A novel coupling quality index to estimate the coupling efficiency in Vibrant Soundbridge

BACKGROUND

The objective-based methods for intraoperative monitoring have been suggested to assess the coupling and the outcomes of Vibrant Soundbridge (VSB). Although several techniques were proposed, they have not been widely adopted due to their complexity and invasiveness.

PURPOSE

This study aimed to investigate the accuracy of a new coupling quality index using an intraoperative ABR threshold via AcoustiAP and its correlation with the perioperative measures.

METHODS

This is a prospective study conducted at a tertiary center. The medical records were retrieved for all patients who underwent VSB implantation and had an intraoperative objective assessment for the coupling efficiency. AcoustiAP was used to evaluate the intraoperative ABR thresholds, which were assessed directly after the floating mass transducer (FMT) placement using acoustic CE-Chirp signals. The Vibrogram was used for the postoperative audiological evaluation. A new coupling quality index was calculated based on the intraoperative ABR thresholds.

RESULTS

Ten patients were eligible for the present study. The ABR thresholds for good coupling ranged from 35 to 60 dBnHL. The loose coupling thresholds ranged considerably from 40 to 100 dBnHL. Overall, the median intraoperative ABR threshold at good coupling was 42.5 (40-60) dBnHL and 60 (40-100) dBnHL at loose coupling. The analysis showed that there was a significant change in the coupling quality index at the good and loose coupling points (24.3 ± 14 vs 38.8 ± 18.2, respectively, p < 0.001). At a cut-off value of 22.6 dB, the coupling quality index had a sensitivity of 70%  and specificity of 90% for discriminating good and loose coupling.

CONCLUSION

This study provides evidence for the utility of intraoperative ABR measurements in predicting the coupling efficiency in patients with VSB. Our results showed that the coupling quality index had an acceptable accuracy in discriminating between good and poor coupling, which can help clinicians optimize the fitting process for individuals and may ultimately lead to improved patient outcomes.

Advancing Cochlear Implant Programming: X-ray Guided Anatomy-Based Fitting

BACKGROUND

Anatomy-based fitting (ABF) is a new research area in the field of cochlear implants (CIs). Despite the reported benefits and acceptable levels of ABF among CI recipients, some limitations remain, like the postoperative computed tomography (CT) scan, which is preferred for confirming electrode array insertion.

OBJECTIVE

This study aimed to investigate the feasibility of using plain film radiography (X-ray) for postoperative electrode detection and for building ABF as an alternative to CT.

METHODS

A total of 53 ears with CI were studied. All cases had routine post-insertion X-rays in the cochlear view and additionally underwent postoperative CT. The insertion angles and center frequencies measured by two independent observers were compared for each imaging modality. The angular insertion depth and center frequencies resulting from the X-ray and CT scans were then compared.

RESULTS

No significant differences were observed between the X-ray- and CT-measured angles for the electrode contacts. Radiographic measurements between the two readers showed an almost perfect (≥0.8) or substantial (0.71) intraclass correlation coefficient along the electrode contacts. X-ray images showed a mean difference of 4.7 degrees from CT. The mean semitone deviation of the central frequency between the CT and X-ray images was 0.6.

CONCLUSIONS

X-ray imaging provides a valid and easy-to-perform alternative to CT imaging, with less radiation exposure and lower costs. The radiographs showed excellent concordance with the CT-measured angular insertion depth and consequently with the central frequency for most electrode contacts. Therefore, plain X-ray could be a viable alternative in building ABF for the CI recipients.

Impact of grazing around industrial areas on milk heavy metals contamination and reproductive ovarian hormones of she-camel with assessment of some technological processes on reduction of toxic residue concentrations

Heavy metals are one of the most toxic chemical pollutants of the environment. Their hazards not restricted to human but extend to animal productivity and reproductively. The present study aimed to assess the impact of grazing around industrial areas on the levels of copper (Cu) and aluminum (Al) residues in milk samples collected from dromedary she-camels and studying their effects on some ovarian hormones. In addition, the study aimed to investigate methods of removal of the toxic concentrations of these heavy metals in milk by applying different technological processes. Blood and milk samples were collected from 30 dromedary she-camels, 15 grazing in non-industrial areas (group A) and 15 grazing in industrial areas (group B). Detection of the levels of these heavy metals in milk was done. Ovarian hormones investigation on the blood was performed. Different technological processes such as boiling, skimming and fermentation were applied to all contaminated samples to reduce the toxic concentrations of these heavy metals. Results revealed that all examined milk samples in both groups contained Cu, while 40% of group A and 100 % of group B contained Al residues with different concentrations. The levels of Cu and Al residues in samples of group A not exceeded the maximum residual limit (MRL) set by World Health Organization (WHO) while 60% and 100% of milk samples in group B contained Cu and Al residues exceeded MRL, respectively. Technological processes induce variant changes in the levels of these metals in milk. Heat treatment of milk in Al vats leads to leaching of Al from containers to the milk causing significant increase in Al load, while Cu level was not significantly affected. Boiling in stainless-steel containers decreased the levels of Al and Cu but in non-significant levels. Regarding skimming process, small amount of Cu and Al escaped into the skimmed milk while greater amount were recovered in the cream. Fermentation by probiotic bacteria showed that milk fermentation has non-significant effect on Cu and Al levels. Investigation of ovarian hormones (estrogen and progesterone) revealed presence of a signification reduction in the levels of these hormones in group B compared to group A. In addition, a negative correlation was found between these heavy metals and ovarian hormones concentrations in the blood. It is concluded that grazing of dromedary camels around industrial areas induce heavy metals toxicity represented by excretion of these metals in milk and significant reduction on ovarian function showed by reduction of estrogen and progesterone levels. Technological processes such as skimming decreased the levels of Al and Cu residues in milk.

Transcatheter arterial embolisation for the relief of shoulder and elbow chronic joint pain refractory to conventional treatment: Systematic review

Angiogenesis and accompanying nerve fibres might cause unsettling joint pain. Studies have suggested that transcatheter arterial embolisation (TAE) of these abnormal neovessels could relieve pain and symptoms in patients with upper limb joint pain refractory to conventional treatment. This study aims to investigate the efficacy and safety of TAE in treating chronic pain of shoulder and elbow joints that have been resistant to other treatments. Using six databases, a systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The primary outcome involved changes in the visual analogue scale (VAS) after TAE; while secondary outcomes involved comparing other parameters where relevant. Average VAS decreased from baseline, then at 1 day, 1 week, 1 month, 3 months, 4 months, 6 months, 1 year, 2 years and 44 months (7.5 at baseline vs. 4.7, 4.3, 3.4, 2.1, 2.5, 1.2, 0.7, 1.1 and 0.1, respectively). Average Quick-DASH scores decreased from baseline, then at 1, 3 and 6 months (61.3 at baseline vs. 30.6, 19.3 and 6.9, respectively). Minor adverse events were reported in 27/143 (18.9%) patients, where they resolved spontaneously or with oral analgesia. TAE is a possible treatment option for refractory shoulder and elbow joint pain; however, randomised controlled trials are still required.

Influence of conventional versus unidirectional barbed suture on leakage pressures in canine vesicourethral anastomosis: An ex-vivo study

OBJECTIVE

To compare leakage pressures of vesicourethral anastomosis (VUA) performed with conventional and unidirectional barbed sutures in canine cadaveric tissue.

STUDY DESIGN

Experimental, ex-vivo, randomized study.

ANIMALS

A total of 24 male canine bladders with the urethra.

METHODS

Specimens after prostatectomy were randomly divided into a unidirectional barbed suture (UBS) or a conventional suture (C) group. For the UBS group, the VUA was performed with 4-0 unidirectional barbed sutures. For the C group, the VUA was performed with 4-0 monofilament absorbable suture. The VUA was completed with two simple continuous sutures. Surgical time, leakage pressure, site of leakage, and the number of suture bites were recorded.

