Post-operative complications affect survival in surgically treated metastatic spinal cord compression

PURPOSE

The prevalence of metastatic epidural spinal cord compression (MESCC) is increasing globally due to advancements in cancer diagnosis and treatment. Whilst surgery can benefit specific patients, the complication rate can reach up to 34%, with limited reporting on their impact in the literature. This study aims to analyse the influence of major complications on the survival of surgically treated MESCC patients.

METHODS

Consecutive MESCC patients undergoing surgery and meeting inclusion criteria were selected. Survival duration from decompressive surgery to death was recorded. Perioperative factors influencing survival were documented and analysed. Kaplan-Meier survival analysis at one year compared these factors. Univariate and multivariate Cox proportional hazard regression analyses were performed. Additionally, univariate analysis compared complicated and uncomplicated groups.

RESULTS

Seventy-five patients were analysed. Median survival for this cohort was 229 days (95% CI 174-365). Surgical complications, low patient performance, and rapid primary tumour growth were significant perioperative variables for survival in multivariate analyses (p < 0.001, p = 0.003, and p = 0.02, respectively) with a hazard ratio of 3.2, 3.6, and 2.1, respectively. Univariate analysis showed no variables associated with complication occurrence.

CONCLUSION

In this cohort, major surgical complications, patient performance, and primary tumour growth rate were found to be independent factors affecting one year survival. Thus, prioritizing complication prevention and appropriate patient selection is crucial for optimizing survival in this population.

Isoniazid preventive therapy completion in children under 5 years old who are contacts of tuberculosis cases in Lima, Peru: study protocol for an open-label, cluster-randomized superiority trial

BACKGROUND

Children < 5 years old in contact with TB cases are at high risk for developing severe and fatal forms of TB. Contact investigation, BCG vaccination, and isoniazid preventive therapy (IPT) are the most effective strategies to prevent TB among children. However, the implementation of IPT faces challenges at several stages of the cascade of care of TB infection among children, particularly those less than 5 years old. In Peru, a large proportion of children do not complete IPT, which highlights the need to design effective interventions that enhance preventive therapy adherence and completion. Although the body of evidence for such interventions has grown, interventions in medium TB incidence settings are lacking. This study aims to test the effectiveness, acceptability, and feasibility of an intervention package to increase information and motivation to complete IPT among children < 5 who have been prescribed IPT.

METHODS

An open-label, cluster-randomized superiority trial will be conducted in two districts in South Lima, Peru. Thirty health facilities will be randomized as clusters, 10 to the intervention and 20 to control (standard of care). We aim to recruit 10 children from different households in each cluster. Participants will be caretakers of children aged < 5 years old who initiated IPT. The intervention consists of educational material, and short message services (SMS) reminders and motivators. The primary outcomes will be the proportion of children who picked up > 90% of the 24 weeks of IPT (22 pick-ups) and the proportion of children who picked up the 24 weeks of IPT. The standard of care is a weekly pick-up with monthly check-ups in a health facility. Feasibility and acceptability of the intervention will be assessed through an interview with the caretaker.

DISCUSSION

Unfavorable outcomes of TB in young children, high effectiveness of IPT, and low rates of IPT completion highlight the need to enhance adherence and completion of IPT among children < 5 years old. Testing of a context-adapted intervention is needed to improve IPT completion rates and therefore TB prevention in young children.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03881228. Registered on March 19, 2019.

Clearance and persistence of Escherichia coli in the freshwater mussel Unio mancus

The excessive use of antibiotics has led to the emergence of resistant bacteria, mainly from the Enterobacterales group, with high pathogenic/zoonotic potentials that can lead to problems in public health. The increasing presence in freshwater ecosystems highlights the need to evaluate potential sentinel species as risk indicators for both ecosystem and human health. The freshwater mussels provide several ecosystem services, may represent potential sentinel species due to their ability to filter water and retain both organic and inorganic particles. We tested the capability of U. mancus to retain Escherichia coli as a model bacterial organism. Under experimental conditions, the mussels could clear suspended E. coli, facilitating its rapid elimination from water within the first 24 h after exposure. The species also presented a maximum retention time of 4 days. We also provide allometric equations correlating the filtering capacity with the length and the weight of mussel body parts often used in biometric studies. We provide a first assessment of the potential of the bivalve Unio mancus to act as a sentinel species for the detection of Enterobacterales and demonstrate the ability to act as a water cleaner.

Interventive psychodiagnosis of children through online orientation of parents in a University Clinical Practice in Brazil: an alternative for underserved populations during the COVID-19 pandemic

Introduction

A private university in Santos offers a free psychological service for assessing and intervening in chilhood psychological problems through a internship program which had to be delivered online due to the COVID-19 pandemic. The interns were only allowed to attend their parents online, instead of their children.

Objectives

Evaluating this new online service is the aim of this work.

Methods

24 parents of 34 children aged 4-10 years were attended by pairs or trios of 52 interns. The were modules made up of assessment, intervention and feedback, using different instruments such as interviews, screening questionnaires and the observation of 5-minute free play in domestic environment and of a family collage through a video recorded by parents. Feedback and intervention happened in various moments. The interns created a storybook using metaphoric narrative as a feedback tool in which a synthesis of the psychodiagnostic process and orientation was presented to the children.

Results

There was progress and decrease or elimination of symptons in 19 of the 34 children. Among the children who did not improve, one of them did not present any difficulties; 7 of them had many absences and the other 7 were referred to further assessment for reasons related to the complexity of their difficulties or a probable unsuitability of the online orientation.

Conclusions

The orientation was helpful for 55,89% of the children, showing to be a valid alternative for families who do not have financial resources for attending private clinics or fail to access public health services or even during social distance measures.

Disclosure

No significant relationships.

Four-month incidence of suicidal thoughts and behaviors among healthcare workers after the first wave of the Spain COVID-19 pandemic

Healthcare workers (HCW) are at high risk for suicide, yet little is known about the onset of suicidal thoughts and behaviors (STB) in this important segment of the population in conjunction with the COVID-19 pandemic. We conducted a multicenter, prospective cohort study of Spanish HCW active during the COVID-9 pandemic. A total of n = 4809 HCW participated at baseline (May-September 2020; i.e., just after the first wave of the pandemic) and at a four-month follow-up assessment (October-December 2020) using web-based surveys. Logistic regression assessed the individual- and population-level associations of separate proximal (pandemic) risk factors with four-month STB incidence (i.e., 30-day STB among HCW negative for 30-day STB at baseline), each time adjusting for distal (pre-pandemic) factors. STB incidence was estimated at 4.2% (SE = 0.5; n = 1 suicide attempt). Adjusted for distal factors, proximal risk factors most strongly associated with STB incidence were various sources of interpersonal stress (scaled 0-4; odds ratio [OR] range = 1.23-1.57) followed by personal health-related stress and stress related to the health of loved ones (scaled 0-4; OR range 1.30-1.32), and the perceived lack of healthcare center preparedness (scaled 0-4; OR = 1.34). Population-attributable risk proportions for these proximal risk factors were in the range 45.3-57.6%. Other significant risk factors were financial stressors (OR range 1.26-1.81), isolation/quarantine due to COVID-19 (OR = 1.53) and having changed to a specific COVID-19 related work location (OR = 1.72). Among other interventions, our findings call for healthcare systems to implement adequate conflict communication and resolution strategies and to improve family-work balance embedded in organizational justice strategies.

