23 Using visual data and teleophthalmology in paediatric ophthalmology with an app-free, browser-based, visual data platform: ISLACARE

Visual data is underutilised in ophthalmology particularly within paediatrics. Following the pandemic, virtual and remote clinics in the form of telephone and video consultations have increased but there are limitations within paediatric ophthalmology as synchronous telephone or video calls are time-consuming.Using a platform known as ISLACARE, we are able to run remote photo and video clinics that has the capability to support asynchronous or synchronous consultations. With this software, parents and clinicians do not need to create logins or download apps thus increasing compliance with the technology.In an audit of 101 consecutive cases, the following was found. Mean age: 6.67 years (0-17years). The top 4 categories used in were anterior segment (36%), Strabismus (24%), Orbit/Trauma (17%), and Oculoplastics (12%).On the use of photographs to support consultations , it was felt that 91% reduced time to treatment/supported clinical decision making and 75% improved clinician to clinician communication. We have found a 30% increase in capacity in our remote teleophthalmology clinics by utilising a pre-consultation proforma. A particular improvement has been in post-operative strabismus cases where 90% of all our first appointment checks are now done remotely.We would like to demonstrate the clinical flow of how we use ISLACARE for asynchronous consultations, remote monitoring, and visual data archiving.

Choroid Plexus Calcification Correlates with Cortical Microglial Activation in Humans: A Multimodal PET, CT, MRI Study

BACKGROUND AND PURPOSE

The choroid plexus (CP) within the brain ventricles is well-known to produce cerebrospinal fluid (CSF). Recently, the CP has been recognized as critical in modulating inflammation. MRI-measured CP enlargement has been reported in neuroinflammatory disorders like MS as well as with aging and neurodegeneration. The basis of MRI-measured CP enlargement is unknown. On the basis of tissue studies demonstrating CP calcification as a common pathology associated with aging and disease, we hypothesized that previously unmeasured CP calcification contributes to MRI-measured CP volume and may be more specifically associated with neuroinflammation.

MATERIALS AND METHODS

We analyzed 60 subjects (43 healthy controls and 17 subjects with Parkinson's disease) who underwent PET/CT using 11C-PK11195, a radiotracer sensitive to the translocator protein expressed by activated microglia. Cortical inflammation was quantified as nondisplaceable binding potential. Choroid plexus calcium was measured via manual tracing on low-dose CT acquired with PET and automatically using a new CT/MRI method. Linear regression assessed the contribution of choroid plexus calcium, age, diagnosis, sex, overall volume of the choroid plexus, and ventricle volume to cortical inflammation.

RESULTS

Fully automated choroid plexus calcium quantification was accurate (intraclass correlation coefficient with manual tracing = .98). Subject age and choroid plexus calcium were the only significant predictors of neuroinflammation.

CONCLUSIONS

Choroid plexus calcification can be accurately and automatically quantified using low-dose CT and MRI. Choroid plexus calcification-but not choroid plexus volume-predicted cortical inflammation. Previously unmeasured choroid plexus calcium may explain recent reports of choroid plexus enlargement in human inflammatory and other diseases. Choroid plexus calcification may be a specific and relatively easily acquired biomarker for neuroinflammation and choroid plexus pathology in humans.

Factors Associated With Hypertension and Cardiovascular Parameters in Children With Infrequently Relapsing Nephrotic Syndrome

OBJECTIVES

To assess prevalence of hypertension in children with infrequently relapsing nephrotic syndrome (IRNS) and its association with dyslipidemia, end organ damage including left ventricular hypertrophy (LVH) at relapse and after steroid induced remission.

METHODS

Prospective observational study conducted in 83 children aged 1-12 years with IRNS, presenting in relapse. Blood pressure, fundus examination, blood and urine investigations were done at relapse and then at 4 weeks of therapy. Echocardiography at 4 weeks was performed for assessment of LVH and relative wall thickness (RWT) for concentric geometry (CG).

RESULTS

27 patients (32.5%) developed hypertension, out of which 21 patients (25.3%) had stage I hypertension. Hypertension in first episode (63.0%, P<0.01) and in previous relapses (87.5%, P<0.001) was significantly associated with hypertension in the current episode. 12 patients had a positive family history of hypertension, of which 8 (66.7%) were classified under the hypertensive group (P=0.016). Concentric geometry (CG) was found in 28% of hypertensive and 5.5% of non-hypertensive children (P=0.011). On regression analysis, a lower Up: Uc at the time of relapse was found to have a protective role for development of hypertension.

CONCLUSION

One third children with IRNS had hypertension at relapse and a high proportion of hypertensive patients had CG pattern on echocardiography.

Ultra-low CONtraSt PCI vs conVEntional PCI in patients of ACS with increased risk of CI-AKI (CONSaVE-AKI)

Objectives

This prospective, randomized study assessed short-term outcomes and safety of ultra-low contrast percutaneous coronary intervention(ULC-PCI) vs conventional PCI in high risk for contrast induced acute kidney injury(CI-AKI) patients presenting with acute coronary syndrome(ACS).

Background

Patients at an increased risk of developing CI-AKI can be identified prior to PCI based on their pre-procedural risk scores. ULC-PCI is a novel contrast conservation strategy in such high risk patients for prevention of CI-AKI.

Methods

82 patients undergoing PCI for ACS were enrolled having estimated glomerular filtration rate(eGFR) < 60 ml/min/1.73 m² and moderate to very high pre-procedural risk of developing CI-AKI as calculated by Maioli risk calculator. They were randomized into two groups of 41 patients each of ULC-PCI (contrast volume ≤ patient's eGFR) and conventional PCI (contrast volume ≤ 3xpatient's eGFR). Primary end point was development of CI-AKI.

