Low rate of new-onset primary biliary cholangitis in a cohort of anti-mitochondrial antibody-positive subjects over six years of follow-up

BACKGROUND AND AIMS

Anti-mitochondrial antibodies (AMA) are closely linked to primary biliary cholangitis (PBC). The prevalence of AMA in the general population is low, and AMA positivity may precede PBC. We aimed to determine the natural history of subjects with positive AMA.

METHODS

In total, 302 patients were tested AMA-positive over a ten-year period. Of these, immunoblotting confirmed specific AMA in 184 (29 male, 155 female, age 59.6 ± 14.1 years). These subjects were invited to our liver outpatient clinic for clinical and biochemical re-evaluation. Detailed clinical history data were additionally collected from the hospital computer system and by telephone. The subsequent course with regard to mortality, liver-related morbidity, extrahepatic co-morbidities and effectiveness of PBC treatment was determined in 150 subjects (81.5%).

RESULTS

After 5.8 ± 5.6 years of follow-up (FU), of 184 AMA-positive subjects, 28 subjects (15.2%; liver-related mortality n = 5) were deceased, and 122 subjects (66.3%) completed FU while 34 subjects (18.5%) were not available for FU. The 122 patients who completed FU were 63 patients with established PBC, six de novo cases of PBC (10.2% of 59 initially at risk), 42 (34.4%) subjects were still AMA-positive without PBC, and 11 (9.0%) subjects were AMA-negative at FU.

CONCLUSIONS

Anti-mitochondrial antibodies-positive patients without PBC at baseline infrequently developed PBC over six years of FU. AMA positivity represented a transient serological autoimmune phenomenon in a significant proportion of subjects.

Society of pediatric liver transplantation: Current registry status 2011-2018

BACKGROUND

SPLIT was founded in 1995 in order to collect comprehensive prospective data on pediatric liver transplantation, including waiting list data, transplant, and early and late outcomes. Since 2011, data collection of the current registry has been refined to focus on prospective data and outcomes only after transplant to serve as a foundation for the future development of targeted clinical studies.

OBJECTIVE

To report the outcomes of the SPLIT registry from 2011 to 2018.

METHODS

This is a multicenter, cross-sectional analysis characterizing patients transplanted and enrolled in the SPLIT registry between 2011 and 2018. All patients, <18 years of age, received a first liver-only, a combined liver-kidney, or a combined liver-pancreas transplant during this study period.

RESULTS

A total of 1911 recipients from 39 participating centers in North America were registered. Indications included biliary atresia (38.5%), metabolic disease (19.1%), tumors (11.7%), and fulminant liver failure (11.5%). Greater than 50% of recipients were transplanted as either Status 1A/1B or with a MELD/PELD exception score. Incompatible transplants were performed in 4.1%. Kaplan-Meier estimates of 1-year patient and graft survival were 97.3% and 96.6%. First 30 days of surgical complications included reoperation (31.7%), hepatic artery thrombosis (6.3%), and portal vein thrombosis (3.2%). In the first 90 days, biliary tract complications were reported in 13.6%. Acute cellular rejection during first year was 34.7%. At 1 and 2 years of follow-up, 39.2% and 50.6% had normal liver tests on monotherapy (tacrolimus or sirolimus). Further surgical, survival, allograft function, and complications are detailed.

Clinical and metabolic characterization of obese subjects without non-alcoholic fatty liver: A targeted metabolomics approach

INTRODUCTION

As a small proportion of obese individuals do not develop metabolic complications and non-alcoholic fatty liver disease (NAFLD), this study aimed to provide a comprehensive clinical, metabolic and genetic description of obese subjects with healthy livers.

METHODS

A total of 183 subjects were stratified, according to BMI, presence of metabolic syndrome, biochemical liver tests and hepatic steatosis on ultrasound, into: (i) lean controls (n = 69); (ii) obese healthy (n = 50); and (iii)obese NAFLD (n = 62) groups. Detailed clinical, genetic and metabolic evaluations were then performed.

