Cardiac magnetic field map topology quantified by Kullback-Leibler entropy identifies patients with clinically suspected myocarditis

Background

Myocarditis is a condition that can have severe adverse outcomes and lead to sudden cardiac death if remaining undetected. This study tested the capability of cardiac magnetic field mapping to detect patients with clinically suspected myocarditis. This could open up the way for rapid, non-invasive, and cost-effective screening of suspected cases before a gold standard assessment via endomyocardial biopsy.

Methods

Historical cardiac magnetic field maps (n = 97) and data from a state-of-the-art magnetocardiography device (n = 30) were analyzed using the Kullback-Leibler entropy (KLE) for dimensionality reduction and topological quantification. Linear discriminant analysis was used to discern between patients with ongoing myocarditis and healthy controls.

Results

The STT segment of a magnetocardiogram, i.e., the section between the end of the S wave and the end of the T wave, was best suited to discern both groups. Using a 250-ms excerpt from the onset of the STT segment gave a reliable classification between the myocarditis and control group for both historic data (sensitivity: 0.83, specificity: 0.85, accuracy: 0.84) and recent data (sensitivity: 0.69, specificity: 0.88, accuracy: 0.80) using the KLE to quantify the topology of the cardiac magnetic field map.

Conclusion

The implementation based on KLE can reliably distinguish between clinically suspected myocarditis patients and healthy controls. We implemented an automatized feature selection based on LDA to replace the observer-dependent manual thresholding in previous studies.

POS1496-HPR HARD TIMES: ADAPTING A FATIGUE MANAGEMENT PROGRAMME IN A PANDEMIC

Background

Fatigue is a symptom of many Rheumatology Conditions (1). Hewlett et al have shown that a Fatigue Management programme (FMP) is effective in reducing fatigue in Rheumatoid Arthritis patients (2). In 2019, a 7-week group-based FMP was developed using a cognitive behavioural approach for Rheumatology patients in NHS Lothian (Scotland). In 2020, due to COVID-19, the in person FMP was adapted for virtual delivery. Referral criteria included Visual Analogue Scale-Fatigue (VAS-F) of ≥6/10 and an inflammatory rheumatic disease diagnosis. The FMP participants recorded Patient Reported Outcome Measures (PROMs) prior to and on completion of the FMP. In August 2021 demand for the FMP far outweighed the capacity of the delivery team and therefore the original 7-week FMP was further adapted to a 4-week programme. This was achieved by focusing on four core elements (i) sleep, (ii) thoughts, emotions and behaviours, (iii) energy conservation, (iv) setbacks.

Objectives

The primary objective was to evaluate whether the 4-week programme produced comparable PROMs results to the 7-week programme. In doing so, the aim was to maintain efficacy of the programme and provide increased capacity by offering more groups in the same timeframe.

Methods

Fatigue Severity Scale (FSS) and VAS-F were selected for comparison between pre and post FMP PROMs results, these being the main indicators of improvement in fatigue management. Fisher’s exact test was used to determine any difference between the PROMs results reported at the end of both programmes. Participants who reported that their PROMs result were the same, worse or who did not respond, were all placed into the category “Other”. The FMP team recorded the average waiting time for those attending each group. The length of the waiting list at any one time was calculated by removing those who were not interested, had been referred elsewhere, or who did not respond to the invitation, from the total number of referrals received by the FMP team.

Results

There was no significant difference in FSS and VAS-F results reported by the participants in both groups at the end of the FMPs as determined by Fisher’s exact test (Table 1). Waiting list times reduced from 24 weeks in August 2021 to 6 weeks in December 2021 as a result of the adaptation of the FMP from a 7-week programme to a 4-week programme (Figure 1).

Table 1.

Reported differences between pre-FMP and post-FMP PROMs.

7 Week FMP (n = 25)4 Week FMP (n = 13)Fischer ExactFSSImproved72%77%p = 1.000Other28%23%VASImproved80%69%p = 0.689Other20%31%Figure 1.

- Review of average waiting times experienced by each group. In August 2021, the decision was made to trial a 4-week FMP to counter large increases in average waiting times.