Results

Baseline clinical and angiographic characteristics were similar between groups. Primary outcome of CI-AKI occurred more in patients of the conventional PCI group [7 (17.1%)] than in the ULC PCI group [(0 patients), p = 0.012]. Contrast volume (41.02 (±9.8) ml vs 112.54 (±25.18) ml; P < 0.0001) was markedly lower in the ULC-PCI group. No significant difference in secondary safety outcomes between two study arms at 30 days. IVUS was used in 17% patients in ULC PCI.

Conclusion

ULC-PCI in patients with increased risk of developing CI-AKI is feasible, appears safe, and has the potential to decrease the incidence of CI-AKI specially in resource limited setting such as ours where coronary imaging by IVUS is not possible in every patient.

Outcome of submitral aneurysm

INTRODUCTION

Submitral aneurysm is a rare cardiac entity with outpouching in relation to the posterior annulus of the mitral valve. Multiple etiology have been described with the role of infection and inflammation with varied clinical presentation in different case reports. However, the literature on clinical outcome and follow-up is lacking.

MATERIAL AND METHOD

This retrospective, observational study included all the adult patients (>18 years) who were diagnosed with a submitral aneurysm. Epidemiological, demographic, laboratory, clinical management, and outcome data were extracted and followed for the endpoints of cardiac death, noncardiac death, recurrent hospitalization (due to heart failure, rupture, arrhythmic events, embolic events), surgical repair, and echocardiography parameters for mitral regurgitation or change in the size of the left ventricle for 1-year postdischarge from the index hospitalization.

RESULTS

A total of 10 patients were enrolled in the study with a mean age of 31.2 ± 11.1 years. Possible etiology could be established in only five (50%) patients (two patients had tuberculosis and three patients had acute coronary syndrome). At index hospitalization, nine (90%) patients had heart failure, two (20%) patients had rupture of a submitral aneurysm, four patients underwent surgery, and one patient expired. On follow-up of 1 year, one more patient underwent surgical repair while three patients expired.

CONCLUSION

A submitral aneurysm is a rare cardiac entity with poor outcomes. Surgical repair with or without mitral valve replacement plays a definitive role in management.

Enigma of Twins: Identical Presentation and Angiographic Lesion in Monozygotic Twins

We present a case of monozygotic identical twins presenting with coronary artery disease (CAD), there were striking similarities in the symptoms, coronary anatomy, and lesions.

Advanced Catalytic Technologies for Compressed Natural Gas – Gasoline Fuelled Engines

The main challenges of the CNG engine fuelling in terms of methane abatement in the aftertreatment system are addressed in this study by using different loaded PGM catalysts. A dual-fuel injection strategy of methane-gasoline was implemented where methane gas was port-injected into the intake in stoichiometric conditions at levels corresponding to 20 and 40% energy density replacement of gasoline fuel. High, medium, and low loaded Pd/Rh catalysts were used and compared to study the effect of PGM loading on the catalyst light-off activity for methane. Results indicate that increasing the Pd loading led to significantly earlier light-off temperatures achieved at relatively lower temperatures of 340, 350 and 395oC respectively. However, the benefit diminishes above Pd loading >142.5 g ft-3. The study has also demonstrated that NH3 is formed over the CNG catalyst due to steam-reforming reactions from the increased levels of methane in the exhaust with the dual-fuelling. Hence aftertreatment technologies such as SCR should be adopted to remove them. This further highlights the need to regulate the harmful NH3 emissions from future passenger cars fuelled with CNG. In addition, the benefits of the dual-fuel system in terms of lower engine output CO2, non-methane hydrocarbon (NMHC) and particulate matter (PM) emissions compared to the GDI mode alone are presented.

LSPR based on-chip detection of dengue NS1 antigen in whole blood

The development of a biosensor for rapid and quantitative detection of the dengue virus continues to remain a challenge. We report a lab-on-chip device that combines membrane-based blood plasma separation and a localized surface plasmon resonance (LSPR) based biosensor for on-chip detection of dengue NS1 antigen from a few drops of blood. The LSPR effect is realized by irradiating UV-NIR light having a spectral peak at 655 nm onto nanostructures fabricated via thermal annealing of a thin metal film. We study the effect of the resulting metal nanostructures on the LSPR performance in terms of sensitivity and limit of detection, by annealing silver films at temperatures ranging from 100 to 500 °C. The effect of annealing temperature on the nanostructure size and uniformity and the resulting optical characteristics are investigated. Further, the binding between non-targeted blood plasma proteins and NS1-antibody-functionalized nanostructures on the LSPR performance is studied by considering different blocking mechanisms. Using a nanostructure annealed at 200 °C and 2X-phosphate buffer saline with 0.05% Tween-20 as the blocking buffer, from 10 μL of whole blood, the device can detect NS1 antigen at a concentration as low as 0.047 μg mL-1 within 30 min. Finally, we demonstrate the detection of NS1 in the blood samples of dengue-infected patients and validate our results with those obtained from the gold-standard ELISA test.

Lead one ratio: A new electrocardiogram marker for cardiac resynchronization therapy response

BACKGROUND

Wider QRS duration and presence of left bundle branch block (LBBB) predict better cardiac resynchronization therapy (CRT) response. Despite strict patient selection, one-third of patients have a sub-optimal response. We aim to evaluate the impact of lead one ratio (LOR) on CRT response.

METHODS

We enrolled 93 patients receiving CRT from August 2016 to August 2019. Pre-implant 12-lead electrocardiogram (ECG) was recorded, and LOR was derived by dividing the maximum positive deflection of QRS complex in ECG lead I by the maximum negative deflection in lead I; cut-off value of 12 was used to divide the cohort into two groups. Patients were followed for 6 months, and outcomes were compared for CRT response, New York Heart Association (NYHA) class improvement, all-cause mortality, and heart failure (HF) hospitalization events.