RESULTS

Obese healthy subjects did not differ in glucose parameters from lean controls, and had a lower rate of minor TM6SF2 gene variants compared with obese NAFLD (2/49 vs. 11/60, respectively; P = 0.035) and lean controls (13/64; P = 0.035), but significantly higher leptin concentrations than lean controls (P < 0.001); they also higher adiponectin concentrations (P < 0.001), and lower TNF-α and IL-6 concentrations (P = 0.01 and P < 0.001, respectively), than obese NAFLD subjects. Also, metabolomic studies identified ether- and ester-containing phospholipids [PC ae C44:6, PC ae C42:5, PC aa C40:4; P < 0.001, corrected by the false discovery rate (FDR) method] and found that the amino-acids lysine, glycine and isoleucine (FDR < 0.001) differed between the two obese groups, but not between lean controls and obese healthy subjects.

CONCLUSION

Obese people with healthy livers are characterized by intact glucose homoeostasis, lower pro-inflammatory cytokine levels, and higher adiponectin and leptin concentrations compared with obese people with NAFLD. In addition, the major allele of TM6SF2, a set of phosphatidylcholines and several amino acids are associated with healthy livers in obesity.

Morbidity and mortality associated with rewarming hypothermic very low birth weight infants

OBJECTIVES

In very low birthweight (VLBW) infants, hypothermia is associated with poor outcomes. The goal of this study is to assess the relationship between the rate of rewarming these babies and their outcomes.

METHODS

This is a retrospective cohort study of 98 inborn VLBW infants who were hypothermic (<36°C rectally) upon admission to the NICU. A logistic regression model was used to examine the relationship between the rates of rewarming and time to achieve euthermia and the following outcomes: death, intraventricular hemorrhage, severe intraventricular hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis and retinopathy of prematurity.

RESULTS

Prolonged rewarming time was associate with increased odds of mortality (OR 1.273 95% CI 1.032-1.571). No associations between rewarming rates and any of the outcomes were seen. Once birthweight was included in a multiple logistic regression model, the association between mortality and rewarming time was no longer significant. Outcomes that were not associated with either rate or time of rewarming (even in a univariate model) were: bronchopulmonary dysplasia, intraventricular hemorrhage, severe intraventricular hemorrhage, necrotizing enterocolitis and retinopathy of prematurity.

CONCLUSION

In moderately hypothermic VLBW infants, after accounting for birthweight, no association between rewarming and outcome is seen.

Electronic Enhancement of the Exciton Coherence Time in Charged Quantum Dots

Minimizing decoherence due to coupling of a quantum system to its fluctuating environment is at the forefront of quantum information and photonics research. Nature sets the ultimate limit, however, given by the strength of the system's coupling to the electromagnetic field. Here, we establish the ability to electronically control this coupling and enhance the optical coherence time of the charged exciton transition in quantum dots embedded in a photonic waveguide. By manipulating the electronic wave functions through an applied lateral electric field, we increase the coherence time from ∼1.4 to ∼2.7  ns. Numerical calculations reveal that longer coherence arises from the separation of charge carriers by up to ∼6  nm, which leads to a 30% weaker transition dipole moment. The ability to electronically control the coherence time opens new avenues for quantum communication and novel coupling schemes between distant qubits.

Monolithic device for modelocking and stabilization of frequency combs

We demonstrate a device that integrates a III-V semiconductor saturable absorber mirror with a graphene electro-optic modulator, which provides a monolithic solution to modelocking and noise suppression in a frequency comb. The device offers a pure loss modulation bandwidth exceeding 5 MHz and only requires a low voltage driver. This hybrid device provides not only compactness and simplicity in laser cavity design, but also small insertion loss, compared to the previous metallic-mirror-based modulators. We believe this work paves the way to portable and fieldable phase-coherent frequency combs.