Conclusion

A 4-week FMP is as effective at improving the management of fatigue in Rheumatology patients as a 7-week FMP and reduces patient waiting times. More research is required to bolster the evidence base to support this novel approach.

References

[1]Overman, C.L., Kool, M.B., Da Silva, J.A.P. et al. The prevalence of severe fatigue in rheumatic diseases: an international study. Clin Rheumatol35, 409–415 (2016).

[2]Hewlett, S., et al., Group cognitive–behavioural programme to reduce the impact of rheumatoid arthritis fatigue: the RAFT RCT with economic and qualitative evaluations. Health Technology Assessment 23(57), 1-130 (2019).

Disclosure of Interests

Joanne Dobson: None declared, Dervil Dockrell: None declared, Kathryn Berg: None declared, Helen Harris Speakers bureau: Galapagos

International Liaison Committee on Resuscitation: COVID-19 consensus on science, treatment recommendations and task force insights

Consensus on Science and Treatment recommendations aim to balance the benefits of early resuscitation with the potential for harm to care providers during the COVID-19 pandemic. Chest compressions and cardiopulmonary resuscitation have the potential to generate aerosols. During the current COVID-19 pandemic lay rescuers should consider compressions and public-access defibrillation. Lay rescuers who are willing, trained and able to do so, should consider providing rescue breaths to infants and children in addition to chest compressions. Healthcare professionals should use personal protective equipment for aerosol generating procedures during resuscitation and may consider defibrillation before donning personal protective equipment for aerosol generating procedures.

256Heart transplant recipients with cardiac allograft vasculopathy have increased platelet aggregation before and after low-dose aspirin therapy

Background

Following heart transplantation (HTx), long-term survival is reduced mainly due to development of a specific form of coronary artery disease, coronary allograft vasculopathy (CAV). Using optical coherence tomography to visualize the coronary artery wall, we have recently shown that layered fibrotic plaques resembling organized clots are the dominant plaque component in CAV. Thus, thrombosis is suggested as a possible mechanism contributing to development and progression of CAV. Aspirin is widely used after HTx despite limited evidence and lack of specific guidelines. The antiplatelet effect of aspirin has not been thoroughly examined in HTx-patients.

Purpose

To investigate baseline platelet aggregation and the antiplatelet effect of aspirin in HTx-patients with and without CAV.

Methods

We included 68 HTx-patients (median 8.6 years from HTx). In 66 patients taking 75 mg aspirin for a minimum of 7 days, platelet aggregation was measured in whole blood using impedance aggregometry with the following agonists: Adenosine diphosphate (ADP) stimulating ADP-receptors and arachidonic acid (AA) for monitoring of aspirin treatment. Aspirin compliance was confirmed by measuring serum-thromboxane B2. Platelet aggregation prior to aspirin therapy was measured in 59 patients as it was not considered clinically safe to interrupt ongoing aspirin treatment for one week prior to blood sampling in 9 patients mainly due to previous coronary stenting. CAV burden was determined by coronary angiography and echocardiography based on international classification. Patients were divided into two groups; no CAV (n=37) and CAV (n=29).

Results

In HTx-patients not treated with aspirin, we found significantly increased ADP-induced platelet aggregation in patients with CAV vs. patients without CAV (904 (95% CI 813–995) vs. 786 (95% CI 728–843) AU*min, P=0.02). Baseline AA-induced aggregation was also higher in patients with CAV vs. patients without CAV, though non-significant (994 (95% CI 907–1081) vs. 905 (95% CI 839–972) AU*min, P=0.10). Even though aspirin reduced AA-induced platelet aggregation in both groups, patients with CAV had significantly increased AA-induced platelet aggregation compared with patients without CAV on aspirin treatment (380 (95% CI 295–465) vs. 286 (95% CI 239–334) AU*min, P=0.04) (Fig. 1).

Conclusions

HTx-patients with CAV have increased platelet aggregation before and after aspirin treatment compared with HTx-patients without CAV. Aspirin monotherapy may not provide sufficient platelet inhibition in HTx-patients with CAV.