RESULTS

At the end of 6-month follow-up, LOR ≥ 12 was associated with significantly better CRT response (75.76% vs. 51.85% in LOR < 12, P = 0.02), lower mortality per 100 patient-years (9.09 vs. 14.81 in LOR < 12, P = 0.012), and more improvement in HF symptoms (NYHA improvement) (78.79% vs. 55.56% in LOR < 12, P = 0.02). Patients with LOR < 12 had more HF hospitalization events (2.04 vs. 1.81 episodes in LOR ≥ 12, P = 0.029) and less QRS narrowing (∆5.74 ± 2.09 vs. ∆7.10 ± 3.97 ms in LOR ≥ 12, P = 0.01). QRS duration and LBBB morphology were predictors of response in both groups of patients.

CONCLUSION

LOR ≥ 12 was associated with better response to CRT, less HF hospitalization, and more relief in HF symptoms. This ratio helps to identify possible sub-optimal response among patients with an indication for CRT.

An Unusual Intracoronary Honeycomb Pattern in a Patient with Coronary Artery Disease with Dextrocardia

This case highlights the diagnostic dilemma and emphasis the role of Optical Coherence Tomography (OCT) to differentiate between spontaneous coronary artery dissection and recanalized thrombus with multiple channels in a patient with dextrocardia.

Comparing the Modified Frailty Index with conventional scores for prediction of cardiac resynchronization therapy response in patients with heart failure

Objective:

The aim of the study was to compare, Modified Frailty Index (mFI), EAARN (LVEF <22%, Atrial Fibrillation, Age ≥70 years, Renal function (eGFR <60 mL/min/1.73m²), NYHA class IV), and ScREEN (female Sex, Renal function (eGFR ≥60 mL/min/1.73m²), LVEF ≥25%, ECG (QRS duration ≥150 ms) and NYHA class ≤III) score for predicting cardiac resynchronization therapy (CRT) response and all-cause mortality.

Methods:

In this prospective, non-randomized, single-center, observational study we enrolled 93 patients receiving CRT from August 2016 to August 2019. Pre-implant scores were calculated, and patients were followed for six months. Performance of each score for prediction of CRT response (defined as ≥15% reduction in left ventricular end-systolic volume [LVESV]) and all-cause mortality was compared.

Results:

Optimal CRT response was seen in seventy patients with nine deaths. All the three scores exhibited modest performance for prediction of CRT response and all-cause mortality with AUC ranging from 0.608 to 0.701. mFI has an additional benefit for prediction of prolonged post-procedure stay and 30-day rehospitalization events.

Conclusion:

mFI, ScREEN and EAARN score can be used reliably for predicting all-cause mortality and response to CRT.

Cardiovascular outcomes of antidiabetic drugs

Type 2 Diabetes Mellitus (T2DM) is associated with a high risk of atherosclerotic cardiovascular disease (ASCVD). Intensive blood glucose reduction with antidiabetic drugs significantly reduce microvascular complications but there is no strong evidence of reduction in cardiovascular (CV) events. In 2008, the US Food and Drug Administration (FDA) issued guidance to demonstrate cardiovascular safety of newer antidiabetic drugs in addition to reduction in blood glucose level. After which a number of CVOTs were conducted involving newer antidiabetic drugs. The newer drugs (e.g. GLP-1 RAs, SGLT2 inhibitors and DPP 4 inhibitors) might have potential effects on body weight, lipid parameters and blood pressure, as well as endothelial dysfunctions, inflammatory markers and oxidative stress. The current review summarizes the results of the main trials focused on the cardiovascular outcomes of traditional as well as newer antidiabetic drugs.

Six months clinical outcome comparison between quadripolar and bipolar left ventricular leads in cardiac resynchronization therapy: A prospective, non-randomized, single-centre observational study

Background and objectives

Quadripolar left ventricular (LV) leads in cardiac resynchronization therapy (CRT) offer multi-vector pacing with different pacing configurations and hence enabling LV pacing at most suitable site with better lead stability. We aim to compare the outcomes between quadripolar and bipolar LV lead in patients receiving CRT.

Methods

In this prospective, non-randomized, single-center observational study, we enrolled 93 patients receiving CRT with bipolar (BiP) (n = 31) and quadripolar (Quad) (n = 62) LV lead between August 2016 to August 2019. Patients were followed for six months, and outcomes were compared with respect to CRT response (defined as ≥5% absolute increase in left ventricle ejection fraction), electrocardiographic, echocardiographic parameters, NYHA functional class improvement, and incidence of LV lead-related complication.

Results

At the end of six months follow up, CRT with quadripolar lead was associated with better response rate as compared to bipolar pacing (85.48% vs 64.51%; p = 0.03), lesser heart failure (HF) hospitalization events (1.5 vs 2; p = 0.04) and better improvement in HF symptoms (patients with ≥1 NYHA improvement 87.09% vs 67.74%; p = 0.04). There were fewer deaths per 100 patient-year (6.45 vs 9.37; p = 0.04) and more narrowing of QRS duration (Δ12.56 ± 3.11 ms vs Δ7.29 ± 1.87 ms; p = 0.04) with quadripolar lead use. Lead related complications were significantly more with the use of bipolar lead (74.19% vs 41.94%; p = 0.02).

Conclusions

Our prospective, non-randomized, single-center observational study reveals that patients receiving CRT with quadripolar leads have a better response to therapy, lesser heart failure hospitalizations, lower all-cause mortality, and fewer lead-related complications, proving its superiority over the bipolar lead.

