The DizzyQuest Combined with Accelerometry: Daily Physical Activities and Limitations among Patients with Bilateral Vestibulopathy Due to DFNA9

BACKGROUND

DFNA9 is a genetic disease of the inner ear, causing progressive bilateral sensorineural deafness and bilateral vestibulopathy (BV). In this study, DizzyQuest, a mobile vestibular diary, and the MOX accelerometer were combined to assess the daily life functional limitations and physical activity of patients with DFNA9 suffering from BV. These parameters might be appropriate as potential candidacy criteria and outcome measures for new therapeutic interventions for BV.

METHODS

Fifteen DFNA9 patients with BV and twelve age-matched healthy controls were included. The DizzyQuest was applied for six consecutive days, which assessed the participants' extent of functional limitations, tiredness, types of activities performed during the day, and type of activity during which the participant felt most limited. The MOX accelerometer was worn during the same six days of DizzyQuest use, measuring the participants intensity and type of physical activity. Mixed-effects linear and logistic regression analyses were performed to compare the DFNA9 patients and control group.

RESULTS

DFNA9 patients with BV felt significantly more limited in activities during the day compared to the age-matched controls, especially in social participation (p < 0.005). However, these reported limitations did not cause adjustment in the types of activities and did not reduce the intensity or type of physical activity measured with accelerometry. In addition, no relationships were found between self-reported functional limitations and physical activity.

CONCLUSIONS

This study demonstrated that self-reported functional limitations are significantly higher among DFNA9 patients with BV. As a result, these limitations might be considered as part of the candidacy criteria or outcome measures for therapeutic interventions. In addition, the intensity or type of physical activity performed during the day need to be addressed more specifically in future research.

Avoiding ecosystem and social impacts of hydropower, wind, and solar in Southern Africa's low-carbon electricity system

The scale at which low-carbon electricity will need to be deployed to meet economic growth, electrification, and climate goals in Africa is unprecedented, yet the potential land use and freshwater impacts from this massive build-out of energy infrastructure is poorly understood. In this study, we characterize low-impact onshore wind, solar photovoltaics, and hydropower potential in Southern Africa and identify the cost-optimal mix of electricity generation technologies under different sets of socio-environmental land use and freshwater constraints and carbon targets. We find substantial wind and solar potential after applying land use protections, but about 40% of planned or proposed hydropower projects face socio-environmental conflicts. Applying land and freshwater protections results in more wind, solar, and battery capacity and less hydropower capacity compared to scenarios without protections. While a carbon target favors hydropower, the amount of cost-competitively selected hydropower is at most 45% of planned or proposed hydropower capacity in any scenario-and is only 25% under socio-environmental protections. Achieving both carbon targets and socio-environmental protections results in system cost increases of 3-6%. In the absence of land and freshwater protections, environmental and social impacts from new hydropower development could be significant.

A framework for transforming the professional identity and brand image of All Nurses as Leaders

BACKGROUND

The professional identity and brand image of nurses as leaders have not kept pace with the roles and scope of contemporary nursing practice.

PURPOSE

To provide a framework to transform the professional identity and brand image of nursing from a caring discipline to one of leaders.

METHODS

A Consensus Development Workgroup (CDW) design was used between the International Society for Professional Identity in Nursing (ISPIN) and the Institute for Brand Image of Nursing (IBIN) to advance the concept of All Nurses as Leaders across all settings and the public domain.

DISCUSSION

The goal is to occupy a position in the minds of all stakeholders that differentiates nursing in a manner that is positive, relevant, accurate, desirable, and consistent over time.

CONCLUSION

Current outcomes are endorsements, evidence-based strategies, and a framework to deconstruct the current brand image and align it with the desired brand image of All Nurses as Leaders.

Deleterious functional consequences of perfluoroalkyl substances accumulation into the myelin sheath

Exposure to persistent organic pollutants during the perinatal period is of particular concern because of the potential increased risk of neurological disorders in adulthood. Here we questioned whether exposure to perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) could alter myelin formation and regeneration. First, we show that PFOS, and to a lesser extent PFOA, accumulated into the myelin sheath of postnatal day 21 (p21) mice, whose mothers were exposed to either PFOA or PFOS (20 mg/L) via drinking water during late gestation and lactation, suggesting that accumulation of PFOS into the myelin could interfere with myelin formation and function. In fact, PFOS, but not PFOA, disrupted the generation of oligodendrocytes, the myelin-forming cells of the central nervous system, derived from neural stem cells localised in the subventricular zone of p21 exposed animals. Then, cerebellar slices were transiently demyelinated using lysophosphatidylcholine and remyelination was quantified in the presence of either PFOA or PFOS. Only PFOS impaired remyelination, a deleterious effect rescued by adding thyroid hormone (TH). Similarly to our observation in the mouse, we also showed that PFOS altered remyelination in Xenopus laevis using the Tg(Mbp:GFP-ntr) model of conditional demyelination and measuring, then, the number of oligodendrocytes. The functional consequences of PFOS-impaired remyelination were shown by its effects using a battery of behavioural tests. In sum, our data demonstrate that perinatal PFOS exposure disrupts oligodendrogenesis and myelin function through modulation of TH action. PFOS exposure may exacerbate genetic and environmental susceptibilities underlying myelin disorders, the most frequent being multiple sclerosis.

