Postoperative outcomes for unilateral congenital trochlear nerve palsy: A retrospective cohort study

PURPOSE

Congenital trochlear nerve palsy is the most common cause of vertical strabismus. The goal of this study was to investigate surgical outcomes after superior oblique tendon plication with or without inferior oblique recession in children and adults with unilateral congenital trochlear nerve palsy.

METHODS

Data and outcomes were collected in patients with a diagnosis of unilateral congenital superior oblique palsy during a retrospective single-center study conducted at the University Hospital of Tours. A reproducible, standard ophthalmological and oculomotor examination was performed pre- and postoperatively at 1 year, including presence or absence of diplopia, vertical and horizontal deviations, and compensatory head posture. Surgical success, defined as an endpoint including absence of diplopia in primary position, absence of head tilt, and vertical deviation at distance fixation<5 prism diopters (PD), was analyzed.

RESULTS

A total of fifty-seven patients (median [IQR] age of 11 years [5-42]) were analyzed. Patients experienced a significant reduction in vertical distance and near deviations (p<0.001), compensatory head tilt (p < 0.001), and diplopia after surgery (p < 0.001). Surgical success was higher in adults (17/24, 70.8%) than in children (15/33, 45.5%), although this did not reach statistical significance (p=0.0657).

CONCLUSION

This study suggests that plication of the superior oblique muscle tendon, with or without recession of the inferior oblique muscle, can be effective in treating unilateral congenital trochlear nerve palsy. Further studies are necessary to compare surgical procedures and investigate their efficacy in adults compared to children in the short and long term.

The impact of protective measures against COVID-19 on the wellbeing of residents in nursing homes and their relatives: a rapid review

During the COVID-19 pandemic and compared to other population groups, older people were at a heightened risk of developing lethal disease symptoms. Thus, many countries put in place protective measures to protect this "at-risk" population, especially in nursing homes, to limit the number of infections. These measures consisted mostly in the absence of social gatherings, the impossibility for relatives to enter the nursing homes, limitations in group activities, and the ban of group-eating. Although these measures were helpful to mitigate the spread of the disease, they also induced long periods of social isolation for the residents of nursing homes. This could have impacted the wellbeing and quality of life of residents and their relatives, with a possible impact on the overall health of residents. We designed this rapid review to investigate the literature on the impact of COVID-19 protective measures in nursing homes on the quality of life, wellbeing and physical health of residents and their relatives. Our results showed that most of the articles included in the review, either using qualitative or quantitative methods, evidenced a detrimental impact of protective measures on resident's and their relatives' wellbeing. We argue that, in the event of a new pandemic similar to the COVID-19, protective measures should also take into account their psychological impact, and not only their physical impact.

POS0468 EXTRACELLULAR VESICLES FROM SERUM OF MYOSITIS PATIENTS AS CIRCULATING BIOMARKERS AND DISEASE MEDIATORS

Background

Inflammatory myopathies (IM) are a heterogeneous group of disorders characterized by autoimmune inflammatory destruction of skeletal muscles. It is many times associated with lung, skin and joint involvement. Identifying biomarkers that can differentiate IM from other muscle disorders may elucidate the pathophysiology of IM, guide novel therapies, monitor disease activity/response to treatments and predict prognosis. Exosomes are membrane-bound nanovesicles with diameters of 30-150 nm that contain multiple proteins, nucleic acid, lipids and other molecules in a tissue- and cell-specific manner. Exosomes are secreted by a large variety of cells, play major roles in cell-cell interactions, and have recently emerged as circulating biomarkers in a variety of pathological conditions, including several autoimmune diseases.

Objectives

To characterize exosomes from serum of IM patients, analyze protein expression and study their potential mediators of disease pathologies.

Methods

Serum was collected from patients suffering from IM(n=5) and from patients suffering from Becker (BMD) and Duchenne (DMD) muscular dystrophies (n=6). Exosomes were isolated by Exoquick precipitation and analyzed for size distribution and by nanoparticle tracking analysis (NTA) and by Western blot for exosome markers. The effects of the isolated EVs on human satellite cell proliferation and differentiation and macrophage activation were examined.