Simulating the impact of non-pharmaceutical interventions limiting transmission in COVID-19 epidemics using a membrane computing model

Epidemics caused by microbial organisms are part of the natural phenomena of increasing biological complexity. The heterogeneity and constant variability of hosts, in terms of age, immunological status, family structure, lifestyle, work activities, social and leisure habits, daily division of time and other demographic characteristics make it extremely difficult to predict the evolution of epidemics. Such prediction is, however, critical for implementing intervention measures in due time and with appropriate intensity. General conclusions should be precluded, given that local parameters dominate the flow of local epidemics. Membrane computing models allows us to reproduce the objects (viruses and hosts) and their interactions (stochastic but also with defined probabilities) with an unprecedented level of detail. Our LOIMOS model helps reproduce the demographics and social aspects of a hypothetical town of 10 320 inhabitants in an average European country where COVID-19 is imported from the outside. The above-mentioned characteristics of hosts and their lifestyle are minutely considered. For the data in the Hospital and the ICU we took advantage of the observations at the Nursery Intensive Care Unit of the Consortium University General Hospital, Valencia, Spain (included as author). The dynamics of the epidemics are reproduced and include the effects on viral transmission of innate and acquired immunity at various ages. The model predicts the consequences of delaying the adoption of non-pharmaceutical interventions (between 15 and 45 days after the first reported cases) and the effect of those interventions on infection and mortality rates (reducing transmission by 20, 50 and 80%) in immunological response groups. The lockdown for the elderly population as a single intervention appears to be effective. This modeling exercise exemplifies the application of membrane computing for designing appropriate multilateral interventions in epidemic situations.

Combination gel of 2% amitriptyline and 0.5% ketamine to treat refractory erythromelalgia pain - a case report of pain control success

Erythromelalgia (EM) is a rare autosomal dominant neuropathy characterized by the combination of severe burning pain and erythematous warm extremities. Chronic pain control is most often unsuccessful and a completely effective therapy is yet to be identified. Recent studies have reported significant improvements in pain management using a combination of amitriptyline and ketamine in a topical formulation. We describe a 1-year follow-up pain control success case of a male patient with EM, proposed for topical use of a 2% Amitriptyline and 0.5% Ketamine gel.

Combination gel of 2% amitriptyline and 0.5% ketamine to treat refractory erythromelalgia pain - a case report of pain control success

Erythromelalgia (EM) is a rare autosomal dominant neuropathy characterized by the combination of severe burning pain and erythematous warm extremities. Chronic pain control is most often unsuccessful and a completely effective therapy is yet to be identified. Recent studies have reported significant improvements in pain management using a combination of amitriptyline and ketamine in a topical formulation. We describe a 1-year follow-up pain control success case of a male patient with EM, proposed for topical use of a 2% Amitriptyline and 0.5% Ketamine gel.

Online psychological therapy for kids during social distancing: A study case in a brazilian clinical setting

Introduction

In response to the spread of COVID-19, many Brazilian therapists faced the challenge of taking their practices online considering legal and ethical issues, besides learning to handle new technologies in a way the therapeutic setting was maintained. The cooperation of the family is fundamental for the creation and maintenance of an adequate therapeutic setting. Children are not sufficiently mature to speak clearly about what bothers them or to talk about how they feel and why, so, drawing, pretend playing, story telling, playing games are the common tools for children’s communication during therapy.

Objectives

Evaluating if online therapy for children can support therapeutic play tools and be effective in a virtual environment preserving the therapeutic setting.

Methods

Two children aged 6 to 11 attended the psychological sessions that were conducted through video calls.The family should provide a silent and private room for those sessions. The children were free to choose the toy they would like to play with and that was available at home such as board games, comic and story books. Mimicry, drawing, an adaptation of the Winnicott Squiggle Game were used, as well as electronic games through screen sharing.

Results

The emotional conflicts were expressed either through conventional games and play or electronic games. Playing with children online was possible as well as maintaining the therapeutic alliance in order to carry on with the treatment in a proper therapeutic setting.

Conclusions

Online therapy for kids showed to be an effective form of service delivery, under strict measures of social distancing in Brazil.

Intervention to promote physical activation and improve sleep and response feeding in infants for preventing obesity early in life, the baby-act trial: Rationale and design

Infant obesity is increasing in the US, particularly among Hispanics. Rapid weight gain during infancy increases the risk of obesity later in life and could be prevented through multi-modal interventions addressing multiple risk factors through population-level programs.

OBJECTIVES

1) determine the extent to which the intervention, compared with the usual care control condition, improves healthy weight gain and specific behaviors (physical activity, sleep, diet) in the first year of life and 2) evaluate the cost of the intervention as a modification of the current WIC standard of care.

METHODS

The lifestyle intervention focuses on age-appropriate infant physical activation, healthy sleep and sedentary patterns, and response feeding, by improving parenting skills delivered through a combination of technology (web-platform and text messages) and phone counseling. It is being tested among caregivers of infant participants of the Puerto Rico WIC program through a cluster-randomized controlled trial in 14 WIC clinics in San Juan starting in pregnancy until the infant is 12 months of age. The main outcome is infant rate of weight gain at 12 months; secondary outcomes include objectively measured hours of infant movement, sedentary behaviors and sleep, diet quality score and response feeding behaviors. We are also recording fees, time and personnel involved in the intervention development, maintenance and dissemination.

CONCLUSIONS

If successful, the intervention could be incorporated as a 'best practice' through WIC policy as a means to strengthen obesity prevention efforts to improve minority health and eliminate health disparities among Hispanics and possibly other at-risk groups beyond the childhood period. Clinicaltrials.gov registration: NCT03517891.