Two Novel Variants in MITF and PAX3 Associated With Splashed White Phenotypes in Horses

Mutations causing depigmentation are relatively common in Equus caballus (horse). Over 40 alleles in multiple genes are associated with increased white spotting (as of February 2023). The splashed white phenotype, a coat spotting pattern described as appearing like the horse has been splashed with white paint, was previously associated with variants in the PAX3 and MITF genes. Both genes encode transcription factors known to control melanocyte migration and pigmentation. We report two novel mutations, a stop-gain mutation in PAX3 (XM_005610643.3:c.927C>T, ECA6:11,196,181, EquCab3.0) and a missense mutation in a binding domain of MITF (NM_001163874.1:c.993A>T, ECA16:21,559,940, EquCab3.0), each with a strong association with increased depigmentation in Pura Raza Española horses (P = 1.144E-11, N = 30, P = 4.441E-16, N = 39 respectively). Using a quantitative method to score depigmentation, the PAX3 and MITF mutations were found to have average white scores of 25.50 and 24.45, respectively, compared to the average white coat spotting score of 1.89 in the control set. The functional impact for each mutation was predicted to be moderate to extreme (I-TASSER, SMART, Variant Effect Predictor, SIFT). We propose to designate the MITF mutant allele as Splashed White 9 and the PAX3 mutant allele as Splashed White 10 per convention.

Combining systems thinking approaches and implementation science constructs within community-based prevention: a systematic review

BACKGROUND

Systems science offers methods for designing population health interventions while implementation science provides specific guidance for successful implementation. Integrating systems and implementation science may strengthen implementation and enhance and sustain systemic change to achieve system-level outcomes. Little is known about the extent to which these two approaches have been integrated to date. This review aimed to identify and synthesise the peer-reviewed literature that has reported the combined use of systems thinking approaches and implementation science constructs (within the same study), to deliver population health interventions.

METHODS

A systematic literature search of peer-reviewed original research was conducted across six databases from 2009 to 2021. Journal manuscripts were included if they: (1) reported on a population health study conducted in a community, (2) reported the use of a systems method in the design of the intervention, and (3) used an implementation science theory, framework or model in the delivery of the intervention. Data extracted related to the specific systems methods and definitions and implementation science constructs used. The Mixed Methods Appraisal Tool (MMAT) was used to assess study quality.

RESULTS

Of the 9086 manuscripts returned, 320 manuscripts were included for full-text review. Of these, 17 manuscripts that reported on 14 studies were included in the final extraction. The most frequently reported systems methods were a 'whole of community systems approach' (n = 4/14) and 'community-based system dynamics' (n = 2/14). Nineteen different implementation science theories, frameworks and models were used for intervention delivery, with RE-AIM being the only framework used in more than one study.

CONCLUSION

There are few published peer-reviewed studies using systems thinking and implementation science for designing and delivering population health interventions. An exploration of synergies is worthwhile to operationalise alignment and improve implementation of systems thinking approaches. Review protocol registration PROSPERO CRD42021250419.

Pacific Healthy Islands Vision: success factors and challenges faced by health promotion programs

The World Health Organization's (WHO) Western Pacific Regional Office developed the biennial Healthy Islands Recognition Awards (HIA) in 2009 to reinforce the Healthy Islands vision and encourage countries to continue to innovate and demonstrate effective and efficient ways of promoting and protecting population health. This research aimed to identify characteristics of and challenges for successful health promotion in the Pacific. The research was undertaken to develop practical guidance for other groups in the Pacific Islands interested in supporting Healthy Islands. We used a qualitative case study to review 2013 and 2015 HIA awardees from eight Pacific Island countries and territories using a set of questions drawn from the HIA application criteria. In 2015-2016, 35 key informant interviews and a review of program documents were undertaken. This was followed by a workshop with representatives from three HIA awardees to further develop recommendations. We reviewed eight programs targeting healthy eating, physical activity, healthy settings and sanitation. Using evidence, careful planning, building capacity, developing partnerships, strengthening and reorientating networks, ensuring accountability and conducting evaluation were keys to the success of healthy islands projects. Considering the local setting and community was perhaps the most crucial theme amongst the programs examined. Challenges included funding and capacity constraints, maintaining commitment and prioritisation, maintaining communication and coordination and technical challenges. Success factors, challenges and recommendations aligned well with mainstream health promotion literature, although some important distinctions exist. Further research is needed to guide successful health promotion practice in the Pacific.