Atomic clock with 1×10(-18) room-temperature blackbody Stark uncertainty

The Stark shift due to blackbody radiation (BBR) is the key factor limiting the performance of many atomic frequency standards, with the BBR environment inside the clock apparatus being difficult to characterize at a high level of precision. Here we demonstrate an in-vacuum radiation shield that furnishes a uniform, well-characterized BBR environment for the atoms in an ytterbium optical lattice clock. Operated at room temperature, this shield enables specification of the BBR environment to a corresponding fractional clock uncertainty contribution of 5.5×10(-19). Combined with uncertainty in the atomic response, the total uncertainty of the BBR Stark shift is now 1×10(-18). Further operation of the shield at elevated temperatures enables a direct measure of the BBR shift temperature dependence and demonstrates consistency between our evaluated BBR environment and the expected atomic response.

Evaluating the thermal damage resistance of graphene/carbon nanotube hybrid composite coatings

We study laser irradiation behavior of multiwalled carbon nanotubes (MWCNT) and chemically modified graphene (rGO)-composite spray coatings for use as a thermal absorber material for high-power laser calorimeters. Spray coatings on aluminum test coupon were exposed to increasing laser irradiance for extended exposure times to quantify their damage threshold and optical absorbance. The coatings, prepared at varying mass % of MWCNTs in rGO, demonstrated significantly higher damage threshold values at 2.5 kW laser power at 10.6 μm wavelength than carbon paint or MWCNTs alone. Electron microscopy and Raman spectroscopy of irradiated specimens show that the coating prepared at 50% CNT loading endure at least 2 kW x cm(-2) for 10 seconds without significant damage. The improved damage resistance is attributed to the unique structure of the composite in which the MWCNTs act as an efficient absorber of laser light while the much larger rGO sheets surrounding them, dissipate the heat over a wider area.

[Clinical and microbiological features of severe infectious keratitis during heatwaves]

PURPOSE

To study clinical and microbiological features of patients with severe microbial keratitis during a heatwave. To evaluate the links between disease severity, causative micro-organisms and temperature variation.

METHODS

Retrospective study of patients with microbial keratitis hospitalized in a referral center during the summer months (between June 1, 2009 and September 30, 2009), separated into two groups by date of hospitalization (heatwave vs non-heatwave). Prevalence and daytime temperatures were compared for data collected during the summers of 2009 (heatwave), 2008 (temperate) and 2003 (prolonged heatwave).

RESULTS

Thirty-three patients were hospitalized during the summer of 2009, with an average age of 51 years and an average stay of 15 days. The primary predisposing factor was the use of contact lenses (36%), followed by pre-existing corneal disease (15%) and systemic disease (15%). Prevalence of severe keratitis was higher in periods of heatwaves vs periods of no heatwaves (mean 9.8 patients vs 3.1, P<0.001). Best corrected visual acuity progressed from 1/30 at admission to 1/10 at 1 month after discharge (P<0.001). The most common bacteria identified were Gram-positive cocci (CNS 27%) and Pseudomonas (23%). Microbiological results were similar in the two groups. Similar variations between the prevalence of severe keratitis and daytime temperatures were found for the summer of 2009 as well as for the summers of 2008 and 2003.

CONCLUSIONS

There appears to be a link between climatic temperature variations and the prevalence of severe microbial keratitis.

Very high laser-damage threshold of polymer-derived Si(B)CN-carbon nanotube composite coatings

We study the laser irradiance behavior and resulting structural evolution of polymer-derived silicon-boron-carbonitride (Si(B)CN) functionalized multiwall carbon nanotube (MWCNT) composite spray coatings on copper substrate. We report a damage threshold value of 15 kWcm(-2) and an optical absorbance of 0.97 after irradiation. This is an order of magnitude improvement over MWCNT (1.4 kWcm(-2), 0.76), SWCNT (0.8 kWcm(-2), 0.65) and carbon paint (0.1 kWcm(-2), 0.87) coatings previously tested at 10.6 μm (2.5 kW CO2 laser) exposure. Electron microscopy, Raman spectroscopy, and X-ray photoelectron spectroscopy suggests partial oxidation of Si(B)CN forming a stable protective SiO2 phase upon irradiation.