GEOTECNOLOGIAS APLICADA NOS CONFLITOS DE USO DO SOLO EM ÁREAS DE PRESERVAÇÃO PERMANENTE NO MUNICÍPIO DE BARRA BONITA/SP

As áreas de conflito são definidas pelo mau uso do solo pelo homem e vem causando sérios problemas ao meio ambiente, resultando em desequilíbrio ecológico e desgaste dos recursos naturais, especialmente quando se refere às áreas de preservação permanente, que têm importância fundamental para os ecossistemas de equilíbrio e preservação dos recursos hídricos. O planejamento é um fator chave para o controle dos impactos ambientais ao meio ambiente. As áreas de preservação permanente evitam o assoreamento e erosão proporcionando uma proteção natural, principalmente em áreas das nascentes. Os serviços ambientais prestados auxiliam a proteção da flora e fauna, na preservação dos corredores ecológicos, e na continuação das espécies ali presentes. Este estudo teve por objetivo avaliar os conflitos de uso e ocupação da terra em áreas de Preservação Permanente do município de Barra Bonita/SP, utilizando como base cartográfica, o Sistema de Informação Geográfica (SIG) e imagem de satélite Sentinel 2-A de 2017, em escala 1:10.000. Os resultados mostraram que quase ¾ da área é ocupado com cana-de-açúcar (72,72%) e que as áreas de preservação permanente estão sendo usados inadequadamente por cana-de-açúcar (72,75%). O SIG ArcGis e as técnicas de geoprocessamento demonstraram agilidade e eficiência na identificação, quantificação e edição de mapas de uso do solo, preservação permanente e de conflitos em áreas de preservação permanente.

Non-adhesion to therapy in the elderly, in Tábua

Introduction Most medicines are taken by the elderly because they suffer natural changes, which lead to chronic and degenerative diseases. Older people often have increasingly complex medication regimens, which may lead to errors with dosing and administration and to non-adherence to therapy. Non-adherence to therapy leads to a decrease in therapeutic efficacy, an increase in morbidity, suffering, and health costs. It is influenced by several factors that can and should be driven to improve health status.

Objectives The objective of this study was to determine and evaluate the medication regimen complexity in an elderly population, in Tábua, and verify its relation with adherence to therapy.

Methodology Surveys were applied to elderly people in order to collect the medication data. The study lasted for 5 months and took place at a pharmacy (n = 337). Only people with ≥65 years were included. Medication regimen complexity was assessed using the Brazilian translation for the Medication Regimen Complexity Index (MRCI) and adhesion to therapy was measured by MAT scale. Data was analysed with SPSS statistical program, version 24.0.

Results Our study showed a high percentage of adhesion to therapy (65%) and also of polypharmacy among the elderly (84,9%). Most medication that elderly take belong to the cardiovascular system pharmaceutical group (94,1%). Still, people described some difficulties to adhesion to therapy, mainly forgetfulness (73,66%). Data also revealed that individuals with more literacy and those who are not under polypharmacy showed more adherence to therapy (p = 0.000 and p = 0.012). The most significant result from our study was that MRCI and non-adherence are correlated statistically, that is, a higher MRCI leads to an increase in non-adherence to therapy (p = 0.001).

Conclusion Healthcare professionals should be aware that high levels of medication regimen complexity suggest bad outcomes and non-adherence to therapy. They should assist the elderly, help avoid errors, and find solutions to improve adherence to therapy, whenever possible.

Histopathological hallmarks of cutaneous lesions of capillary malformation-arteriovenous malformation syndrome

IMPORTANCE

Capillary malformation-arteriovenous malformation (CM-AVM) syndrome is a recently described syndrome with distinctive cutaneous lesions. Very little is known about the histopathology of these lesions.

OBJECTIVE

The purpose of the study was to evaluate the histopathological characteristics of the pink macules of the CM-AVM syndrome and to investigate if these pink macules could be classified as capillary malformations or arteriovenous malformations based on their histopathological features.

DESIGN-SETTINGS-PARTICIPANTS

We conducted a retrospective multicenter study involving eight hospitals in Spain. Fifteen biopsies from pink macules of the CM-AVM syndrome were analysed and compared with five biopsies of diverse capillary malformations and three stage I arteriovenous malformations.

RESULTS

Pink macules' biopsies of the CM-AVM syndrome showed similar features including a high vascular density encompassing capillaries and numerous thick-walled arterioles mainly located in the superficial dermis, a predominance of elongated over round vessels, scarce or absent erythrocytes within the lumina and discrete perivascular inflammation. CMs were characterized by an increased number of capillary-type vessels mostly rounded and located in the upper dermis. AVMs were composed by highly increased numbers of vessels with a branching pattern involving the full thickness of the dermis, without erythrocytes within the lumina. Wilms tumour 1 protein was positive in the endothelial cells both in pink macules of the CM-AVM and in arteriovenous malformations.

CONCLUSIONS AND RELEVANCE

Pink macules of the CM-AVM syndrome seem to be different from capillary malformations. Our results suggest that histologically and immunohistochemically they are closer to incipient arteriovenous malformations than to capillary malformations. A deepened knowledge about the nature of these skin lesions will contribute to the better understanding of capillary malformation-arteriovenous malformation syndrome, and will open the possibility of new and more specific treatments in the future.

[COVID-19: how to transform a noninvasive ventilation device in a critical care ventilator]

La pandemia del COVID-19 ha hecho estragos, no solo en el número de víctimas fatales sino también en la infraestructura de los hospitales y unidades de cuidados intensivos. El número limitado de respiradores es una preocupación de toda la comunidad dada la demanda masiva y a muy corto plazo de estos equipos. Esta presentación tiene como fin dar soluciones sencillas para ventilar pacientes intubados de modo mandatorio utilizando equipos de ventilación no invasiva. Las soluciones propuestas permiten 2 estrategias claras frente al COVID-19: Reemplazar las máquinas de anestesia para disponer de ellas en pacientes. Usar la opción de equipos de ventilación no invasiva para pacientes con COVID-19 a modo de «puente» y a la espera de la liberación de un respirador específico en la unidad de cuidados críticos.

DECLIVIDADE E POTENCIAL PARA MECANIZAÇÃO AGRÍCOLA DA BACIA HIDROGRÁFICA DO RIBEIRÃO PEDERNEIRAS - PEDERNEIRAS/SP

A declividade do terreno contribui para o escoamento das águas, pois quanto maior for o trecho em declive, maior será o escoamento da água pela superfície, arrastando outros materiais para os recursos hídricos superficiais, influenciando a qualidade da água e a infiltração e nos processos erosivos fluviais e pluviais, assim como na tipologia da vegetação, bem como contribui para a formação do solo e serve de indicador na definição de áreas de risco e restrição de uso. A declividade dos rios pode ser associada à velocidade do escoamento, transporte de sedimentos e conformação das áreas de preservação permanentes. Este trabalho teve como objetivo analisar a declividade do terreno na bacia hidrográfica do ribeirão Pederneiras, estado de São Paulo e classificá-la quanto as áreas aptas e inaptas à mecanização agrícola. A área de estudo está localizada entre as coordenadas geográficas 22°20' e 22°26' de latitude S e 48°44' e 48°56' de longitude W Gr., situadas nos municípios de Agudos e Pederneiras, do estado de São Paulo, com uma área de 14918,28 ha. Os mapas de declividade foram elaborados por meio de técnicas de geoprocessamento, tendo-se como base cartográfica: as cartas planialtimétricas do Instituto Brasileiro de Geografia e Estatística e a imagem do satélite Sentinel-2 em ambiente de Sistema de Informação Geográfica – ArcGis 10.4.1. As classes de declividade do solo foram classificadas como relevo plano (0 – 3%), suave ondulado (3 – 8%), ondulado (8 – 20%), forte ondulado (20 – 45%), montanhoso (45 – 75%) e escarpado (> 75%) e áreas para mecanização agrícola como aptas (áreas mecanizáveis) e inaptas (áreas não mecanizáveis). Os resultados mostraram que o relevo plano e suavemente ondulado predominou em quase 89% da área, enquadrando-as em áreas aptas à mecanização com pequenas restrições. v