5'UTR Variant in KIT Associated with White Spotting in Horses

Mutations in KIT, a gene that influences melanoblast migration and pigmentation, often result in mammalian white spotting. As of February 2023, over 30 KIT variants associated with white spotting were documented in Equus caballus (horse). Here we report an association of increased white spotting on the skin and coat with a variant in the 5'UTR of KIT (rs1149701677: g.79,618,649A>C). Horses possessing at least one alternate allele demonstrate phenotypic characteristics similar to other KIT mutations: clear borders around unpigmented regions on the body, face, and limbs. Using a quantitative measure of depigmentation, we observed an average white score of 10.70 among individuals with rs1149701677, while the average score of the control, homozygous reference sample was 2.23 (p=1.892e-11, n=109, t-test). The rs1149701677 site has a cross-species conservation score of 3.4, one of the highest scores across the KIT 5'UTR, implying regulatory importance for this site. Ensembl also predicted a "moderately impactful" functional effect for the rs1149701677 variant. We propose that this single nucleotide variant likely alters the regulation of KIT, which in turn may disrupt melanoblast migration causing an increase in white spotting on the coat. Alternatively, the rs1149701677 variant may be in linkage with another nearby variant with an as-yet-undiscovered functional impact. We propose to term this new allele "Holiday White" or W35 based on conventional nomenclature.

Work outcomes of breast cancer survivors who returned to work after treatment: CANTO cohort

Background

As survival rates among breast cancer patients improve there is an increasing need to address breast cancer survivors’ (BCS) issues, professional life being a key aspect. Return to work (RTW) of BCS has been largely studied, but studies on job maintenance and its determinants are scarce. We aim to study job maintenance after RTW and the associated factors among BCS.

Methods

We used data from the CANTO cohort, a French prospective cohort of BCS. We included 1643 BCS aged <57 at diagnosis (dx) who returned to work two years after dx. We excluded self-employed BCS. Using multinomial logistic models, we assessed the association between activity status one year after they return to work. (i.e. active, sick leave, or unemployed, retired or invalidity) and sociodemographic, clinical, health status and work-related factors.

Results

Overall, 87% of BCS were active, 10% were on sick leave and 3% were on unemployment, retirement or invalidity one year after they return to work. In the fully adjusted model being on sick leave was associated with stage III at dx (OR: 1.89, 95% CI: 1.11-3.22), being severely fatigued at the moment of returning to work (OR: 1.53, 1.04-2.27), and having workplace accommodations (OR: 1.79, 1.14-2.81). The unemployed, retired, invalidity status was negatively associated with professional life being more than or as important as one’s personal life (OR: 0.51, 0.26-0.98) and being <50 years old (OR: 0.51, 0.27-0.96), and positively associated with having a fixed-term contract (OR: 2.69, 1.39-5.18) and working for a small company (OR: 2.73, 1.24-6.02).

Conclusions

A non-negligible proportion of BCS are non-active one year after they return to work. While clinical factors are associated with sick leave, work related factors are associated with the unemployed, retired, and invalidity status. RTW should not be regarded as the ultimate goal and future policies should focus on ensuring people are ready to return to work and maintain their jobs.

Key messages

• A non-negligible proportion of breast cancer survivors are non-active one year after they return to work.

• Future policies should ensure job maintenance along with return to work.

Predictive Role of Aortic Valve Calcium score on post-procedural outcomes and mortality after Transcatheter aortic valve replacement

Introduction

Extent of aortic valve (AV) calcium increases as degenerative aortic valve stenosis progresses. Initial studies postulated AV calcium (AVC) score to be a predictor of complications such as need for pacemaker implantation, paravalvular regurgitation and mortality after Trans-catheter Aortic valve Replacement (TAVR). However, evidence regarding the impact of AVC score as a predictor of post-procedural complications and mortality has been conflicting.

Objective

This study aimed to determine the prognostic impact of AVC as predictor of post-procedural outcomes and mortality in patients with severe aortic stenosis (AS) who underwent TAVR.

Methods

We retrospectively abstracted the records of 497 patients with severe AS who underwent TAVR between January 2016 and July 2019 at our institution. All patients underwent a non-contrast cardiac CT scan on a Siemens Somatom Definition Flash 128 slice scanner. AVC score using the Agatston method was obtained retrospectively. Patients were divided into two groups: 1) Non-severe AVC score group [women &lt;1200 Agatston unit (AU) and men &lt;2000 AU]; 2) Severe AV Calcium Score group [women &gt;1200 AU and men &gt;2000 AU]. Primary outcome was 1-year mortality.

Results

Among 466 patients included in the analysis, 352 patients were included severe AVC group while 114 patients were in the non-severe AVC group. Patients in the severe AVC group were older (81±8 vs 79±8 years), were predominantly males (79% vs 71%), and had less diabetes mellitus (31% vs 42%, p=0.02). Post-TAVR AV dimensionless index (0.58±0.13 vs 0.58±0.12, p=0.8) and AV mean gradient (9.5±4.9 vs 9.2±5.4 mmHg) were not statistically different between both groups. There was no statistical difference in the need for PPM (12% vs 7%, p=0.16), post-TAVR stroke (1.5% vs 0%), post-TAVR major complications (17.4% vs 10%, p=0.07), 30 day (3.7% vs 4.4%), and 1-year mortality (13.6 vs 11.4, p=0.6) between both groups.

Conclusion

Our study report that the severity of AVC score does not have a prognostic impact on major post-procedural outcomes and mortality after TAVR.

Funding Acknowledgement

Type of funding sources: None.

