov M, Harris P, Hsu D, Hu M, Klute M, Kovalskyi D, Krupa J, Lee YJ, Luckey PD, Maier B, Marini AC, Mcginn C, Mironov C, Narayanan S, Niu X, Paus C, Rankin D, Roland C, Roland G, Shi Z, Stephans GSF, Sumorok K, Tatar K, Velicanu D, Wang J, Wang TW, Wang Z, Wyslouch B, Chatterjee RM, Evans A, Hansen P, Hiltbrand J, Jain S, Krohn M, Kubota Y, Lesko Z, Mans J, Revering M, Rusack R, Saradhy R, Schroeder N, Strobbe N, Wadud MA, Acosta JG, Oliveros S, Bloom K, Chauhan S, Claes DR, Fangmeier C, Finco L, Golf F, Fernández JRG, Kravchenko I, Siado JE, Snow GR, Tabb W, Yan F, Agarwal G, Bandyopadhyay H, Harrington C, Hay L, Iashvili I, Kharchilava A, McLean C, Nguyen D, Pekkanen J, Rappoccio S, Roozbahani B, Alverson G, Barberis E, Freer C, Haddad Y, Hortiangtham A, Li J, Madigan G, Marzocchi B, Morse DM, Nguyen V, Orimoto T, Parker A, Skinnari L, Tishelman-Charny A, Wamorkar T, Wang B, Wisecarver A, Wood D, Bhattacharya S, Bueghly J, Chen Z, Gilbert A, Gunter T, Hahn KA, Odell N, Schmitt MH, Sung K, Velasco M, Bucci R, Dev N, Goldouzian R, Hildreth M, Anampa KH, Jessop C, Karmgard DJ, Lannon K, Loukas N, Marinelli N, Mcalister I, Meng F, Mohrman K, Musienko Y, Ruchti R, Siddireddy P, Taroni S, Wayne M, Wightman A, Wolf M, Zygala L, Alimena J, Bylsma B, Cardwell B, Durkin LS, Francis B, Hill C, Lefeld A, Winer BL, Yates BR, Das P, Dezoort G, Elmer P, Greenberg B, Haubrich N, Higginbotham S, Kalogeropoulos A, Kopp G, Kwan S, Lange D, Lucchini MT, Luo J, Marlow D, Mei K, Ojalvo I, Olsen J, Palmer C, Piroué P, Stickland D, Tully C, Malik S, Norberg S, Barnes VE, Chawla R, Das S, Gutay L, Jones M, Jung AW, Negro G, Neumeister N, Peng CC, Piperov S, Purohit A, Qiu H, Schulte JF, Stojanovic M, Trevisani N, Wang F, Wildridge A, Xiao R, Xie W, Cheng T, Dolen J, Parashar N, Baty A, Dildick S, Ecklund KM, Freed S, Geurts FJM, Kilpatrick M, Kumar A, Li W, Padley BP, Redjimi R, Roberts J, Rorie J, Shi W, Leiton AGS, Bodek A, de Barbaro P, Demina R, Dulemba JL, Fallon C, Ferbel T, Galanti M, Garcia-Bellido A, Hindrichs O, Khukhunaishvili A, Ranken E, Taus R, Chiarito B, Chou JP, Gandrakota A, Gershtein Y, Halkiadakis E, Hart A, Heindl M, Hughes E, Kaplan S, Karacheban O, Laflotte I, Lath A, Montalvo R, Nash K, Osherson M, Salur S, Schnetzer S, Somalwar S, Stone R, Thayil SA, Thomas S, Wang H, Acharya H, Delannoy AG, Spanier S, Bouhali O, Dalchenko M, Delgado A, Eusebi R, Gilmore J, Huang T, Kamon T, Kim H, Luo S, Malhotra S, Mueller R, Overton D, Perniè L, Rathjens D, Safonov A, Akchurin N, Damgov J, Hegde V, Kunori S, Lamichhane K, Lee SW, Mengke T, Muthumuni S, Peltola T, Undleeb S, Volobouev I, Wang Z, Whitbeck A, Appelt E, Greene S, Gurrola A, Janjam R, Johns W, Maguire C, Melo A, Ni H, Padeken K, Romeo F, Sheldon P, Tuo S, Velkovska J, Arenton MW, Cox B, Cummings G, Hakala J, Hirosky R, Joyce M, Ledovskoy A, Li A, Neu C, Tannenwald B, Wang Y, Wolfe E, Xia F, Karchin PE, Poudyal N, Thapa P, Black K, Bose T, Buchanan J, Caillol C, Dasu S, De Bruyn I, Everaerts P, Galloni C, He H, Herndon M, Hervé A, Hussain U, Lanaro A, Loeliger A, Loveless R, Sreekala JM, Mallampalli A, Pinna D, Savin A, Shang V, Sharma V, Smith WH, Teague D, Trembath-reichert S, Vetens W. Search for low-mass dilepton resonances in Higgs boson decays to four-lepton final states in proton-proton collisions at s = 13 TeV

