Surface Degradation of Ion-releasing Restorative Materials With Cariogenic Challenge

This study examined the influence of cariogenic environments on the surface roughness of ion-releasing restorative materials (IRMs). Custom-made stainless steel molds with holes of 5 mm × 2mm were used to fabricate 60 disc-shaped specimens of each of the following materials: Activa Bioactive (AV), Beautifil Bulk Restorative (BB), Cention N (Bulk-fill) (CN), and Filtek Z350XT (FZ) (Control). Baseline surface roughness (Ra) measurements were obtained using an optical 3D measurement machine (Alicona Imaging GmbH, Graz, Austria). The specimens were then randomly divided into five subgroups (n=12) and exposed to 10 ml of the following mediums at 37°C: distilled water (DW), demineralization solution (DM), remineralization solution (RM), pH cycling (PC) and air (AR) (control). Ra measurements were again recorded after one week and one month, followed by statistical evaluations with two-way analysis of variance (ANOVA) to determine interactions between materials and mediums. One-way ANOVA and post hoc Games Howell tests were performed for intergroup comparisons at a significance level of 0.05. Mean Ra values ranged from 0.085 ± 0.004 (µm) to 0.198 ± 0.001 µm for the various material-medium combinations. All IRMs showed significant differences in Ra values after exposure to the aqueous mediums. The smoothest surfaces were observed in the AR for all materials. When comparing materials, AV presented the roughest surfaces for all mediums. All IRM materials showed increased surface roughness over time in all cariogenic environments but were below the threshold value for bacterial adhesion, except for AV 1-month post immersion with pH cycling. Therefore, besides AV, the surface roughness of IRMs did not deteriorate to an extent that it is clinically relevant.

MARGINAL FITNESS OF BIOACTIVE BULKFILL RESTORATIONS TO GINGIVAL ENAMEL OF CLASS II CAVITIES: AN IN VITRO COMPARATIVE STUDY

This study's goal was to assess the marginal fitness for the two bioactive bulkfill restorative materials in Cl. II cavities regarding the storage in PBS. Twenty-four sound molars with nearly same size were placed in PVC tube, showing 3 mm below the CEJ; divided into three major groups (n=8) based on type of restorative materials. Each tooth exposed to two independed MO and DO cavities preparation. After cavities restorations and samples thermocycling, each group was further separated into two subgroups (n=4); the first subgroup does not undergo storage. While the second subgroup was stored for 28 days in PBS. After that all teeth samples were sent for FESEM/EDX analyses. Statistical analyses were be done using "Two-Way ANOVA" and "Duncan's Multiple Range" test to evaluate and compare the results at 5% significant level. According to the study, there was a statistically significant difference at (P≤0.05) between the groups in the term of gap width formation in µm at the interface between restorative materials and gingival enamel margin, group (C1: Predicta bioactive non-storage) represent the highest mean of gap width (11.76±2.07), while group (A1: Tetric powerFill non-storage) represent the lowest mean of gap width (6.08±1.36). The marginal adaptation at the interface between resin restorative material and gingival enamel margin can be affected by the composition and the properties of the restorative materials used. The bioactive restorative materials showed statistically significant reduction in gaps width after storage in PBS for 28 days.

ESTIMATION OF VON WILLEBRAND FACTOR IN PATIENTS CARDIAC DISEASES

Ischemic heart disease, also called coronary artery disease (CAD), is the term given to heart problems caused by narrowed heart (coronary) arteries that supply blood to the heart muscle.The study aims to determine the levels of Von Willebrand factor in patients with coronary artery disease.A total of 60 CAD patients and 30 healthy individuals were enrolled in the present study. Blood was withdrawn and serum was separated for measurement of lipid profile, human von Willebrand Factor, and lactate dehydrogenase (LDH).The study demonstrated that the highest mean of VWF was observed among IHD patients (81.75±29.75 ng/ml) and the lowest mean was within the control group (26.53±5.12 ng/ml). The differences were highly significant (P=0.0001). The study showed that the highest means of cholesterol, triglyceride, and LDL and the lowest mean of HDL were detected in IHD patients as compared with the healthy control group. The study showed that the mean of VWF was (88.76 ng/ml) in patients with hypertension which were significantly highest than in non-hypertensive IHD patients (75.76 ng/ml) at P=0.043. The study showed that the highest means of cholesterol, Triglyceride and HDL were detected in hypertensive IHD patients (264.3, 349.1, and 29.24 mg/dl respectively) as compared with non-hypertensive IHD patients group (217.5, 226.1 and 22.02 mg/dl), respectively. The study showed a significant negative correlation between VWF and LDL among IHD patients and showed a positive correlation of VWF with each of cholesterol, triglyceride, and HDL among IHD patients.In conclusion, the findings of the study suggest that patients with ischemic heart disease (IHD) have elevated levels of the von Willebrand factor. More research is needed to fully understand the relationship between VWF and cardiovascular disease and to determine the clinical utility of its measuring in the diagnosis and management of these conditions.

Prevalence and Determinants of Female-Perpetrated Intimate Partner Violence against Heterosexual Men Living with HIV in a Semi Rural Community, Northern Nigeria

BACKGROUND

Globally, female-perpetrated IPV has been well studied among various groups but little is known about IPV against heterosexual men living with HIV. This study sought to identify the prevalence and determinants of female-perpetrated IPV among heterosexual HIV-positive men in Birnin Kudu, Jigawa State, Nigeria.