Sex-based differences of the impact of aortic valve calcium score on mortality and post-procedural outcomes after trans-catheter aortic valve replacement

Introduction

Sex based differences exist in the presentation, outcomes, and management of cardiovascular diseases. Although aortic valve calcium (AVC) score has been postulated to be associated with post-procedural outcomes after transcatheter aortic valve replacement (TAVR), data on the impact of AVC score on procedural outcomes after TAVR based on sex have been scarce.

Objective

The aim of the present study was to elucidate sex related differences in the prognostic impact of AVC score as a predictor of post-procedural outcomes and mortality in patients with severe aortic stenosis (AS) who underwent TAVR.

Methods

We retrospectively abstracted the records of 497 patients with severe AS who underwent TAVR between January 2016 and July 2019 at our institution. All patients underwent a non-contrast cardiac CT scan on a Siemens Somatom Definition Flash 128 slice scanner. AVC score using the Agatston method was calculated retrospectively. Primary outcome was 1-year mortality. Patients were divided into two groups: 1) Non-severe AVC score group [women &lt;1200 Agatston unit (AU) and men &lt;2000 AU]; 2) Severe AVC Score group [women &gt;1200 AU and men &gt;2000 AU]. Cox-regression model was used to predict effect of variables on 1-year mortality in male and female patients.

Results

Among 466 patients included, 268 patients were male and 198 were female (57.5% vs 42.5%). When compared with males, female patients had significantly lower AVC score (p&lt;0.001), aortic valve area (AVA) (p&lt;0.001), obstructive CAD (p&lt;0.001), and history of previous PCI (p&lt;0.004), and CABG (&lt;0.001) but had a significantly higher STS score (6.7±3.2 vs 5.8±3.3 P=0.01). There was no difference between need for permanent pacemaker (PPM) implantation (11% vs 9.6%, p=0.4), major complications (16% vs 15%, p=0.9), stroke (0.8% vs 1.6%, p=0.7), 30-day (3.7% vs 4%, p=0.9), and 1-year mortality (14% vs 12%, p=0.6) between males and females, respectively. Female patients required smaller bio-prosthetic valves compared with males (26±3.2 vs 30±3, p&lt;0.001). Cox regression analysis for female patients showed BMI, hemoglobin level, and AVA independently predicted 1-year mortality, while there was no impact of severe AVC score (&gt;1200 AU) on 1-year mortality in females. Similarly, Cox regression analysis for male patients showed there was no impact of severe AVC score (&gt;2000 AU) on 1-year mortality in males. When males in the severe AVC group were compared with female patients in the severe AVC group, there was no difference in 30 day (4.3% vs 3.3%, p=0.82) and 1-year mortality (14.2% vs 13.3%, p=0.77). Similarly, in the severe AVC group there was no difference between need for PPM implantation (12.8% vs 12.1%, p=0.9), major complications (19.7% vs 15.8%, p=0.4), and stroke (2.2% vs 1%, p=0.6) between males and females, respectively.

Conclusion

There were no sex differences in the impact of AVC score on mortality and post-procedural outcomes after TAVR.

Funding Acknowledgement

Type of funding sources: None.

[Stereotactic radiotherapy for localized primary lung tumours of stage T1-T2]

The historical treatment for stage I non-small cell lung cancer is surgical. Parenchymal amputation is not always possible due to cardiopulmonary comorbidities and stereotactic radiotherapy is one of the alternatives to an invasive procedure. The excellent results observed for inoperable tumors raised the question of this treatment in operable patients. This article presents the data in these two situations and the future perspectives.

Associations between inattention and impulsivity ADHD symptoms and disordered eating risk in a community sample of young adults

BACKGROUND

Symptoms of attention deficit hyperactivity disorder (ADHD) and trait impulsivity have been associated with disordered eating but are seldom assessed in community studies, or longitudinally and little is known about the mediating mechanisms.

METHODS

We tested associations between ADHD symptoms and disordered eating cross-sectionally and between trait impulsivity and disordered eating longitudinally. We utilised data from a normative cohort of young adults (642 participants: 65% female, M_age = 23 years). Participants were classified as high risk or low risk for disordered eating using the SCOFF instrument. In the first two steps of both cross-sectional and longitudinal hierarchical logistic regression models, demographics and covariates were entered. For the cross-sectional regression, Adult ADHD self-report scale (ASRS) scores, separated into inattentive and hyperactive/impulsive symptoms, were entered in the third step. In a separate longitudinal model, Barratt impulsivity scale subscales (attentional, motor and non-planning impulsivity) were entered in the third step. Depression, as assessed by the moods and feelings questionnaire (MFQ), was examined as a mediator.

RESULTS

Cross-sectionally, sex, MFQ score and inattentive symptoms predicted disordered eating risk (model R² = 20%). Longitudinally, sex, MFQ score and attentional impulsivity predicted disordered eating risk (model R² = 16%). The relationship between inattentive symptoms and the disordered eating risk was partially mediated by MFQ score, whereas the relationship between attentional impulsivity and the disordered eating risk was fully mediated by MFQ scores.