RESULTS

The median suturing time was 12.70 minutes (range: 7.50-16.10 min) for the UBS group and 17.30 minutes (range: 14.00-21.30 min) for the C group (p < .0002). The median leakage pressure was 8.60 mmHg (range: 5.00-17.20 mmHg) for the UBS group and 11.70 mmHg (range: 6.00-18.50 mmHg) for the C group (p = .236). The median number of suture bites was 14 (range:11-27) for the UBS group and 19 (range:17-28) for the C group (p = .012).

CONCLUSION

Unidirectional barbed suture does not statistically affect the acute leakage pressure of VUA in normal cadaveric specimen. It resulted in a shorter surgical time and fewer suture bite placements.

CLINICAL SIGNIFICANCE

A urinary catheter will still be required when a unidirectional barbed suture is used to complete a VUA in dogs to prevent extravasation of urine in the postoperative period.

Boosting selectivity towards formate production using CuAl alloy nanowires by altering the CO2 reduction reaction pathway

Understanding the fundamentals behind an electrocatalyst's selectivity enables the ability to steer product formation. Herein, we study Cu nanowires doped with a small amount of Al (12%) for CO₂R, which enhances formate production by 16.9% over pure Cu nanowires. Density functional theory calculations and COR were employed to posit the preference of the formate formation pathway as a result of the Al doping.

Shear bond strength of orthodontic brackets bonded to a new version of zirconium all ceramic restoration: An in vitro comparative study

Objectives

Esthetic restorations such as monolithic zirconia crowns are highly requested for adults nowadays. Bonding orthodontic braces on this type of material became a challenge for orthodontists, because of the special surface treatment needed. This study aims to assess the shear bond strength (SBS) of metal, and ceramic brackets bonded on two types of zirconia ceramics, surface roughness (SR) after different surface treatments for their surfaces, and adhesive remnant index (ARI).

Materials and methods

Brackets' base surface area (BSA) was scanned by an extra-oral scanner, then measured. The doubled labial surface of monolithic zirconia crowns (n = 30) and monolithic high translucent zirconia crowns (n = 30) were prepared and each was divided into three groups (n = 10) depending on surface treatment (hydrofluoric acid etching, no treatment, and rocatec airborne abrasion). Extracted lower central incisors (n = 20) were prepared. Each of them was divided into two subgroups depending on the type of bracket bonded on their surfaces (metal and ceramic). The SR, SBS, and ARI were assessed.

Statistical analysis used

Tests used are independent-samples t-test, Fisher's exact test, One-Way ANOVA, and Kruskal-Wallis test.

Results

The highest SBS and SR were observed in Enamel/Metal and Zirconia/Metal/Rocatec subgroups, respectively.

Conclusion

Adequate bond strength could be obtained with the high translucent zirconia group if bonded with ceramic or metal brackets even if no treatment was used.

Clinical significance

A proportion of simulation was done like practicing inside the dental clinic to reach the best results regarding the adhesion strength of orthodontic brackets.

Utility of CYP2D6 copy number variants as prognostic biomarker in localized anal squamous cell carcinoma

BACKGROUND

Anal squamous cell carcinoma (ASCC) is an infrequent tumor whose treatment has not changed since the 1970s. The aim of this study is the identification of biomarkers allowing personalized treatments and improvement of therapeutic outcomes.

METHODS

Forty-six paraffin tumor samples from ASCC patients were analyzed by whole-exome sequencing. Copy number variants (CNVs) were identified and their relation to disease-free survival (DFS) was studied and validated in an independent retrospective cohort of 101 ASCC patients from the Multidisciplinary Spanish Digestive Cancer Group (GEMCAD). GEMCAD cohort proteomics allowed assessing the biological features of these tumors.

RESULTS

On the discovery cohort, the median age was 61 years old, 50% were males, stages I/II/III: 3 (7%)/16 (35%)/27 (58%), respectively, median DFS was 33 months, and overall survival was 45 months. Twenty-nine genes whose duplication was related to DFS were identified. The most representative was duplications of the CYP2D locus, including CYP2D6, CYP2D7P, and CYP2D8P genes. Patients with CYP2D6 CNV had worse DFS at 5 years than those with two CYP2D6 copies (21% vs. 84%; p < .0002, hazard ratio [HR], 5.8; 95% confidence interval [CI], 2.7-24.9). In the GEMCAD validation cohort, patients with CYP2D6 CNV also had worse DFS at 5 years (56% vs. 87%; p = .02, HR = 3.6; 95% CI, 1.1-5.7). Mitochondria and mitochondrial cell-cycle proteins were overexpressed in patients with CYP2D6 CNV.

CONCLUSIONS

Tumor CYP2D6 CNV identified patients with a significantly worse DFS at 5 years among localized ASCC patients treated with 5-fluorouracil, mitomycin C, and radiotherapy. Proteomics pointed out mitochondria and mitochondrial cell-cycle genes as possible therapeutic targets for these high-risk patients.

PLAIN LANGUAGE SUMMARY

Anal squamous cell carcinoma is an infrequent tumor whose treatment has not been changed since the 1970s. However, disease-free survival in late staged tumors is between 40% and 70%. The presence of an alteration in the number of copies of CYP2D6 gene is a biomarker of worse disease-free survival. The analysis of the proteins in these high-risk patients pointed out mitochondria and mitochondrial cell-cycle genes as possible therapeutic targets. Therefore, the determination of the number of copies of CYP2D6 allows the identification of anal squamous carcinoma patients with a high-risk of relapse that could be redirected to a clinical trial. Additionally, this study may be useful to suggest new treatment strategies to increase current therapy efficacy.

AVOIDable medical errors in invasive procedures: Facts on the ground - An NHS staff survey

BACKGROUND

Never Events represent a serious problem with a high burden on healthcare providers' facilities. Despite introducing various safety checklists and precautions, many Never Events are reported yearly.

OBJECTIVE

This survey aims to assess awareness and compliance with the safety standards and obtain recommendations from the National Health Service (NHS) staff on preventative measures.

METHODS

An online survey of 45 questions has been conducted directed at NHS staff involved in invasive procedures. The questions were designed to assess the level of awareness, training and education delivered to the staff on patient safety. Moreover, we designed a set of focused questions to assess compliance with the National Safety Standards for Invasive Procedures (NatSSIPs) guidance. Open questions were added to encourage the staff to give practical recommendations on tackling and preventing these incidents. Invitations were sent through social media, and the survey was kept live from 20/11/2021 to 23/04/2022.

RESULTS

Out of 700 invitations sent, 75 completed the survey (10.7%). 96% and 94.67% were familiar with the terms Never Events and near-miss, respectively. However, 52% and 36.49% were aware of National and Local Safety Standards for Invasive procedures (NatSSIPs-LocSSIPs), respectively. 28 (37.33%) had training on preventing medical errors. 48 (64%) believe that training on safety checklists should be delivered during undergraduate education. Fourteen (18.67%) had experiences when the checklists failed to prevent medical errors. 53 (70.67%) have seen the operating list or the consent forms containing abbreviations. Thirty-three (44%) have a failed counting reconciliation algorithm. NHS staff emphasised the importance of multi-level checks, utilisation of specific checklists, patient involvement in the safety checks, adequate staffing, avoidance of staff change in the middle of a procedure and change of list order, and investment in training and education on patient safety.

CONCLUSION

This survey showed a low awareness of some of the principal patient safety aspects and poor compliance with NatSSIPs recommendations. Checklists fail on some occasions to prevent medical errors. Process redesign creating a safe environment, and enhancing a safety culture could be the key. The study presented the recommendations of the staff on preventative measures.