Insulin degludec: four times lower pharmacodynamic variability than insulin glargine under steady-state conditions in type 1 diabetes

AIMS

Insulin degludec (IDeg) is a new-generation basal insulin with an ultra-long duration of action. We compared the pharmacodynamic (PD) variability of IDeg and insulin glargine (IGlar) under steady-state conditions.

METHODS

Day-to-day variability in glucose-lowering effect was investigated in 54 subjects with type 1 diabetes who underwent a 24-h euglycaemic glucose clamp on the 6th, 9th and 12th day of treatment with 0.4 U/kg of IDeg or IGlar once daily. Within-subject variability was estimated using a linear mixed model on log-transformed PD endpoints derived from the glucose infusion rate (GIR) profiles during the clamps.

RESULTS

For IDeg the day-to-day variability in glucose-lowering effect was four-times lower than for IGlar for total metabolic effect (AUC(GIR,0-24h,SS), CV 20% vs. 82%) and for the last 22 h [AUC(GIR,2-24h,SS) (not influenced by intravenous insulin during the clamp), CV 22% vs. 92%]. Furthermore, lower variability in the maximum effect was observed for IDeg vs. IGlar (GIR(max,SS), CV 18% vs. 60%). The lower within-subject variability of IDeg was consistent over time (CVs of 33% for AUC(GIR,0-2h,SS), 32% for AUC(GIR,10-12h,SS) and 33% for AUC(GIR,22-24h,SS)), whereas the variability of IGlar was higher and increased substantially 8 h post-dosing (CVs of 60% for AUC(GIR,0-2h,SS), 135% for AUC(GIR,10-12h,SS) and 115% for AUC(GIR,22-24h,SS)).

CONCLUSIONS

These results show that IDeg has a significantly more predictable glucose-lowering effect from day to day than IGlar.

[Role of intolerance to hypoxia in the occurrence of anterior bilateral ischaemic optic neuropathy at high altitude]

The pathophysiology of nonarteritic anterior ischemic optic neuropathy (NA-AION) is still imperfectly understood, but arterial hypertension seems to play a decisive role. Intolerance to hypoxia is defined as desaturation of hemoglobin more than 15% at rest and/or elevation of blood pressure at rest or after exercise over 20mmHg in hypoxia. We report the case of a 66-year-old woman who presented bilateral NA-AION during a trek at high altitude (>2500m). The etiological check up was negative. Due to the circumstances of occurrence, we requested a tolerance to hypoxia test, which was positive. In this case, the combined effects of altitude and effort probably led to prolonged desaturation of oxyhemoglobin associated with an excessive blood pressure increase upon exercise leading to ischemia of the optic nerve head. This case showed the value of a systematic search for hypoxia tolerance in patients with nonarteritic anterior ischemic optic neuropathy occurring during a situation of prolonged hypoxia (long-distance flight, high altitude).

A Model-Based Active Testing Approach to Sequential Diagnosis

Model-based diagnostic reasoning often leads to a large number of diagnostic hypotheses. The set of diagnoses can be reduced by taking into account extra observations (passive monitoring), measuring additional variables (probing) or executing additional tests (sequential diagnosis/test sequencing). In this paper we combine the above approaches with techniques from Automated Test Pattern Generation (ATPG) and Model-Based Diagnosis (MBD) into a framework called FRACTAL (FRamework for ACtive Testing ALgorithms). Apart from the inputs and outputs that connect a system to its environment, in active testing we consider additional input variables to which a sequence of test vectors can be supplied. We address the computationally hard problem of computing optimal control assignments (as defined in FRACTAL) in terms of a greedy approximation algorithm called FRACTAL-G. We compare the decrease in the number of remaining minimal cardinality diagnoses of FRACTAL-G to that of two more FRACTAL algorithms: FRACTAL-ATPG and FRACTAL-P. FRACTAL-ATPG is based on ATPG and sequential diagnosis while FRACTAL-P is based on probing and, although not an active testing algorithm, provides a baseline for comparing the lower bound on the number of reachable diagnoses for the FRACTAL algorithms. We empirically evaluate the trade-offs of the three FRACTAL algorithms by performing extensive experimentation on the ISCAS85/74XXX benchmark of combinational circuits.