CONCLUSIONS

These data highlight (1) a specific role for inattentive symptoms of ADHD and (2) the importance of both depression and impulsivity in predicting eating disorder risk.

Drosophila CRISPR/Cas9 mutants as tools to analyse cardiac filamin function and pathogenicity of human FLNC variants

Filamins are large proteins with actin binding properties. Mutations in FLNC, one of the three filamin genes in humans, have recently been implicated in dominant cardiomyopathies, but the underlying mechanisms are not well understood. Here, we aimed to use Drosophila melanogaster as a new in vivo model to study these diseases. First, we show that adult-specific cardiac RNAi-induced depletion of Drosophila Filamin (dFil) induced cardiac dilatation, impaired systolic function and sarcomeric alterations, highlighting its requirement for cardiac function and maintenance of sarcomere integrity in the adult stage. Next, we introduced in the cheerio gene, using CRISPR/Cas9 gene editing, three missense variants, previously identified in patients with hypertrophic cardiomyopathy. Flies carrying these variants did not exhibit cardiac defects or increased propensity to form filamin aggregates, arguing against their pathogenicity. Finally, we show that deletions of the C-term part of dFil carrying the last four Ig-like domains are dispensable for cardiac function. Collectively, these results highlight the relevance of this model to explore the cardiac function of filamins and increase our understanding of physio-pathological mechanisms involved in FLNC-related cardiomyopathies.

Factors associated with enrolment in clinical trials among women with early-stage breast cancer

Background

Clinical trials allow development of innovative treatments and ameliorate the quality of clinical care in oncology. Data show that only a minority of patients are enrolled in clinical trials. We assessed enrolment in clinical trials and its correlates among women with early breast cancer.

Methods

We included 9516 patients with stage I-III breast cancer from the multicenter, prospective CANTO study (NCT01993498), followed-up until year 4 (Y4) post-diagnosis. We assessed factors associated with enrolment using multivariable logistic regression. In exploratory, propensity score matched analyses, we used multiple linear regression to evaluate the relationship of enrolment in clinical trials with the European Organisation for Research and Treatment of Cancer Quality Of Life (QoL) questionnaire (EORTC QLQ-C30) Summary Score and described clinical outcomes (distant disease event, invasive disease event, and death by any cause) according to enrolment.

Results

Overall, 1716 patients (18%) were enrolled in a clinical trial until Y4 post-diagnosis of breast cancer. Socioeconomic factors were not associated with enrolment. Centres of intermediate volume were most likely to enrol patients in clinical trials [versus low volume, odds ratio 1.45 (95% confidence interval (CI) 1.08-1.95), P = 0.0124]. Among 2118 propensity score matched patients, enrolment was associated with better QoL at Y4 (adjusted mean difference versus not enrolled 1.37, 95% CI 0.03-2.71, P = 0.0458), and clinical outcomes (enrolled versus not enrolled, distant disease event 7.3% versus 10.1%, P = 0.0206; invasive disease event 8.2% versus 10.5%, P = 0.0732; death by any cause 2.8% versus 3.7%, P = 0.2707).

Conclusions

In this large study, one in five patients enrolled on a clinical trial until Y4 after diagnosis of early breast cancer. Geographical and centre-related factors were significantly associated with enrolment in clinical trials. Inclusion in clinical trials seemed associated with improved QoL and clinical outcomes. Access to innovation for early-stage breast cancer patients should be encouraged and facilitated by overcoming organizational and geographical barriers to recruitment.

•

The proportion of patients who access innovation through participation in clinical trials is generally limited.

•

Rate of enrolment in clinical trials among women with early breast cancer exceeded what previously found in other settings.

•

Clinical and geographical factors were associated to access to innovation in clinical trials.

•

Enrolment in clinical trials is associated with better quality of life and clinical outcomes.

[Intermediate-risk prostate cancer treated with exclusive external irradiation: Focus on anatomical sites of recurrence in two French trials]

PURPOSE

Retrospective description of anatomical sites of relapse based on (18F)-choline PET-CT, (68Ga)-prostatic specific-membrane antigen PET-CT, bone scan, and prostate magnetic resonance imaging (MRI) data.

MATERIALS AND METHODS

From two French prospective cohorts, patients treated with exclusive radiotherapy for an intermediate-risk cancer were identified during their follow-ups. They were included if they presented a rising of the prostate-specific antigen (PSA) associated with the realization of an imaging showing the sites of recurrences.

RESULTS

Two hundred and sixty-three patients were included. After a median follow-up of 76 months (interquartile range [IQR] 67-95), 65 patients had biochemical recurrence and positive imaging. The median nadir PSA was 0.6ng/mL and the median PSA at recurrence was 3.4ng/mL. A single lesion was found in 48% of cases, 2 to 4 lesions in 43% of cases and more than 4 lesions in 9% of cases. The sites of relapse identified were prostate (37/65), prostate only (19/65), seminal vesicles (9/65) Pelvic nodes (35/65), extrapelvic nodes (15/65) and bone (13/65).

CONCLUSIONS

The majority of relapses presented as a single lesion localized in the pelvis.