Common preventable errors in hand surgery: Analysis of NHS never events data and a proposed safety checklist

BACKGROUND

Hand surgical procedures are common interventions in elective and emergency settings. The complex nature of the injuries and management by multiple specialities could be a potential source of medical errors and never events (NEs). Awareness of the common NEs could potentially help prevent their occurrence in the future.

OBJECTIVE

To analyse the NHS England database to identify the common NEs in hand surgery and present a simple, practical safety checklist for hand surgery.

METHODS

The NHS NEs database from 2012 to 2021 has been analysed to identify the common hand surgery-related never events. We identified the common categories and themes within. Our theme development process is based on anatomical considerations and the nature of the incidents. Additionally, we designed a simple Safety Checklist for hand surgery.

RESULTS

We identified a total of 3742 never events with 50 incidents related to hand surgery, representing (1.3%). Wrong-site surgery was the commonest category (n = 30), representing 60% of the hand surgery-related NEs. We identified seven different themes under wrong-site surgery. Wrong finger or digit surgery was the commonest theme, with 17 reported incidents representing 57% of wrong-site surgeries. This is followed by five wrong digits injections and three wrong k wire placements representing 16.6% and 10%, respectively. The second most common category was wrong incisions (n = 15), representing 30%; 13 patients had wrong finger incisions. Two patients had carpal tunnel incisions before surgeons realised that the procedures were for trigger finger release. The third category included four wrong procedures, with two incidents of carpal tunnel release instead of trigger finger operation or Dequervain tendon release. Finally, one patient had an injection for carpal tunnel intended for another patient.

CONCLUSION

Hand surgery-related NEs represent a small fraction (1.3%) of all NEs within the NHS database. We identified 50 hand surgery-related NEs arranged into 14 different themes. Additionally, we proposed a hand surgery-specific safety checklist to reduce the incidence of these incidents in the future.

Biomarkers of caspofungin resistance in Candida albicans isolates: A proteomic approach

Candida albicans is a clinically important polymorphic fungal pathogen that causes life-threatening invasive infections in immunocompromised patients. Antifungal therapy failure is a substantial clinical problem, due to the emergence of an increasing number of drug-resistant isolates. Caspofungin is a common antifungal drug, often used as first-line therapy that inhibits cell wall β-(1,3)-glucan synthesis. In this work, the cell surface of different echinocandin-resistant C. albicans clinical isolates was compared with sensitive isolates and their responses to echinocandin treatment analyzed. Proteomic analysis detected changes in the repertoire of proteins involved in cell wall organization and maintenance, in drug-resistant strains compared to susceptible isolates and after incubation with caspofungin. Moreover, an interaction network was created from the differential expression results. Our findings suggest drug resistance may involve not only a different cell wall architecture, but also a different response to drugs.

Description of the technique for laparoscopic radical prostatectomy in canine cadavers: 2D vs. 3D camera

OBJECTIVE

To describe the technique of laparoscopic radical prostatectomy in canine cadavers.

STUDY DESIGN

Cadaveric study.

ANIMALS

8 canine cadavers.

METHODS

Specimens were randomly divided into a 2D or 3D group. The vesicourethral anastomosis (VUA) was performed with 5 mm laparoscopic needle holders. A unidirectional barbed suture was used to complete the VUA with two simple continuous suture patterns. The number of stitches placed, the patency of the anastomosis, and the distance between the VUA and the ureters were recorded.

RESULTS

Four dogs were entered into each group. The prostatectomy was completed in each dog following the same technique. VUA were completed with nine stitches (range: 8-10 stitches) for the 2D group and ten stitches (range: 9-11 stitches) for the 3D group (p<0.176). All the stitches were placed full thickness. The VUA was patent in each case. The left ureter was 1.05 cm (range: 0.5 to 1.1cm) from the VUA in the 2D group and 1.8 cm (range: 1.3-1.8 cm) for the 3D group (p< 0.025). The right ureter was 1.5 cm (range: 1 to 2 cm) from the VUA in the 2D group and 1.75 cm (range: 1.3-2 cm) for the 3D group (p< 0.55).

CONCLUSION

Laparoscopic radical prostatectomy can be performed with a 2D or a 3D camera in canine cadavers. The 3D camera results in more accurate placement of the sutures since they were placed further away from the left ureter.

CLINICAL SIGNIFICANCE

Radical prostatectomy with laparoscopy should be considered for dogs.

Comparison of leakage pressures of vesicourethral anastomosis performed with intracorporeal suturing in a simulator and conventional suturing ex vivo in canine cadaveric tissue

OBJECTIVE

To compare conventional and intracorporeal vesicourethral anastomosis (VUA) in canine cadaveric tissue.

STUDY DESIGN

Cadaveric ex vivo study.

STUDY POPULATION

Twenty-eight canine bladders with urethra.

METHODS

Specimens after prostatectomy were randomly divided into intracorporeal (I) group or conventional (C) group. For the I group, VUA was performed in a simulator with laparoscopic needle holders and telescope. For the C group, the anastomosis was performed in vitro with standard instruments. The VUA was performed with 4-0 monofilament absorbable suture and was completed with two simple continuous sutures. Surgical time, leakage pressure, site of leakage, and number of suture bites were recorded.

RESULTS

Fourteen samples were entered in each group. The dorsal side of the anastomosis was initially performed, followed by the ventral side. The median suturing time was 30.8 minutes (range, 19.3-39.2) for the I group and 17.3 minutes (range, 9.2-21.3) for the C group (P < .0001). The median leakage pressure was 10.9 mm Hg (range, 4.1-29.7) for the I group and 10.8 mm Hg (range, 6.2-18.5) for the C group (P = .94). The median number of stitches was 20 (range, 14-26) for the I group and 19 (range, 11-28) for the C group (P = .96). The distribution of the site of leakage was similar between groups (P = .381).

CONCLUSION

Vesicourethral anastomosis can be performed with leakage pressures similar to intracorporeal and conventional suturing.

CLINICAL SIGNIFICANCE

This study represents the first step toward laparoscopic radical prostatectomy in dogs.

POS1117 SAFETY AND EFFICACY OF ADIPOSE-DERIVED MESENCHYMAL STEM CELLS FOR OSTEOARTHRITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background

Osteoarthritis (OA) is a debilitating joint disorder affecting articular cartilages and subchondral bones, prompting synovial membrane irritation and inflammation (1). Nowadays, knee OA can be treated either by surgical or non-surgical approaches, while the Osteoarthritis Research Society International (OARSI) suggested pharmacological medications joined with other functional approaches such as exercise, joint inflammation instructions, and weight reduction (2), yet most of them exhibit modest safety and efficacy (3). Mesenchymal stem cells (MSCs) have been well-known in regenerative medicine for their wide differentiation capacity. Moreover, MSCs can be derived from various sources (4); however, Adipose-derived mesenchymal stem cells (ADMSCs) are easiest to assemble for clinical use with higher isolation yields (4).

Objectives

This study investigated the potential and regenerative capacity of adipose-derived mesenchymal stem cells (ADMSCs) for osteoarthritis (OA).

Methods

We created a search strategy and applied it to six databases. After screening the records for eligibility, we identified and evaluated the risk of bias in both the randomized and non-randomized research studies. Then, data were extracted and implemented into single-arm and double-arm analyses

Results

16 studies with 469 patients were included. We found a significant improvement in the quality of life (QOL) among the three doses subgroups (high, medium, and low doses) which was estimated by the SF-36 scores after a year of follow up (low dose: Mean (M) -23.991; p = 0.000; medium dose: M -15.96; p = 0.000; high dose: M -19.306, p = 0.000). Furthermore, we noticed a significant decrease in pain as estimated by the numeric pain rating scale (NPRS) after three months of follow-up with no significant difference between the low and medium doses (low dose: M -3.119; p = 0.002; medium dose; M -2.17; p = 0.000).