Results

Exosomes from IM patients decreased human satellite cell proliferation (51%, P<0.01) and inhibited their myogenic differentiation as indicated by lower fusion index (24% inhibition, P<0.01) and expression of myosin heavy chain (72% inhibition, P<0.001). Similar results were obtained also with exosomes derived from DMD and BMD patients; however, their inhibitory effect were more pronounced on MyoG expression. Treatment of macrophages with exosomes from IM patients significantly increased the expression of IL-10 (3-fold, P<0.001), compared to exosomes of healthy controls and DMD patients. Another significant difference was in the expression of signaling molecules: Thus, exosomes from BMD patients increased the phosphorylation of Erk and p38, whereas a smaller effect was induced by IM exosomes.

Conclusion

Exosomes from IM patients decrease satellite cell proliferation and myogenic differentiation compared to healthy exosomes. In addition, these exosomes increased the expression of IL-10 in macrophages. These effects are unique to exosomes of IM patients compared to muscular dystrophies. These promising results suggest that serum exosomes should be further investigated as a novel biomarker with potential therapeutic implications.

Disclosure of Interests

Shaye Kivity Speakers bureau: BI, Abbvie, Lilly, Pfizer, Janssen, Neopharm, Grant/research support from: Sobi, Haya Kravitz: None declared, Coral Cohen: None declared, Darya Margoulis: None declared, Moshe Amar: None declared, Gila Kazimirsky: None declared, David Ozeri Speakers bureau: Neopharm, Consultant of: Abbvie, Amir Dori Grant/research support from: Biogen, Chaya Brodie Grant/research support from: Biogen.

POS0031 FUNCTIONAL GENOMICS INVESTIGATION OF THE ANKYLOSING SPONDYLITIS ASSOCIATED LOCUS RUNX3

Background

Ankylosing Spondylitis (AS), is a highly heritable disease with >100 genomic loci incriminated. Among these, RUNX3, a transcription factor (TF) involved in diverse immunological processes, is robustly (10−15) associated. [1] We have extensively investigated the single nucleotide polymorphism (SNP) rs4648889 located in a 2kb regulatory locus upstream of the RUNX3 promoter. We have demonstrated that the association between AS and this SNP can be explained by allele-specific effects on TF recruitment (including IRF4, IRF5 and the NuRD complex) that alter gene expression, specifically in CD8+ T-cells, and having a crucial role in CD8+ T-cells function. [2, 3]

Further, we have recently shown a clear chromatin looping event between the region encompassing SNP rs4648889 and the RUNX3 promoter confirming the functional role of this genetic variant. [4]

Objectives

The purpose of this work is: (1) to better characterise the chromatin looping landscape of the whole AS-associated RUNX3 genomic locus and (2) to determine the single-cell expression of the RUNX3-related genes identified previously [2, 3] in CD8+ T-cells lymphocytes.

Methods

(1) Chromosome conformation capture (3C) technique followed by qPCR was performed to define the chromatin looping events at the RUNX3 genomic locus in relevant cell lines, including Jurkat T-cells and U937 monocytes-like cells. (2) 10X Chromium single-cell (sc) sequencing was performed to define RUNX3 and RUNX3-related genes expression profile in CD8+ T cells obtained from AS cases.

Results

(1) In addition to the recent results published, [4] 3C-qPCR experiments revealed a high interaction frequency between the distal promoter of RUNX3 and an intronic region (called Int2), overlapping open chromatin and TF binding sites. This was highly reproducible in both cell lines analysed. (2) Four different clusters were identified in CD8+ T-cells obtained from AS peripheral blood via 10x sc-seq based on the expression of RUNX3. Five other genes (TBX21, EOMES, CHD4, IRF5 and IKZF3) previously identified [2] were considered: cluster 1 showed a strong co-expression for RUNX3, IKZF3, CHD4 and EOMES. Further analysis is required to better characterize this subpopulation.

Conclusion

The AS-associated RUNX3 genomic locus has a plausible functional role in AS, probably by regulating gene transcription and DNA looping. These observations are critically important in defining dysregulated pathways and potential therapeutic drug targets.

References

[1]IGAS et al. Nat Genet. 2013 Jul;45(7):730-8.

[2]Vecellio M. et al, Ann Rheum Dis. 2016 Aug;75(8):1534-40.

[3]Vecellio M. et al, Arthritis Rheumatol 2020. doi: 10.1002/art.41628.

[4]Cohen CJ. et al, Front Genet 2022 doi.org/10.3389/fgene.2021.741867.