Approximate Model-Based Diagnosis Using Greedy Stochastic Search

We propose a StochAstic Fault diagnosis AlgoRIthm, called SAFARI, which trades off guarantees of computing minimal diagnoses for computational efficiency. We empirically demonstrate, using the 74XXX and ISCAS-85 suites of benchmark combinatorial circuits, that SAFARI achieves several orders-of-magnitude speedup over two well-known deterministic algorithms, CDA* and HA*, for multiple-fault diagnoses; further, SAFARI can compute a range of multiple-fault diagnoses that CDA* and HA* cannot. We also prove that SAFARI is optimal for a range of propositional fault models, such as the widely-used weak-fault models (models with ignorance of abnormal behavior). We discuss the optimality of SAFARI in a class of strong-fault circuit models with stuck-at failure modes. By modeling the algorithm itself as a Markov chain, we provide exact bounds on the minimality of the diagnosis computed. SAFARI also displays strong anytime behavior, and will return a diagnosis after any non-trivial inference time.

[Intravitreal ranibizumab for choroidal neovascularization secondary to pathological myopia: 12-month results]

PURPOSE

To evaluate the efficacy and safety of intravitreal ranibizumab (Lucentis) in the first-line treatment of choroidal neovascularization (CNV) secondary to pathological myopia.

METHODS

Consecutive series of patients with primary subfoveal CNV secondary to pathological myopia treated with intravitreal ranibizumab 0.5mg (0.05ml) were included prospectively in this study. Best-corrected visual acuity, fundus examination, fluorescein angiography, optical coherence tomography, and the presence of metamorphopsia were assessed at baseline and then monthly. Indications for retreatment were persistent leakage from CNV shown on FA and/or evidence of CNV activity on OCT.

RESULTS

Eight eyes of seven patients were followed from November 2007 to April 2009. The mean age was 61 years. None of these eyes had been treated previously with photodynamic therapy or direct photocoagulation. The mean spherical equivalent refractive error was -10.75 (range: -7.75 to -15.75). Follow-up was 12 months or more for all patients except one (3 months). The mean number of intravitreal injections administered for each patient was 1.5 (range: 1-4). Six eyes received one ranibizumab injection, one eye received two, and one eye received four. Four eyes demonstrated a gain in visual acuity, three eyes stabilization, and one eye vision loss. No injection complications or drug-related side effects were noted during the follow-up period.

CONCLUSIONS

In this small series of eyes with limited follow-up, intravitreal ranibizumab was a safe and effective treatment for CNV secondary to pathological myopia, resulting in functional and anatomic improvements.

Laquinimod suppress antigen presentation in relapsing-remitting multiple sclerosis: in-vitro high-throughput gene expression study

Laquinimod (LAQ) is a new immunomodulatory drug shown to be effective in the treatment of relapsing-remitting multiple sclerosis (RRMS); however, its molecular target pathways are not well recognized. In this study we characterized in-vitro the molecular effects of LAQ in peripheral blood mononuclear cells (PBMC) of healthy subjects and RRMS patients by gene expression microarrays. We demonstrated that LAQ induced suppression of genes related to antigen presentation and corresponding inflammatory pathways. These findings were demonstrated mainly via the NFkB pathway. Analysis of PBMC subpopulations identified activation of Th2 response in CD14+ and CD4+ cells and suppression of proliferation in CD8+ cells.

