SAT0225 THE POSITIVITY FOR HISTOPATHOLOGIC ASSESSMENT IN SALIVARY GLANDS SHOWED LITTLE IMPACTS ON CLINICAL FEATURES FOR ESTABLISHED PRIMARY SJÖGREN’S SYNDROME IN A CERTAIN ETHNIC POPULATION

Background:

The presence and the severity of focal lymphocytic sialadenitis in minor salivary glands is a pathognomonic feature in primary Sjögren’s syndrome (pSS). However, it has not been determined whether performing of minor salivary gland biopsy (MSGB) in a setting of serologically and clinically established pSS give us additional clinical information.

Objectives:

To investigate the necessity of MSGB in established pSS patients with the anti-Ro/SSA antibody.

Methods:

We extracted 185 patients with anti-Ro/SSA antibody-positive pSS from the Korean Initiative of primary Sjögren’s Syndrome, a prospective cohort. We assigned them into two groups, 161 patients with focus score ≥1 and other 24 with focus score < 1. The two groups were compared in various clinical aspects including the severity of glandular dysfunctions, systemic disease activities, extra-glandular manifestations, and other clinical indices and laboratory values. We also evaluated relationship between focus score and clinically important variables in pSS.

Results:

Between two groups, there were no significant differences in the severity of secretory dysfunctions, the frequency of extra-glandular manifestations, systemic disease activities represented by various clinical indices, and laboratory findings possibly predicting the risk for lymphoma. Rather, the Sjögren’s syndrome disease damage index was higher in the group with focus score < 1. Among all variables, serum immunoglobulin G level solely showed the correlation with focus score.

Conclusion:

Given that little influence on clinical phenotypes, unconditional performing of MSGB should be reconsidered for serologically and clinically established pSS, especially in low-risk area for lymphoproliferative diseases.

Disclosure of Interests:

None declared

Critical elements and lessons learnt from the implementation of an RFID-enabled healthcare management system in a medical organization

Healthcare services are complex and life-critical. One mistake in any procedure may lead to irremediable consequences; numerous researchers, thus, introduce information and communication technology to improve quality of services and enhance patient safety by reducing the medical errors. Radio frequency identification (RFID) is considered as one of the emerging tool assist in meeting the challenges of the present situation. In recent years, RFID has been applied in medical organizations for the purpose of managing and tracking medical equipment, monitoring and identifying patients, ensuring that the right medication is given to the right patient, and preventing the use of counterfeit medicine. However, most of the existing literature focuses on demonstrating how RFID can benefit the healthcare industry, whereas little attention has been given to the management issues involved in constructing an RFID project in medical organizations. In this paper, an exploratory case study is conducted in a medical organization to illustrate the development framework and critical issues that should be taken into consideration in the preparation, implementation and maintenance stage of constructing such a project. All the experiences and results discussed in this paper offer valuable and useful insights to steer those who would like to start their journey using RFID in medical organizations.

Circulating osteoprotegerin levels are elevated and correlated with antiphospholipid antibodies in patients with systemic lupus erythematosus

Patients with antiphospholipid syndrome (APS) have an increased risk for the development of thrombotic complications. Recent studies indicate that osteoprotegerin (OPG) acts as an important molecule in the development of vascular diseases. The aim of the present study was to examine the association between serum OPG levels and APS manifestations in patients with SLE. Seventy-nine patients with SLE and ninety-two healthy controls, matched for age and sex, were included in this study. Serum levels of OPG, monocyte chemoattractant protein(MCP)-1 and soluble E-selectin were determined by ELISA. At the time of serum sampling, various clinical and laboratory parameters were assessed. We found that serum levels of OPG were significantly higher in patients with SLE than in healthy controls (1236 ± 82 vs 967 ± 37 pg/mL, P = 0.003). Particularly, serum OPG levels were significantly higher in SLE patients with APS than those without (1615 ± 191 vs 1171 ± 91 pg/mL, P = 0.006). Serum OPG levels correlated with titres of IgG anti-cardiolipin antibody ( P = 0.026) and anti-β2-glycoprotein I antibody ( P < 0.001). Moreover, serum OPG also correlated with serum levels of sE-selectin ( P = 0.002), which is an endothelial cell activation marker, and MCP-1 ( P = 0.003), a well known chemokine implicated in thrombogenesis. Collectively, serum OPG levels were increased in SLE patients with APS and correlated with titres of antiphospholipid antibodies, suggesting that OPG might be linked to the development of APS.

A Study of Knowledge-Based Simulation for Enterprise Resources Planning

The conventional way of using the Enterprise Resources Planning (ERP) applications is inadequate for the highly dynamic, complex and demanding business environment. The efficient use of the ERP system relies heavily on the know-how, experience and quality of the users. Since the knowledge of operating ERP system is difficult to be acquired, shared and diffused among the users, it takes time and money to train well-experienced users. As a result, this paper presents a framework of Knowledge-based Simulation System for Enterprise Resources Planning named KBSimERP. The KBSimERP provides an integrated learning environment for achieving three perspectives, which includes the knowledge acquisition, knowledge diffusion and performance measurement perspectives respectively. Hence, a prototype of the KBSimERP is built for production planning and control, and the performance of the system is preliminarily evaluated. Satisfactory results are obtained.

Central corneal dellen: a complication of upper eyelid tarsotomy

PURPOSE

To report a rare complication of central corneal dellen that developed after a tarsotomy procedure to correct cicatricial entropion.