Disclosure of Interests

Carla Cohen: None declared, Davide Simone: None declared, Carlo Selmi Speakers bureau: Speakers fee (AbbVie, Amgen, Alfa-Wassermann, Biogen, Celgene, Eli-Lilly, Gilead, Janssen, MSD, Novartis, Pfizer, Sanofi-Genzyme), Consultant of: Consulting (AbbVie, Amgen, Alfa-Wassermann, Biogen, Celgene, Eli-Lilly, Gilead, Janssen, MSD, Novartis, Pfizer, Sanofi-Genzyme), Grant/research support from: Research support (AbbVie, Amgen, Janssen, Pfizer), aul Bowness Grant/research support from: Regeneron, Celgene/BMS and GSK, Paul Bryan Wordsworth: None declared, Matteo Vecellio: None declared

Prolonged shedding of SARS-CoV-2 at high viral load amongst hospitalised immunocompromised persons living with HIV in South Africa

Purpose

Methods & Materials

Results

Conclusion

Sheep as a large animal model for cochlear implantation

INTRODUCTION

In surgical training, large animal models are more suitable as their anatomy is more similar to humans. In otology, there have been relatively few studies about large animal models for surgical training.

OBJECTIVE

In this study, we aimed to do a neuroradiologic evaluation and surgical insertion of a cochlear implant electrode array on a sheep head model.

METHODS

Twenty cadaveric sheep heads were studied. A computed tomography scan and neuroradiologic evaluation was performed on each head, obtaining measurements of the inner ear for each sheep. Sheep measurements were compared to those from temporal bone computed tomography scans from 20 female humans. Surgical procedures were first trained with 13 of the sheep temporal bones, after which cochlear implantation was performed on the remaining 7 temporal bones. The position of the inserted electrode array insertion was confirmed by computed tomography scan after the procedure.

RESULTS

Neuroradiologic evaluation showed that, relative to the 20 female humans, the mean ratio for sheep was 0.60 for volume of cochlea, 0.70 for height of cochlea, 0.73 for length of cochlea; ratios for other metrics were >0.80. For the surgical training, the round window was found in all 20 sheep temporal bones. Computed tomography scans confirmed that electrode insertions were fully complete; the mean value of electrode array insertion was 18.3 mm.

CONCLUSION

The neuroradiologic and surgical training data suggest that the sheep is a realistic animal model to train cochlear implant surgery and collection of perilymph samples, but less so for surgical training of mastoidectomy due to pneumatization of the mastoid.

Diagnosis and management of community-acquired pneumonia in children: South African Thoracic Society guidelines

BACKGROUND

Pneumonia remains a major cause of morbidity and mortality amongst South African children. More comprehensive immunisation regimens, strengthening of HIV programmes, improvement in socioeconomic conditions and new preventive strategies have impacted on the epidemiology of pneumonia. Furthermore, sensitive diagnostic tests and better sampling methods in young children improve aetiological diagnosis.

OBJECTIVES

To produce revised guidelines for pneumonia in South African children under 5 years of age.

METHODS

The Paediatric Assembly of the South African Thoracic Society and the National Institute for Communicable Diseases established seven expert subgroups to revise existing South African guidelines focusing on: (i) epidemiology; (ii) aetiology; (iii) diagnosis; (iv) antibiotic management and supportive therapy; (v) management in intensive care; (vi) prevention; and (vii) considerations in HIV-infected or HIVexposed, uninfected (HEU) children. Each subgroup reviewed the published evidence in their area; in the absence of evidence, expert opinion was accepted. Evidence was graded using the British Thoracic Society (BTS) grading system. Sections were synthesized into an overall guideline which underwent peer review and revision.

RECOMMENDATIONS

Recommendations include a diagnostic approach, investigations, management and preventive strategies. Specific recommendations for HIV infected and HEU children are provided.

VALIDATION

The guideline is based on available published evidence supplemented by the consensus opinion of SA paediatric experts. Recommendations are consistent with those in published international guidelines.

Brachistochrone on a velodrome

The Brachistochrone problem, which describes the curve that carries a particle under gravity in a vertical plane from one height to another in the shortest time, is one of the most famous studies in classical physics. There is a similar problem in track cycling, where a cyclist aims to find the trajectory on the curved sloping surface of a velodrome that results in the minimum lap time. In this paper, we extend the classical Brachistochrone problem to find the optimum cycling trajectory in a velodrome, treating the cyclist as an active particle. Starting with two canonical cases of cycling on a sloping plane and a cone, where analytical solutions are found, we then solve the problem numerically on the reconstructed surface of the velodrome in Montigny le Bretonneux, France. Finally, we discuss the parameters of the problem and the effects of fatigue.