[Prospective study of 34 retinal detachments associated with giant retinal tear]

PURPOSE

To report the anatomical and functional outcomes of vitrectomy with silicone oil tamponade in the treatment of retinal detachment associated with giant retinal tears due to various factors.

METHODS

We prospectively followed 34 eyes of 33 patients with giant retinal tear. That underwent vitrectomy, injection of perfluorocarbon liquids and silicone oil tamponade. Scleral buckle was associated with vitrectomy in cases of inferior giant retinal tear; 26,5 % and 11,8 %, respectively, demonstrated pseudophakia and aphakia. Seven eyes (20,5 %) had a history of trauma (blunt injuries in four and a penetrating injury in three) and, 14 eyes (41,2 %) had severe myopia. One patient developed a bilateral giant retinal tear during the follow-up.

RESULTS

Retinal attachment was obtained in 33 (97 %) of 34 eyes, with a mean follow-up of 14,5+/-6 months. Retinal detachment reoccurred in four eyes (11,6 %) under silicone oil, in one eye (2,9 %) during the silicone removal, and in two eyes (5,8 %) after silicone removal and cataract surgery. Silicone oil was removed from all eyes (4,3+/-1 months). The most frequent postoperative complication was cataract in ten of 18 phakic eyes (55,5 %). Functional success with visual acuity 0,4 or better was obtained in 18 cases (52,96 %).

CONCLUSION

Pars plana vitrectomy with silicone oil tamponade proved to be highly effective in giant retinal tears in terms of the anatomical and functional results. The analysis of recurrent retinal detachment allowed us to refine the technique and to suggest scleral buckle in one case of inferior retinal tear with laser over 360 degrees .

Proinflammatory cytokines in a mouse model of central retinal artery occlusion

PURPOSE

To analyze cytokines in the retina and serum in an experimental model of central retinal artery occlusion (CRAO) in mice.

METHODS

CRAO was induced by laser activation of intravenously injected rose bengal, a photosensitive dye, in 60 C57Bl/6 mice. mRNA and protein levels of macrophage inhibitory protein-2 (MIP-2), interleukin-6 (IL-6), and tumor necrosis factor- alpha (TNF-alpha) were analyzed using real-time polymerase chain reaction, and western blot, respectively. Cytokine levels in serum were measured by ELISA. Analysis was performed at various time intervals from CRAO induction.

RESULTS

In the retina, MIP-2 and IL-6 mRNA expression decreased 3 h after induction of CRAO and increased thereafter, peaking at 12-24 h. By 7 days, levels were again mostly undetectable. TNF-alpha mRNA expression increased at 3 h and decreased to control levels at 7 days. At the protein level, all cytokines were present at 3 h, following similar patterns to their respective gene expression thereafter. In serum, MIP-2 and TNF-alpha levels peaked early, and decreased to control levels at 12 h, with a second late rise of TNF-alpha. IL-6 levels increased between 3 and 12 h and decreased at 24 h.

CONCLUSIONS

Temporal variations in cytokines were observed following the induction of CRAO, both at the retinal mRNA expression and protein levels. These temporal changes, and the variable effects of the cytokines at the different time intervals, should be taken into account during the formulation of therapeutic strategies.