Acknowledgement/Funding

Aarhus University (PhD-salary)

Brief Report: Repetitive Behaviour Profiles in Williams syndrome: Cross Syndrome Comparisons with Prader-Willi and Down syndromes

This study describes the profile of repetitive behaviour in individuals with Williams syndrome, utilising cross-syndrome comparisons with people with Prader-Willi and Down syndromes. The Repetitive Behaviour Questionnaire was administered to caregivers of adults with Williams (n = 96), Prader-Willi (n = 103) and Down (n = 78) syndromes. There were few group differences, although participants with Williams syndrome were more likely to show body stereotypies. Individuals with Williams syndrome also showed more hoarding and less tidying behaviours than those with Down syndrome. IQ and adaptive ability were negatively associated with repetitive questioning in people with Williams syndrome. The profile of repetitive behaviour amongst individuals with Williams syndrome was similar to the comparison syndromes. The cognitive mechanisms underlying these behaviours in genetic syndromes warrant further investigation.

Cyberbullying prevention: Insight and recommendations from youths, parents, and paediatricians

BACKGROUND

The purpose of this study was to identify injunctive norms for cyberbullying prevention among youths, parents, and primary care providers, as well as barriers to preventive behaviours.

METHODS

Semi-structured interviews on the topic of cyberbullying were conducted with 29 adolescents, 13 paediatricians, and 15 parents recruited from 3 primary care sites. Transcripts were coded for themes related to various stakeholders' perceived roles in cyberbullying prevention and barriers to preventive behaviours.

RESULTS

Participants reported perceptions that youths should intervene in the moment and get outside help for others. Fear of repercussions emerged as a significant barrier to these behaviours. Participants believed that parents should communicate with their children and monitor and supervise youths' online activities. Barriers included perception of priority and low parental efficacy or naiveté. Participants believed that providers should provide education and resources and ask screening questions; the most frequently identified barrier to those behaviours was the perception of providers' role.

CONCLUSIONS

Youths and providers may not be aware of their potential to prevent cyberbullying before it occurs. Educating youths, parents, and providers about cyberbullying prevention is warranted.

Enhanced targeting of triple-negative breast carcinoma and malignant melanoma by photochemical internalization of CSPG4-targeting immunotoxins

Triple-negative breast cancer (TNBC) and malignant melanoma are highly aggressive cancers that widely express the cell surface chondroitin sulfate proteoglycan 4 (CSPG4/NG2). CSPG4 plays an important role in tumor cell growth and survival and promotes chemo- and radiotherapy resistance, suggesting that CSPG4 is an attractive target in cancer therapy. In the present work, we applied the drug delivery technology photochemical internalization (PCI) in combination with the novel CSPG4-targeting immunotoxin 225.28-saporin as an efficient and specific strategy to kill aggressive TNBC and amelanotic melanoma cells. Light-activation of the clinically relevant photosensitizer TPCS2a (fimaporfin) and 225.28-saporin was found to act in a synergistic manner, and was superior to both PCI of saporin and PCI-no-drug (TPCS2a + light only) in three TNBC cell lines (MDA-MB-231, MDA-MB-435 and SUM149) and two BRAFV600E mutated malignant melanoma cell lines (Melmet 1 and Melmet 5). The cytotoxic effect was highly dependent on the light dose and expression of CSPG4 since no enhanced cytotoxicity of PCI of 225.28-saporin compared to PCI of saporin was observed in the CSPG4-negative MCF-7 cells. The PCI of a smaller, and clinically relevant CSPG4-targeting toxin (scFvMEL-rGel) validated the CSPG4-targeting concept in vitro and induced a strong inhibition of tumor growth in the amelanotic melanoma xenograft A-375 model. In conclusion, the combination of the drug delivery technology PCI and CSPG4-targeting immunotoxins is an efficient, specific and light-controlled strategy for the elimination of aggressive cells of TNBC and malignant melanoma origin. This study lays the foundation for further preclinical evaluation of PCI in combination with CSPG4-targeting.

In vitro genotoxicity of carcinogenic asarone isomers

Cytotoxic and genotoxic properties of the carcinogenic phenylpropanoids α-asarone and β-asarone in different cell lines.