A search for low-mass dilepton resonances in Higgs boson decays is conducted in the four-lepton final state. The decay is assumed to proceed via a pair of beyond the standard model particles, or one such particle and a Z boson. The search uses proton-proton collision data collected with the CMS detector at the CERN LHC, corresponding to an integrated luminosity of 137 fb - 1 , at a center-of-mass energy s = 13 TeV . No significant deviation from the standard model expectation is observed. Upper limits at 95% confidence level are set on model-independent Higgs boson decay branching fractions. Additionally, limits on dark photon and axion-like particle production, based on two specific models, are reported.

Ischemic and Bleeding Profile of Patients on Dual Antiplatelet Therapy beyond 1 Year of Index Acute Coronary Syndrome / Percutaneous Intervention

Dual antiplatelet treatment (DAPT) is the cornerstone of the management and prophylaxis of acute coronary syndrome (ACS). However, the associated risk of bleeding with the usage of DAPT and risk of thrombosis with stoppage of the drug makes it a challenging task to take appropriate decisions regarding the choice and duration of DAPT. The present study is aimed to tackle these challenges and to analyze whether prolonged dual antiplatelet therapy carries more risk of bleeding or a higher risk of thrombosis is present with discontinuation of the same.

MATERIAL

In this study, a total of 235 cases of confirmed myocardial infarction, unstable angina, or those who underwent percutaneous intervention were included. After 1 year, the number of patients on DAPT, the type of antiplatelets they were using were observed, their ischemic risk was calculated using DAPT score, and bleeding risk was calculated using PRECISE-DAPT score. Bleeding events were assessed using BARC classification.

OBSERVATION

Out of 235 patients, the majority of the patients were males (78.7%). Only 7.2% of the patients had bleeding since the start of the drugs. The majority (5% out of 7.2%) of bleeding episodes were clinically insignificant. 163 (69%) patients were on Dual antiplatelet therapy after 1 year. Out of which 115 were appropriately taking DAPT as per their DAPT score. Patients with high bleeding risk (PRECISE DAPT score ≥25) were 89, out of which 38 (53.2%) patients were taking SAPT, appropriate for their bleeding risk. While 112 (68.7%) were taking prolonged DAPT, appropriate for PRECISE-DAPT risk.

CONCLUSION

The majority of patients remained on DAPT following discharge for more than 1 year after ACS. This suggests that treating physicians prioritizes ischemic risk reduction over bleeding risk in patients with ACS, according to the patient's risk profile.

INFLUENCE OF THE DURATION OF DIABETES AND VIBRATION PERCEPTION THRESHOLD ON THE SEVERITY OF ERECTILE DYSFUNCTION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

BACKGROUND

Erectile dysfunction(ED) in men is a frequent under-reported complication of diabetes mellitus, which is becoming significant health problem worldwide.

AIMS

The study aims to determine the prevalence and risk factors for development of ED in North Indian patients with type 2 diabetes mellitus.