Mesenchymal progenitor cells in red and yellow bone marrow

Marrow cavities in all bones of newborn mammals contain haematopoietic tissue and stromal microenvironment that support haematopoiesis (haematopoietic microenvironment), known as red bone marrow (BM). From the early postnatal period onwards, the haematopoietic microenvironment, mainly in tubular bones of the extremities, is replaced by mesenchymal cells that accumulate lipid drops, known as yellow BM, whereas haematopoietic tissue gradually disappears. We analysed the ability of mesenchymal cell progenitors in red and yellow BM to produce bone and haematopoietic microenvironment in vivo after transplantation into normal or haematopoietically deficient (irradiated and old) recipients. We found that (1) normal substitution of red with yellow BM results from a gradual loss of mesenchymal stem cells (MSCs) capable of developing bone and haematopoietic microenvironment; (2) the mesenchymal cell population in tubular bones still containing active haematopoietic tissue gradually becomes depleted of MSCs, starting from a young age; (3) haematopoietic microenvironment is incapable of self-maintenance and its renewal depends on the presence of precursor cells; (4) the mesenchymal cell population remaining in areas with yellow BM contains cells able to develop functionally active haematopoietic microenvironment in conditions of haematopoietic insufficiency. Our data also indicate the possible existence of bi-potential stromal precursor cells producing either bone in normal, or bone together with active haematopoietic microenvironment in irradiated or old recipients. This study opens a spectrum of opportunities for the extension of haematopoietic territories by substituting the fat contents of BM cavities with haematopoietic tissue, thereby improving haematopoiesis compromised by cytotoxic treatments, irradiation, ageing, etc.

Bone trephining for osteoid osteoma excision: a case report

Osteoid osteomas may be treated medically or surgically; both have similar long-term outcomes. Nonetheless, only surgery allows complete excision of the lesion for histological analysis. Excessive removal of surrounding bone may destabilise and weaken the bony structure and predispose it to fractures. We describe a surgical technique using a bone graft trephine to enable precise lesion removal with minimal bone excision.

Local anesthesia for inguinal hernia repair in adolescents

BACKGROUND

Many centers use local anesthesia for adult inguinal hernia surgery in the setting of day-case surgery. There are no reports on, or guidelines for, use of anesthesia for inguinal hernia surgery in adolescents. We describe our initial experience with the use of local anesthesia and intravenous sedation for inguinal hernia surgery in adolescents in the setting of a day-surgery facility.

METHODS

The charts of 14 consecutive adolescent patients (aged 12-17) who had inguinal hernia surgery from July 2004 to March 2005 were reviewed retrospectively. Intravenous sedation was administered 1-3 min before injection of local anesthetic. Sedation consisted of midazolam 0.085 mg kg(-1) and either fentanyl 0.85 mug kg(-1) or ketamine 0.085 mg kg(-1), according to the preference of the anesthesiologist. Additional sedation with half the initial dose was administered if required. Local anesthesia using a combination of lignocaine and bupivacaine was administered by the surgeon with infiltration in the skin and deep tissues.

RESULTS

Fourteen adolescents aged 12-17 years (mean 14.8 +/- 1.37), weighing 34-100 kg (mean 61.2 +/- 16.5), had 15 inguinal hernia repairs with sedation and local anesthesia. All the patients were male. All completed the surgery with sedation and local anesthesia. None required conversion to general anesthesia. There were no immediate or subsequent complications. Mean time from the end of surgery to discharge home was under 2 h (mean 106 +/- 36 min). Examination of patient charts did not reveal any complaints regarding the surgery or the postoperative course at the postoperative follow up visit.

CONCLUSIONS

The use of local anesthesia with intravenous sedation for inguinal hernia repair in the adolescent age group seems feasible and requires further prospective study.