'Aeromonas intestinalis' and 'Aeromonas enterica' isolated from human faeces, 'Aeromonas crassostreae' from oyster and 'Aeromonas aquatilis' isolated from lake water represent novel species

Four Aeromonas strains from clinical and environmental samples differed from known species on the basis of rpoD gene sequence. Multilocus phylogenetic analysis and in silico DNA-DNA hybridization confirmed them as four new species even though their 16S rRNA gene sequence similarity with their closest relatives was >98.7%, as occurred for other Aeromonas spp.

Heart rate during basketball game play and volleyball drills accurately predicts oxygen uptake and energy expenditure

AIM

There is currently little information regarding the ability of metabolic prediction equations to accurately predict oxygen uptake and exercise intensity from heart rate (HR) during intermittent sport. The purpose of the present study was to develop and, cross-validate equations appropriate for accurately predicting oxygen cost (VO2) and energy expenditure from HR during intermittent sport participation.

METHODS

Eleven healthy adult males (19.9±1.1yrs) were recruited to establish the relationship between %VO2peak and %HRmax during low-intensity steady state endurance (END), moderate-intensity interval (MOD) and high intensity-interval exercise (HI), as performed on a cycle ergometer. Three equations (END, MOD, and HI) for predicting %VO2peak based on %HRmax were developed. HR and VO2 were directly measured during basketball games (6 male, 20.8±1.0 yrs; 6 female, 20.0±1.3yrs) and volleyball drills (12 female; 20.8±1.0yrs). Comparisons were made between measured and predicted VO2 and energy expenditure using the 3 equations developed and 2 previously published equations.

RESULTS

The END and MOD equations accurately predicted VO2 and energy expenditure, while the HI equation underestimated, and the previously published equations systematically overestimated VO2 and energy expenditure.

CONCLUSION

Intermittent sport VO2 and energy expenditure can be accurately predicted from heart rate data using either the END (%VO2peak=%HRmax x 1.008-17.17) or MOD (%VO2peak=%HRmax x 1.2-32) equations. These 2 simple equations provide an accessible and cost-effective method for accurate estimation of exercise intensity and energy expenditure during intermittent sport.

Prevalence of oral lesions of autoimmune etiology in patients with primary Sjogren's syndrome

OBJECTIVE

The primary objective of this study was to determine the prevalence of oral lesions of autoimmune etiology (OLAIE) in a cohort of patients with primary Sjögren's syndrome (pSS).

MATERIALS AND METHODS

A multi-center retrospective cohort study was conducted at the oral medicine practices of Carolinas Medical Center (CMC), Baylor College of Dentistry (BCD), and the University of Florida (UF). Each site performed a chart review of patients with well-characterized pSS. Clinical variables such as OLAIE, traumatic lesions, and medical conditions were compiled at each site. The association between clinical variables and the presence of OLAIE was then assessed for significance.

RESULTS

We evaluated 155 patients diagnosed with pSS. Nineteen patients with pSS (12.3%) had an OLAIE. CMC reported 11 (21.2%) patients with OLAIE, while BCD and UF reported 4 (7.3%) and 4 (8.3%), respectively. Eleven of the 19 (58%) patients with OLAIE had lichen planus, 6 (32%) had aphthous stomatitis, 1 (5%) had chronic ulcerative stomatitis, and 1 (5%) had lesions of systemic connective tissue disease by immunofluorescence.

CONCLUSION

The results of our analysis suggest that patients with pSS have a 12% prevalence of OLAIE with a wide range (7.3-21.2%) found between practices. This difference is likely related to the different screening protocols for oral dryness between sites.

["Common variable immunodeficiency"--first diagnosis of a rare pneumological disease]

Common variable immunodeficiency (CVID) is generally used synonymously with "late onset hypogammaglobulinaemia", which is already indicative of the central pathological finding. Patients with CVID produce specifically less immunoglobulins, thus reducing their immunological competence. Our patient showed the typical medical history of undetected CVID. After excluding differential pneumological diseases, the suspected diagnosis was confirmed. This case report examines the complex of CVID as a cause for recurrent pneumological infections. It is the most prevalent form of severe antibody deficiency in children and adults and occurs with a probability of 1:25,000 in the population.