MODELO AUTOMÁTICO DE CLASSIFICAÇÃO DE BOVINOS PARA O ABATE VIA REDES NEURAIS ARTIFICIAIS

Hoje em dia, a busca por ferramentas que facilitam e até mesmo substituem o trabalho humano têm ganhado grande destaque mundial. As redes neurais artificiais (RNAs) é uma dessas ferramentas, pois apresentam uma quantidade de aplicações, principalmente quando se trata de classificação de dados, reconhecimento de padrões, análise de imagens, entre outros. Com este intuito, o objetivo deste trabalho foi desenvolver uma ferramenta de classificação automática de bovinos por intermédio de uma Rede Neural Artificial (RNA) de três camadas. Essa rede é conhecida como Multilayer Perceptron (MLP), aqui do tipo feed forward (sem realimentação) e com algoritmo de treinamento backpropagation (retropropagação do erro) com treinamento supervisionado. A ideia foi identificar os grupos de abate e os que requerem alimentação mais intensiva, utilizando como variáveis de entrada da rede massa e altura e como variável de saída, o índice de massa corporal (IMC). Os dados utilizados neste trabalho foram obtidos de um rebanho de 147 vacas Nelore, localizadas na cidade de Santa Rita do Pardo - Mato Grosso do Sul (MS). Dos resultados, a rede obteve um excelente desempenho na fase de treinamento (100 amostras), com erro quadrado médio em torno de 10-5. Já na fase do diagnóstico (operação da rede), foi submetida à rede as 47 amostras restantes dos dados de vacas Nelore que não fizeram parte do treinamento da mesma, desses resultados, a rede apresentou em média, um erro em torno de 0,6% em relação à saída desejada (dados normalizados), o que acarretou num erro de 1 amostra das 47 analisadas.

Prevalence of lumbar high-intensity zone: assessment using a screening tool independent of spinal symptoms

High-intensity zone is an area of high-intensity signal within the posterior annulus fibrosus observed in magnetic resonance imaging; initially described in painful discs, recent studies have described similar prevalence in symptomatic and asymptomatic subjects. Since its' prevalence in the general population has not been established, we used a screening tool independent of spinal symptoms to determine high-intensity zone prevalence. We studied 217 patients evaluated with abdominal-pelvic magnetic resonance imaging; we looked for high-intensity zone, disc degeneration, spondylolysis, spondylolisthesis, Modic changes and scoliosis. We determined if these variables, age and sex affected the presence of high-intensity zone; through a logistic regression analysis we evaluated their independent effect. Patients' mean age was 56.3±17.4 years; 66.8% were females. Prevalence of high-intensity zone (11.06%) was larger in males (18.06%) than females (7.59%), p = 0.02. Patients with and without high-intensity zone did not differ in age or presence of scoliosis. High-intensity zone was more frequent in degenerated discs, but not in levels with spondylolisis, spondylolisthesis or Modic changes. Male sex (OR = 2.3, 1.04-5.38) and disc degeneration (OR = 6.76, 1.77-25.81) independently influenced the presence of high-intensity zone. The prevalence of high-intensity zone in this sample of the general population, including 217 subjects, was 11.06%. Similarly, a recent meta-analysis mentioned a 9.5% prevalence in asymptomatic subjects; on the other hand it stressed a 10.4% prevalence in symptomatic subjects. All these data do not plead for a strict correlation between high-intensity zone and low back pain complaints.

The META score for differentiating metastatic from osteoporotic vertebral fractures: an independent agreement assessment

BACKGROUND CONTEXT

Differentiating osteoporotic vertebral fractures (OVFs) from metastatic vertebral fractures (MVFs) is an important clinical challenge. A novel magnetic resonance imaging (MRI)-based score (the META score) was described, aiming to differentiate OVF from MVF. This score showed an almost perfect agreement by the group developing it, but an independent agreement evaluation is pending.

PURPOSE

We aimed to perform an independent inter- and intraobserver agreement evaluation of the META score and to test the score's capability of differentiating OVF from MVF.

STUDY DESIGN

This is an agreement study of the META score.

METHODS

Sixty-four patients with confirmed OVF or MVF were assessed by six independent evaluators (three spine surgeons and three fellowship-trained radiologists) using the META score. We used the intraclass correlation coefficient (ICC) to determine the overall inter-and intraobserver agreement, and the kappa statistic (κ) to express the agreement for each individual score criterion. The score accuracy was determined by calculating the area under the receiver operating characteristic curve. Finally, we used κ to evaluate the agreement among raters to determine whether the fracture was OVF or MVF.

RESULTS

The overall interobserver agreement was poor [ICC=0.10 (0.02-0.20)]; spine surgeons [ICC=0.75 (0.66-0.83)] had better agreement than radiologists did [ICC=0.05 (-0.08 to 0.21)]. The intraobserver agreement was poor [ICC=0.17 (0.01-0.32)]; both spine surgeons [ICC=0.21 (0.05-0.41)] and radiologists had a poor agreement [ICC=0.03 (-0.29 to 0.27)]. The agreement for each specific criterion varied from κ=0.24 to κ=0.60. The area under the receiver operating characteristic curve was 0.58 (0.64 for spine surgeons and 0.52 for radiologists, p<.01).

CONCLUSIONS

The interobserver agreement using the META score was adequate for spine surgeons but not for other potential users (radiologists); the intraobserver agreement was poor. Further studies are thus necessary before the use of this score is recommended.

Pectoral nerve block as a single anesthetic technique for breast surgery and sentinel lymph node investigation

Breast cancer surgery is usually performed under general anesthesia or, more recently, combined with conventional regional techniques. Pectoral nerves (PECs) block appears as an analgesic alternative in these procedures, but few studies refer to it as a single anesthetic technique^1-3. In this case report, we describe a 56-year-old female patient, BMI 31kg/m², ASA IV, admitted for elective tumorectomy of the left upper quadrant of the breast and sentinel node investigation. Given the multiple comorbidities and the high anesthetic and surgical risk, the anaesthetic plan consisted in ultrasound guided PECs II block as a single anesthetic technique. The authors report a successful anesthetic and pain management without complications in breast surgery. PECs block, as a single anesthetic technique, may be safe, advantageous and effective with haemodynamic stability and few side effects in high risk cardiac patients.