Our double-arm analyses illustrated significant pain reduction in the ADMSCs group over the control after 12 months as estimated by WOMAC pain subscore (Mean difference (MD) -1.85, p =0.03); moreover, The knee functions and activity levels improved significantly among the low dose group as measured by the WOMAC physical function and stiffness subscales after six months (M -23.797; p = 0.001; M -10.249; p = 0.009, respectively) and the KOOS scores after 12 months (p ≤ 0.007 for all KOOS subscales). No significant adverse events were observed in the ADMSCs injections group (Event rate (ER) p = 0.001).

Conclusion

Although ADMSCs were associated with significant reductions in pain scores, improvements in QOL score and knee functions, and achieving disease modification in patients with OA, they did not significantly differ from the control. Therefore, implementing ADMSCs in routine clinical practice needs more studies with large sample sizes, longer follow-up periods.

References

[1]Morille M, Toupet K, Montero-Menei CN, Jorgensen C, Noël D. PLGA-based microcarriers induce mesenchymal stem cell chondrogenesis and stimulate cartilage repair in osteoarthritis. Biomaterials. 2016 May; 88:60–9

[2]Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthr Cartil. 2019;27(11):1578–89

[3]Abraham NS, El-Serag HB, Hartman C, Richardson P, Deswal A. Cyclooxygenase-2 selectivity of non-steroidal anti-inflammatory drugs and the risk of myocardial infarction and cerebrovascular accident. Aliment Pharmacol Ther. 2007;25(8):913–24

[4]Lv FJ, Tuan RS, Cheung KMC, Leung VYL. Concise review: The surface markers and identity of human mesenchymal stem cells. Vol. 32, Stem Cells. Wiley-Blackwell; 2014. p. 1408–19.

Disclosure of Interests

None declared

Pycnogenol a promising remedy for diabetic keratopathy in experimentally induced corneal alkali burns in diabetic rats

AIM

This study aimed to investigate the efficiency of topically applied pycnogenol (PYC) in healing the standardized alkaline corneal ulcer in diabetic and normal rats.

MATERIALS AND METHODS

The corneal alkali-burn injury (CA-I) model was unilaterally developed in Wistar rats by filter paper saturated with 0.01 M of NaOH and touching the eyes for 45 s. Rats were divided into four groups: Normal control (NC), normal PYC (NPYC), diabetic control (DC), and diabetic PYC (DPYC). Both NPYC and DPYC groups were daily treated with PY eye drops three times, whereas NC and DC ones were treated with ordinary saline for six successive days.

RESULTS

The wound healing of corneal epithelial was improved in the NPYC group compared to the NC group. Meanwhile, it was significantly improved (P < 0.05) in the DPYC group than in the DC group. Histological examination revealed that corneal re-epithelialization was more accomplished in the DPYC group than in the DC group. In addition, the inflammatory cells were augmented in the DC group more than those in the DPYC one.

CONCLUSION

The findings obtained revealed the efficiency of PYC for enhancing the corneal re-epithelialization and reducing the inflammatory reaction post alkali burn in rats, and thus it could be beneficially valuable as a treatment for the diabetic keratopathy.

Impact of Cotadutide drug on patients with type 2 diabetes mellitus: a systematic review and meta-analysis

BACKGROUND

The food and drug administration approved many drugs to treat diabetes mellitus, but those drugs do not have a noticeable effect on weight management. Recently, glucagon-like peptide 1 agonist known as Cotadutide serve as a potent drug in treating type 2 diabetes by reducing blood glucose levels and body weight indices. This study aimed to explore the safety and efficacy of Cotadutide as a treatment for type 2 diabetes individuals.

METHODS

A comprehensive literature search was done on different databases, including PubMed, Scopus, Web of Science, and Cochrane Library to capture all relevant articles using an established search strategy. The inclusion criteria were randomized controlled trials that assessed the safety and efficacy of Cotadutide versus placebo or any anti-diabetes drugs in patients with type 2 diabetes mellitus and a BMI between 22 kg/m2 and 40 kg/m2. We conducted the analysis using Revman software version 5.4.

RESULTS

We found 663 relevant articles. From which nine studies were included and subjected to qualitative analysis and eight for quantitative analysis. The pooled effect showed that Cotadutide was better than placebo in reducing body weight (kg) (Mean difference (MD) = 3.31, p < 0.00001), glycated hemoglobin (HbA1c) (MD = 0.68, p > 0.00001), glucose area under the plasma concentration curve (AUC [0-4 h]) (MD = 30.15, p < 0.00001), and fasting plasma glucose over time (mg/dl) (MD = 31.31, p < 0.00001).

CONCLUSION

Cotadutide is safe and effective in reducing plasma glucose levels, HbA1c and body weight in individuals with type 2 diabetes.

TRIAL REGISTRATION

The study protocol was registered on PROSPERO (CRD: CRD42021257670 ).

Impact of Cotadutide Drug on Obese Individuals with Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis.. [DOI: 10.21203/rs.3.rs-1236048/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background: The food and drug administration approved many drugs to treat diabetes mellitus, but those drugs do not have a noticeable effect on weight management. Recently, glucagon-like peptide 1 agonist known as Cotadutide was estimated to serve as a potent drug in treating type 2 diabetes by reducing blood glucose levels and body weight indices. This study aimed to explore the safety and efficacy of Cotadutide as a treatment for type 2 diabetes individuals.Methods: A comprehensive literature search was done on different databases, including PubMed, Scopus, Web of Science, and Cochrane Library to capture all relevant articles using an established search strategy. The inclusion criteria were randomized controlled trials that assessed the safety and efficacy of Cotadutide versus placebo or any anti-diabetes drugs in obese and overweight people with type 2 diabetes mellitus. Data analysis was accomplished using Revman 5.4 software.Results: We found 663 relevant articles. From which nine studies were included and subjected to qualitative analysis and eight for quantitative analysis. The pooled effect showed that Cotadutide was better than placebo in reducing body weight (Mean difference (MD) = 3.31, p > 0.00001), glycated hemoglobin (HbA1c ) (MD = -0.68, p > 0.00001), glucose area under the plasma concentration curve (AUC [0-4h]) (MD = 30.15, p > 0.00001), and fasting plasma glucose over time (mg/dl) (MD = 31.31, p > 0.00001).Conclusion: Cotadutide is safe and effective in reducing blood glucose levels and body weight in individuals with type 2 diabetes.Study protocol registration: The study protocol was registered on PROSPERO (CRD: CRD42021257670).

SP6.1.3 Readmissions After Cholecystectomy in a Tertiary UK Center: Incidence, Causes and Burden

Context

Although cholecystectomy is a widely performed procedure, postoperative readmissions place a heavy burden on healthcare facilities.

Aims

This study assesses the incidence, causes and burden of 30-day readmissions after cholecystectomy in a tertiary UK center.

Settings and Design

University Hospital, Retrospective Cohort Study.

Methods and Material

Information was obtained from our prospectively maintained database and hospital’s computerised records.

Statistical analysis

The encounters are expressed in numbers and percentages. The hospital stay, BMI and age are expressed in mean, standard deviation (SD), min-max and median. Microsoft Excel® was used to calculate the means, SD, min-max and median.

Results

Out of the 1,140 cholecystectomies performed over this time, there were 75 true readmissions and 29 revisits; thus, the actual readmission rate is 6.58%. Non-specific abdominal pain ± deranged liver function tests (LFT) is the most common cause of readmission at (38;36.54%) cases, followed by (18;17.31%) wound infections and (12;11.54%) collections/bile leaks/abscess. This costed the center 93 scans; 30 procedures and 295 days of hospital stay.

Conclusions

Non-specific abdominal pain ± deranged LFT is the most common cause of readmissions/revisits in the center. Readmissions after a cholecystectomy are a significant encumbrance.