Environmental shedding of toxigenic Clostridioides difficile by asymptomatic carriers: A prospective observational study

OBJECTIVES

The aim was to compare the burden of environmental shedding of toxigenic Clostridioides difficile among asymptomatic carriers, C. difficile-infected (CDI) patients and non-carriers in an inpatient non-epidemic setting.

METHODS

C. difficile carriage was determined by positive toxin-B PCR from rectal swabs of asymptomatic patients. Active CDI was defined as a positive two-step enzyme immunoassay/polymerase chain reaction (EIA/PCR) test in patients with more than three unformed stools/24 hr. C. difficile environmental contamination was assessed by obtaining specimens from ten sites in the patients' rooms. Toxigenic strains were identified by PCR. We created a contamination scale to define the overall level of room contamination that ranged from clean to heavy contamination.

RESULTS

One hundred and seventeen rooms were screened: 70 rooms inhabited by C. difficile carriers, 30 rooms by active CDI patients and 17 rooms by non C. difficile -carriers (control). In the carrier rooms 29 (41%) had more than residual contamination, from which 17 (24%) were heavily contaminated. In the CDI rooms 12 (40%) had more than residual contamination from which three (10%) were heavily contaminated, while in the control rooms, one room (6%) had more than residual contamination and none were heavily contaminated. In a multivariate analysis, the contamination score of rooms inhabited by carriers did not differ from rooms of CDI patients, yet both were significantly more contaminated than those of non-carriers odd ratio 12.23 and 11.16 (95% confidence interval 1.5-99.96 p 0.0195, and 1.19-104.49 p 0.035), respectively.

DISCUSSION

Here we show that the rooms of C. difficile carriers are as contaminated as those of patients with active CDI and significantly more than those of non-carriers.

[Cell-free DNA fraction: Can it be used to evaluate the risk of obstetrical issues?]

OBJECTIVE

The aim of the study was to evaluate if fetal cell-free DNA (cfDNA) fraction circulating in maternal blood at the beginning of the second trimester is associated with obstetrical complications.

METHODS

This is a retrospective unicentric study conducted at the hospital of Poissy Saint Germain between the 1^st January 2015, and the 31^st. December 2016, Each woman who had a genetic counseling in order to realize a non-invasive prenatal test (NIPT) was included. Only singleton pregnancies with a documented-issue were analysed. The primary criteria was a composite criteria, defined as the occurrence of preeclampsia, in utero fetal growth, or a spontaneous preterm delivery. A descriptive analyse was first conducted, secondly completed by a sub-group one: "high fetal fraction" (>90^th percentile) group, "low fetal-fraction" group (<10^th percentile) and "medium fetal-fraction" (control group) group.

RESULTS

A total of 417 women had a cfDNA test, which was performed at a mean gestational age of 17.1 weeks of gestation. A total of 17% of pregnancies met the primary criteria. Among them, there were 8 (1.9%) pre-eclampsia, 49 (11.8%) intra-uterine growth restriction and 14 (3.4%) preterm births. There was no significant difference for the occurrence of the primary criteria (P>0.99) and of each obstetrical complication between each group.

CONCLUSION

Fetal cf-DNA fraction measured at the beginning of the second trimester is not associated with common obstetrical complications.

Factors associated with missed and delayed DTP3 vaccination in children aged 12 - 59 months in two communities in South Africa, 2012 - 2013

BACKGROUND

Although immunisation services are available to all children in South Africa (SA), many children miss or have delays in receiving vaccines. There are limited data on factors associated with missed or delayed vaccination in children in this setting.

OBJECTIVES

To assess vaccination coverage and factors associated with missed and delayed diphtheria-tetanus-pertussis vaccine third dose (DTP3) vaccination in children aged 12 - 59 months in two SA communities.

METHODS

We used data from household-level healthcare utilisation surveys conducted in Soweto in 2012 and in Pietermaritzburg in 2013. Information on vaccination status was recorded from the Road to Health cards or vaccination history from clinics for children aged <5 years. Factors associated with missed or delayed DTP3 vaccination were assessed using unconditional logistic regression.