StraightenUp+: Monitoring of Posture during Daily Activities for Older Persons Using Wearable Sensors

Monitoring the posture of older persons using portable sensors while they carry out daily activities can facilitate the process of generating indicators with which to evaluate their health and quality of life. The majority of current research into such sensors focuses primarily on their functionality and accuracy, and minimal effort is dedicated to understanding the experience of older persons who interact with the devices. This study proposes a wearable device to identify the bodily postures of older persons, while also looking into the perceptions of the users. For the purposes of this study, thirty independent and semi-independent older persons undertook eight different types of physical activity, including: walking, raising arms, lowering arms, leaning forward, sitting, sitting upright, transitioning from standing to sitting, and transitioning from sitting to standing. The data was classified offline, achieving an accuracy of 93.5%, while overall device user perception was positive. Participants rated the usability of the device, in addition to their overall user experience, highly.

Circadian monitoring as an aging predictor

The ageing process is associated with sleep and circadian rhythm (SCR) frailty, as well as greater sensitivity to chronodisruption. This is essentially due to reduced day/night contrast, decreased sensitivity to light, napping and a more sedentary lifestyle. Thus, the aim of this study is to develop an algorithm to identify a SCR phenotype as belonging to young or aged subjects. To do this, 44 young and 44 aged subjects were recruited, and their distal skin temperature (DST), activity, body position, light, environmental temperature and the integrated variable TAP rhythms were recorded under free-living conditions for five consecutive workdays. Each variable yielded an individual decision tree to differentiate between young and elderly subjects (DST, activity, position, light, environmental temperature and TAP), with agreement rates of between 76.1% (light) and 92% (TAP). These decision trees were combined into a unique decision tree that reached an agreement rate of 95.3% (4 errors out of 88, all of them around the cut-off point). Age-related SCR changes were very significant, thus allowing to discriminate accurately between young and aged people when implemented in decision trees. This is useful to identify chronodisrupted populations that could benefit from chronoenhancement strategies.

Selecting native perennial plants for ecological intensification in Mediterranean greenhouse horticulture

Natural control by predators and parasitoids provides an important and often unnoticed ecosystem service to agricultural landscapes by reducing pest populations in crops. The current model of horticultural intensification in south-eastern Spain produces high yields but has also resulted in a landscape almost completely covered by plastic. Promoting natural areas among greenhouses could enhance biodiversity, by being beneficial insects, and reduce pest pressure outdoors. The first step is to ascertain how pests and their natural enemies (NEs) use Mediterranean vegetation for selecting the best plants for pest suppression outdoors. The abundance of the two major horticultural pests, the tobacco whitefly, Bemisia tabaci, and the western flower thrips, Frankliniella occidentalis, together with their NEs, were assayed in 22 flowering perennial plants, which were newly planted in an experimental field surrounded by greenhouses. Eight plant species were identified as the most critical species for sustaining pest populations outdoors. A set of five plant species supported a medium level of pests, and another set of ten plant species supported the lowest level of both pests. Tobacco whitefly occurred in a few plants species, whereas western flower thrips occurred on almost all the plant species studied, and was favoured by the presence of flowers in perennial plants. The results suggest that plant diversity may provide relatively few acceptable host plants for tobacco whitefly than for western flower thrips. NEs were generally collected in plants that also supported abundance of pests, indicating that host/prey availability, more than food resources from flowers, was a stronger predictor of NE abundance in perennial plants. Field trials using the plants with the lowest host acceptance by pests are needed in order to ascertain whether pest abundance outdoors is reduced.

Lumbar paraspinal muscle fat infiltration is independently associated with sex, age, and inter-vertebral disc degeneration in symptomatic patients

PURPOSE

To determine the association of paraspinal muscles and psoas relative cross-sectional area (RCSA) and fat signal fraction (FSF) with sex, age, and intervertebral disc degeneration (IDD) in symptomatic patients.

METHODS

We retrospectively evaluated 80 adult patients with spinal symptoms using T2-weighted magnetic resonance images. We determined RCSA and FSF of the paraspinal muscles (erector spinae and multifidus) and psoas from L1-L2 to L5-S1; we determined IDD using the Pfirrmann classification. We compared differences in muscle RCSA and FSF based on sex and IDD, and we correlated age and IDD with RCSA and FSF. Using multivariate linear regression analyses, we determined the impact of sex, age, and IDD on RCSA and FSF.

RESULTS

Men exhibited larger psoas RCSA but not larger paraspinal muscles RCSA than women. Women had larger FSF in the paraspinal muscles and psoas. Increasing IDD was associated with larger FSF if ≥2 Pfirrmann grades were observed. IDD correlated with FSF of the paraspinal muscles, and age correlated with FSF of the paraspinal muscles and psoas. IDD was less consistently correlated with RCSA, but age correlated negatively with RCSA of all three muscles. Linear regression analyses demonstrated that sex, age, and IDD were each independently associated with FSF of the paraspinal muscles; additionally, sex and age, but not IDD, were associated with psoas FSF. RCSA was less consistently influenced by these three variables.

CONCLUSIONS

Sex, age, and IDD are independently associated with paraspinal muscles FSF; only sex and age influence psoas FSF.

Abstract P1-05-01: Breast cancer and the human microbiome

The human body harbors ten times more bacterial cells than human cells – a stunning figure that suggests a likely dynamic between our bodies and the bacteria we carry, both in health and disease. In this study, we characterized and compared the gut, oral, and breast tissue microbiomes from women with invasive breast cancer, women with ductal carcinoma in situ (DCIS), and healthy women. Samples were collected prior to any systemic therapy to avoid therapy-associated effects on the microbiomes studied. Kits containing materials for collecting oral and stool swab samples were distributed to patients for self-collection. DNA was isolated from these samples and bacterial 16S rRNA was PCR amplified and sequenced. Based on the sequencing results, bacterial taxa present in the samples were enumerated. In our analyses, we looked at microbial diversity and differential relative abundance of bacterial taxa across the three cohorts. Oral and gut microbial diversity at various taxa levels were assessed using Shannon and Simpson diversity indices. The oral microbiome did not show any significant difference in microbial diversity across the three cohorts. In the gut microbiome, the invasive cohort showed a significant decrease in microbial diversity when compared to the healthy cohort. Differences in phylogenetic and relative abundance of bacterial taxa across the three cohorts were measured using a T-test analysis with a p value less than 0.05 considered significant. In the oral microbiome, there were no significant differences in the relative abundance of bacteria across the three cohorts. In the gut microbiome, there were significant differences in the relative abundance of bacteria within each cohort on the phylum, family, and genus levels. The genus Fusicanterbacter (associated with the Lachnospiracaea family and Firmicutes phylum) was significantly overabundant in gut microbiomes of healthy women when compared to the gut microbiomes of women with DCIS or invasive breast cancer. Meanwhile, the genus Bacteriodes (associated with the Bacteroidaceae family and Bacteriodetes phylum) was significantly overabundant in the gut microbiomes of women with invasive breast cancer when compared to the gut microbiomes of healthy women. Although tissues are often thought of as sterile, there is emerging data indicating that different tissues may harbor their own unique microbiomes. We obtained breast tissue microbiome data from a small subset of our breast cancer and DCIS cohorts, as well as healthy breast tissue from reduction mammaplasty specimens. At the genus level, we observed an enrichment of Lactococcus, Lactobacillus, and Halomonas in healthy breast tissues compared to breast cancer tissues and an enrichment of Hyphomicrobium in breast cancer tissues compared to healthy breast tissues. Understanding how gut, oral, and tissue microbiomes relate to breast cancer may open up new opportunities for the development of novel markers for early detection (or markers of susceptibility) as well as new strategies for prevention and/or treatment.