Percutaneous management of Stuck Rotational Atherectomy Burr: Experience at a tertiary care centre

Background: The incidence of stuck rotational atherectomy (RA) burr is extremely low, and its description has been sporadic in the literature about the systemic management of this complication. Aims and Objective: The current study was designed to present the experience of our center and propose an algorithm for the retrieval of stuck RA burr. Materials and Methods: We retrospectively evaluated cases of RA between August 2018 to August 2020 at our center. An entrapped RA burr was defined as an inability to move the burr backward without any additional maneuvers during or after the rotablation of a coronary lesion. Angiographic and procedural details were reviewed in the identified cases of entrapped rotablator burr, details of maneuvers used to retract the burr was documented. We further analyzed the literature using PubMed search using the keywords “entrapment of rotablator burr”, “stuck rotablator” and “rotablation complications”. All the articles with entrapped rotablation burr were identified and scrutinized for the techniques used for percutaneous retrieval. Results: Out of the total 5780 Percutaneous coronary intervention (PCI) procedures, RA was performed in 75 patients and RA burr entrapment was confirmed in two cases. Both the cases were seen in patients with angulated and heavily calcified lesions. The cases were managed percutaneously by endovascular maneuvers. A total of 8 techniques were identified by analysis of available literature for burr retrieval with surgery being the favored one. Using the experience of our center and available literature we propose a simplified working algorithm towards systematic management of this complication. Conclusion: RA burr entrapment is rare, but a life-threatening complication, and the operator should be prepared with strategies for successful retrieval of stuck burr. Percutaneous retraction maneuvers should be used as the first-line management for retrieval of stuck burr followed by surgical referral. Using the proposed algorithm this rare complication can be managed systematically and effectively.

1214 Higher Bedroom Temperature Associated With Poorer Sleep: Data From Over 3.75 Million Nights

Introduction

Bedroom temperature can influence nocturnal thermoregulation and sleep. To date, limited, small experimental studies have shown that bedroom temperatures outside the recommended range of 65 and 70°F can negatively impact sleep. However, this association has not been studied in a large-scale data set. Using over 3.75 million nights of objectively measured data, we analyzed the associations between habitual bedroom temperatures and sleep.

Methods

Over 3.75 million nights of sleep and bedroom temperature data were collected using S+ by ResMed technology from 34,096 Individuals (57% male, 20-90 years, mean age 48.7 +/-14.5 years, all US residents). Multilevel regression analyses were used to analyze associations between bedroom temperature and sleep. A stricter alpha level of 0.001 was used to account for the large number of observations in the dataset.

Results

Bedroom temperature was above 70°F for 69% of nights, with the average temperature ranging between 68.8 and 76.2°F. For each 1°F increase in bedroom temperature between 60-85°F, sleep efficiency decreased by 0.06%. Likewise, higher bedroom temperatures were linked to shorter Total Sleep Time duration (-0.45 mins/°F), longer Sleep Onset Latency (+0.04 mins/°F), and longer Wake After Sleep Onset (+0.11 mins/°F), all ps&lt;0.001.

Conclusion

Analyzing data from over 3.75 million nights, we found that many people sleep in a bedroom warmer than the optimal temperature. Further, higher bedroom temperatures - even within the recommended range for optimal sleep - are associated with poorer sleep and higher wakefulness. Bedroom thermostats and cooling options should be considered to achieve optimal sleeping temperature conditions.

Support

N/A

0412 Parents Sleep Longer When School is Out for the Summer: Associations Among Parenthood, Gender, and Season

Introduction

Seasonal effects in sleep are often attributed to day length; however, change in obligatory daily activities might also have an impact on sleep behavior. Longitudinal measurement using consumer sleep technology enables the observation of patterns in sleep behavior in the home environment. We analyzed the impact of parenthood and gender on total sleep time (TST) over the summer break period using data collected in the home.

Methods

Sleep data were collected using the SleepScore mobile application from October 2018 through October 2019, with the summer break period defined as June 25th - August 5th. U.S. age and gender matched samples of parents and non-parents were selected using Mahalanobis distance from a pool of users more likely to have school-aged children. The final samples included n=345 parents (38.7 +/- 4.5 years) and n=345 non-parents (37.8 +/- 4.7 years); both groups were 46% female. Only weeknights (n=34,323) were analyzed to maximize impact of school schedule. Linear regression and independent t-tests were used to analyze main and interaction effects for gender, parenthood, and summer break.

Results

Male gender, parenthood, and summer break were associated with decreased sleep duration (ps &lt; .01). However, during summer break, parents exhibited an increase in TST, with mothers (+5.6 mins) having a greater increase than fathers (+1.1 mins). In contrast, adults without children showed a decrease in TST during summer break, with males having a greater reduction (-8.8 mins) than females (-6.5 mins).

Conclusion

These results suggest that parental status may play a part in seasonal sleep patterns. Contrary to the typical trend of shorter TST during summer, being a parent is associated with longer TST during summer break, with a greater increase for females. This change may be attributed to parents following a less rigid schedule when their children are not in school.

Support

N/A

0443 Intra Week Sleep Patterns Analyzed Using Consumer Sleep Tracker Data

Introduction

Big data collected using consumer sleep technology can provide objectively measured insights on sleep behavior in the real-life environment. It has the advantage over self-report data of being less prone to bias. Here we used a non-contact bio-motion sensor to remotely capture objective sleep data. We analyzed 168432 nights of sleep data to test if differences between weekday versus weekend sleep behavior, known from self-report, would still hold using objective data in a large population.

Methods

Sleep data was acquired using the SleepScore Max remote sleep sensor and included 168432 nights (2730 users, mean age: 46.6 +/- 11.8 years, 33% female, all resident in the USA). Analysis was restricted to those of working age; adults between 20-65. Any sleep which ended from Monday to Friday was considered weekday sleep, and any ending on Saturday or Sunday as weekend sleep. Data records were inspected and cleaned before analyzing. Descriptive statistics and independent t-tests were used to analyze the data.