EP.WE.28Routine histopathology examination of the sleeved stomach after sleeve gastrectomy - significance and comparison with preoperative endoscopy

Background

Sleeve gastrectomy (SG) is one of the most commonly performed bariatric procedures. However, the available literature on histological examination of the resected sleeved stomachs is widely inconsistent. This study aimed at assessing the histopathological findings after SG performed in our center compared to the routinely performed preoperative esophagogastroduodenoscopy (OGD) and the intraoperative findings.

Material and methods

We conducted a retrospective cohort study using the bariatric unit database of all patients who had SG procedures from June 2007 to December 2019.

Results

Out of the 620 SG performed, there were 219 patients with complete data, including preoperative OGD reports, operative notes, and postoperative histopathology reports. We found normal specimens in 43.83% (n = 96) and evidence of inflammation in 50.68% (n = 111) of cases. There were 10 (4.56%) specimens with evidence of inflammation and other lesions and two (0.91%) specimens with lesions only. Twenty-five patients had inflammation, and 10 had lesions on preoperative OGD with negative histopathology reports.

Conclusion

Routine histopathology examination after SG does not change the management, and preoperative OGD can detect inflammatory changes and lesions, which could have been missed with histology analysis only.

1224 Effect of Distal Brachioradialis Release During Open Reduction and Internal Fixation of Distal Radius Fractures

Aim

The study aim is to determine the impact of the brachioradialis release during the open reduction and internal fixation of distal radius fractures using a volar approach

Method

Total of 40 patients was treated with Open reduction and internal fixation of intra articular distal radius fractures. Distal release of Brachioradialis was performed to 19 patients, while 21 patients had no release of BR during surgery. Radiological parameters including Radial height, Inclination and volar tilt were measured 1 month post-operatively, while functional outcomes assessed with modified mayo wrist scores and Quick-dash scores

Results

There is no significant difference between age, gender and pre-operative conditions indicating that both the groups (BR release and without BR release) have similar demographic characteristics. Pre-operatively both groups had disturbed values for radial height, inclination, and volar tilt. Postoperatively, the mean of both groups was closer to normal ranges for radial inclination and volar tilt; however, radial height was the least adequately restored radiological parameter for both study group (11.54 ± 1.35 for BR group versus 10.21 ± 2.29 for Non-BR group). Pain, functional status, and grip strength had similar values in both groups whereas BR group showed higher ROM and DASH scores with P values of 0.048 and 0.025 respectively.

Conclusions

Brachioradialis release enhances the reduction and operative fixation, restoring the necessary radiological and subsequent functional parameters in distal radius fractures with reported no complications.

37 Accuracy of Venous Thromboembolism Risk Assessments in The Trauma and Orthopaedics Wards of The Gloucestershire Royal Hospital

Introduction

Venous thromboembolism (VTE) risk assessment is crucial for patients undergoing orthopaedic surgery. An accurate risk assessment leads to patient stratification into risk groups for appropriate VTE prophylaxis.

Aim

To evaluate the accuracy of VTE risk assessment in the orthopaedic wards of the Gloucestershire Royal Hospital (GRH).

Method

We used the drug charts available on the wards of GRH which follow the NICE Clinical guideline [CG92]. We identified four variables out of the 19 questions that assess thrombosis risk: age, BMI, presence of infection/inflammatory conditions and surgery to the lower limb. Drug charts from the 10th of November to the 15th of November 2020 were assessed for completeness and accuracy. The number and accuracy of drug charts with VTE risk assessments on admission and 24 hours after admission were assessed.

Results

Fifty-seven drug charts with VTE risk assessments were identified over this period. Only 66.7% of VTE risk assessments were complete on admission and 21.1% were complete 24 hours after admission. Accuracy of assessment on admission was 92.1%, 86.1%, 81.6% and 79.0% for age, BMI, categories of surgery to the lower limbs and presence of inflammation, respectively. Accuracy of assessment at 24 hours was 91.7%, 83.3%, 50.0% and 91.7% for age, BMI, surgery to the lower limbs and presence of infection/inflammation, respectively.

Conclusions

VTE risk assessment upon admission and at 24 hours is relatively low and needs improvement. A further enquiry is necessary to evaluate the reasons for defective VTE assessment.

246 FRActure Clinic Treatment: a sURvey of patient Experience (FRACTURE)

Aim

BOAST guidelines on fracture clinics suggest a standard of care that all patients with significant injury should expect to receive in a Trauma & Orthopaedics outpatient setting in the United Kingdom.

Method

A prospective analysis of 358 patients presenting to fracture clinic at Gloucestershire Hospitals NHS Foundation Trust from September to November 2020. Patients completed an anonymous questionnaire based on BOAST guidelines.

Results

Most patients received a written management plan (82%), but only some received a leaflet (36%) and definite information about their procedure (47%). Most patients felt a leaflet (72%) and information about procedures (87%) would be useful. Patients were generally seen early or within 30 minutes of their appointment time (77%), but some waited more than 30 minutes (23%). Most patients found X-rays easily (91%) and rated staff (97%) and fracture clinic experience (93%) as very good or good. Comments included noting an efficient and friendly service, with suggestions on providing more information on waiting times and procedures to be performed.

Conclusions

Our study showed high patient satisfaction with fracture clinic and particularly positive feedback about staff. Areas of improvement include providing more leaflets and information about practical procedures. Following this audit, we will produce leaflets on common conditions and record videos on common procedures such as application of casts, splints and removal of k-wires or sutures, which can be accessed by patients prior to their appointment. The audit could be repeated at a regional or national level to help centres assess the level of care provided.

Thoracoscopic treatment of persistent right aortic arch in dogs with and without one lung ventilation

OBJECTIVE

To evaluate thoracoscopic treatment of persistent right aortic arch (PRAA) in dogs with and without the use of one lung ventilation (OLV).

STUDY DESIGN

Retrospective cohort study.

ANIMALS

Twenty-two (client-owned and shelter) dogs diagnosed with PRAA.

METHODS

Medical records were reviewed retrospectively and intraoperative and immediate postoperative data were compared between dogs that underwent thoracoscopic treatment of PRAA with (OLV+) and without (OLV-) OLV.

RESULTS

Ten of the 12 dogs in the OLV+ group and 7/10 dogs in the OLV- group had their left ligamentum arteriosum successfully ligated during thoracoscopy. Median surgical time, surgery complications, anesthesia complications, and rate of conversion to an open thoracotomy due to limited visualization or surgical complications were similar between the two groups.

CONCLUSION

Thoracoscopic treatment of PRAA can be performed with or without OLV. Surgical time, intraoperative complications, and conversion rates were similar between dogs that underwent thoracoscopic treatment of PRAA with and without OLV. OLV may not have contributed to improved visualization in this group of dogs.

CLINICAL SIGNIFICANCE (OR IMPACT)

The use of OLV is safe during thoracoscopic treatment of PRAA. OLV did not appear to provide significant benefits in this case series and thoracoscopic treatment of PRAA in dogs may be performed successfully with or without the use of OLV.

Ex vivo comparison of hand-sutured versus circular stapled anastomosis in canine large intestine

OBJECTIVE

To compare leakage pressures of colonic anastomoses performed with circular staplers to conventional hand-sewn techniques in dogs.

STUDY DESIGN

Ex-vivo study.

ANIMALS

Colon from 11 canine cadavers.

METHODS

Thirty-two colonic anastomoses were performed. Four segments from each colon were randomly assigned to one of four techniques: hand-sewn colonic anastomoses performed with 4-0 glycomer 631 (G) and 4-0 barbed glycomer 631 (BG), and circular stapled colonic anastomoses using 4.8 mm End-to-End Anastomosis (EEA C4.8mm) and 3.5 mm End-to-End Anastomosis (EEA C3.5mm), 21 mm diameter circular staples in cadaveric canine colon. Leakage pressure was defined as the pressure at which dye-containing solution was first observed to leak from the anastomosis site.