Citation Format: McCune E, Johnson B, O'Meara T, Theiner S, Campos M, Heditsian D, Brain S, Esserman L, Campbell M. Breast cancer and the human microbiome [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-05-01.

Early Rehospitalization Post-Kidney Transplant Due to Infectious Complications: Can We Predict the Patients at Risk?

INTRODUCTION

Rehospitalization early post-kidney transplant is common and has a negative impact in morbidity, graft survival, and health costs. Infection is one the most common causes, and identifying the risk factors for early readmission due to infectious complications may guide a preventive program and improve outcome. The aim of this study was to evaluate the incidence, characterize the population, and identify the risk factors associated with early readmission for infectious complications post-kidney transplantation.

METHODS

We performed a retrospective cohort study of all the kidney transplants performed during 2015. The primary outcome was readmission in the first 3 months post-transplant due to infectious causes defined by clinical and laboratory parameters.

RESULTS

We evaluated 141 kidney transplants; 71% of subjects were men, with an overall mean age of 50.8 ± 15.4 years. Prior to transplant, 98% of the patients were dialysis dependent and 2% underwent pre-emptive living donor kidney transplant. The global readmission rate was 49%, of which 65% were for infectious complications. The most frequent infection was urinary tract infection (n = 28, 62%) and the most common agent detected by blood and urine cultures was Klebsiella pneumonia (n = 18, 40%). The risk factors significantly associated with readmission were higher body mass index (P = .03), diabetes mellitus (P = .02), older donor (P = .007), and longer cold ischemia time (P = .04). There were 3 graft losses, but none due to infectious complications.

CONCLUSION

There was a high incidence of early rehospitalization due to infectious complications, especially urinary tract infections to nosocomial agents. The risk factors identified were similar to other series.

Polyomavirus Nephropathy: Ten-Year Experience

BACKGROUND

Polyomavirus nephropathy (BKVN) is an important cause of chronic allograft dysfunction (CAD). Recipient determinants (male sex, white race, and older age), deceased donation, high-dose immunosuppression, diabetes, delayed graft function (DGF), cytomegalovirus infection, and acute rejection (AR) are risk factors. Reducing immunosuppression is the best strategy in BKVN. The objective of our study was to evaluate CAD progression after therapeutic strategies in BKVN and risk factors for graft loss (GL).

METHODS

Retrospective analysis of 23 biopsies, from patients with CAD and histological evidence of BKVN, conducted over a period of 10 years. Glomerular filtration rate was <30 mL/min in 16 patients at the time of the BKVN diagnosis.

RESULTS

BKVN was histologically diagnosed in 23 recipients (19 men, 4 women). All patients were white, with age of 51.2 ± 12.1 years (6 patients, age >60 years), and 22 had a deceased donor. Diabetes affected 4 patients, DGF occurred in 3, cytomegalovirus infection in 2, and AR in 15. All patients were medicated with calcineurin inhibitors (CNI) (95.7% tacrolimus) and corticoids, and 16 also received an antimetabolite. One year after antimetabolite reduction/discontinuation and/or CNI reduction/switching and/or antiviral agents, graft function was decreased in 11 patients, increased/stabilized in 10, and unknown in 2. GL occurred in 9 patients. Older age (hazard ratio, 1.76; 95% confidence interval, 0.94-3.28) and DGF (hazard ratio, 2.60; 95% confidence interval, 0.54-12.64) were the main risk factors for GL. The lower GFR at the time of the BKVN diagnosis was associated with an increased risk of initiation of dialysis.

CONCLUSIONS

GL occurred in 39.1% of patients with BKVN and DGF; older age and lower GFR at the time of diagnosis were important risk factors. Early diagnosis of BKVN is essential to prevent GL.

Understanding Monitoring Technologies for Adults With Pain: Systematic Literature Review

BACKGROUND

Monitoring of patients may decrease treatment costs and improve quality of care. Pain is the most common health problem that people seek help for in hospitals. Therefore, monitoring patients with pain may have significant impact in improving treatment. Several studies have studied factors affecting pain; however, no previous study has reviewed the contextual information that a monitoring system may capture to characterize a patient's situation.

OBJECTIVE

The objective of this study was to conduct a systematic review to (1) determine what types of technologies have been used to monitor adults with pain, and (2) construct a model of the context information that may be used to implement apps and devices aimed at monitoring adults with pain.

METHODS

A literature search (2005-2015) was conducted in electronic databases pertaining to medical and computer science literature (PubMed, Science Direct, ACM Digital Library, and IEEE Xplore) using a defined search string. Article selection was done through a process of removing duplicates, analyzing title and abstract, and then reviewing the full text of the article.

RESULTS

In the final analysis, 87 articles were included and 53 of them (61%) used technologies to collect contextual information. A total of 49 types of context information were found and a five-dimension (activity, identity, wellness, environment, physiological) model of context information to monitor adults with pain was proposed, expanding on a previous model. Most technological interfaces for pain monitoring were wearable, possibly because they can be used in more realistic contexts. Few studies focused on older adults, creating a relevant avenue of research on how to create devices for users that may have impaired cognitive skills or low digital literacy.

CONCLUSIONS

The design of monitoring devices and interfaces for adults with pain must deal with the challenge of selecting relevant contextual information to understand the user's situation, and not overburdening or inconveniencing users with information requests. A model of contextual information may be used by researchers to choose possible contextual information that may be monitored during studies on adults with pain.

Effect of Propionibacterium acnes (PA) injection on intervertebral disc degeneration in a rat model: Does it mimic modic changes?

INTRODUCTION

Multiple reports of bacterial isolates in human disc tissue have suggested a role of low-grade infection on intervertebral disc degeneration and modic changes (MC) generation. Animal models have been extensively used to study IDD; however, until recently, no consideration had been given to eventual infectious processes. To reproduce the phenomena by inoculating an infecting agent would support the infectious hypothesis. Therefore, we studied the effect of Propionibacterium acnes (PA) inoculation on rat-tails and determined whether it would produce MCs on the adjacent endplates.