MATERIALS AND METHODS

This was a descriptive crosssectional study carried out at one secondary and tertiary health facility respectively, both situated in Birnin Kudu. Using an intervieweradministered pre-tested questionnaire, the prevalence and determinants of female-perpetrated IPV was assessed among 322 heterosexual HIV-positive men attending the anti-retroviral therapy clinics at the two health facilities. Data was entered into and analyzed using statistical package for social sciences version 25.

RESULTS

The prevalence of IPV in the last year was 45% (145D 322). Out of the survivors of IPV, 143 (98.6%), 75 (51.7%), and 51 (35.2%) had experienced psychological aggression, physical assault and sexual coercion respectively. The number of children fathered, experience of childhood violence, and marital status were significantly associated with IPV (p< 0.05) However, they remained significant determinants of IPV after controlling for confounders (ethnicity, marital status, educational status ) {Adjusted Odds ratio (aOR) = 7.34 and 95% confidence interval (C.I.) = 1.49 - 35.4; aOR= 1.84 C.I. 1.33 - 2.80; aOR = O.51 (0.29 - 0.90) respectively}.

CONCLUSION

This study identified a high prevalence of femaleperpetrated IPV against heterosexual men living with HIV and emphasizes that exposure to childhood violence and being childless are determinants of IPV. Efforts should be made to screen for IPV among men living with HIV so as to optimize their health and wellbeing.

Few-cycle Yb laser source at 20 kHz using multidimensional solitary states in hollow-core fibers

We demonstrate ultrashort pulse compression from 300 fs down to 17 fs at a repetition rate of 20 kHz and 160-µJ output pulse energy (3.2 W of average power) using multidimensional solitary states (MDSS) in a 1-meter hollow-core fiber (HCF) filled with N₂O. Under static pressure, thermal limitations at this repetition rate annihilate the MDSS with suppression of spectral broadening. The results obtained in differential pressure configuration mitigate thermal effects and significantly increase the range of repetition rate over which MDSS can be used to compress sub-picosecond laser pulses.

P-164 COVID-19 vaccination does not impair fertilisation outcomes in IVF or ICSI cycles. A retrospective cohort study of patients’ cycle outcomes before and after vaccination

Study question

Does vaccination against Covid-19 affect fertilisation outcomes for patients returning for further IVF/ICSI cycle following vaccination?

Summary answer

Fertilisation outcome and selection of fertilisation method based on semen parameters are not altered after COVID-19 vaccination of both partners.

What is known already

There has been much speculation regarding the impact of the COVID-19 vaccine on fertility in both men and women. While vaccine hesitancy has been high amongst people of reproductive age, there is no current evidence that COVID-19 vaccines impact fertility. However, infection with SARS-CoV-2 virus can cause severe complications in pregnancy. Fertility may also be impacted as suggested by observation of decreased sperm count in some men, presence of SARS-CoV-2 virus in the testicles as well as invasion of SARS-CoV-2 in ovaries, uterus, vagina and placenta.

Study design, size, duration

The study included 89 returning, consenting couples undergoing IVF/ICSI in 2021 at Westmead Fertility Centre soon after receiving their COVID-19 vaccine. The fertilisation method and outcomes were compared to their most recent cycle preceding vaccination (2017-2021).

Participants/materials, setting, methods

Fertilisation method was decided based on semen parameters. Semen ejaculates on the day of oocyte retrieval were assessed according to WHO criteria (5th edition). Conventional IVF was performed for patients with normozoospermic samples above lower reference limits for concentration and motility and ICSI was done in patients falling below these criteria. Fertilisation method and outcomes for IVF and ICSI were compared to the most recent cycle performed prior to either partner receiving their COVID-19 vaccine.

Main results and the role of chance

89 couples returned for an IVF/ICSI cycle following vaccination against Covid-19. Fertilisation outcomes were not significantly different following COVID-19 vaccination (NS, p &gt; 0.05, c2). Average fertilisation rate (2PN/MII oocyte) per couple undergoing conventional IVF post-vaccination was 71.9±1.1% compared to 68.1±1.1% in the previous cycle (NS), while average fertilisation rate per couple undergoing ICSI post-vaccination was 51.7±1.2% compared to 47.6±1.2% pre-vaccination (NS). The average age of women/men at the time of OPU post-vaccination was 36.1±0.6/38.3±0.7 years, compared to 35.3±0.6/37.5±0.7 years in the treatment prior vaccination. In the post-vaccination cycle, 55 patients had normozoospermic samples on the day and underwent conventional IVF (61.8%), while 34 patients underwent ICSI (38.2%). Vaccination against COVID-19 did not affect fertilisation method selection with 82/89 (92.1%) of couples having the same method in pre- and post-vaccination cycles. Fertilisation method was different for seven couples (7.9%), with two choosing ICSI post-vaccination, and five being driven by change in semen parameters. Four couples had ICSI in the pre-vaccination cycle and IVF in the post-vaccination cycle, while one couple had IVF in the pre-vaccination cycle and ICSI in the post-vaccination cycle, all resulting in a non-significantly different fertilisation rate per couple (70.5±3.8% post-vaccination compared to 66.7±3.6% in the pre-vaccination cycle, NS).

Limitations, reasons for caution

The results represent the experience gained from current practice and not of a prospective controlled study. The developmental potential of embryos generated and clinical outcomes were not explored.