Results

Total Sleep Time, Time In Bed and Sleep Onset Latencies were longer during weekend (TST: + 20.6 mins, TIB: +22.9 mins, SOL: +1.1 min, all p &lt;0.001), resulting in a slightly poorer Sleep Efficiency (-.016%, p&lt;0.01) for weekend nights. Time to bed and final awakening were both delayed in weekends as compared to weekdays (Time to bed +30.0 mins, and final awakening +53.4 mins, both p&lt;0.001).

Conclusion

This big data analysis confirms the earlier observed difference in sleep and sleep behavior between weekdays and weekends. This should be considered for optimizing (automated) sleep interventions, that may not normally take the weekend effect into consideration.

Support

 

Outcome of pregnancies in women with pulmonary hypertension: a single-centre experience from South India

OBJECTIVE

To study maternal complications and pregnancy outcome in women with pulmonary hypertension, attending a tertiary centre in south India.

STUDY DESIGN

Retrospective observational study.

SETTING

Tertiary centre in south India.

POPULATION

Pregnant women with pulmonary hypertension.

METHOD

Data regarding demographics, clinical course, medication received, and echocardiographic diagnosis regarding pulmonary hypertension and antenatal care received were collected from the records. Details of labour and delivery, and postpartum follow up were retrieved. We compared the outcome based on the presence or absence of cyanosis and right ventricular systolic pressure levels.

MAIN OUTCOME MEASURES

Maternal mortality, occurrence of complications such as heart failure, fetal growth restriction.

RESULTS

There were 81 pregnancies in 73 women with pulmonary hypertension. The majority of them had pulmonary hypertension secondary to congenital heart disease (80.8%); 17.8% had Eisenmenger syndrome. An advanced pulmonary artery hypertension (PAH) medication, sildenafil, was administered in 25 (31.3%) pregnancies. There were four maternal deaths, of which three had Eisenmenger syndrome. Heart failure complicated 6.3% and fetal growth restriction 26.3% of pregnancies. Morbidity was significantly increased in women with pulmonary hypertension associated with a cyanotic cardiac lesion or with right ventricular systolic pressure >70 mmHg.

CONCLUSION

Despite advances in care, mortality in pregnant women with pulmonary hypertension is a matter of concern, especially in those with Eisenmenger syndrome. Multidisciplinary team management in tertiary centres and the use of advanced PAH medications even in low- to middle-income countries with limited resources, could lead to a reduction in morbidity and mortality related to pulmonary hypertension.

TWEETABLE ABSTRACT

Multidisciplinary care and use of new medication may improve outcomes in pregnant women with pulmonary hypertension.

Predictive model of spread of Parkinson's pathology using network diffusion

Growing evidence suggests that a "prion-like" mechanism underlies the pathogenesis of many neurodegenerative disorders, including Parkinson's disease (PD). We extend and tailor previously developed quantitative and predictive network diffusion model (NDM) to PD, by specifically modeling the trans-neuronal spread of alpha-synuclein outward from the substantia nigra (SN). The model demonstrated the spatial and temporal patterns of PD from neuropathological and neuroimaging studies and was statistically validated using MRI deformation of 232 Parkinson's patients. After repeated seeding simulations, the SN was found to be the most likely seed region, supporting its unique lynchpin role in Parkinson's pathology spread. Other alternative spread models were also evaluated for comparison, specifically, random spread and distance-based spread; the latter tests for Braak's original caudorostral transmission theory. We showed that the distance-based spread model is not as well supported as the connectivity-based model. Intriguingly, the temporal sequencing of affected regions predicted by the model was in close agreement with Braak stages III-VI, providing what we consider a "computational Braak" staging system. Finally, we investigated whether the regional expression patterns of implicated genes contribute to regional atrophy. Despite robust evidence for genetic factors in PD pathogenesis, NDM outperformed regional genetic expression predictors, suggesting that network processes are far stronger mediators of regional vulnerability than innate or cell-autonomous factors. This is the first finding yet of the ramification of prion-like pathology propagation in Parkinson's, as gleaned from in vivo human imaging data. The NDM is potentially a promising robust and clinically useful tool for diagnosis, prognosis and staging of PD.

Learning from UJAMBO: Perspectives on Gynecologic Care in African Immigrant and Refugee Women in Boston, Massachusetts

African-born immigrant women, and particularly refugees and asylum seekers, are at risk for reproductive health disparities but inadequately use relevant gynecologic services. We sought to elucidate perspectives on gynecologic care in a population of Congolese and Somali immigrants. We conducted a secondary qualitative analysis of focus group data using a grounded theory approach and the Integrated Behavioral Model as our theoretical framework. Thirty one women participated in six focus groups. Participant beliefs included the states of pregnancy and/or pain as triggers for care, preferences included having female providers and those with familiarity with female genital cutting. Barriers included stigma, lack of partner support, and lack of resources to access care. Experiential attitudes, normative beliefs, and environmental constraints significantly mediated care preferences for/barriers to gynecologic health service utilization in this population. Centering of patient perspectives to adapt delivery of gynecologic care to immigrants and refugees may improve utilization and reduce disparities.

Weak correlation of bleeding scores to platelet electron microscopy: A retrospective chart review of pediatric patients with delta-storage pool disorder

BACKGROUND

Delta granule storage pool deficiency (δ-SPD) is a rare platelet disorder in which a deficiency of platelet granules leads to poor aggregation, resulting in varying clinical bleeding phenotypes. Children with δ-SPD have variable laboratory results, making the proper diagnosis and evaluation controversial.

OBJECTIVES

To describe the demographic and laboratory trends of this population and to assess the value of electron microscopy in diagnostic evaluation and its correlation to bleeding symptoms.