METHOD

Central corneal dellen developed in a 60-year-old woman 3 months after a tarsotomy procedure for correction of cicatricial upper eyelid entropion. Eversion of the upper eyelid showed a retracted and buckled tarsal plate and the presence of a 5 x 10-mm depression between the edge of the tarsoconjunctival flap and lower tarsal bridge.

RESULTS

The recalcitrant corneal defect was reversed when the upper eyelid tarsoconjunctival surface contour was restored by full-thickness tarsal incisions designed to flatten the dome-shaped tarsal plate.

CONCLUSION

An upper eyelid defect producing suboptimal lid-globe apposition during lid closure can lead to dellen formation because of focal corneal dehydration as the result of an altered tear meniscus.

An analysis of the incidence and risk factors of developing severe keratopathy in eyes after megavoltage external beam irradiation

OBJECTIVE

To investigate the incidence and risk factors of developing severe keratopathy in eyes exposed to megavoltage external beam irradiation.

DESIGN

Retrospective noncomparative case series.

PARTICIPANTS

The authors evaluated 88 eyes of 88 consecutive patients who had received irradiation of an entire orbit during radiation therapy for nasopharyngeal carcinoma. Mean follow-up was 40 months (range, 24-106 months).

INTERVENTION

Slit-lamp biomicroscopic findings of the cornea after irradiation were categorized into four grades in accordance with a standard protocol. Grade 3 or above changes were defined as severe radiation keratopathy.

MAIN OUTCOME MEASURES

The incidence of severe radiation keratopathy was evaluated along with patient's age, radiation dose, lacrimal shielding, and tumor involvement of the trigeminal nerve.

RESULTS

Severe radiation keratopathy developed in 32 patients. Mean latency was 15 months (range, 4-36 months). Its incidence increased from 0% after doses less than 59 Gy to 100% after doses greater than 70 Gy. Between 59 Gy and 69 Gy, the adverse factor was omission of lacrimal shield during radiation therapy (P < 0.01).

CONCLUSION

Radiation dose to the cornea is the most important factor in determining the outcome of radiation keratopathy. When the threshold dose is reached, visual prognosis is grave despite protection of the lacrimal gland. Clinical trials on newer strategies to treat ocular surfaces exposed to heavy irradiation are necessary.

Neovascular glaucoma developing after uncomplicated cataract surgery for heavily irradiated eyes

PURPOSE

The purpose of the study was to evaluate the effect of cataract surgery and postoperative panretinal photocoagulation (PRP) on the development of neovascular glaucoma (NVG) in heavily irradiated eyes.

PATIENTS AND METHODS

The authors performed a retrospective study on the incidence of NVG in 90 eyes that had received megavoltage external beam irradiation at a retinal dose of 56 to 80 Gy and that had at least 48 months of follow-up. These eyes were categorized into different groups depending on whether cataract surgery or PRP was performed. Rates and proportions of NVG occurring in these groups were compared and analyzed with one-tailed Fisher's exact test.

RESULTS

The incidence of NVG was significantly higher in patients who underwent cataract surgery without postoperative PRP (P < 0.01). Neovascular glaucoma did not develop in any patient who underwent cataract surgery and PRP.

CONCLUSIONS

Cataract surgery may accelerate the development of NVG in heavily irradiated eyes. Photoablation of ischemic retina is recommended before cataract surgery or soon thereafter if cataract density precludes laser treatment.

Ocular defects in children and adolescents with severe mental deficiency

To assess the need for eye care in children and adolescents with severe mental deficiency, a cross-sectional study of the prevalence and causes of ocular defects amongst these individuals was conducted. Two hundred and sixty residents in a mental handicap unit were examined from January 1992 to June 1993. It was found that there was an unusually high prevalence of severe visual impairment (25%), refractive errors (24%), squint (8%) and a number of organic ocular diseases (8%). All the patients studied were non-verbal and 18% of them were deaf. Only 23 patients could walk. The results emphasize the need for establishing an efficient system to provide regular ophthalmic care for children with severe mental deficiency.

A study on the health hazard of toluene in the polythene printing industry in Singapore

A study was conducted to determine if there were any health effects among the polythene printers who were exposed to toluene and to evaluate the use of urinary hippuric acid in biological monitoring. The study covered 54 printers from 6 plants out of the universe population of 32 polythene printing plants who used toluene as ink dilutants. They were matched with 54 controls for age, sex, race and similar occupational status. All were interviewed and examined clinically. 23 patients were selected for neurobehavioural tests. 26% of the printers had more than 10 years of exposure to toluene. No case of clinical encephalopathy or peripheral neuropathy was detected. 38.9% of the printers had hand dermatitis compared with 1.9% among the controls. Results of the neurobehavioural tests for the 23 printers were not statistically different from the controls. The results of the liver function test were within normal limits. The mean toluene-in-air level was 246 +/- 25 mg/m. Mean blood toluene was 0.63 +/- 0.14 microgram/ml. The mean urinary hippuric acid was 2.83 +/- 0.48 mg/ml as compared to 0.35 +/- 0.08 mg/ml in the controls. Urine hippuric acid corrected to SG of 1.016 was well correlated to air toluene level (r = 0.81). Toluene appears not to have any significant nervous system or liver effects in these printers. Urinary hippuric acid is a useful indicator for biological monitoring of atmospheric exposure to toluene.