RESULTS

Leakage pressures were 49.5 mmHg (range:16-72) in group G, 45.5 mmHg (range:19-80) in group BG, 5.3 mmHg (range:0-31) in group C3.5mm, and 29.5 mmHg (range:23-50.3) in group C4.8mm. Anastomoses leaked at lower pressures when stapled rather than hand-sewn (C4.8mm-G p = .0313, C4.8mm-BG p = .0131, C3.5mm-G p = .0469, C3.5mm-BG p = .0313). Two of the C3.5mm constructs leaked immediately after saline infusion with 4/6 leaking at <5.3 mmHg.

CONCLUSION

End-to-end colonic anastomoses closed with circular stapler leaked at lower pressures than hand-sutured anastomoses. Use of the EEA stapler with a staple height of 3.5 mm did not result in safe colonic anastomoses.

CLINICAL SIGNIFICANCE

These results provide evidence to support hand-suturing colonic anatomoses with G and BG in dogs. The 4.8 mm staples may be considered in anatomical locations difficult to reach.

Self-assembly of millimeter-scale magnetic particles in suspension

Self-assembly is ubiquitous at all scales in nature. Most studies have focused on the self-assembly of micron-scale and nano-scale components. In this study, we explore the self-assembly of millimeter-scale magnetic particles in a bubble-column reactor to form 9 different structures. Two component systems (N-N and S-S particles) assemble faster than one-component systems (all particles have N-S poles) because they have more numerous bonding pathways. In addition, two-components add control to process initiation and evolution, and enable the formation of complex structures such as squares, tetrahedra and cubes. Self-assembly is collision-limited, thus, the formation time increases with the total number of bonds required to form the structure and the injected power. The dimensionless Mason number captures the interplay between hydrodynamic forces and magnetic interactions: self-assembly is most efficient at intermediate Mason numbers (the system is quasi-static at low Mason numbers with limited chances for particle interaction; on the other hand, hydrodynamic forces prevail over dipole-dipole interactions and hinder bonding at high Mason numbers). Two strategies to improve yield involve (1) the inclusion of pre-assembled nucleation templates to prevent the formation of incorrect initial structures that lead to kinetic traps, and (2) the presence of boundaries to geometrically filter unwanted configurations and to overcome kinetic traps through particle-wall collisions. Yield maximization involves system operation at an optimal Mason number, the inclusion of nucleation templates and the use of engineered boundaries (size and shape).

SeqEditor: an application for primer design and sequence analysis with or without GTF/GFF files

MOTIVATION

Sequence analyses oriented to investigate specific features, patterns and functions of protein and DNA/RNA sequences usually require tools based on graphic interfaces whose main characteristic is their intuitiveness and interactivity with the user's expertise, especially when curation or primer design tasks are required. However, interface-based tools usually pose certain computational limitations when managing large sequences or complex datasets, such as genome and transcriptome assemblies. Having these requirments in mind we have developed SeqEditor an interactive software tool for nucleotide and protein sequences' analysis.

RESULT

SeqEditor is a cross-platform desktop application for the analysis of nucleotide and protein sequences. It is managed through a Graphical User Interface and can work either as a graphical sequence browser or as a fasta task manager for multi-fasta files. SeqEditor has been optimized for the management of large sequences, such as contigs, scaffolds or even chromosomes, and includes a GTF/GFF viewer to visualize and manage annotation files. In turn, this allows for content mining from reference genomes and transcriptomes with similar efficiency to that of command line tools. SeqEditor also incorporates a set of tools for singleplex and multiplex PCR primer design and pooling that uses a newly optimized and validated search strategy for target and species-specific primers. All these features make SeqEditor a flexible application that can be used to analyses complex sequences, design primers in PCR assays oriented for diagnosis, and/or manage, edit and personalize reference sequence datasets.

AVAILABILITYAND IMPLEMENTATION

SeqEditor was developed in Java using Eclipse Rich Client Platform and is publicly available at https://gpro.biotechvana.com/download/SeqEditor as binaries for Windows, Linux and Mac OS. The user manual and tutorials are available online at https://gpro.biotechvana.com/tool/seqeditor/manual.

SUPPLEMENTARY INFORMATION

Supplementary data are available at Bioinformatics online.

Antifungal susceptibility, genotyping, resistance mechanism, and clinical profile of Candida tropicalis blood isolates

Candida tropicalis is one of the major candidaemia agents, associated with the highest mortality rates among Candida species, and developing resistance to azoles. Little is known about the molecular mechanisms of azole resistance, genotypic diversity, and the clinical background of C. tropicalis infections. Consequently, this study was designed to address those questions. Sixty-four C. tropicalis bloodstream isolates from 62 patients from three cities in Iran (2014–2019) were analyzed. Strain identification, antifungal susceptibility testing, and genotypic diversity analysis were performed by MALDI-TOF MS, CLSI-M27 A3/S4 protocol, and amplified fragment length polymorphism (AFLP) fingerprinting, respectively. Genes related to drug resistance (ERG11, MRR1, TAC1, UPC2, and FKS1 hotspot9s) were sequenced. The overall mortality rate was 59.6% (37/62). Strains were resistant to micafungin [minimum inhibitory concentration (MIC) ≥1 μg/ml, 2/64], itraconazole (MIC > 0.5 μg/ml, 2/64), fluconazole (FLZ; MIC ≥ 8 μg/ml, 4/64), and voriconazole (MIC ≥ 1 μg/ml, 7/64). Pan-azole and FLZ + VRZ resistance were observed in one and two isolates, respectively, while none of the patients were exposed to azoles. MRR1 (T255P, 647S), TAC1 (N164I, R47Q), and UPC2 (T241A, Q340H, T381S) mutations were exclusively identified in FLZ-resistant isolates. AFLP fingerprinting revealed five major and seven minor genotypes; genotype G4 was predominant in all centers. The increasing number of FLZ-R C. tropicalis blood isolates and acquiring FLZ-R in FLZ-naive patients limit the efficiency of FLZ, especially in developing countries. The high mortality rate warrants reaching a consensus regarding the nosocomial mode of C. tropicalis transmission.

Oxidative stress in Strongylus spp. infected donkeys treated with piperazine citrate versus doramectin

Background:

Parasitic infection is one of the main problems in equidae, particularly donkeys.

Aim:

This study evaluated the oxidative stress in donkeys infected with Strongylus spp by determining the correlation between antioxidants levels; malondialdehyde (MDA), total antioxidant capacity (TAC), and the severity of parasitic infection. It also compared the therapeutic efficacy of piperazine citrate as an oral anthelmintic drug and Doramectin as an injectable one.

Methods:

The study was conducted on 40 donkeys naturally infected with Strongylus spp. These donkeys were divided into two groups (20 donkeys each) according to treatment; One group was treated with piperazine citrate (P_ipTG) and the other with doramectin (D_oraTG). Thorough clinical examination, hematological, biochemical, and parasitological assays were performed before (Day 0) and after treatment (Days 7, 14, 21, and 28). All data were statistically analyzed by independent-sample t-test or paired t-test.