METHODS

We performed a retrospective review of 109 pediatric patients diagnosed with δ-SPD. We collected demographic information and bleeding scores using a validated bleeding assessment tool. A descriptive and exploratory analysis was performed.

RESULTS

The majority of patients were female, with an average age at diagnosis of 11.61 years. Females were diagnosed at a significantly older age presenting most often with menorrhagia, while males presented most commonly with epistaxis. The majority showed normal lumiaggregometry, the mean platelet electron microscopy (PEM) value was 2.37, and the mean bleeding score was 6. Bleeding assessment tool and PEM had a significantly weak correlation.

CONCLUSIONS

Patients with more dense granules per platelet had higher bleeding scores than those with fewer dense granules per platelet. The current body of evidence does not favor the use of PEM in routine clinical practice, and results are difficult to interpret. In patients with severe mucocutaneous bleeding symptoms and normal platelet aggregation studies, consideration should be given to an alternative diagnosis and further evaluation is warranted.

Non-inertial lift induced migration for label-free sorting of cells in a co-flowing aqueous two-phase system

We present a novel label-free passive microfluidic technique for isolation of cancer cells (EpCAM+ and CD45−) from peripheral blood mononuclear cells (PBMCs) (CD45+ and EpCAM−) in aqueous two-phase system (ATPS).

Acute effect of primary PCI on diastolic dysfunction recovery in anterior wall STEMI - A non-invasive evaluation by echocardiography

BACKGROUND

It is well established fact that acute coronary occlusion leads to diastolic dysfunction, followed by systolic dysfunction when myonecrosis occur. It is also proven that primary percutaneous coronary intervention (PPCI) is an excellent therapy for ST elevation myocardial infarction (STEMI) to improve outcomes. However there is a paucity of information on efficacy of PPCI in improving diastolic function. Evaluation of the role of PPCI in improving diastolic dysfunction is required.

METHODS

61 patients with first anterior wall STEMI who underwent PPCI to left anterior descending artery were included. Echocardiographic evaluation was performed within 24 h of PPCI and then on day 15, 3 months and 6 months after PPCI. We evaluated the prevalence of diastolic dysfunction after PPCI and its recovery during 6 months along with effect of duration of chest pain on diastolic function.

RESULTS

54.1% of patients had diastolic dysfunction after PPCI whereas it was only 21.3% after 6 months (p value < 0.001). Diastolic function indices like deceleration time, isovolumic relaxation time, E wave, A wave, E/A ratio, left atrial volume and index improved statistically from baseline to 6 months except mitral E/e' ratio. As time required to achieve reperfusion increases (chest pain duration and D to B time) the incidence of residual diastolic dysfunction also increases (p value < 0.001). Patients with TIMI flow < III had more diastolic dysfunction (p value < 0.001).

CONCLUSIONS

Primary PCI improves diastolic dysfunction in patients with anterior wall STEMI over a period of 6 months. Time to achieve reperfusion and effectiveness of reperfusion have significant effect on diastolic dysfunction.

Entry and passage behavior of biological cells in a constricted compliant microchannel

We report an experimental and theoretical investigation of the entry and passage behaviour of biological cells (HeLa and MDA-MB-231) in a constricted compliant microchannel. Entry of a cell into a micro-constriction takes place in three successive regimes: protrusion and contact (cell protrudes its leading edge and makes a contact with the channel wall), squeeze (cell deforms to enter into the constriction) and release (cell starts moving forward). While the protrusion and contact regime is insensitive to the flexibility of the channel, the squeeze zone is significantly smaller in the case of a more compliant channel. Similarly, in the release zone, the acceleration of the cells into the microconstriction is higher in the case of a more compliant channel. The results showed that for a fixed size ratio ρ and E c, the extension ratio λ decreases and transit velocity U c increases with increase in the compliance parameter f p. The variation in the cell velocity is governed by force due to the cell stiffness F s as well as that due to the viscous dampening F d, explained using the Kelvin-Voigt viscoelastic model. The entry time t e = m(ρ) k 1 (1 + f p) k 2 (E c) k 3 and induced hydrodynamic resistance of a cell ΔR c/R = k(ρ) a (1 + k f f p) b (k E E c) c were correlated with cell size ratio ρ, Young's modulus E c and compliance parameter f p, which showed that both entry time t e and the induced hydrodynamic resistance ΔR c are most sensitive to the change in the compliance parameter f p. This study provides understanding of the passage of cells in compliant micro-confinements that can have significant impact on mechanophenotyping of single cells.

A slow-cycling subpopulation of melanoma cells with highly invasive properties

Melanoma is a heterogeneous tumor with different subpopulations showing different proliferation rates. Slow-cycling cells were previously identified in melanoma, but not fully biologically characterized. Using the label-retention method, we identified a subpopulation of slow-cycling cells, defined as label-retaining cells (LRC), with strong invasive properties. We demonstrate through live imaging that LRC are leaving the primary tumor mass at a very early stage and disseminate to peripheral organs. Through global proteome analyses, we identified the secreted protein SerpinE2/protease nexin-1 as causative for the highly invasive potential of LRC in melanomas.