METHODS

We used international index of erectile function (IIEF-5) for the assessment of ED in 796 patients with type 2 diabetes mellitus. We recorded the age, duration of diabetes, glycemic status, body mass index, diabetes medications, microvascular and macrovascular complications.

RESULTS

The mean age of patients in the study was 49.38 ± 9.52 years. The prevalence of ED in patients with type 2 diabetes mellitus was 79.4%. Logistic regression analysis revealed that age, body mass index, glycemic control, insulin therapy, retinopathy and nephropathy was not significantly associated with erectile dysfunction in patients with type 2 diabetes mellitus. Duration of diabetes (OR = 1.054, 95% CI 1.007 to 1.102, P=0.023) and vibration perception threshold (OR = 1.071, 95% CI 1.042 to 1.102, P=0.000) were identified as key risk factors for development of ED.

CONCLUSION

Duration of diabetes and peripheral neuropathy emerged as significant risk factors for development of severe erectile dysfunction.

Using Z Boson Events to Study Parton-Medium Interactions in Pb-Pb Collisions

The spectra measurements of charged hadrons produced in the shower of a parton originating in the same hard scattering with a leptonically decaying Z boson are reported in lead-lead nuclei (Pb-Pb) and proton-proton (pp) collisions at a nucleon-nucleon center-of-mass energy of 5.02 TeV. Both Pb-Pb and pp data sets are recorded by the CMS experiment at the LHC and correspond to an integrated luminosity of 1.7  nb^{-1} and 320  pb^{-1}, respectively. Hadronic collision data with one reconstructed Z boson candidate with the transverse momentum p_{T}>30  GeV/c are analyzed. The Z boson constrains the initial energy and direction of the associated parton. In heavy ion events, azimuthal angular distributions of charged hadrons with respect to the direction of a Z boson are sensitive to modifications of the in-medium parton shower and medium response. compared to reference data from pp interactions, the results for central Pb-Pb collisions indicate a modification of the angular correlations. The measurements of the fragmentation functions and p_{T} spectra of charged particles in Z boson events, which are sensitive to medium modifications of the parton shower longitudinal structure, are also reported. Significant modifications in central Pb-Pb events compared to the pp reference data are also found for these observables.

Search for strongly interacting massive particles generating trackless jets in proton-proton collisions at s = 13 TeV

A search for dark matter in the form of strongly interacting massive particles (SIMPs) using the CMS detector at the LHC is presented. The SIMPs would be produced in pairs that manifest themselves as pairs of jets without tracks. The energy fraction of jets carried by charged particles is used as a key discriminator to suppress efficiently the large multijet background, and the remaining background is estimated directly from data. The search is performed using proton-proton collision data corresponding to an integrated luminosity of 16.1 fb - 1 , collected with the CMS detector in 2016. No significant excess of events is observed above the expected background. For the simplified dark matter model under consideration, SIMPs with masses up to 100 GeV are excluded and further sensitivity is explored towards higher masses.

A review on electrocoagulation process for the removal of emerging contaminants: theory, fundamentals, and applications

Electrocoagulation (EC) is an excellent and promising technology in wastewater treatment, as it combines the benefits of coagulation, flotation, and electrochemistry. During the last decade, extensive researches have focused on removal of emerging contaminants by using electrocoagualtion, due to its several advantages like compactness, cost-effectiveness, efficiency, low sludge production, and eco-friendness. Emerging contaminants (ECs) are micropollutants found in trace amounts that discharging into conventional wastewater treatment (WWT) plants entering surface waters and imposing a high threat to human and aquatic life. Various studies reveal that about 90% of emerging contaminants are disposed unscientifically into water bodies, creating problems to public health and environment. The studies on removal of emerging contaminants from wastewater are by global researchers are critically reviewed. The core findings proved that still more research required into optimization of parameters, system design, and economic feasibility to explore the potential of EC combined systems. This review has introduced an innovative collection of current knowledge on electro-coagulation for the removal of emerging contaminants.