Results:

In both groups, mean values of MDA were significantly reduced, while those of TAC were significantly elevated after treatment on days 7, 14, 21, and 28. These significant changes were reported after treatment between P_ipTG and D_oraTG in favor of D_oraTG. Serum concentrations of MDA were significantly reduced, while those of TAC were significantly elevated for D_oraTG treatment group when their values were compared with those of P_ipTG either on days 7, 14, 21, or 28. Significant correlations were reported in P_ipTG and D_oraTG. Negative significant correlations were reported between fecal egg count (FEC) and each of whole blood picture indices (RBCS, Hb, and PCV), serum TAC and faecal egg count reduction percentage FECR%. A positive correlation was seen between FEC and MDA. MDA exhibited a negative correlation with both blood picture and TAC; hence, TAC was positively correlated with these blood picture indices in both P_ipTG and D_oraTG. In P_ipTG, anthelmintic resistance (R) was present on days 7 and 14, while it was suspected (S) at day 21 then it was absent (N) at day 28. In D_oraTG, anthelmintic resistance was suspected (S) on day 7, then it became absent (N) on days 14, 21, and 28 post therapy.

Conclusion:

The immunological status of the infected donkeys had greatly improved after treatment. The therapeutic efficacy of injectable doramectin was more efficient than that of oral piperazine citrate in Strongylus spp. infected donkeys.

Role of insulin, insulin sensitivity, and abomasal functions monitors in evaluation of the therapeutic regimen in ketotic dairy cattle using combination therapy with referring to milk yield rates

Background:

Ketosis is one of the most critical metabolic disorders that occur in dairy cows after parturition due to negative energy balance around calving.

Aim:

The study evaluated a specific therapeutic regimen of ketosis in Holstein dairy cattle by using the combination therapy including hormones, corticosteroids, propylene glycol, and vitamin B12 as well as the use of milk yield rates, insulin, insulin sensitivity, and abomasal functions monitors as diagnostic biomarkers for the recovery of ketotic cows either pre-therapy (0 days) or post-therapy (7 and 14 days).

Methods:

This study was conducted on ketotic cattle (n = 20) belonged to different dairy farms in Cairo and Giza governorates, Egypt. The diseased cows were undergoing clinical and biochemical investigations for the estimation of serum insulin. Quantitative Insulin Sensitivity Check Index (RQUICKI) and abomasal functions monitor mainly serum levels of gastrin, pepsinogen, and chloride.

Results:

The milk production rates, cost: benefit analysis ratio, and benefit of the dairy farm in ketotic animals were significantly increased post-treatment. An improvement of insulin sensitivity was stated as serum insulin, and RQUICKI were remarkably increased in post-therapeutic ketotic cows. Monitors of the abomasal function revealed abomasal functions improvement through the significant elevation of blood gastrin and a substantial reduction in serum pepsinogen due to treatment.

Conclusion:

The study revealed high efficacy of the applied therapeutic strategy regime. It led to a high recovery rate and a very low relapse rate for ketosis. An improvement in milk yield rates, insulin sensitivity, and abomasal function monitors was reported. Hypoinsulinaemia was still reported, however, serum insulin was improved.

Clonal Candidemia Outbreak by Candida parapsilosis Carrying Y132F in Turkey: Evolution of a Persisting Challenge

As the second leading etiological agent of candidemia in Turkey and the cause of severe fluconazole-non-susceptible (FNS) clonal outbreaks, Candida parapsilosis emerged as a major health threat at Ege University Hospital (EUH). Evaluation of microbiological and pertinent clinical profiles of candidemia patients due to C. parapsilosis in EUH in 2019–2020. Candida parapsilosis isolates were collected from blood samples and identified by sequencing internal transcribed spacer ribosomal DNA. Antifungal susceptibility testing was performed in accordance with CLSI M60 protocol and ERG11 and HS1/HS2-FKS1 were sequenced to explore the fluconazole and echinocandin resistance, respectively. Isolates were typed using a multilocus microsatellite typing assay. Relevant clinical data were obtained for patients recruited in the current study. FNS C. parapsilosis isolates were recovered from 53% of the patients admitted to EUH in 2019–2020. Y132F was the most frequent mutation in Erg11. All patients infected with C. parapsilosis isolates carrying Y132F, who received fluconazole showed therapeutic failure and significantly had a higher mortality than those infected with other FNS and susceptible isolates (50% vs. 16.1%). All isolates carrying Y132F grouped into one major cluster and mainly recovered from patients admitted to chest diseases and pediatric surgery wards. The unprecedented increase in the number of Y132F C. parapsilosis, which corresponded with increased rates of fluconazole therapeutic failure and mortality, is worrisome and highlights the urgency for strict infection control strategies, antifungal stewardship, and environmental screening in EUH.

Readmissions after cholecystectomy in a tertiary UK centre: Incidence, causes and burden

Context

Although cholecystectomy is a widely performed procedure, post-operative readmissions place a heavy burden on healthcare facilities.

Aims

This study assesses the incidence, causes and burden of 30-day readmissions after cholecystectomy in a tertiary UK centre.

Settings and Design

This study was conducted at a university hospital, and the study design involves retrospective cohort study.

Materials and Methods

Information was obtained from our prospectively maintained database and hospital's computerised records.

Statistical Analysis

The encounters are expressed in numbers and percentages. The hospital stay, body mass index and age are expressed in mean, standard deviation (SD), min-max and median. Microsoft Excel® was used to calculate the means, SD, min-max and median.

Results

Out of the 1140 cholecystectomies performed over this time, there were 75 true readmissions and 29 revisits; thus, the actual readmission rate is 6.58%. Non-specific abdominal pain ± deranged liver function test (LFT) is the most common cause of readmissions/ revisits in (38; 36.54%) cases, followed by (18; 17.31%) wound infections and (12; 11.54%) collections/bile leaks/abscess. This cost the centre 93 scans, 30 procedures and 295 days of hospital stay.

Conclusions

Non-specific abdominal pain ± deranged LFT is the most common cause of readmissions/revisits in the centre. Readmissions after a cholecystectomy are a significant encumbrance.

The effect of particle shape on discharge and clogging

Granular flow is common across different fields from energy resource recovery and mineral processing to grain transport and traffic flow. Migrating particles may jam and form arches that span constrictions and hinder particle flow. Most studies have investigated the migration and clogging of spherical particles, however, natural particles are rarely spherical, but exhibit eccentricity, angularity and roughness. New experiments explore the discharge of cubes, 2D crosses, 3D crosses and spheres under dry conditions and during particle-laden fluid flow. Variables include orifice-to-particle size ratio and solidity. Cubes and 3D crosses are the most prone to clogging because of their ability to interlock or the development of face-to-face contacts that can resist torque and enhance bridging. Spheres arriving to the orifice must be correctly positioned to create stable bridges, while flat 2D crosses orient their longest axes in the direction of flowlines across the orifice and favor flow. Intermittent clogging causes kinetic retardation in particle-laden flow even in the absence of inertial effects; the gradual increase in the local particle solidity above the constriction enhances particle interactions and the probability of clogging. The discharge volume before clogging is a Poisson process for small orifice-to-particle size ratio; however, the clogging probability becomes history-dependent for non-spherical particles at large orifice-to-particle size ratio and high solidities, i.e., when particle–particle interactions and interlocking gain significance.

Recent Increase in the Prevalence of Fluconazole-Non-susceptible Candida tropicalis Blood Isolates in Turkey: Clinical Implication of Azole-Non-susceptible and Fluconazole Tolerant Phenotypes and Genotyping

Candida tropicalis is the fourth leading cause of candidemia in Turkey. Although C. tropicalis isolates from 1997 to 2017 were characterized as fully susceptible to antifungals, the increasing global prevalence of azole-non-susceptible (ANS) C. tropicalis and the association between high fluconazole tolerance (HFT) and fluconazole therapeutic failure (FTF) prompted us to re-evaluate azole susceptibility of C. tropicalis in Turkey. In this study, 161 C. tropicalis blood isolates from seven clinical centers were identified by ITS rDNA sequencing, genotyped by multilocus microsatellite typing, and tested for susceptibility to five azoles, two echinocandins, and amphotericin B (AMB); antifungal resistance mechanisms were assessed by sequencing of ERG11 and FKS1 genes. The results indicated that C. tropicalis isolates, which belonged to 125 genotypes grouped into 11 clusters, were fully susceptible to echinocandins and AMB; however, 18.6% of them had the ANS phenotype but only two carried the ANS-conferring mutation (Y132F). HFT was recorded in 52 isolates, 10 of which were also ANS. Large proportions of patients infected with ANS and HFT isolates (89 and 40.7%, respectively) showed FTF. Patients infected with azole-susceptible or ANS isolates did not differ in mortality, which, however, was significantly lower for those infected with HFT isolates (P = 0.007). There were significant differences in mortality (P = 0.02), ANS (P = 0.012), and HFT (P = 0.007) among genotype clusters. The alarming increase in the prevalence of C. tropicalis blood isolates with ANS and HFT in Turkey and the notable FTF rate should be a matter of public health concern.