RESULTS

Of a total of 847 eligible children aged 12 - 59 months, 716 had available vaccination information. Overall DTP3 vaccination coverage was high for both sites: 90.6% in Pietermaritzburg and 93.9% in Soweto. However, 32.6% and 25.2% of DTP3 vaccinations were delayed (received after 18 weeks of age) in Pietermaritzburg and Soweto, respectively. The median delay for DTP3 vaccinations was 4.7 weeks (interquartile range 1.7 - 23.0). Factors associated with delayed DTP3 vaccination included being born in 2010 (adjusted odds ratio (aOR) 3.0, 95% confidence interval (CI) 1.4 - 6.3) or 2011 (aOR 2.7, 95% CI 1.3 - 5.7) compared with being born in 2008, probably due to vaccine shortages; a low level of education of the primary caregiver, with children whose caregivers had completed secondary education having lower odds of delayed vaccination (aOR 0.5, 95% CI 0.3 - 0.9) than children whose caregivers only had primary education; and maternal HIV status, with unknown status (aOR 3.5, 95% CI 1.6 - 7.6) associated with higher odds of delay than positive status. Factors associated with missed DTP3 vaccination (not vaccinated by 12 months of age) included two or more children aged <5 years in a household (aOR 2.4, 95% CI 1.2 - 4.9) compared with one child, and household monthly income <ZAR500 (aOR 3.4, 95% CI 1.1 - 11.4) compared with ≥ZAR2 000.

CONCLUSIONS

Despite high overall DTP3 coverage observed in two communities, many vaccinations were delayed. Vulnerable groups identified in this study should be targeted with improved vaccination services to enhance uptake and timeliness of vaccination.

Feasibility of Hyperfunctioning Parathyroid Gland Localization Using [18F]fluciclovine PET/CT

PURPOSE

To evaluate the ability of anti-1-amino-3-anti-1-amino-3-[¹⁸F]fluorocyclobutane-1-carboxylic acid ([¹⁸F]fluciclovine) positron emission tomography/X-ray computed tomography (PET/CT) in comparison to Technetium-99m 2-methoxy isobutyl isonitrile ([^99mTc]sestamibi) single-photon emission computed tomography/CT (SPECT/CT) for the localization of hyperfunctioning parathyroid glands in patients with hyperparathyroidism.

PROCEDURES

Four patients with hyperparathyroidism underwent 60-minutes sequential neck and thorax PET/CT after [¹⁸F]fluciclovine (352 ± 28 MBq) injection. Lesion uptake and target-to-background ratios (TBR) were compared with [^99mTc]sestamibi (798 ± 27 MBq) SPECT/CT in the same patient.

RESULTS

Both techniques detected 4/5 hyperfunctioning parathyroid glands identified at surgery. The highest [¹⁸F]fluciclovine uptake and TBRs were at 5-9 min with rapid washout. [^99mTc]sestamibi had significantly higher TBRs compared with [¹⁸F]fluciclovine (5-9 min) for blood pool (10.9 ± 4.7 vs 1.3 ± 0.6; p < 0.01) and reference muscle backgrounds (5.8 ± 3.0 vs 1.7 ± 0.6; p < 0.01), with non-significant trend for thyroid tissue background (1.3 ± 0.5 vs 1.1 ± 0.5; p = 0.73).

CONCLUSION

Hyperfunctioning parathyroid glands can be detected on [¹⁸F]fluciclovine PET/CT at early imaging, but conspicuity (TBR) is better with [^99mTc]sestamibi. [¹⁸F]fluciclovine PET/CT does not seem promising in the detection of hyperfunctioning parathyroid glands.

Evaluation of endothelial function and arterial stiffness in obese individuals with insulin resistance

BACKGROUND

Obesity is associated with metabolic imbalance, including insulin resistance and endothelial dysfunction.

AIM

We aimed to evaluate clinical and vascular parameters in obese with or without insulin resistance.

METHODS

Participants ( n=39) were divided into two groups according to Homeostasis Model Assessment - Insulin Resistance lower (group 1) or higher (group 2) than 2.7. All patients were submitted to clinical, anthropometric, biochemical, vascular structure and endothelial function assessment.