A combined experimental and theoretical approach towards mechanophenotyping of biological cells using a constricted microchannel

We report a combined experimental and theoretical technique that enables the characterization of various mechanical properties of biological cells. The cells were infused into a microfluidic device that comprises multiple parallel micro-constrictions to eliminate device clogging and facilitate characterization of cells of different sizes and types on a single device. The extension ratio λ and transit velocity U_c of the cells were measured using high-speed and high-resolution imaging which were then used in a theoretical model to predict the Young's modulus E_c = f(λ, U_c) of the cells. The predicted Young's modulus E_c values for three different cell lines (182 ± 34.74 Pa for MDA MB 231, 360 ± 75 Pa for MCF 10A and, 763 ± 93 Pa for HeLa) compare well with those reported in the literature from micropipette measurements and atomic force microscopy measurement within 10% and 15%, respectively. Also, the Young's modulus of MDA-MB-231 cells treated with 50 μM 4-hyrdroxyacetophenone (for localization of myosin II) for 30 min was found out to be 260 ± 52 Pa. The entry time t_e of cells into the micro-constrictions was predicted using the model and validated using experimentally measured data. The entry and transit behaviors of cells in the micro-constriction including cell deformation (extension ratio λ) and velocity U_c were experimentally measured and used to predict various cell properties such as the Young's modulus, cytoplasmic viscosity and induced hydrodynamic resistance of different types of cells. The proposed combined experimental and theoretical approach leads to a new paradigm for mechanophenotyping of biological cells.

Iatrogenic left main coronary artery dissection due to pin-hole balloon rupture: Not to be panicked…

Iatrogenic left main coronary artery (LMCA) dissection is a rare complication and may have devastating consequences if not immediately intervened. The management includes urgent revascularization mostly with percutaneous coronary intervention (PCI) with bail-out stenting and rarely requires coronary artery bypass graft (CABG) surgery. In clinically and hemodynamically stable patients, a conservative approach may be preferred. Here, we present a rare case of iatrogenic retrograde LMCA dissection due to pin-hole rupture of angioplasty balloon that was managed conservatively.

Characterization and sorting of cells based on stiffness contrast in a microfluidic channel

This paper reports the characterization and sorting of cells based on stiffness contrast. A microfluidic device with focusing and spacing control for stiffness based sorting of cells is designed, fabricated and demonstrated.

Assessment of knowledge of medicinal plants and their use in tribal region of Jashpur district of Chhattisgarh, India

The present study was conducted to assess the knowledge of medicinal plants and their use in tribal region of Jashpur district of Chhattisgarh. Under the socio-economic profile, farmers of middle age (36-55 yrs) people showed the maximum percentage (78%) distribution and frequency, 50 per cent of respondents belonged to primary to middle school level of education and 63 per cent of respondents were having medium size of family (5 to 8 members). A total number of 50 medicinal plant species belonging to 29 families were recorded, in which Euphorbiaceae registered as the largest family with 4 plant species (8%). Shrub showed their maximum presence (34%) followed by tree (32%), herb (20%) and climber (14%). As per knowledge of respondents about medicinal plants Haldi and Bhui-neem is mostly use as medicinal purpose as 5.2% (n=40) followed by Harra, Munga, Karanj and Hadjod (3.9% each). This information through respondent (tribals) showed very diverse nature of medicinal flora, their usage in healing purpose with socioeconomic/ living standard upliftment. Therefore, it is needful aspect of conserving these biological resources for sustainable ecosystem.

Modeling the relationship among gray matter atrophy, abnormalities in connecting white matter, and cognitive performance in early multiple sclerosis

BACKGROUND AND PURPOSE

Quantitative assessment of clinical and pathologic consequences of white matter abnormalities in multiple sclerosis is critical in understanding the pathways of disease. This study aimed to test whether gray matter atrophy was related to abnormalities in connecting white matter and to identify patterns of imaging biomarker abnormalities that were related to patient processing speed.

MATERIALS AND METHODS

Image data and Symbol Digit Modalities Test scores were collected from a cohort of patients with early multiple sclerosis. The Network Modification Tool was used to estimate connectivity irregularities by projecting white matter abnormalities onto connecting gray matter regions. Partial least-squares regression quantified the relationship between imaging biomarkers and processing speed as measured by the Symbol Digit Modalities Test.

RESULTS

Atrophy in deep gray matter structures of the thalami and putamen had moderate and significant correlations with abnormalities in connecting white matter (r = 0.39-0.41, P < .05 corrected). The 2 models of processing speed, 1 for each of the WM imaging biomarkers, had goodness-of-fit (R(2)) values of 0.42 and 0.30. A measure of the impact of white matter lesions on the connectivity of occipital and parietal areas had significant nonzero regression coefficients.

CONCLUSIONS

We concluded that deep gray matter regions may be susceptible to inflammation and/or demyelination in white matter, possibly having a higher sensitivity to remote degeneration, and that lesions affecting visual processing pathways were related to processing speed. The Network Modification Tool may be used to quantify the impact of early white matter abnormalities on both connecting gray matter structures and processing speed.

Factors associated with study attrition among HIV-infected risky drinkers in St. Petersburg, Russia

BACKGROUND

Participant attrition in HIV longitudinal studies may introduce bias and diminish research quality. The identification of participant characteristics that are predictive of attrition might inform retention strategies.

OBJECTIVE

The study aimed to identify factors associated with attrition among HIV-infected Russian risky drinkers from the secondary HIV prevention HERMITAGE trial. We examined whether current injection drug use (IDU), binge drinking, depressive symptoms, HIV status nondisclosure, stigma, and lifetime history of incarceration were predictors of study attrition. We also explored effect modification due to gender.

METHODS

Complete loss to follow-up (LTFU), defined as no follow-up visits after baseline, was the primary outcome, and time to first missed visit was the secondary outcome. We used multiple logistic regression models for the primary analysis, and Cox proportional hazards models for the secondary analysis.

RESULTS

Of 660 participants, 101 (15.3%) did not return after baseline. No significant associations between independent variables and complete LTFU were observed. Current IDU and HIV status nondisclosure were significantly associated with time to first missed visit (adjusted hazard ratio [AHR], 1.39; 95% CI, 1.03-1.87; AHR, 1.38; 95% CI, 1.03-1.86, respectively). Gender stratified analyses suggested a larger impact of binge drinking among men and history of incarceration among women with time to first missed visit.