POS1295 SYSTEMIC AND AUTO-INFLAMMATORY DISEASES OF PEDIATRIC ONSET: THE EXPERIENCE OF THE FRENCH OVERSEAS DEPARTMENTS OF AMERICA

Background

Systemic diseases of pediatric onset are more frequent in Afro-Caribbean population, especially Pediatric systemic lupus (pSLE).

Objectives

Our work is a retrospective study of patients followed in French overseas departments of America for systemic disease or auto-inflammatory syndrome of pediatric onset. It describes their clinical and biological specificities at diagnosis, during childhood and early adulthood.

Methods

Our retrospective study was conducted between 01/01/2000 and 01/09/2021. Listings of adult patients with pediatric onset and pediatric patients were obtained in each center through computerized hospital archives, list of patients followed by referent pediatricians and adult specialists in internal medicine and the French National Registry for rare disease. Data were then gathered by going through their medical files. The spectrum of diseases studied included pSLE, Sjogren syndrome, antiphospholipid syndrome (APS), connectivitis, systemic scleroderma, dermatomyositis, Systemic juvenile idiopathic arthritis (sJIA), unclassified auto-inflammatory syndrome.

Results

2148 patients were identified on a 21 year-period, and 135 patients were included. Most patients diagnosed with a systemic pathology (102) suffered from pSLE (53%), followed by dermatomyositis (17%). Average follow up was 8.3 years (0.3 - 25 years), median age at last follow up was 21.2 (14 - 36.7). We found an increase in the number of new diagnoses throughout the years. For pSLE, sex repartition was 4/1 girl/boy and did not vary according to age (p= 0,31). At onset, patients had 10 Sclicc criteria (4-12) and median EULAR/ACR 2019 score was 38 (12 - 54). The combination of typical skin involvement, arthritis and fever was found for 87%. At onset, a third of patients had renal involvement, 15% had Neurolupus and 41% cardiac involvement. All patients had a positive ANA and Anti-DNA antibodies, followed by anti-Ssa/Ssb antibodies (78%), Anti-Sm (78%) and anti RNP (52%). During childhood, 54% had renal involvement and 26% suffered from Neurolupus. Patients suffered in median from 3 flares and 26% suffered from more than 5 flares during childhood. Pre-pubertal patients (26%) had worst outcomes, 93% had renal and / or neurological involvement, they had more flares (median at 5 p = 0,02) and needed an average of 4 background therapies (p = 0,04). Boys seemed to have better disease control at transition to adult care but gender was not an independent predictor of severity during childhood (p = 0,21). 17 patients had dermatomyositis, 29% of them had respiratory involvement during childhood. 33 patients had auto-inflammatory syndromes mostly sJIA (67%), 50% of them had hemophagocytic syndrome during childhood and their disease was controlled by steroids for 64%, 36% needed biotherapy. The overall mortality was 3%.

Conclusion

This is a large cohort of patients of Afro-Caribbean origin with a higher frequency of pSLE. Although the outcomes for these patients were similar to western countries, they had loud symptoms at onset, not corelated to delay at diagnosis. Compared to ethnic studies of North America or Africa, the French health care system being universal and free, the bias related to socio-economic status was lower. This work will continue with the exploration by transcriptomic and genetic tests for early and severe forms to identify the extra-environmental causes. The environmental factors specific to these regions should be explored in additional prospective studies.

Figure 1.

Clinical and biological characteristics of patients with pediatric onset systemic lupus. Orange: clinical signs at onset, Green: immunological profile, Blue: evolutive profile and proportion of organ involvement during childhood. ANA: anti-nuclear antibody.

Disclosure of Interests

None declared

Global burden of early pregnancy gestational diabetes mellitus (eGDM): A systematic review

AIMS

Gestational diabetes mellitus (GDM) diagnosed during the first trimester of pregnancy is called 'early pregnancy Gestational Diabetes Mellitus' (eGDM). The burden of eGDM has only been studied sporadically. This review aims to understand the global burden of eGDM in terms of prevalence, risk factors, pregnancy outcomes, treatment and postpartum dysglycemia.  METHODS: A review of epidemiologic studies reporting on early GDM screening as per Joanna Briggs Institute (JBI) methodology for prevalence reviews was conducted. A customized search strategy was used to search electronic databases namely, PubMed, CINAHL, EMBASE, Cochrane Library, Scopus, MEDLINE, Ovid, ScienceDirect, and Google Scholar. Three independent reviewers reviewed studies using Covidence software. Observational studies irrespective of study design and regardless of diagnostic criteria were included. Quality of evidence was appraised, and findings were synthesized.

RESULTS

Of 58 included studies, 41 reported a prevalence of eGDM, ranging from 0.7 to 36.8%. Body mass index (BMI), previous history of GDM, family history of diabetes and multiparity were reported as eGDM risk factors. Adverse pregnancy outcomes associated with eGDM were macrosomia, caesarean delivery, induction of labour, hypertension, preterm delivery, and shoulder dystocia. The incidence of postpartum dysglycemia and the need for insulin was higher in women with eGDM. The risk of bias was moderate. Heterogeneity of studies is a limitation. Meta-analysis was not performed.