RESULTS

The mean age (53±9 vs. 52±7 years, p=0.784) and body mass index (34.3±4.1 vs. 35.2±3.9 kg/m², p=0.464) were similar in both groups, and 74.4% were treated hypertensive subjects. Fasting glucose (84±7 vs. 97±18 mg/dl, p=0.004) and insulin (9.32±2.48 vs. 22.74±7.49 μU/ml, p<0.001) were higher in group 2. Group 2 presented lower HDL-cholesterol (59±14 vs. 42±12 mg/dl, p<0.001) and higher triglycerides (122±87 vs. 191±112 mg/dl, p=0.042) levels compared with group 1. HOMA-IR was correlated with abdominal circumference ( r=0.51, p=0.001), abdominal/hip ratio ( r=0.57, p<0.001) and triglycerides/HDL ratio ( r=0.53, p=0.001). Differences in brachial flow-mediated dilation did not reach statistical significance (10.2±6.2 vs. 7.9±4.7%, p=0.245). Carotid intima-media thickness, carotid-femoral pulse wave velocity (8.5±1.9 vs. 9.1±1.5 m/s, p=0.334) and central hemodynamic parameters were also similar between groups.

CONCLUSION

Obese individuals with insulin resistance have higher visceral adiposity associated with impaired glucose and lipid metabolism. Endothelial function and arterial stiffness were similar between the groups, perhaps because of antihypertensive treatment in most of these subjects.

Temporal association of rotavirus vaccination and genotype circulation in South Africa: Observations from 2002 to 2014

BACKGROUND

Rotavirus vaccination has reduced diarrhoeal morbidity and mortality globally. The monovalent rotavirus vaccine was introduced into the public immunization program in South Africa (SA) in 2009 and led to approximately 50% reduction in rotavirus hospitalization in young children. The aim of this study was to investigate the rotavirus genotype distribution in SA before and after vaccine introduction.

MATERIALS AND METHODS

In addition to pre-vaccine era surveillance conducted from 2002 to 2008 at Dr George Mukhari Hospital (DGM), rotavirus surveillance among children <5 years hospitalized for acute diarrhoea was established at seven sentinel sites in SA from April 2009 to December 2014. Stool specimens were screened by enzyme immunoassay and rotavirus positive specimens genotyped using standardised methods.

RESULTS

At DGM, there was a significant decrease in G1 strains from pre-vaccine introduction (34%; 479/1418; 2002-2009) compared to post-vaccine introduction (22%; 37/170; 2010-2014; p for trend <.001). Similarly, there was a significant increase in non-G1P[8] strains at this site (p for trend <.001). In expanded sentinel surveillance, when adjusted for age and site, the odds of rotavirus detection in hospitalized children with diarrhoea declined significantly from 2009 (46%; 423/917) to 2014 (22%; 205/939; p<.001). The odds of G1 detection declined significantly from 2009 (53%; 224/421) to 2010-2011 (26%; 183/703; aOR=0.5; p<.001) and 2012-2014 (9%; 80/905; aOR=0.1; p<.001). Non-G1P[8] strains showed a significant increase from 2009 (33%; 139/421) to 2012-2014 (52%; 473/905; aOR=2.5; p<.001).

CONCLUSIONS

Rotavirus vaccination of children was associated with temporal changes in circulating genotypes. Despite these temporal changes in circulating genotypes, the overall reduction in rotavirus disease in South Africa remains significant.

Market assessment of tuberculosis diagnostics in India in 2013

BACKGROUND

India represents a significant potential market for new tests. We assessed India's market for tuberculosis (TB) diagnostics in 2013.

METHODS

Test volumes and unit costs were assessed for tuberculin tests, interferon-gamma release assays, sputum smear microscopy, serology, culture, speciation testing, nucleic-acid amplification tests (i.e., in-house polymerase chain reaction, Xpert(®) MTB/RIF, line-probe assays) and drug susceptibility testing. Data from the public sector were collected from the Revised National TB Control Programme reports. Private sector data were collected through a survey of private laboratories and practitioners. Data were also collected from manufacturers.

RESULTS

In 2013, India's public sector performed 19.2 million tests, with a market value of US$22.9 million. The private sector performed 13.6 million tests, with a market value of US$60.4 million when prices charged to the patient were applied. The overall market was US$70.8 million when unit costs from the ingredient approach were used for the 32.8 million TB tests performed in the entire country. Smear microscopy was the most common test performed, accounting for 25% of the overall market value.