Wider implications of the findings

IVF/ICSI fertilisation outcomes are likely not affected by both partners being vaccinated against COVID-19 when considering fertilisation rates, semen characteristics and fertilisation method. This information may assist vaccine hesitant couples of reproductive age in making their choice regarding vaccination.

Trial registration number

2101-08 QA

Deeply Virtual Compton Scattering Cross Section at High Bjorken x_{B}

We report high-precision measurements of the deeply virtual Compton scattering (DVCS) cross section at high values of the Bjorken variable x_{B}. DVCS is sensitive to the generalized parton distributions of the nucleon, which provide a three-dimensional description of its internal constituents. Using the exact analytic expression of the DVCS cross section for all possible polarization states of the initial and final electron and nucleon, and final state photon, we present the first experimental extraction of all four helicity-conserving Compton form factors (CFFs) of the nucleon as a function of x_{B}, while systematically including helicity flip amplitudes. In particular, the high accuracy of the present data demonstrates sensitivity to some very poorly known CFFs.

Measurement of the Nucleon F_{2}^{n}/F_{2}^{p} Structure Function Ratio by the Jefferson Lab MARATHON Tritium/Helium-3 Deep Inelastic Scattering Experiment

The ratio of the nucleon F_{2} structure functions, F_{2}^{n}/F_{2}^{p}, is determined by the MARATHON experiment from measurements of deep inelastic scattering of electrons from ^{3}H and ^{3}He nuclei. The experiment was performed in the Hall A Facility of Jefferson Lab using two high-resolution spectrometers for electron detection, and a cryogenic target system which included a low-activity tritium cell. The data analysis used a novel technique exploiting the mirror symmetry of the two nuclei, which essentially eliminates many theoretical uncertainties in the extraction of the ratio. The results, which cover the Bjorken scaling variable range 0.19<x<0.83, represent a significant improvement compared to previous SLAC and Jefferson Lab measurements for the ratio. They are compared to recent theoretical calculations and empirical determinations of the F_{2}^{n}/F_{2}^{p} ratio.

Form Factors and Two-Photon Exchange in High-Energy Elastic Electron-Proton Scattering

We present new precision measurements of the elastic electron-proton scattering cross section for momentum transfer (Q^{2}) up to 15.75  (GeV/c)^{2}. Combined with existing data, these provide an improved extraction of the proton magnetic form factor at high Q^{2} and double the range over which a longitudinal or transverse separation of the cross section can be performed. The difference between our results and polarization data agrees with that observed at lower Q^{2} and attributed to hard two-photon exchange (TPE) effects, extending to 8  (GeV/c)^{2} the range of Q^{2} for which a discrepancy is established at >95% confidence. We use the discrepancy to quantify the size of TPE contributions needed to explain the cross section at high Q^{2}.

Pulmonary arterial hypertension in hereditary hemorrhagic telangiectasia associated with ACVRL1 mutation: a case report

INTRODUCTION

Hereditary hemorrhagic telangiectasia is an autosomal dominant condition with an estimated prevalence of 1 in 5000. It is characterized by the presence of abnormalities of vascular structures, and may affect many organ systems, including the lungs, brain, spinal cord, gastrointestinal tract, and liver. A causative mutation is identified in approximately 97% of patients with definite hereditary hemorrhagic telangiectasia in one of three genes including a mutation in endoglin, a mutation in a locus mapped to chromosome 5, and an activin receptor-like kinase-1 (ACVRL1) mutation that is associated with an increased incidence of primary pulmonary hypertension. Pulmonary arterial hypertension is a rare (15-25 cases per million people) but severe vascular disorder. Heritable pulmonary arterial hypertension is associated with several gene mutations, with 75% having a mutation in the bone morphogenetic protein receptor 2 (BMPR2). However, the remaining 25% of patients have other associated genetic mutations including ACVLR1, which is also associated with hereditary hemorrhagic telangiectasia. Pulmonary arterial hypertension is a rare complication in patients with hereditary hemorrhagic telangiectasia (< 1% of the hereditary hemorrhagic telangiectasia population). We describe a case report with this rare occurrence.

CASE PRESENTATION

A 70-year-old white/caucasian Irish male presented for screening for hereditary hemorrhagic telangiectasia due to a history of recurrent epistaxis (once/week) and a family history suggestive of pulmonary hypertension. Genetic testing confirmed an ACVRL1 mutation, while an echocardiogram and right heart catheterization confirmed pulmonary arterial hypertension. On examination, he had several mucocutaneous telangiectasia across his face. He was commenced on tadalafil and macitentan. However, this led to increased iron deficiency anemia and pedal edema. Selexipag was also added to his drug regime. He continues to require intermittent admissions for diuresis and blood transfusions.

CONCLUSION

The association of hereditary hemorrhagic telangiectasia and pulmonary arterial hypertension is rare (< 1%). Here we describe a case of hereditary hemorrhagic telangiectasia complicated with pulmonary arterial hypertension as a result of an ACVRL1 mutation. We also describe the clinical challenges of treating these two conditions together, as treatment options for pulmonary arterial hypertension tend to worsen hereditary hemorrhagic telangiectasia symptoms.