CONCLUSIONS

There is heterogeneity in the prevalence of eGDM and intrapartum and postpartum ill effects for the mother and the offspring. There is a need to develop a universal screening protocol for eGDM.

Leveraging the Code of Ethics to Practically Promote Ethics During COVID-19

The COVID-19 pandemic has surfaced many ethical challenges for nurse leaders who need the courage, ability, and support to make the right decisions. This paper discusses 3 ethical challenges: workforce shortages, staff assignments, and moral distress. It also offers strategies to leverage our code of ethics to navigate these situations.

869 Colorectal Cancer Referral Pathways: Impact of First Months of COVID-19

Introduction

Whilst daily living has adapted to the “new normal” during Covid-19, colorectal cancer pathways are yet to be revised to reflect this transformation. Government advice to stay at home, hospital avoidance and reduced healthcare access, may be masking a significant proportion of population at risk. We aim to identify changes in colorectal cancer target pathways.

Method

All cancer referrals during the initial Covid-19 period were retrospectively analysed, recording type and date of first clinic and investigation, MDT discussion and decision to treat dates. A comparison was made with referral and treatment data from the same referral period in 2019.

Results

338 referrals were received during March-April 2020, compared to 542 in 2019, indicating a 37.6% decrease. A high proportion of patients were reviewed by telephone clinic (63.4%) rather than face-to-face (23.8%), representing a significant shift in practice. An increasing number of patients were initially investigated by CT(40.2%) instead of endoscopy (37.8%). 51(15.5%) patients were not investigated, with COVID-19 being the commonest reason. 25 patients were diagnosed with colorectal cancer, of which 8(32.0%) breached the investigation and 13(52.0%) the treatment date, both usually postponed due to the pandemic. There was a 66.7% reduction in surgical management compared to 2019.

Conclusions

Two-week wait pathways are strained in the era of Covid-19. As the fight against the global pandemic continues, patients are mostly seen virtually and receive non-gold standard investigation. With fewer patient presentations and elective surgeries, it is important to continue colorectal cancer surveillance and timely treatment, considering possible alternative pathways.

Participation, retention and uptake in a multicentre pre-exposure prophylaxis cohort using online, smartphone-compatible data collection

Objectives

The aim of the study was to assess the feasibility of a national pre‐exposure prophylaxis (PrEP) programme using smartphone‐compatible data collection.

Methods

This was a multicentre cohort study (NCT03893188) enrolling individuals interested in PrEP in Switzerland. All centres participate in the SwissPrEPared programme, which uses smartphone‐compatible data collection. Feasibility was assessed after centres had enrolled at least one participant. Participants were HIV‐negative individuals presenting for PrEP counselling. Outcomes were participation (number enrolled/number eligible), enrolment rates (number enrolled per month), retention at first follow‐up (number with first follow‐up/number enrolled), and uptake (proportion attending first visit as scheduled). Participant characteristics were compared between those retained after baseline assessment and those who dropped out.

Results

Between April 2019 and January 2020, 987 individuals were assessed for eligibility, of whom 969 were enrolled (participation: 98.2%). The median enrolment rate was 86 per month [interquartile range (IQR) 52–137]. Retention at first follow‐up and uptake were both 80.7% (782/969 and 532/659, respectively). At enrolment, the median age was 40 (IQR 33–47) years, 95% were men who have sex with men, 47% had a university degree, and 75.5% were already taking PrEP. Most reported multiple casual partners (89.2%), previous sexually transmitted infections (74%) and sexualized drug use (73.1%). At baseline, 25.5% tested positive for either syphilis, gonorrhoea or chlamydia. Participants who dropped out were at lower risk of HIV infection than those retained after baseline assessment.

Conclusions

In a national PrEP programme using smartphone‐compatible data collection, participation, retention and uptake were high. Participants retained after baseline assessment were at considerable risk of HIV infection. Younger, less educated individuals were underrepresented in the SwissPrEPared cohort.

Integration of functional imaging in brachytherapy

Functional imaging allows the evaluation of numerous biological properties that could be considered at all steps of the therapeutic management of patients treated with brachytherapy. Indeed, it enables better initial staging of the disease, and some parameters may also be used as predictive biomarkers for treatment response, allowing better selection of patients eligible for brachytherapy. It may also improve the definition of target volumes with the aim of dose escalations by dose-painting. Finally, it could be useful during the follow-up to assess response to treatment. In this review, we report how functional imaging is integrated at the present time during the brachytherapy procedure, and what are its potential future contributions in the main tumour locations where brachytherapy is recommended. Functional imaging has great potential in the contact of brachytherapy, but still, several issues remain to be resolved before integrating it into clinical practice, especially as a biomarker or in dose painting strategies.