HYPOTHESIS

Disc infection with PA would accelerate IDD compared with the standard model and would also lead to MCs on the adjacent endplates.

METHODS

Twelve Sprague-Dawley rats were randomized to receive a needle puncture in a caudal tail disc with either saline (control) or an inoculum of 5×10⁷ CFU of strain 1a PA. Twelve weeks later, the rats were euthanized and the tails were analyzed. The main assessment criteria were obtained from the post-mortem MRI: T2 values of punctured discs and adjacent endplates, as well as disc volumes. A histological grading score for IDD was also used, measuring the morphology and cellularity of the nucleus and annulus, as well as endplate disruption.

RESULTS

The median T2 value and disc volume were smaller in PA-punctured discs [T2 value: 30ms (23-44) vs. 61ms (38-132), respectively, P=0.01; 0.01mm³ (0.01-0.05) vs. 0.5mm³ (0.01-5.35), respectively; P=0.049]. There was no change in the adjacent endplates. There was no significant difference in histological grading between the test and control [13 (10-14) vs. 10.5 (6-13); P=0.05].

DISCUSSION

Inoculation of caudal discs with PA generated increased degeneration; however, no MCs were observed on the adjacent endplates. A better understanding of low-grade disc infections is still needed.

LEVEL OF EVIDENCE

V (animal study).

What Can We Do When All Collapses? Fatal Outcome of Collapsing Glomerulopathy and Systemic Lupus Erythematosus With Diffuse Alveolar Hemorrhage: Case Report

INTRODUCTION

Collapsing glomerulopathy (CG) is a rare form of glomerular injury. Although commonly associated with human immunodeficiency virus (HIV) infection, it can occur in association with systemic lupus erythematosus (SLE).

CASE REPORT

We present the case of a 50-year-old man, with chronic kidney disease secondary to focal and segmental glomerulosclerosis, who received a cadaveric kidney transplant in 2007. There were no relevant intercurrences until May 2015, when he presented with nephrotic range proteinuria (± 4 g/d). A graft biopsy was performed and it did not show any significant pathological changes. In September, he developed a full nephrotic syndrome (proteinuria 19 g/d) and a graft biopsy was repeated. CG features were evident with a rich immunofluorescence. Antinuclear antibodies (ANA) and anti-double-stranded DNA (anti-dsDNA) antibodies were positive; the remaining immunologic study was normal. Viral markers for HIV, hepatitis C virus (HCV), and hepatitis B virus (HBV) were negative. The patient was treated with corticosteroid pulses and plasmapheresis (seven treatments). A rapid deterioration of kidney function was seen and he became dialysis dependent. He was discharged with a low-dose immunosuppressive treatment. In October, he was hospitalized with diffuse alveolar hemorrhage (DAH). The auto-immune study was repeated, revealing complement consumption and positive titers of ANA and Anti-dsDNA antibodies. Anti-neutrophil cytoplasmic antibodies (ANCAs) and antiglomerular basement membrane antibody (anti-GBM) were negative. Treatment with intravenous corticosteroids, plasmapheresis, and human immunoglobulin was ineffective and the outcome was fatal.

CONCLUSION

This case report highlights the possible association of CG and SLE. To our knowledge, it is the first case of SLE presenting with CG and DAH, with the singularity of occurring in a kidney transplant recipient receiving immunosuppression.

Bioaugmentation and rhizosphere-assisted biodegradation as strategies for optimization of the dissipation capacity of biobeds

Biobeds are on-farm biodepuration systems whose efficiency rely on their high pesticide biodegradation capacity. We evaluated two optimization strategies, bioaugmentation and/or rhizosphere-assisted biodegradation, to maximize the dissipation capacity of biobeds. Iprodione was used as a model pesticide. Its dissipation and metabolism was determined in a biobed packing material inoculated with an iprodione-degrading Arthrobacter strain C1 (bioaugmentation, treatments B+C1) and/or seeded with ryegrass (rhizosphere-assisted biodegradation, treatments B+P). The impact of those strategies on the activity and composition of the microbial community was determined. Bioaugmentation accelerated the dissipation of iprodione which was further enhanced in the bioaugmented, rhizosphere-assisted treatment (treatment B+P+C1, Half-life (DT₅₀) = 3.4 d), compared to the non-bioaugmented, non rhizosphere-assisted control (DT₅₀ = 9.5 d, treatment B). Bioaugmentation resulted in the earlier formation of intermediate formation of metabolites I (3,5-dichlorophenyl-carboxamide), II (3,5-dichlorophenylurea acetate) and 3,5-dichloroaniline (3,5-DCA). The latter was further dissipated by the indigenous microbial community. Acid phosphatase (AP) and β-glucosidase (GLU) were temporarily stimulated in rhizosphere-assisted treatments, whereas a stimulation of the fluorescein diacetate (FDA) hydrolytic activity in the bioaugmented treatments coincided with the hydrolysis of iprodione. q-PCR showed that changes in the abundance of alpha-proteobacteria and firmicutes was driven by the presence of rhizosphere while bioaugmentation had no significant effect.

GEOTECNOLOGIA APLICADA NA OBTENÇÃO DAS SUBCLASSES DE CAPACIDADE DE USO DAS TERRAS DE UMA MICROBACIA, VISANDO A CONSERVAÇÃO DOS RECURSOS NATURAIS

A exploração da terra para produzir alimentos para o sustento do homem quase sempre foi de forma desordenada e sem planejamento.Aconsequência dessa exploração predatória foi oempobrecimento do solo por erosão intensa, assoreamento de cursos d’água, desertificação, entre outros. O trabalho objetivou a utilização de geotecnologias na elaboração dos mapas de classes de declive, de solos e da capacidade de uso do solo numa microbacia, de forma a contribuirno processo de gestão ambiental e na tomada de decisões por parte dos Administradores Públicos.A microbacia do Ribeirão das Agulhas, Botucatu (SP) apresenta uma área de 1.429,28ha e está localizada entre os paralelos 22o47'05" a 22o05'55" de latitude S e 48o28'10” a 48o30'04" de longitude W Gr. Os resultados permitiram inferir que a subclasse mais significativa foi a IIIs,e(44,50%)e orelevo ondulado (57,59%). Assubclasses de capacidade de uso IIIs, IIIs,e,IVs, IVs,e e IVeocuparam 89,36% da área, mostrando o grande potencial de uso para culturas anuais, perenes, pastagens e reflorestamentos. O Sistema de Informações Geográficas (SIG)mostrou-se uma excelente ferramenta para determinação da capacidade de uso da terra, demonstrando que a utilização do geoprocessamento facilita e dá maior rapidez no cruzamento dos dados digitais, permitindo seu armazenamento, que poderão ser utilizados para outras análises em futuros planejamentos geoambientais.