Influence of Unsaturations on the Organization and Air Reactivity of Triglyceride Monolayers

The behavior of Langmuir monolayers of saturated and unsaturated C18 triglycerides (TAGs) was studied as two-dimensional (2D) models for paint systems at the air-water interface or transferred onto solid films. The organization of saturated tristearin (C18:0) monolayer was probed thanks to grazing incidence X-ray diffraction: one observes a hexagonal packing of the chains perpendicular to the air-water interface, in contrast to what is described in the literature. Conversely, the mono- and polyunsaturated TAGs (triolein C18:1, trilinolein C18:2, and trilinolenin C18:3) monolayers do not present any organization at the air-water interface but do exhibit peculiar reactivity regarding the air atmosphere. The obtained results derived from the evolution of surface pressure-molecular area isotherms and monolayer compressibility under different atmospheres over time, combined with ultrahigh-vacuum infrared (UHV-FTIR) spectroscopy, showed the adsorption of O₂ molecules in the monolayer together with chemical reactions with hydrocarbon chains. The kinetic effect of lead ions, known to be efficient siccative agents in oil paints, was also assessed: the addition of Pb²⁺ in the subphase induces an increase of the O₂ adsorption.

Deep Exclusive Electroproduction of π^{0} at High Q^{2} in the Quark Valence Regime

We report measurements of the exclusive neutral pion electroproduction cross section off protons at large values of x_{B} (0.36, 0.48, and 0.60) and Q^{2} (3.1 to 8.4  GeV^{2}) obtained from Jefferson Lab Hall A experiment E12-06-014. The corresponding structure functions dσ_{T}/dt+εdσ_{L}/dt, dσ_{TT}/dt, dσ_{LT}/dt, and dσ_{LT^{'}}/dt are extracted as a function of the proton momentum transfer t-t_{min}. The results suggest the amplitude for transversely polarized virtual photons continues to dominate the cross section throughout this kinematic range. The data are well described by calculations based on transversity generalized parton distributions coupled to a helicity flip distribution amplitude of the pion, thus providing a unique way to probe the structure of the nucleon.

Recurrent asthma exacerbations: co-existing asthma and common variable immunodeficiency

Common variable immunodeficiency is characterized by impaired B-cell differentiation and defective immunoglobulin production manifesting as recurrent respiratory tract infections. While the condition can masquerade as asthma, late diagnosis of CVID in known asthmatic is rarely reported.

We present the case of a 43-year-old lady with recurrent episodes of wheeze, cough, sinusitis and multiple lower respiratory tract infections. Transiently responsive to antibiotics and steroids. These episodes had been occurring for many years and she had a longstanding clinical diagnosis of asthma.

As part of her work up for recurrent respiratory tract infections a CT thorax was performed and demonstrated bronchiectasis. Further tests including Immunoglobulin levels revealed critically low IgG, IgM, and IgA levels. Immunoglobulin replacement therapy was commenced with a reduction in exacerbation frequency and severity, and objective improvement of asthma control. Subsequent lung function tests demonstrated reversible airflow limitation (obstructive lung function with 13% reversibility in FEV₁ post-bronchodilator) consistent with asthma.

Our case illustrates the importance of searching for alternate and co-existent diagnoses in patients diagnosed with asthma who are unresponsive to conventional therapy. We believe that serum immunoglobulin measurement should form a component of such a workup.

Quantitative FIT stratification is superior to NICE referral criteria NG12 in a high-risk colorectal cancer population

BACKGROUND

Guidelines for urgent investigation of colorectal cancer (CRC) are based on age and symptom-based criteria. This study aims to compare the diagnostic value of clinical features and faecal immunochemical test (FIT) results to identify those at a higher risk of CRC, thereby facilitating effective triage of patients.

METHODS

We undertook a review of all patients referred for investigation of CRC at our centre between September 2016 and June 2018. Patients were identified using a prospectively recorded local database. We performed a logistic regression analysis of factors associated with a diagnosis of CRC.

RESULTS

One-thousand-and-seven-hundred-eighty-four patients with FIT results were included in the study. Change in bowel habit (CIBH) was the most common referring clinical feature (38.3%). Patients diagnosed with CRC were significantly older than those without malignancy (74.0 years vs 68.9 years, p = 0.0007). Male patients were more likely to be diagnosed with CRC than females (6.5% vs 2.5%, Chi-squared 16.93, p < 0.0001). CRC was diagnosed in 3.5% (24/684) with CIBH compared to 8.1% (6/74) with both CIBH and iron deficiency anaemia. No individual or combination of referring clinical features was associated with an increased diagnosis of CRC (Chi-squared, 8.03, p = 0.155). Three patients with negative FIT results (< 4 µg Hb/g faeces) were diagnosed with CRC (3/1027, 0.3%). The highest proportion of cancers detected was in the ≥ 100 µg Hb/g faeces group (55/181, 30.4%).

CONCLUSION

In a multivariate model, FIT outperforms age, sex and all symptoms prompting referral. FIT has greater stratification value than any referral symptoms. FIT does have value in patients with iron deficiency anaemia.

Characterizing the carrier-envelope phase stability of mid-infrared laser pulses by high harmonic generation in solids

We present a novel approach for measuring the carrier-envelope phase (CEP) stability of a laser source by employing the process of high harmonic generation (HHG) in solids. HHG in solids driven by few-cycle pulses is very sensitive to the waveform of the driving pulse, therefore enabling to track the shot-to-shot CEP fluctuations of a laser source. This strategy is particularly practical for pulses at long central wavelength up to the mid-infrared spectral range where usual techniques used in the visible or near-infrared regions are challenging to transpose. We experimentally demonstrate this novel tool by measuring the CEP fluctuations of a mid-infrared laser source centered at 9.5~μm.