CONCLUSION

India's estimated market value for TB diagnostics in 2013 was US$70.8 million. These data should be of relevance to test developers, donors and implementers.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

KC60 coding: room for improvement – a study into consistencies and inconsistencies in the use of diagnosing codes

Twenty mock cases were designed. Thirty-two doctors completed the study, assigning local and KC60 codes for service provision and diagnoses. They gave a wide range of responses, often missing codes or adding inappropriate ones. Where the diagnosis was clear, e.g. gonorrhoea, 97% assigned the correct KC60 code. However, the KC60 codes for service provision (S1, S2, P1A, P3, etc.) were frequently omitted, representing a significant underestimate of workload. Some local codes were given by only 6–28% of clinicians, and when they included them, doctors were more likely to omit KC60 codes. Low response rates for local codes renders these codes unhelpful. Simplification of coding procedures is needed so that diagnoses and workload are documented accurately. This is crucial at a time of modernization of genitourinary (GU) Medicine services and the introduction of Payment by Results.

Mentoring in genitourinary medicine

Mentoring is a process whereby one doctor (the mentor) facilitates and encourages another doctor (the mentee) to develop their career, in light of their own priorities. Mentees benefit from time dedicated to addressing their needs, challenging the status quo, and exploring ways to change. Mentoring schemes depend on the availability and enthusiasm of suitably trained mentors, as well as the voluntary participation of mentees. The specialty of genitourinary (GU) medicine is setting up such a scheme, which will initially be offered to new consultants. Workshops to train mentors are starting that are specifically tailored to our specialty. We discuss the principles and benefits of mentoring, different models that can be used, and potential difficulties. We also present the results of a survey that demonstrated widespread interest in mentoring within GU medicine.

Correction: Temporal Patterns of Influenza A and B in Tropical and Temperate Countries: What Are the Lessons for Influenza Vaccination?

[This corrects the article DOI: 10.1371/journal.pone.0152310.].

Multicentre study of neoadjuvant chemotherapy for stage I and II oesophageal cancer

Background

The benefit of neoadjuvant chemotherapy (NCT) for early-stage oesophageal cancer is unknown. The aim of this study was to assess whether NCT improves the outcome of patients with stage I or II disease.

Methods

Data were collected from 30 European centres from 2000 to 2010. Patients who received NCT for stage I or II oesophageal cancer were compared with patients who underwent primary surgery with regard to postoperative morbidity, mortality, and overall and disease-free survival. Propensity score matching was used to adjust for differences in baseline characteristics.

Results

Of 1173 patients recruited (181 NCT, 992 primary surgery), 651 (55·5 per cent) had clinical stage I disease and 522 (44·5 per cent) had stage II disease. Comparisons of the NCT and primary surgery groups in the matched population (181 patients in each group) revealed in-hospital mortality rates of 4·4 and 5·5 per cent respectively (P = 0·660), R0 resection rates of 91·7 and 86·7 per cent (P = 0·338), 5-year overall survival rates of 47·7 and 38·6 per cent (hazard ratio (HR) 0·68, 95 per cent c.i. 0·49 to 0·93; P = 0·016), and 5-year disease-free survival rates of 44·9 and 36·1 per cent (HR 0·68, 0·50 to 0·93; P = 0·017).

Conclusion

NCT was associated with better overall and disease-free survival in patients with stage I or II oesophageal cancer, without increasing postoperative morbidity.

Carcinosarcoma of the ovary: a single institution experience and review of the literature

PURPOSE

To evaluate the management and outcome in patients with advanced stage primary carcinosarcoma (CS) of the ovary in a single institution.

MATERIALS AND METHODS

The authors performed a retrospective analysis of all patients treated for CS of the ovary between 1994 and 2011. The medical records, operative reports and pathology records were abstracted for baseline characteristics, surgical staging, degree of cytoreduction and chemotherapy regimens used. Standard statistical methods for analysis of the data were used.