86 Adherence to Best Practice Tariffs (BPT) for Neck of Femur (NOF) Fracture Admissions During the COVID-19 Pandemic

Introduction

For patients with fragility hip fractures, care needs to be promptly organised to undertake a holistic assessment and preparation for surgery. The aim of the Best Practice Tariffs (BPT) is to promote hip fracture programmes that provide best practice in the care and secondary prevention of fragility fractures.

Method

Results

Conclusions

Holographic Plasma Lenses

A hologram fully encodes a three-dimensional light field by imprinting the interference between the field and a reference beam in a recording medium. Here we show that two collinear pump lasers with different foci overlapped in a gas jet produce a holographic plasma lens capable of focusing or collimating a probe laser at intensities several orders-of-magnitude higher than the limits of a nonionized optic. We outline the theory of these diffractive plasma lenses and present simulations for two plasma mechanisms that allow their construction: spatially varying ionization and ponderomotively driven ion-density fluctuations. Damage-resistant plasma optics are necessary for manipulating high-intensity light, and divergence control of high-intensity pulses-provided by holographic plasma lenses-will be a critical component of high-power plasma-based lasers.

Performance of artificial intelligence system for prescriptive acquisition guidance of transthoracic echocardiography by novice users combined with automated quantification of ejection fraction

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Caption Health

Background

Artificial intelligence (AI) has the potential to expedite the acquisition of transthoracic echocardiograms (TTE) and provide automated quantitative data including left ventricular ejection fraction (LVEF).  Specifically, AI-based imaging systems may permit less experienced individuals to obtain quantitative measurements of LVEF, with important implications for clinical workflow. 

Purpose

We sought to evaluate the accuracy of an AI-based imaging system for the evaluation of LVEF in a spectrum of novice TTE imagers in a real-world clinical setting, and hypothesized that after appropriate training, it can perform as well as experienced sonographers. 

Methods

Consecutive exams (N = 102; BMI 29 ± 7; most common indications for TTE: heart failure, arrhythmia, valve assessment) were performed by a cohort of physician trainees (MD) and nurses (RN) with no prior TTE experience, using an AI-guided imaging system equipped with real-time prescriptive guidance software that automatically measures LVEF. Guided imaging included 3 views: parasternal long-axis (PLAX), apical 4-and apical 2-chamber (AP4, AP2), with the software recognizing when a satisfactory imaging window is obtained and then auto-capturing and automatically generating an AI based LVEF. AI-EF measurements were compared against the reference standard EF (Ref EF) measured by 2 expert sonographers according to ASE chamber quantification guidelines. Bland-Altman analysis was performed to determine inter-technique agreement.

Results

Feasibility was 80%. AI-EF and Ref EF demonstrated strong correlation when all 3 views were obtained, with a small bias (Table). In cases when &lt;3 views were available, the combination of PLAX and AP4 views achieved comparable results, with a slight increase in bias and limits of agreement. When results were stratified by cohort (MD vs RN), MD AI-EF attempts showed greater feasibility (100%, n = 51) with stronger correlation (r = 0.93) and smaller bias (-1.9%) compared to RN (feasibility of 61%; n = 31 and r= 0.85, bias -2.1%). 

Conclusions

Use of an AI-assisted imaging system for limited TTE imaging by novices is feasible in a real-world setting, with the AI based EF in good agreement with reference standard. Acquisition of all 3 views provided optimal results, but the combination of AP4/PLAX views performed reasonably well, without the AP2 view that is more difficult to acquire for less skilled users. Untrained MD were more successful when compared to RN, suggesting additional training may be needed for specific user groups. Abstract Figure.

A multicentre survey of paediatric out-of-hospital cardiac arrest incidence, aetiology, and survival in New South Wales over an 11-year period

Funding Acknowledgements

Type of funding sources: None.