High energy redshifted and enhanced spectral broadening by molecular alignment

We demonstrate an efficient approach for enhancing the spectral broadening of long laser pulses and for efficient frequency redshifting by exploiting the intrinsic temporal properties of molecular alignment inside a gas-filled hollow-core fiber (HCF). We find that laser-induced alignment with durations comparable to the characteristic rotational time scale TRotAlign enhances the efficiency of redshifted spectral broadening compared to noble gases. The applicability of this approach to Yb lasers with (few hundred femtoseconds) long pulse duration is illustrated, for which efficient broadening based on conventional Kerr nonlinearity is challenging to achieve. Furthermore, this approach proposes a practical solution for high energy broadband long-wavelength light sources, and it is attractive for many strong field applications.

Probing Few-Body Nuclear Dynamics via ^{3}H and ^{3}He (e,e^{'}p)pn Cross-Section Measurements

We report the first measurement of the (e,e^{'}p) three-body breakup reaction cross sections in helium-3 (^{3}He) and tritium (^{3}H) at large momentum transfer [⟨Q^{2}⟩≈1.9  (GeV/c)^{2}] and x_{B}>1 kinematics, where the cross section should be sensitive to quasielastic (QE) scattering from single nucleons. The data cover missing momenta 40≤p_{miss}≤500  MeV/c that, in the QE limit with no rescattering, equals the initial momentum of the probed nucleon. The measured cross sections are compared with state-of-the-art ab initio calculations. Overall good agreement, within ±20%, is observed between data and calculations for the full p_{miss} range for ^{3}H and for 100≤p_{miss}≤350  MeV/c for ^{3}He. Including the effects of rescattering of the outgoing nucleon improves agreement with the data at p_{miss}>250  MeV/c and suggests contributions from charge-exchange (SCX) rescattering. The isoscalar sum of ^{3}He plus ^{3}H, which is largely insensitive to SCX, is described by calculations to within the accuracy of the data over the entire p_{miss} range. This validates current models of the ground state of the three-nucleon system up to very high initial nucleon momenta of 500  MeV/c.

COVID-19: Four Paediatric Cases in Malaysia

OBJECTIVE

This is a brief report of 4 paediatric cases of COVID-19 infection in Malaysia BACKGROUND: COVID-19, a coronavirus, first detected in Wuhan, China has now spread rapidly to over 60 countries and territories around the world, infecting more than 85000 individuals. As the case count amongst children is low, there is need to report COVID-19 in children to better understand the virus and the disease.

CASES

In Malaysia, until end of February 2020, there were four COVID-19 paediatric cases with ages ranging from 20 months to 11 years. All four cases were likely to have contracted the virus in China. The children had no symptoms or mild flu-like illness. The cases were managed symptomatically. None required antiviral therapy.

DISCUSSION

There were 2 major issues regarding the care of infected children. Firstly, the quarantine of an infected child with a parent who tested negative was an ethical dilemma. Secondly, oropharyngeal and nasal swabs in children were at risk of false negative results. These issues have implications for infection control. Consequently, there is a need for clearer guidelines for child quarantine and testing methods in the management of COVID-19 in children.

High-field mid-infrared pulses derived from frequency domain optical parametric amplification

We present a novel, to the best of our knowledge, approach for scaling the peak power of mid-infrared laser pulses with few-cycle duration and carrier-to-envelope phase stabilization. Using frequency domain optical parametric amplification (FOPA), selective amplification is performed on two spectral slices of broadband pulses centered at 1.8 µm wavelength. In addition to amplification, the Fourier plane is used for specific pulse shaping to control both the relative polarization and the phase/delay between the two spectral slices of the input pulses. At the output of the FOPA, intrapulse difference frequency generation provides carrier-envelope phase stabilized two-cycle pulses centered at 9.5 µm wavelength with 25.5 µJ pulse energy. The control of the carrier-envelope phase is demonstrated through the dependence of high-harmonic generation in solids. This architecture is perfectly adapted to be scaled in the future to high average and high peak powers using picosecond ytterbium laser technologies.

64 Evaluating the Acute use of Rotigotine Patch for Dopaminergic Replacement in An Inpatient Population

Introduction

Rotigotine, a trans-dermal dopamine agonist (DA), can be used acutely for inpatient populations and is an option in end of life (EoL) care for people with Parkinson’s disease (PD) where enteral (oral or naso-gastric) routes are no longer available or appropriate. Concerns regarding acute use of DAs in hospital include: i) difficulty achieving dopaminergic equivalence; ii) promotion of delirium; and iii) promotion of terminal agitation at EoL.

Methods

We retrospectively evaluated acute inpatient Rotigotine use in a UK teaching hospital. Prescriptions between January-June 2018 were identified from the pharmacy database and relevant inpatient records were analysed. The OPTIMAL calculator was used as a gold standard for dopaminergic conversion.