CROSSMAPPER: estimating cross-mapping rates and optimizing experimental design in multi-species sequencing studies

Motivation

Numerous sequencing studies, including transcriptomics of host-pathogen systems, sequencing of hybrid genomes, xenografts, mixed species systems, metagenomics and meta-transcriptomics, involve samples containing genetic material from divergent organisms. A crucial step in these studies is identifying from which organism each sequencing read originated, and the experimental design should be directed to minimize biases caused by cross-mapping of reads to incorrect source genomes. Additionally, pooling of sufficiently different genetic material into a single sequencing library could significantly reduce experimental costs but requires careful planning and assessment of the impact of cross-mapping. Having these applications in mind we designed Crossmapper, the first to our knowledge tool able to assess cross-mapping prior to sequencing, therefore allowing optimization of experimental design.

Results

Using any combination of reference genomes, Crossmapper performs read simulation and back-mapping of those reads to the pool of references, quantifies and reports the cross-mapping rates for each organism. Crossmapper performs these analyses with numerous user-specified parameters, including, among others, read length, read layout, coverage, mapping parameters, genomic or transcriptomic data. Additionally, it outputs the results in highly interactive and publication-ready reports. This allows the user to perform multiple comparisons at once and choose the experimental setup minimizing cross-mapping rates. Moreover, Crossmapper can be used for resource optimization in sequencing facilities by pooling different samples into one sequencing library.

Availability and implementation

Crossmapper is a command line tool implemented in Python 3.6 and available as a conda package, allowing effortless installation. The source code, detailed information and a step-by-step tutorial is available at our GitHub page https://github.com/Gabaldonlab/crossmapper.

Supplementary information

Supplementary data are available at Bioinformatics online.

THU0491 HYALURONIC ACID INJECTION IN PLANTER FASCIITIS: CAN WE USE?

Background:

Plantar fasciitis is the most common cause of hind foot pain. Treatment is aimed at pain reduction and maintaining or improving function. Several types of injected materials are used including corticosteroids, hyaluronic acid and Platelet-rich plasma.

Objectives:

The aim of this study was to evaluate the efficacy of hyaluronic acid injection in comparison to corticosteroid injection for the treatment of degenerative plantar fasciitis.

Methods:

This study included forty patients with degenerative plantar fasciitis diagnosed according to clinical examination and ultrasound findings. They were divided into two groups. Group one included twenty patients who were injected with Methylprednisolone (MP). Group two included another twenty patients who were injected with hyaluronic acid (HA). Clinical assessment was done including morning heel pain, localized heel tenderness, patient assessment of heel pain using the numerical rating scale (NRS), Functional assessment using the Manchester-Oxford foot questionnaire (MOXFQ) and musculoskeletal ultrasound assessment including planter fascia thickness, echogenicity, power Doppler signals, erosions and calcification.

Patients were injected and a follow up was done at two and six weeks for each group.

Results:

The two groups MP &HA showed no significant baseline differences in clinical and sonographic variables, while they both significantly improved from baseline after two &six weeks injection (P<0.001).The MP group achieved a significant improvement in NRS, MOXFQ, plantar fascial thickness and echogenicity in the first follow up after two weeks better than the second follow up after six weeks (P<0.001). The HA group achieved significant improvement in NRS, MOXFQ, plantar fascial thickness and echogenicity in the second follow up after six weeks better than the first follow up after two weeks (P<0.001).

Over all, MP group had significant improvement clinically and sonographically than HA group after two weeks (P<0.001), while HA group had significant improvement clinically and sonographically in comparison with MP group after six weeks.

Conclusion:

Our study supports the use of a single injection of hyaluronic acid as therapy for plantar fasciitis in preference to methylprednisolone acetate injections, while MP offers short term improvement (after two weeks). HA injection offers better therapeutic advantages in the intermediate-term follow up (after six weeks). Moreover, it has a longer duration of action and enables better tissue healing and can therefore be used as an effective alternative treatment for plantar fasciitis.

Disclosure of Interests: :

None declared

Candida tropicalis is the most prevalent yeast species causing candidemia in Algeria: the urgent need for antifungal stewardship and infection control measures

Background

Despite being associated with a high mortality and economic burden, data regarding candidemia are scant in Algeria. The aim of this study was to unveil the epidemiology of candidemia in Algeria, evaluate the antifungal susceptibility pattern of causative agents and understand the molecular mechanisms of antifungal resistance where applicable. Furthermore, by performing environmental screening and microsatellite typing we sought to identify the source of infection.

Methods

We performed a retrospective epidemiological-based surveillance study and collected available blood yeast isolates recovered from the seven hospitals in Algiers. To identify the source of infection, we performed environmental screening from the hands of healthcare workers (HCWs) and high touch areas. Species identification was performed by API Auxa-Color and MALDI-TOF MS and ITS sequencing was performed for species not reliably identified by MALDI-TOF MS. Antifungal susceptibility testing followed CLSI M27-A3/S4 and included all blood and environmental yeast isolates. ERG11 sequencing was performed for azole-resistant Candida isolates. Microsatellite typing was performed for blood and environmental Candida species, where applicable.

Results

Candida tropicalis (19/66) was the main cause of candidemia in these seven hospitals, followed by Candida parapsilosis (18/66), Candida albicans (18/66), and Candida glabrata (7/66). The overall mortality rate was 68.6% (35/51) and was 81.2% for C. tropicalis-infected patients (13/16). Fluconazole was the main antifungal drug used (12/51); 41% of the patients (21/51) did not receive any systemic treatment. Candida parapsilosis was isolated mainly from the hands of HCWs (7/28), and various yeasts were collected from high-touch areas (11/47), including Naganishia albida, C. parapsilosis and C. glabrata. Typing data revealed interhospital transmission on two occasions for C. parapsilosis and C. glabrata, and the same clone of C. parapsilosis infected two patients within the same hospital. Resistance was only noted for C. tropicalis against azoles (6/19) and fluconazole-resistant C. tropicalis isolates (≥8 μg/ml) (6/19) contained a novel P56S (5/6) amino acid substitution and a previously reported one (V234F; 1/6) in Erg11p.

Conclusions

Collectively, our data suggest an urgent need for antifungal stewardship and infection control strategies to improve the clinical outcome of Algerian patients with candidemia. The high prevalence of C. tropicalis joined by fluconazole-resistance may hamper the therapeutic efficacy of fluconazole, the frontline antifungal drug used in Algeria.

nextPARS: parallel probing of RNA structures in Illumina

RNA molecules play important roles in virtually every cellular process. These functions are often mediated through the adoption of specific structures that enable RNAs to interact with other molecules. Thus, determining the secondary structures of RNAs is central to understanding their function and evolution. In recent years several sequencing-based approaches have been developed that allow probing structural features of thousands of RNA molecules present in a sample. Here, we describe nextPARS, a novel Illumina-based implementation of in vitro parallel probing of RNA structures. Our approach achieves comparable accuracy to previous implementations, while enabling higher throughput and sample multiplexing.