CONCLUSIONS

Although no factors were significantly associated with complete LTFU, current IDU and HIV status nondisclosure were significantly associated with time to first missed visit in HIV-infected Russian risky drinkers. An understanding of these predictors may inform retention efforts in longitudinal studies.

Reduced glucose uptake and Aβ in brain regions with hyperintensities in connected white matter

Interstitial concentration of amyloid beta (Aß) is positively related to synaptic activity in animal experiments. In humans, Aß deposition in Alzheimer's disease overlaps with cortical regions highly active earlier in life. White matter lesions (WML) disrupt connections between gray matter (GM) regions which in turn changes their activation patterns. Here, we tested if WML are related to Aß accumulation (measured with PiB-PET) and glucose uptake (measured with FDG-PET) in connected GM. WML masks from 72 cognitively normal (age 61.7 ± 9.6 years, 71% women) individuals were obtained from T2-FLAIR. MRI and PET images were normalized into common space, segmented and parcellated into gray matter (GM) regions. The effects of WML on connected GM regions were assessed using the Change in Connectivity (ChaCo) score. Defined for each GM region, ChaCo is the percentage of WM tracts connecting to that region that pass through the WML mask. The regional relationship between ChaCo, glucose uptake and Aß was explored via linear regression. Subcortical regions of the bilateral caudate, putamen, calcarine, insula, thalamus and anterior cingulum had WM connections with the most lesions, followed by frontal, occipital, temporal, parietal and cerebellar regions. Regional analysis revealed that GM with more lesions in connecting WM and thus impaired connectivity had lower FDG-PET (r = 0.20, p<0.05 corrected) and lower PiB uptake (r = 0.28, p<0.05 corrected). Regional regression also revealed that both ChaCo (β = 0.045) and FDG-PET (β = 0.089) were significant predictors of PiB. In conclusion, brain regions with more lesions in connecting WM had lower glucose metabolism and lower Aß deposition.

Inhibition of intestinal tumor formation by deletion of the DNA methyltransferase 3a

Aberrant de novo methylation of DNA is considered an important mediator of tumorigenesis. To investigate the role of de novo DNA methyltransferase 3a (Dnmt3a) in intestinal tumor development, we analyzed the expression of Dnmt3a in murine colon crypts, murine colon adenomas and human colorectal cancer using RNA fluorescence in situ hybridization (FISH), quantitative PCR and immunostaining. Following conditional deletion of Dnmt3a in the colon of APC((Min/+)) mice, we analyzed tumor numbers, genotype of macroadenomas and laser dissected microadenomas, global and regional DNA methylation and gene expression. Our results showed increased Dnmt3a expression in colon adenomas of APC((Min/+)) mice and human colorectal cancer samples when compared with control tissue. Interestingly, in tumor tissue, RNA FISH analysis showed highest Dnmt3a expression in Lgr5-positive stem/progenitor cells. Deletion of Dnmt3a in APC((Min/+)) mice reduced colon tumor numbers by ~40%. Remaining adenomas and microadenomas almost exclusively contained the non-recombined Dnmt3a allele; no tumors composed of the inactivated Dnmt3a allele were detected. DNA methylation was reduced at the Oct4, Nanog, Tff2 and Cdkn1c promoters and expression of the tumor-suppressor genes Tff2 and Cdkn1c was increased. In conclusion, our results show that Dnmt3a is predominantly expressed in the stem/progenitor cell compartment of tumors and that deletion of Dnmt3a inhibits the earliest stages of intestinal tumor development.

Sexually transmitted infections among HIV-infected heavy drinkers in St Petersburg, Russia

The objective of this study was to estimate the prevalence and identify correlates of four sexually transmitted infections (STIs) among HIV-infected Russians reporting heavy alcohol use and recent unprotected sex, we conducted a cross-sectional analysis of baseline data from the HERMITAGE study. The primary outcome was any current STI, based on urine tests for Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis and serological testing for infection with Treponema pallidum. Data on potential demographic and behavioural predictors of STI were obtained from surveys administered at study entry. Of 682 participants, 12.8% (95% confidence interval [CI] 10.3, 15.3) tested positive for at least one STI. In a multivariable model adjusted for gender, age and marital status, only sex trade involvement over the last three months was significantly associated with an increased odds of STI (adjusted odds ratio [AOR] 2.00, 95% CI 1.13, 3.55). Given that STIs were common in this HIV-infected cohort, and that few patient characteristics predicted STI, the current practice of screening HIV-infected Russians for syphilis alone merits re-evaluation.

D-Dimer assay as a non invasive test for the diagnosis of left atrial Thrombi in Indian patients with Rheumatic MS

BACKGROUND

Systemic embolism is a serious and sometime fatal complication of rheumatic MS.

OBJECTIVE

We assessed the predictive power of D-Dimer level to predict occurrence of left atrial (LA) thrombi in patients with rheumatic mitral stenosis (MS).

METHODS

D-dimer levels were analyzed for 24 patients with rheumatic MS with LA clot and 22 patients with rheumatic MS with no LA clot undergoing transeosophageal echocardiography. A level more than 4 µg/ml was taken as elevated to predict the presence of LA clot in the study groups.

RESULTS

For a cut-off value of 4 µg/ml, sensitivity was 66.67 % and specificity 100 % for prediction of LA clot and AUC 0.710. A cut-off value of less than 1 µg/ml, sensitivity was 91.67 % and 87. 5 % negative predictive value for ruling out presence of LA clot and AUC 0.721.

CONCLUSION

A higher value of D-dimer can predict the possible presence of a LA clot and very low value can predict absence of clot in patients with rheumatic MS.