Results

33 eligible inpatients were identified. 13 (39%) patients were prescribed the recommended dose of Rotigotine; 7 (21%) higher and 13 (39%) lower than recommended dose. Of 22 (66%) patients with delirium, 18 (82%) inappropriately received the higher dose. 12 (36%) patients developed new or worsening delirium; and 6 (18%) developed new or worsening hallucinations. 19 (58%) patients were dead at time of evaluation with median survival of 22 days (range 1-207). For patients prescribed Rotigotine for EoL (n=13), median survival was 15 days (range 1-62); for patients not prescribed Rotigotine for EoL (n=20), median survival was 81 days (range 6-207). Of 13 (39%) patients prescribed Rotigotine for EoL, 9 (69%) had evidence of terminal agitation.

Conclusions

Acute conversion to Rotigotine remains problematic, despite availability of validated tools. Inappropriate dosing may precipitate or worsen delirium. Acute prescription of Rotigotine appears to act as a proxy marker for poor prognosis and could be a red flag for triggering advanced care planning. Little is published regarding use of Rotigotine at EoL, this data raises concerns regarding risk of terminal agitation and is an important area for further study.

The effectiveness of Reslizumab in severe asthma treatment: a real-world experience

Background

Increased numbers of blood and sputum eosinophils are associated with higher exacerbation frequency and increased asthma severity. In clinical trials, targeting Interleukin-5 has been shown to be a useful therapeutic strategy for patients with severe eosinophilic asthma.

Methods

Twenty-six patients have been commenced on Reslizumab in our institution since early 2017. Safety and clinical efficacy parameters were recorded at regular intervals.

Results

Mean ACQ-6 score at the start of treatment was 3.5. The average number of exacerbations in the year preceding treatment was 8.3 per person. 30% of patients had been admitted to hospital at least once over the 12 months preceding therapy. 54% of our patients were on long term oral steroid.

Our data showed sustained improvement of Asthma control (Mean improvement in ACQ-6 was 1.7 at 1 year, and 2.0 at 2 years, P = 0.0001). Of the patients who were on long term systemic steroids, 35.7% discontinued steroids completely, with a mean reduction of prednisolone dose of 5.2 mg at 1 year. There was a 79% reduction in the annual exacerbation frequency at 1 year, and 88% at 2 years (P = < 0.0001). Modest, albeit statistically significant increases in creatine kinase which seemed to plateau by 1 year were noted.

Conclusions

Overall, Reslizumab was well tolerated with discontinuation of treatment due to side effects recorded in only one patient. Our data confirm the utility of anti-IL5 therapy in a carefully selected phenotype of severe asthma with evidence of eosinophilic airway inflammation.

Merkel cell carcinoma with divergent differentiation

Merkel cell carcinoma (MCC) is a rare primary neuroendocrine carcinoma of the skin, usually occurring at sun-exposed sites in elderly people. Divergent differentiation in MCC, although rare, has been reported in previous case series. We describe two new cases of MCC with divergent differentiation. Patient 1 was a 96-year-old man with a scalp lesion; on biopsy, the morphology and immunoprofile suggested MCC with divergent squamous differentiation. Patient 2 was an 87-year-old woman with a lesion on her leg, originally reported as squamous cell carcinoma, later showing extensive local recurrence. On review, primary histology showed an MCC with divergent differentiation, most likely trichilemmal carcinoma; the recurrence showed only MCC. These cases illustrate that MCC is capable of divergent differentiation, including squamous and adnexal morphologies. Correct diagnosis is essential for appropriate prognosis and management, as later recurrence or metastases may only show the Merkel cell component.

Phase-matching-free pulse retrieval based on transient absorption in solids

In this paper, we introduce a pulse characterization technique that is free of phase-matching constraints, exploiting transient absorption in solids as an ultrafast optical switch. Based on a pump-probe setup, this technique uses pump pulses of sufficient intensity to induce the switch, while the pulses to characterize are probing the transmissivity drop of the photoexcited material. This enables the characterization of low-intensity ultra-broadband pulses at the detection limit of the spectrometer and within the transparency range of the solid. For example, by using zinc selenide (ZnSe), pulses with wavelengths from 0.5 to 20 μm can be characterized, denoting five octaves of spectral range. Using ptychography, we retrieve the temporal profiles of both the probe pulse and the switch. To demonstrate this approach, we measure ultrashort pulses from a titanium-sapphire (Ti-Sa) amplifier, which are compressed using a hollow core fiber setup, as well as infrared to mid-infrared pulses generated from an optical parametric amplifier (OPA). The characterized pulses are centered at wavelengths of 0.77, 1.53, 1.75, 4, and 10 μm, down to sub-two optical cycles duration, exceeding an octave of bandwidth, and with energy as low as a few nanojoules.

Genetic Modifiers of Fetal Haemoglobin (HbF) and Phenotypic Severity in β-Thalassemia Patients

BACKGROUND

The phenotypic severity of β-thalassemia is highly modulated by three genetic modifiers: β-globin (HBB) mutations, co-inheritance of α-thalassemia and polymorphisms in the genes associated with fetal haemoglobin (HbF) production. This study was aimed to evaluate the effect of HbF related polymorphisms mainly in the HBB cluster, BCL11A (B-cell CLL/lymphoma 11A) and HBS1L-MYB (HBS1-like translational GTPase-MYB protooncogene, transcription factor) with regards to clinical severity.

METHODS

A total of 149 patients were included in the study. HBA and HBB mutations were characterised using multiplex PCR, Sanger sequencing and multiplex ligationdependent probe amplification. In addition, 35 HbF polymorphisms were genotyped using mass spectrometry and PCR-restriction fragment length polymorphism (PCRRFLP). The genotype-phenotype association was analysed using SPSS version 22.