TÉCNICAS DE GEOPROCESSAMENTO PARA ANÁLISE MORFOMÉTRICA DA MICROBACIA DO RIBEIRÃO ALTO ÁGUA FRIA – BOFETE (SP)

Técnicas de geoprocessamento foram realizadas para a caracterização morfométrica da microbacia do Ribeirão Alto Água Fria – Bofete (SP) pelo Sistema de Informação Geográfica, visando à preservação, racionalização do seu uso e recuperação ambiental. A microbacia apresenta uma área de 4012,17 ha e está localizada entre as coordenadas geográficas: 22o 57’ 41” a 23o 02’ 42” S e 48o 11’ 29” a 48o 20’ 09” WGR. A base cartográfica utilizada foi a carta planialtimétrica de Bofete (SP) para extração das curvas de nível e hidrografia, para determinação dos índices morfométricos. Os resultados apresentaram que os baixos valores da densidade de drenagem, associados à presença de rochas permeáveis, facilitam a infiltração da água no solo, diminuindo o escoamento superficial e o risco de erosão e da degradação ambiental. Os baixos valores do fator de forma e do índice de circularidade indica que a microbacia tende a ser mais alongada com menor susceptibilidade à ocorrência de enchentes mais acentuadas. O parâmetro ambiental, coeficiente de rugosidade, permitiu classificar a microbacia para vocação com agricultura.

Evaluation of native plant flower characteristics for conservation biological control of Prays oleae

Several studies have shown that manipulating flowering weeds within an agroecosystem can have an important role in pest control by natural enemies, by providing them nectar and pollen, which are significant sources of nutrition for adults. The aim of this study was to assess if the olive moth, Prays oleae (Bernard, 1788) (Lepidoptera: Praydidae), and five of its main natural enemies, the parasitoid species Chelonus elaeaphilus Silvestri (Hymenoptera: Braconidae), Apanteles xanthostigma (Haliday) (Hymenoptera: Braconidae), Ageniaspis fuscicollis (Dalman) (Hymenoptera: Encyrtidae) and Elasmus flabellatus (Fonscolombe) (Hymenoptera: Eulophidae), as well as the predator Chrysoperla carnea (Stephens) (Neuroptera: Chrysopidae), can theoretically access the nectar from 21 flowering weeds that naturally occur in olive groves. Thus, the architecture of the flowers as well as the mouthpart structure and/or the head and thorax width of the pest and its enemies were analyzed. The results suggested that all beneficial insects were able to reach nectar of the plant species from Apiaceae family, i.e. Conopodium majus (Gouan) Loret, Daucus carota L. and Foeniculum vulgare Mill., as well as Asparagus acutifolius L., Echium plantagineum L., Capsella bursa-pastoris (L.) Medik., Raphanus raphanistrum L., Lonicera hispanica Boiss. et Reut., Silene gallica L., Spergula arvensis L., Hypericum perforatum L., Calamintha baetica Boiss. et Reut, Malva neglecta Wallr. and Linaria saxatilis (L.) Chaz. P. oleae was not able to access nectar from five plant species, namely: Andryala integrifolia L., Chondrilla juncea L., Dittrichia viscosa (L.) Greuter, Sonchus asper (L.) Hill and Lavandula stoechas L.

The Pfirrmann classification of lumbar intervertebral disc degeneration: an independent inter- and intra-observer agreement assessment

PURPOSE

Grading inter-vertebral disc degeneration (IDD) is important in the evaluation of many degenerative conditions, including patients with low back pain. Magnetic resonance imaging (MRI) is considered the best imaging instrument to evaluate IDD. The Pfirrmann classification is commonly used to grade IDD; the authors describing this classification showed an adequate agreement using it; however, there has been a paucity of independent agreement studies using this grading system. The aim of this study was to perform an independent inter- and intra-observer agreement study using the Pfirrmann classification.

METHODS

T2-weighted sagittal images of 79 patients consecutively studied with lumbar spine MRI were classified using the Pfirrmann grading system by six evaluators (three spine surgeons and three radiologists). After a 6-week interval, the 79 cases were presented to the same evaluators in a random sequence for repeat evaluation. The intra-class correlation coefficient (ICC) and the weighted kappa (wκ) were used to determine the inter- and intra-observer agreement.

RESULTS

The inter-observer agreement was excellent, with an ICC = 0.94 (0.93-0.95) and wκ = 0.83 (0.74-0.91). There were no differences between spine surgeons and radiologists. Likewise, there were no differences in agreement evaluating the different lumbar discs. Most differences among observers were only of one grade. Intra-observer agreement was also excellent with ICC = 0.86 (0.83-0.89) and wκ = 0.89 (0.85-0.93).

CONCLUSIONS

In this independent study, the Pfirrmann classification demonstrated an adequate agreement among different observers and by the same observer on separate occasions. Furthermore, it allows communication between radiologists and spine surgeons.

Invasive Fungal Infections After Kidney Transplantation: A Single-center Experience

INTRODUCTION

Invasive fungal infections (IFI) affecting transplant recipients are associated with increased mortality and graft dysfunction.

OBJECTIVE

Describe the frequency, clinical features, and outcomes of IFI (except pneumocystis infection) in kidney transplant recipients.

METHOD

Single-center descriptive study including every kidney transplant recipient with a culture-proven or probable IFI between 2003 and 2013, according to the EORTC-MSG criteria.

RESULTS

We identified 45 IFI. There were 13 cases of invasive candidiasis (C. albicans: 6 and non-C. albicans candidial spp.: 7), 11 cases of pulmonary aspergillosis (A. fumigatus: 9 and A. flavus: 2); 11 cases of subcutaneous mycosis (Alternaria spp.: 9, Paecilomyces spp.: 1, and Pseudallescheria spp.: 1); 7 cases of cryptococcosis; 2 cases of pneumonia by non-Aspergillus molds (Mucor spp.: 1 and Cunninghamella spp.: 1); and 1 case of Geotrichum capitatum pneumonia. All patients were recipients from deceased donors. Six cases occurred in the first 3 months post-transplant, 15 cases between the third and twelfth months, and 21 cases after the twelfth month. Treatment options were fluconazole for Candida infections, voriconazole or caspofungin for aspergillosis, liposomal amphotericin for cryptococcosis, and itraconazole plus excision or cryotherapy for subcutaneous mycosis. Fifteen patients died (33%). Mortality rates were 15% for invasive candidiasis, 45% for aspergillosis, 71% for cryptococcosis, 100% for non-Aspergillus molds and G. capitatum pneumonia, and 0% for subcutaneous mycosis. Six patients who survived (14%) started regular hemodialysis.

CONCLUSION

IFI still have a high mortality and morbidity in kidney transplant recipients, as verified in this report. We reinforce the need for a high index of suspicion and prompt treatment.