National Health Service interventions in England to improve care to Armed Forces veterans

Armed Forces veterans (AFVs) are first and foremost citizens of the UK and are therefore—like all UK residents—entitled to universal healthcare, free at the point of need. This means that AFVs have nearly all their healthcare needs met by the NHS, which provides access to a full range of generic services. However, since 2013 there has been an Armed Forces team that can also support veterans. This review is an assessment of the work of this group over the last eight years. The health needs of AFVs have been investigated and are not significantly different from those of their demographically matched peers. However, due to their demographics, selection at recruitment and their roles, AFVs compared with the general population are more likely to be male, white and old and have fewer pre-existing or hereditary conditions. However, they do suffer from higher rates of musculoskeletal injury, different patterns of mental health illness and have historically been higher users—and abusers—of alcohol and tobacco. In addition to supporting mainstream services used by AFVs, the NHS in England commissions a bespoke range-specific ‘Priority’ NHS services such as those for mental health or for rehabilitation of veterans using prostheses. New interventions are continuing to be developed to improve AFVs’ healthcare and are aligned to the NHS Long Term Plan and the restoration and recovery plans after the COVID-19 pandemic.

Multi O- and S-isotopes as tracers of black crusts formation under volcanic and non-volcanic atmospheric conditions in Sicily (Italy)

The deterioration of monument or building stone materials is mostly due to the growth of black crusts that cause blackening and disaggregation of the exposed surface. This study reports on new oxygen (δ¹⁷O, δ¹⁸O and Δ¹⁷O) and sulphur (δ³³S, δ³⁴S, δ³⁶S, Δ³³S and Δ³⁶S) isotopic analyses of black crust sulphates formed on building stones in Sicily (Southern Italy). The measurements are used to identify the possible influence of volcanic emissions on black crust formation. Black crusts were mostly sampled on carbonate stone substrate in different locations subject to various sulphur emission sources (marine, anthropogenic and volcanic). Unlike atmospheric sulphate aerosols that mostly exhibit Δ³³S > 0‰, here most of the analysed black crust sulphates show negative Δ³³S. This confirms that black crust sulphates do not result from deposition of sulphate aerosols or of rainwater but mostly from the oxidation of dry deposited SO₂ onto the stone substrate. The δ³⁴S and δ¹⁸O values indicate that most of black crust sulphate originates from anthropogenic activities. Δ¹⁷O values are found to be related to the sampling location. The largest ¹⁷O-anomalies (up to ~4‰) are measured in black crust from areas highly influenced by volcanic emissions, which demonstrates the strong involvement of ozone in the formation of black crusts in volcanically influenced environments.

Visual word form processing deficits driven by severity of reading impairments in children with developmental dyslexia

The visual word form area (VWFA) in the left ventral occipito-temporal (vOT) cortex is key to fluent reading in children and adults. Diminished VWFA activation during print processing tasks is a common finding in subjects with severe reading problems. Here, we report fMRI data from a multicentre study with 140 children in primary school (7.9-12.2 years; 55 children with dyslexia, 73 typical readers, 12 intermediate readers). All performed a semantic task on visually presented words and a matched control task on symbol strings. With this large group of children, including the entire spectrum from severely impaired to highly fluent readers, we aimed to clarify the association of reading fluency and left vOT activation during visual word processing. The results of this study confirm reduced word-sensitive activation within the left vOT in children with dyslexia. Interestingly, the association of reading skills and left vOT activation was especially strong and spatially extended in children with dyslexia. Thus, deficits in basic visual word form processing increase with the severity of reading disability but seem only weakly associated with fluency within the typical reading range suggesting a linear dependence of reading scores with VFWA activation only in the poorest readers.

Immune checkpoint inhibitors versus second line chemotherapy for patients with lung cancer refractory to first line chemotherapy

PURPOSE

Anti Programmed Death-ligand (PD1/PD-L1) directed immune-checkpoint-inhibitors (ICI) are widely used to treat patients with advanced non-small cell lung cancer (NSCLC) who progress after first line chemotherapy. The best strategy after early progression under first line has not been specifically studied.

PATIENTS AND METHODS

We conducted a multicenter, retrospective study including all consecutive NSCLC patients progressing within the first 3 months following introduction of first-line chemotherapy and being treated with second line ICI monotherapy or chemotherapy between March 2010 and November 2017. We analysed the clinicopathological data and outcome under second line chemotherapy vs. second line ICI: objective response rate (ORR), progression-free survival (PFS), overall survival (OS.

RESULTS

We identified 176 patients with refractory disease, 99 who received subsequent immunotherapy and 77 undergoing chemotherapy. The 2 populations were comparable regarding the main prognostic criteria, median age was 60, main histology was adenocarcimoma (68.2%). PFS was not significantly different between both treatments 1.9 [1.8-2.1] versus 1.6 month [1.4-2.0] (P=0.125). Compared to chemotherapy, ICI treated patients had a superior OS (P=0.03) (Median [95% CI] OS 4.6 [2.8-6.7] versus 4.2 months [3.4-5.9] and a non-significant improvement in ORR (17.2% versus 7.9%, respectively, P=0.072). Poor performance status (ECOG PS≥2) and a higher number of metastatic sites (≥3) were associated with poorer prognosis. KRAS-mutated patients did not seem to benefit more from ICI than chemotherapy.

CONCLUSIONS

ICI appears to be the preferred second-line treatment for patients who are refractory to first line chemotherapy.