RESULTS

Twenty-one HBB mutations were identified in the study population. Patients with HBB mutations had heterogeneous phenotypic severity due to the presence of other secondary modifiers. Co-inheritance of α-thalassemia (n = 12) alleviated disease severity of β-thalassemia. In addition, three polymorphisms (HBS1LMYB, rs4895441 [P = 0.008, odds ratio (OR) = 0.38 (0.18, 0.78)], rs9376092 [P = 0.030, OR = 0.36 (0.14, 0.90)]; and olfactory receptor [OR51B2] rs6578605 [P = 0.018, OR = 0.52 (0.31, 0.89)]) were associated with phenotypic severity. Secondary analysis of the association between single-nucleotide polymorphisms with HbF levels revealed three nominally significant SNPs: rs6934903, rs9376095 and rs9494149 in HBS1L-MYB.

CONCLUSION

This study revealed 3 types of HbF polymorphisms that play an important role in ameliorating disease severity of β-thalassemia patients which may be useful as a predictive marker in clinical management.

Bifidobacterium longum-fermented rice bran and rice bran supplementation affects the gut microbiome and metabolome

This study investigated gut microbiota composition along with food, host, and microbial derived metabolites in the colon and systemic circulation of healthy mice following dietary rice bran and fermented rice bran intake. Adult male BALB/c mice were fed a control diet or one of two experimental diets containing 10% w/w rice bran fermented by Bifidobacterium longum or 10% w/w non-fermented rice bran for 15 weeks. Metabolomics was performed on the study diets (food), the murine colon and whole blood. These were analysed in concert with 16S rRNA amplicon sequencing of faeces, caecum, and colon microbiomes. Principal components analysis of murine microbiota composition displayed marked separation between control and experimental diets, and between faecal and tissue (caecum and colon) microbiomes. Colon and caecal microbiomes in both experimental diet groups showed enrichment of Roseburia, Lachnospiraceae, and Clostridiales related amplicon sequence variants compared to control. Bacterial composition was largely similar between experimental diets. Metabolite profiling revealed 530 small molecules comprising of 39% amino acids and 21% lipids that had differential abundances across food, colon, and blood matrices, and statistically significant between the control, rice bran, and fermented rice bran groups. The amino acid metabolite, N-delta-acetylornithine, was notably increased by B. longum rice bran fermentation when compared to non-fermented rice bran in food, colon, and blood. These findings support that dietary intake of rice bran fermented with B. longum modulates multiple metabolic pathways important to the gut and overall health.

A web-based educational intervention module to improve knowledge and attitudes towards thalassaemia prevention in Malaysian young adults

BACKGROUND

Thalassaemia is a public health burden in Malaysia and its prevention faces many challenges. In this study, we aimed to assess the effectiveness of a web-based educational module in improving knowledge and attitudes about thalassaemia prevention amongst Malaysian young adults.

METHODS

We designed an interactive web-based educational module in the Malay language wherein videos were combined with text and pictorial visual cues. Malaysians aged 18-40 years old who underwent the module had their knowledge and attitudes assessed at baseline, post-intervention and at 6-month follow-up using a selfadministered validated questionnaire.

RESULTS

Sixty-five participants: 47 Malays (72.3%), 15 Chinese (23.1%), three Indians (4.6%) underwent the module. Questionnaires were completed at baseline (n=65), postintervention (n=65) and at 6-month follow-up (n=60). Out of a total knowledge score of 21, significant changes were recorded across three time-points- median scores were 12 at pre-intervention, 19 at post-intervention and 16 at 6-month follow-up (p<0.001). Post-hoc testing comparing preintervention and 6-month follow-up scores showed significant retention of knowledge (p<0.001). Compared to baseline, attitudes at 6-month follow-up showed an increased acceptance for "marriage avoidance between carriers" (pre-intervention 20%, 6-month follow-up 48.3%, p<0.001) and "prenatal diagnosis" (pre-intervention 73.8%, 6-month follow-up 86.2%, p=0.008). Acceptance for selective termination however, remained low without significant change (pre-intervention 6.2%, 6-month follow-up 16.7%, p=0.109).

CONCLUSION

A web-based educational module appears effective in improving knowledge and attitudes towards thalassaemia prevention and its incorporation in thalassaemia prevention programs is potentially useful in Malaysia and countries with a high internet penetration rate.

Subtle Myocardial Dysfunction and Fibrosis in Children with Rheumatic Heart Disease: Insight from 3D Echocardiography, 3D Speckle Tracking and Cardiac Magnetic Resonance Imaging

Rheumatic heart disease (RHD) is a major cause of morbidity and mortality in developing countries, so early diagnosis and treatment can reduce morbidity and mortality resulting from subsequent valvular damage. The aim of this study was to detect subtle myocardial dysfunction among children with RHD with preserved left ventricular systolic function. This is a cross-sectional case-control study that was conducted on 30 children with RHD (who had valvular affection of any degree and were not in activity) compared to 23 healthy children. After history taking and cardiac examination, 2D echocardiography, tissue Doppler imaging, 3D-echocardiography and 3D speckle tracking echocardiography were done to both groups, whereas cardiac magnetic resonance imaging was done only to the patient group. The 3D-derived left ventricular end-diastolic volume and sphericity index among patients were significantly increased when compared to controls [131.5 (101.5 to 173.7) vs. 69 (58 to 92), P = 0.001, and 0.46 (0.36 to 0.59) vs. 0.33 (0.29 to 0.38), P = 0.001, respectively]. The 3D-derived ejection fraction and longitudinal strain did not differ significantly among both groups. The 3D-derived global circumferential strain was higher in patients when compared to controls [- 14 (- 16 to - 10) vs. - 11(- 13 to - 10), P = 0.04]. None of the examined patients demonstrated late enhancement myocardial fibrosis. In children with RHD and preserved systolic function, subtle systolic dysfunction could not be detected using conventional and novel non-conventional methods. This may indicate that the myocardial affection during the acute stage of rheumatic carditis is minimal with almost complete resolution.