The role of BRCA1 in DNA repair and chemosensitivity

10606

Introduction: The BRCA1 tumor suppressor protein has been implicated in many cellular processes, including several different DNA repair pathways. Inherited mutations in the BRCA1 gene result in an increased risk for developing breast and ovarian cancer. BRCA1 associated tumors are frequently estrogen receptor negative thus rendering them ineffective targets of hormonal manipulations. Therefore chemotherapy is the only treatment option available to patients with metastatic disease. Methods: Global genomic repair activity was detected by an immunoslotblot assay. UV-C and chemosensitivity was determined by the MTT assay. The comet assay was used to measure oxidative DNA damage (ODD). Results: Brca1 deficient cells demonstrate decreased global genomic repair independent of p53 expression. These cells are 3-fold more sensitive to UV-C radiation, 5-fold more sensitive to cisplatin, and 25-fold more sensitive to gemcitabine than Brca1 positive cells. The combination of cisplatin and gemcitabine is synergistic. This synergy is independent of Brca1 protein expression. In addition, the cholesterol lowering drug lovastatin is able mitigate the ODD caused by hydrogen peroxide. Reduced ODD is also observed in breast epithelial cells from high risk patients after 6 months of oral lovastatin use. Discussion: These results confirm our earlier findings that BRCA1 is involved in the nucleotide excision repair pathway. In addition, we demonstrate that this effect is independent of p53 expression. We also find that Brca1 deficient MMECs are more sensitive to UV-C, and the cytotoxic drugs cisplatin and gemcitabine. Cisplatin is known to cause DNA intra- and inter-strand crosslinks whereas gemcitabine is a nucleoside analog. The increased sensitivity of Brca1 deficient MMEC's to these agents supports the role of Brca1 in the different molecular pathways involved in their repair. In addition, we demonstrate that lovastatin can overcome ODD in vitro and in vivo and may be an effective agent to modify breast cancer risk for individuals at increased risk.

No significant financial relationships to disclose.

Role of data aggregation in biosurveillance detection strategies with applications from ESSENCE

INTRODUCTION

Syndromic surveillance systems are used to monitor daily electronic data streams for anomalous counts of features of varying specificity. The monitored quantities might be counts of clinical diagnoses, sales of over-the-counter influenza remedies, school absenteeism among a given age group, and so forth. Basic data-aggregation decisions for these systems include determining which records to count and how to group them in space and time.

OBJECTIVES

This paper discusses the application of spatial and temporal data-aggregation strategies for multiple data streams to alerting algorithms appropriate to the surveillance region and public health threat of interest. Such a strategy was applied and evaluated for a complex, authentic, multisource, multiregion environment, including >2 years of data records from a system-evaluation exercise for the Defense Advanced Research Project Agency (DARPA).

METHODS

Multivariate and multiple univariate statistical process control methods were adapted and applied to the DARPA data collection. Comparative parametric analyses based on temporal aggregation were used to optimize the performance of these algorithms for timely detection of a set of outbreaks identified in the data by a team of epidemiologists.

RESULTS

The sensitivity and timeliness of the most promising detection methods were tested at empirically calculated thresholds corresponding to multiple practical false-alert rates. Even at the strictest false-alert rate, all but one of the outbreaks were detected by the best method, and the best methods achieved a 1-day median time before alert over the set of test outbreaks.

CONCLUSIONS

These results indicate that a biosurveillance system can provide a substantial alerting-timeliness advantage over traditional public health monitoring for certain outbreaks. Comparative analyses of individual algorithm results indicate further achievable improvement in sensitivity and specificity.

Coronary artery calcification in older adults to age 99: prevalence and risk factors

BACKGROUND

Coronary artery calcification has been proposed as a noninvasive method to assess cardiovascular disease (CVD) risk. However, the prevalence and risk factors for coronary artery calcification in populations >65 years have not been well studied.

METHODS AND RESULTS

Electron beam tomography was performed to assess coronary artery calcium (CAC) in 614 older adults aged, on average, 80 years (range, 67 to 99 years); 367 (60%) were women, and 143 (23%) were black. Calcium scores ranged from 0 to 5459. Median scores were 622 for men and 205 for women. Scores increased by age and were lower in blacks than in whites. Nine percent of subjects (n=57) had no CAC, and 31% (n=190) had a score lower than 100. A history of CVD was associated with calcium score. Age, male sex, white race, CVD, triglyceride level, pack-years of smoking, and asthma, emphysema, or bronchitis (chronic obstructive pulmonary disease) were independently associated with CAC score in the fourth quartile.

CONCLUSIONS

A wide range of CAC scores was observed, suggesting adaptation with aging. CAC may have potential to predict CVD in older adults, but this remains to be determined.