RESULTS

A total of 33 patients with ovarian CS were identified. Of these, 28 records were available for analysis. One patient was Stage I (3.5%), two were Stage II (11.1%), 20 were Stage III (71.4%), and five (17.9%) were Stage IV. The early stage (Stage I and II) patients were excluded from analysis. Of the 25 advanced stage (III and IV) patients, 21 (84.0%) were optimally cytoreduced to a residual disease of < one cm and four (16.0%) were suboptimally cytoreduced. The median progression free survival (PFS) and overall survival (OS) were ten and 21 months, respectively, for advanced stages. Twenty-one (75%) patients received adjuvant chemotherapy and 62% (13 of 21) of treated patients received paclitaxel/carboplatin (T/C) as first-line chemotherapy. The median PFS and OS were 15.6 and 31.7 months, respectively, for those treated with T/C. There was no.difference in PFS (p = 0.42) and OS (p = 0.91) between the patients who received T/C vs. other chemotherapy regimens as a first-line adjuvant chemotherapy. Patients with optimal cytoreduction had an improved PFS compared to those with suboptimal cytoreduction (ten vs. four monthsp = 0.015); however, there was no difference in OS (21 vs. 13 p = 0.117). The two-year OS was 48.0%. In the preset study, PFS was improved in patients who were optimally cytoreduced at the time of diagnosis.

CONCLUSION

T/C is an active regimen in the treatment of ovarian CS and has the potential to be the backbone for addition of biologic targeted therapies in the future. For advanced ovarian CS the authors recommend optimal cytoreductive surgery followed by T/C chemotherapy.

Weightlifting and the actomyosin cycle

How does a human lift a weight? Can we relate the dynamics of the lift to the molecular actin–myosin interactions responsible for muscle contraction? We address these questions with bench press experiments that we analyse with a theoretical model, based on the sliding filament theory. The agreement is fair, and we discuss its possible extension to medical diagnostics.

Selective induction of interleukin-12 in reconstructed human epidermis by chemical allergens

Keratinocytes play an important role in skin inflammatory and immunological reactions through the release of cytokines and response to them. These cells have been shown to direct T-cell priming by producing cytokines such as interleukin (IL)-10 and IL-12. The purpose of this work was to explore the potential use of IL-12 production to discriminate between skin irritants and contact allergens in vitro. Initially, a reconstituted human epidermis was treated with a known human skin irritant, sodium lauryl sulphate (SLS), and a known human contact allergen, 1-chloro-2,4-dinitrobenzene (DNCB). The expression of IL-12p40 was assessed at specific time intervals by the semi-quantitative reverse transcriptase-polymerase chain reaction (rt-PCR). The data obtained indicated that only DNCB induced an up-regulation of IL-12p40. This up-regulation occurred after exposure to DNCB for 3 hours. Importantly, the application of SLS or vehicles did not induce IL-12 mRNA up-regulation. An increase in total IL-12 protein content was detected in supernatants of allergen-stimulated, but not vehicle-stimulated, reconstituted epidermis. To confirm these results, the effects of benzalkonium chloride, oxazolone and eugenol were assessed. At concentrations that resulted in equivalent IL-1α release, only contact allergens increased IL-12 expression, which confirmed the previous results. These data suggest that IL-12, which is crucial for T-helper type 1 cell responses, could be a useful marker for discriminating between contact allergens and irritants.

American cancer society guideline for the early detection of cervical neoplasia and cancer

An update to the American Cancer Society (ACS) guideline regarding screening for the early detection of cervical neoplasia and cancer, based on recommendations from a formal review and recent workshop, is presented. The new screening recommendations address when to begin screening, when screening may be discontinued, whether to screen women who have had a hysterectomy, appropriate screening intervals, and new screening technologies, including liquid-based cytology and HPV DNA testing.

Implications of spatially heterogeneous vaccination coverage for the risk of congenital rubella syndrome in South Africa

Rubella is generally a mild childhood disease, but infection during early pregnancy may cause spontaneous abortion or congenital rubella syndrome (CRS), which may entail a variety of birth defects. Since vaccination at levels short of those necessary to achieve eradication may increase the average age of infection, and thus potentially the CRS burden, introduction of the vaccine has been limited to contexts where coverage is high. Recent work suggests that spatial heterogeneity in coverage should also be a focus of concern. Here, we use a detailed dataset from South Africa to explore the implications of heterogeneous vaccination for the burden of CRS, introducing realistic vaccination scenarios based on reported levels of measles vaccine coverage. Our results highlight the potential impact of country-wide reductions of incidence of rubella on the local CRS burdens in districts with small population sizes. However, simulations indicate that if rubella vaccination is introduced with coverage reflecting current estimates for measles coverage in South Africa, the burden of CRS is likely to be reduced overall over a 30 year time horizon by a factor of 3, despite the fact that this coverage is lower than the traditional 80 per cent rule of thumb for vaccine introduction, probably owing to a combination of relatively low birth and transmission rates. We conclude by discussing the likely impact of private-sector vaccination.