Evidence based classification/staging system for Obstetric Fistula: Planning and preliminary intervention in Nigeria

Aims: To review the classification systems of obstetric fistula (OF).  Methods: A two-day stakeholders’ meeting in Nigeria involving fistula surgeons, nurses, anesthetists, trainee, fistula desk officers at the federal and state government levels and other stakeholders was facilitated by Engender health. The meeting involved presentation of common classifications of obstetric fistula, critical analysis of each classification, group and plenary discussions. Presentation involved a critical analysis of classification parameters, strength and weakness. Three working groups designed classification criteria, prognostic scoring and suggested level of surgical skills needed to manage the patient. Outcome of each group work was presented and discussed in plenary. Each of the classification scenarios were modified by consensus and ratified at subsequent follow up meeting. Results: Three new classification systems of the OF were developed, and from these, a consensus classification was also developed in plenary. The initial three classifications developed from group work were similar to each other. Each classification considered size, location, previous repair, scaring, associated morbidity involvement of closing mechanism of the bladder neck, degree of urethral involvement and presence of transection of bladder neck (circumferential defect). The consensus classification, that was adopted, considered classification and prognostic scoring system. The four classification systems will be field tested to generate evidence for reliability and reproducibility. Conclusions: We believe a new classification system of obstetric fistula that will provide robust information to the managing team and patient is long overdue. This modest idea is a wake-up call for practitioners to design appropriate tool that is back up with reproducible evidence.

Desmopressin Has No Beneficial Effect on Excessive Postoperative Bleeding or Blood Product Requirements Associated with Cardiopulmonary Bypass

Cardiopulmonary bypass during open-heart surgery is sometimes associated with excessive perioperative bleeding. Following a non-randomized study suggesting that desmopressin acetate (desmopressin) reduced blood product requirements in these patients, we conducted a double-blind, placebo-controlled randomized trial of desmopressin (0.3 µg/kg, i. v.) in 92 patients with overt bleeding and a prolonged bleeding time.

Mean blood loss during the first 24 h post-treatment was similar in the desmopressin and placebo groups (582 vs 465 ml, respectively; p = 0.15). Red-cell (p = 0.76), fresh frozen plasma (r = 0.66) and platelet unit (p = 0.74) requirements were also similar.

The haemostatic effect of desmopressin has been attributed to the release of von Willebrand factor (vWF) and a reduced bleeding time. In our study, vWF and factor VIII :C levels increased while the bleeding time decreased significantly at 90 min and 24 h in both groups and, although vWF and factor VIII: C levels were slightly higher in desmopressin-treated patients at 90 min, the difference was not significant. Thrombin-antithrombin III complex, fibrinogen degradation product and tissue plasminogen activator levels, reflecting activation of the coagulation and fibrinolytic systems, respectively, decreased uniformely in both groups.

We conclude that desmopressin is not useful in reducing blood loss or blood product requirements in patients with excessive immediate postoperative bleeding.

Optimizing OCT acquisition parameters for assessments of vitreous haze for application in uveitis

Detection and evaluation of inflammatory activity in uveitis is essential to the management of the condition, and yet continues to be largely dependent on subjective clinical measures. Optical coherence tomography (OCT) measurement of vitreous activity is an alternative to clinical vitreous haze scoring and has passed a number of early validation studies. In this study we aimed to evaluate the impact of ‘operator factors’ on the variability of the technique as part of the validation process, and to help evaluate its suitability for ‘real world’ use. Vitreous haze index was calculated as a ratio between the reflectivity of the vitreous and of the outer retina in each scan. Different scanning conditions were tested and their effect on the measurement is reported. Our results show that the ‘quantitative imaging’ technique of OCT-measured vitreous activity had good reliability in normal subjects under a range of ‘real world’ conditions, such as when the operator changes the averaging value. The technique was however vulnerable to highly inaccurate focussing or abnormal downward displacement of the image. OCT-based quantification of vitreous activity is a promising alternative to current subjective clinical estimates, with sufficient ‘tolerance’ to be used in routine clinical practice as well as clinical trials.

2.5 TW, two-cycle IR laser pulses via frequency domain optical parametric amplification

Broadband optical parametric amplification in the IR region has reached a new milestone through the use of a non-collinear Frequency domain Optical Parametric Amplification system. We report a laser source delivering 11.6 fs pulses with 30 mJ of energy at a central wavelength of 1.8 μm at 10 Hz repetition rate corresponding to a peak power of 2.5 TW. The peak power scaling is accompanied by a pulse shortening of about 20% upon amplification due to the spectral reshaping with higher gain in the spectral wings. This source paves the way for high flux soft X-ray pulses and IR-driven laser wakefield acceleration.