Introduction

Out-of-hospital cardiac arrest (OOHCA) is commonly associated with pulseless ventricular tachycardia and ventricular fibrillation (VT/VF) and cardiac aetiologies. One New South Wales (NSW) ambulance registry reported(1) cardiac aetiologies with a prevalence of 31% among OOHCA cases. Multicentre OOHCA data and NSW’s well-developed services for cardiac genetic predisposition screening motivate us to consider the following study of paediatric OOHCA in this state.

Purpose

We present a multicentre, retrospective study summarizing the demographics, clinical characteristics, incidence, presenting rhythm, and survival-to-discharge status of paediatric OOHCA cases in NSW over an 11-year period. We also present and categorize diagnostic outcomes for patients presenting with VT/VF.

Methods

A retrospective case series of 298 patients admitted to one of three NSW PICUs (two in Sydney and one in Newcastle) under 18 years of age and presenting with OOHCA between January 2009 and December 2019.

Results

Out of 296 paediatric OOHCA patients that survived until PICU admission, 187 (63.2%) were male and 160 (54.1%) survived until hospital discharge. Of those surviving to discharge, 105 (65.6%) were male. Presenting rhythm was asystole or pulseless electrical activity in 240 patients (84.8%, aged 0–17 years, median age 2 years), VT/VF in 41 patients (14.5%, aged 0–16 years, median age 9 years), and complete heart block in 2 patients (0.7%, aged 4–4 years, median age 4 years). Survival was higher in the VT/VF group (82.9%) relative to the asystole and pulseless electrical activity group (50.0%). Of the 41 patients presenting with VT/VF, 13 (31.7%) had a predisposing cardiac condition (2 truncus arteriosus, 1 arrhythmogenic right ventricular cardiomyopathy, 1 double outlet right ventricle, 1 hypoplastic right ventricle, 1 left ventricular non-compaction, 2 asystolic syncope, 2 left ventricular intramyocardial fibroma, 1 familial dilated cardiomyopathy, and 2 undetermined cardiac conditions) and 20 (48.8%) had a genetic condition (9 catecholaminergic polymorphic ventricular tachycardia, 4 hypertrophic cardiomyopathies, 1 Nkx-2.5 mutation, 2 Long QT syndrome, 2 PPA2 mutation, 1 TANGO2 mutation, 1 supraventricular tachycardia). Toxins or trauma were involved in 4 (9.8%) cases, while no cause was determined in 4 (9.8%) other cases.

Conclusions

Overall, 54.1% of paediatric OOHCA patients admitted to PICU survived until hospital discharge, rising to 82.9% among those with VT/VF. Genetic conditions (48.8%), predominated by CPVT, were present in over one-third of VT/VF cases: this figure confirms the continued need for detailed cardiac/genetic assessment for paediatric OOHCA cases.

Test-retest reproducibility of echocardiography and CMR in the same patients for assessing left atrial function

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

Background

 Cardiovascular magnetic resonance (CMR) has been shown to give higher left atrial (LA) volumes than trans-thoracic echocardiography (TTE) but the agreement and test-retest reproducibility of LA functional measure have not been directly compared in the same patient cohort.

Methods

 People with type 2 diabetes mellitus (T2D) without cardiovascular disease underwent TTE and CMR on the same day on two separate occasions with a mean period of 11± 4 days. TTE images were analysed using TomTec-ARENA (v2.4, 2D-CPA), where Medis Suite (v3.1, medical imaging system) was used for CMR images. The analysis included LA strain, corresponding to LA reservoir, conduit, and booster pump (contraction function), LA volumes, and LA emptying fraction (LAEF), which was calculated using area length method. Strain and volume were assessed on 4- and 2-chamber long-axis and average values were calculated for both modalities.