Effects of adult familiarity on social behaviours in Angelman syndrome

BACKGROUND

Individuals with Angelman syndrome appear strongly motivated by social contact, but there have been few studies that have examined the relationship between sociability and familiarity. In this study we compared social behaviour in Angelman syndrome when in contact with mothers and strangers.

METHODS

We systematically manipulated adult familiarity, eye contact and speech to examine the effect on social approach behaviours in children with Angelman syndrome. Eleven children (deletion 15q11-13) participated and were observed during interactions with their mother and an unfamiliar adult, while adult eye contact and talking were manipulated. Laughing and smiling, looking and social approach were observed.

RESULTS

There was no effect of familiarity on laughing and smiling or eye contact. Participants showed more social approach towards their mother than the unfamiliar adult but only when their mother was looking at them.

CONCLUSIONS

In Angelman syndrome, looking at adults, laughing and smiling appear to be unaffected by the familiarity of the adult. However, approach behaviours are more common with mothers than strangers. The function of the approach behaviours might be to increase investment from the primary caregiver.

The prevalence and phenomenology of self-injurious and aggressive behaviour in genetic syndromes

BACKGROUND

Self-injurious and aggressive behaviours are reported as components of some behavioural phenotypes but there are few studies comparing across syndrome groups. In this study we examined the prevalence of these behaviours and the associated person characteristics in seven genetic syndromes.

METHODS

Questionnaire data on self-injury and aggression, mood, hyperactivity, autism spectrum disorder and repetitive behaviour were collected on Angelman (AS, n=104), Cornelia de Lange (CdLS, 101), Cri du Chat (CdCS, 58), Fragile X (FXS, 191), Lowe (LS, 56), Prader-Willi (PWS, 189) and Smith-Magenis (SMS, 42) syndromes.

RESULTS

A significantly higher prevalence of self-injury was evident in CdCS, CdLS, FXS, PWS, LS and SMS. The prevalence of aggression was significantly heightened in AS and SMS. Self-injury was associated with repetitive and impulsive behaviour in CdLS, FXS, PWS and LS. Impulsivity and overactivity were significantly higher in those showing aggression across all syndrome groups.

CONCLUSIONS

These data quantify the risk for self-injury and aggression in the syndromes studied with implications for early intervention. The associations between these behaviours and person characteristics both within and between syndromes warrant further research.

The association between repetitive behaviours, impulsivity and hyperactivity in people with intellectual disability

BACKGROUND

There is a need for assessments of psychological difference and disorder in people who have more severe intellectual disability (ID). Hyperactivity and impulsivity are two behavioural domains of importance as they are correlated with self-injury and aggression and this alludes to a shared cognitive correlate of compromised behavioural inhibition. Additionally, compromised behavioural inhibition is demonstrably related to repetitive behaviour and the latter might be expected to be associated with impulsivity and hyperactivity.

METHODS

The Activity Questionnaire (TAQ) was developed for this study. Three sub-scales with high levels of face validity were supported by factor analysis of the scoring of 755 intellectually disabled participants on the TAQ items. These sub-scales mapped onto the constructs of Overactivity, Impulsivity and Impulsive Speech. Test-retest, inter-rater reliability and internal consistency were robust. TAQ scores and scores on the Repetitive Behaviour Questionnaire (RBQ) were collected for a sample of 136 participants with varying degrees of ID.

RESULTS

Scores on the TAQ at sub-scale and full-scale level were not related to level of adaptive functioning. There were significant positive associations between overactivity (TAQ) and stereotyped behaviour (RBQ), impulsivity (TAQ) and restricted preferences (RBQ), and impulsive speech (TAQ) and repetitive speech (RBQ).

CONCLUSIONS

The TAQ is a reliable assessment of hyperactivity and impulsivity for people with ID with robust factor structure. Validity requires evaluation. The relationship between impulsivity and restricted preferences may result from a common cognitive impairment in inhibition, which may underpin these two classes of behaviour.