Results

 10 participants with T2D (mean age 65.6 ± 7.3 years, 50% male) were studied. CMR LA volumes were significantly higher and LAEF significantly lower compared to TTE (P &lt; 0.01 for all), whilst reservoir strain on CMR was lower compared to TTE (29.2 ± 6.5 vs 33.8 ± 3.7, p = 0.04).  The inter-modality agreement was moderate for LA volumes and contraction strain (ICC ≥0.55) and poor for LAEF, strain at reservoir and conduit. Overall, the test-retest reproducibility of CMR was higher than for TTE, but the overall limits of agreement were not too dissimilar on Bland-Altman analysis (Table & Figure). TTE reproducibility was good for LA volumes and strain at conduit (CoV 18-24%, ICC ∼0.80) and moderate for LAEF, strain at reservoir and contraction. CMR showed excellent test-retest reproducibility for LA volumes, EF and strain at reservoir (CoV 7-20%, ICC ≥0.83).

Conclusion

 The test-retest reproducibility of CMR is slightly better than TTE for LA assessment using volumes and strain. LA volumes have superior reproducibility compared to functional LA parameters. Abstract Table: Test-retest reproducibility  Abstract Figure: Bland-Altman plot

Evidence for X(3872) in Pb-Pb Collisions and Studies of its Prompt Production at sqrt[s_{NN}]=5.02 TeV

The first evidence for X(3872) production in relativistic heavy ion collisions is reported. The X(3872) production is studied in lead-lead (Pb-Pb) collisions at a center-of-mass energy of sqrt[s_{NN}]=5.02  TeV per nucleon pair, using the decay chain X(3872)→J/ψπ^{+}π^{-}→μ^{+}μ^{-}π^{+}π^{-}. The data were recorded with the CMS detector in 2018 and correspond to an integrated luminosity of 1.7  nb^{-1}. The measurement is performed in the rapidity and transverse momentum ranges |y|<1.6 and 15<p_{T}<50  GeV/c. The significance of the inclusive X(3872) signal is 4.2 standard deviations. The prompt X(3872) to ψ2S yield ratio is found to be ρ^{Pb-Pb}=1.08±0.49(stat)±0.52(syst), to be compared with typical values of 0.1 for pp collisions. This result provides a unique experimental input to theoretical models of the X(3872) production mechanism, and of the nature of this exotic state.

Effect of physiological status and parity on metabolic and trace element profile of crossbred Rambouillet sheep of Himalayan region

The study was designed to evaluate the effect of physiological status and parity on metabolic profile in crossbred Rambouillet ewes of the Himalayan region. The study was conducted on 20 ewes divided into two groups, primiparous (PP) and multiparous (MP), with 10 ewes in each group. Blood samples were collected on 4- and 1-week pre-lambing and 1- and 4-week post-lambing to measure metabolic parameters and minerals. The glucose (p < 0.01), total plasma protein (TPP) (p < 0.05), albumin (p < 0.05), blood urea nitrogen (BUN) (p < 0.05), cholesterol (p < 0.05), triglyceride (p < 0.01), high-density lipoprotein cholesterol (HDL-C) (p < 0.05), calcium (Ca) (p < 0.01), phosphorus (Pi) (p < 0.05), magnesium (Mg) (p < 0.01), copper (Cu) (p < 0.05), and zinc (Zn) (p < 0.01) levels revealed significant change along the time with the concentration decreasing from 3-week pre-lambing to immediate post-lambing; thereafter, levels increased steadily. Significant increase (p < 0.01) was observed in non-esterified fatty acid (NEFA), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), iron (Fe) (p < 0.05), and bilirubin (p < 0.05) concentrations along the sampling time. No group difference was observed in any of the parameters; however, parity and time interaction was observed in glucose, NEFA, GGT, Ca, and Pi. While NEFA levels were significantly high in pre-lambing in PP ewes compared to MP ewes, the post-lambing levels were significantly high in MP ewes. Pre-lambing levels of GGT were at par between the two groups; however, post-lambing levels were significantly high in MP ewes. Glucose, Ca, and Pi were low during pre-lambing in PP ewes and post-lambing in MP ewes. The result showed that ewes show a significant change in metabolic profile and trace minerals during late gestation and immediate postpartum; however, these changes were more pronounced during late gestation in primiparous and post-lambing in multiparous.