[Photochemical internalisation (PCI): a further development of photodynamic therapy for the treatment of skin cancer]

Recently, several new and non-invasive methods have been introduced for the treatment of skin cancers. Topical creams using the immune modulator imiquimod or the COX inhibitor diclofenac (with hyaluronic acid) are now registered for use against neoplasms such as basal or squamous cell carcinoma. Another modern treatment option is photodynamic therapy (PDT). A refined version of PDT, namely photochemical internalisation, is currently subject to a first clinical trial in patients with osteosarcoma, squamous cell carcinoma, head and neck cancer as well as adenocarcinoma of the breast. Preliminary results from this trial suggest that PCI seems to be a promising treatment.

The effect of weight training on bone mineral density and bone turnover in postmenopausal breast cancer survivors with bone loss: a 24-month randomized controlled trial

SUMMARY

This study examined whether 24 months of weight training exercises enhanced the effectiveness of risedronate, calcium, and vitamin D in maintaining or improving bone mineral density (BMD) in 223 postmenopausal breast cancer survivors. Subjects who were > or =50% adherent to exercise had no improvement in BMD but were less likely to lose BMD.

INTRODUCTION

This study examined whether (1) postmenopausal breast cancer survivors (BCS) with bone loss taking 24 months of risedronate, calcium, and vitamin D had increased bone mineral density (BMD) at the total hip, femoral neck, L1-L4 spine, total radius and 33% radius, and decreased bone turnover; (2) subjects who also participated in strength/weight training (ST) exercises had greater increases in BMD and greater decreases in bone turnover; and (3) subjects who also exercised were more likely to preserve (at least maintain) BMD.

METHODS

Postmenopausal BCS (223) were randomly assigned to exercise plus medication or medication only groups. Both groups received 24 months of 1,200 mg of calcium and 400 IU of vitamin D daily and 35 mg of risedronate weekly, and the exercise group additionally had ST exercises twice weekly.

RESULTS

After 24 months, women who took medications without exercising had significant improvements in BMD at the total hip (+1.81%) and spine (+2.85%) and significant decreases in Alkphase B (-8.7%) and serum NTx (-16.7%). Women who also exercised had additional increases in BMD at the femoral neck (+0.29%), total hip (+0.34%), spine (+0.23%), total radius (+0.30%), and additional decreases in Alkphase B (-2.4%) and Serum NTx (-6.5%). Additional changes in BMD and bone turnover with exercise were not significant. Subjects who were > or =50% adherent to exercise were less likely to lose BMD at the total hip (chi-square [1] = 4.66, p = 0.03) and femoral neck (chi-square [1] = 4.63, p = 0.03).

CONCLUSION

Strength/weight training exercises may prevent loss of BMD in postmenopausal BCS at risk for bone loss.

Oxygen cost of sprint training

AIM

The purpose of the study was to profile the oxygen uptake of sprinters during various portions of a typical sprint training workout.

METHODS

This was a descriptive study of 11 female sprinters and jumpers on an NCAA Division II university track team. Subjects were assessed for VO(2max), and VO(2) and HR kinetics during a 65 min typical sprint training session on a treadmill. The sprint session included a warm-up, static stretching, acceleration runs, 8x20 s sprints at 150% of velocity VO(2max) (vVO(2max)) with a 3-min walk recovery, and a cool-down.

RESULTS

Mean VO(2) and HR (M+/-SD) for the entire 65 min sprint training session were 19.1+/-7.6 mL/kg/min and 138.7+/-24.0 b/min, respectively. VO(2) rose to 33 mL/kg/min during and immediately following each 20 s sprint which represented 73% of VO(2max). VO(2) during and after each sprint remained nearly constant (P>0.05) rather than rising as hypothesized.

CONCLUSION

VO(2) during a 65 min sprint training workout in female college athletes varies greatly but was elevated to 33 mL/kg/min following each 20 s sprint. VO(2) did not rise across the series of eight sprints. These results suggest that chronic sprint training may elicit a moderate aerobic training effect. Implications for training are discussed.