A Retrospective Dosimetric Study in Breast Cancer Patients Who Received Conformal Radiation Therapy for Achievability of Recommended Dose Constraints of RTOG, DBCG, EORTC for Lung and Heart

PURPOSE/OBJECTIVE(S)

In India, carcinoma of breast is the commonest malignancy among women. In multidisciplinary approach of its management, radiotherapy (RT) is an important component. Different cooperative groups have defined dose constraints to lungs and heart to minimize these late side effects such as radiation pneumonitis and coronary artery disease. To assess the achievability of dose constraints given for lung and heart by RTOG, EORTC and DBCG in our cohort of breast cancer patients who underwent conformal radiation therapy to chest wall / breast along with supraclavicular nodal region.

MATERIALS/METHODS

This retrospective dosimetric study included all breast cancer patients who underwent conformal radiation in our institute from Jan 2021 to Dec 2022 and was treated with a dose of 40 Gy in 15 fractions.

RESULTS

A total of 302 patients (162 - Left sided, 140 - Right sided) were in the study cohort. Majority of them received RT with 3DCRT with FiF (266 patients) and 36 patients received RT by VMAT technique. Respiratory gating was done in left sided breast cancer by DIBH for 46.2 % of patients due to COVID pandemic during this period. Our analysis showed that for the ipsilateral lung, EORTC (77.8%) dose constraints were easy to achieve followed by DBCG (65.2%) and RTOG (61.9 %). For the heart constraints in left sided breast cancer patients, easily achievable constraints were by DBCG (91.9 %) followed by RTOG (66.6 %) and EORTC (53.1%). The DBCG constraints of Dmean <5 Gy was more liberal than any other recommendations. All the dose constraint recommendations were easily achieved for heart in right sided breast cancer patients, by more than 90 % of the population. Usage of respiratory gating with DIBH technique improves the rates of achievability of lung constraints in 56 (74.6%) out of 75 patient and heart constraints in 54 (72 %) out of 75 patients. Our institutional policy is to treat chest wall / breast along with supraclavicular nodal chain in case of NACT or T3/T4 disease and this could have been the reason why we were unable to achieved the dose constraints recommended.

CONCLUSION

The DBCG dose constraint recommendations for heart was achieved in the left chest wall treatment in majority of women and EORTC was best achieved for ipsilateral lung. All heart dose constraint recommendations were achieved for right chest wall treatment. Respiratory gating improves achievability rates of the recommendations. It is difficult to achieve all the dose constraints as recommended by different cooperative groups as there is variation among them.

Basic Findings of Incidence of Breast Cancer in Allied Hospital Faisalabad, Pakistan: A Retrospective Study

Background

Breast cancer is the most common malignancy among women worldwide. We aimed to know the past trends of age-specific breast cancer incidence rates in Faisalabad city.

Methods

A retrospective study was designed at Allied Hospital Faisalabad (AHF), Pakistan from 2014-2018. Overall, 12742 cancer patients presented throughout these years, out of which 3390 were breast cancer cases. Descriptive statistics were computed and the results were presented as counts and percentage for categorical variables. Means and standard errors were computed for the continuous variables. For testing the association among categorical variables, a chi-square test of independence was used and the p-values less than 0.05 are reported as significant.

Results

84.70% patients were diagnosed with invasive breast carcinoma and 15.30% were all other types reported in the Allied Hospital Faisalabad. The incidence of breast cancer was outrageous in the 40-49 year-old age group (1021 patients, 30.12%) and the mean age is 45 in all years. An increase of 34.86% was observed from 2014 to 2018. The comprehensive four-year data (2015 to 2018) were further analyzed for histology, surgery, staging and grading pattern as 2014 files data was insufficient to discuss. The stage III and grade III were most common throughout the years from 2015 to 2018 with 33.9% and 55.71% respectively.

Conclusion

Breast cancer is diagnosed more commonly in women than in any other type of cancers in Faisalabad city. There is a need to upgrade the existing hospital facilities to make the women diagnose the cancer at an earlier stage.

Nickel centered pyromellitic acid/pyridine-3,5-dicarboxylic acid bi-linker organic webbing for battery-supercapacitor hybrids

Metal-organic frameworks are a complex of metal nodes and organic ligands that have attracted widespread interest in technological applications owing to their diverse characteristics. Bi-linker MOFs can prove to be more conductive and efficient than the mono-linker MOFs, however, they have been investigated less often. In this current study two distinct organic ligands i.e., 1,2,4,5-benzene-tetra-carboxylic acid and pyridine-3,5-dicarboxylic acid were used to synthesize a bi-linker nickel MOF. The obtained Ni-P-H MOF having a unique construction was examined for its structural, morphological, and electrochemical properties. To the best of our knowledge, for the first time its potential use was specifically explored as a component in hybrid supercapacitors, as it has not been previously reported for such applications. In standard three-electrode assembly, the electrochemical properties of the Ni-P-H MOF were examined, followed by the fabrication of a Ni-P-H MOF hybrid supercapacitor with activated carbon. This hybridization results in a device with both high energy and power density, making it suitable for a variety of practical applications. To further understand the behavior of this hybrid supercapacitor, a semi-empirical technique was implemented employing Dunn's model. This model allows for the extraction of regression parameters and the quantification of the diffusive/capacitive contributions of the two-cell assembly. Overall, the combination of Ni-PMA-H₂pdc MOF//activated carbon in a hybrid supercapacitor holds great potential for advancements in energy storage technology.

Exploring MOF-199 composites as redox-active materials for hybrid battery-supercapacitor devices

Metal-organic frameworks (MOFs) have emerged as intriguing porous materials with diverse potential applications. Herein, we synthesized a copper-based MOF (MOF-199) and investigated its use in energy storage applications. Methods were adapted to intensify the electrochemical characteristics of MOF-199 by preparing composites with graphene and polyaniline (PANI). The specific capacity of the synthesized MOF in a three-electrode assembly was significantly enhanced from 88 C g^-1 to 475 C g^-1 and 766 C g^-1 with the addition of graphene and polyaniline (PANI), respectively. Due to the superior performance of (MOF-199)/PANI, a hybrid supercapacitor was fabricated with the structure of (MOF-199)/PANI//activated carbon, which displayed an excellent maximum energy and power density of 64 W h kg^-1 and 7200 W kg^-1, respectively. The hybrid device exhibited an appreciable capacity retention of 92% after 1000 charge-discharge cycles. Moreover, using Dunn's model, the capacitive and diffusive contributions as well as the k ₁ and k ₂ currents of the fabricated device were calculated, validating the hybrid nature of the supercapattery device. The current studies showed that MOF-199 exhibits promising electrochemical features and can be considered as potential electrode material for hybrid energy storage devices.

Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study

BACKGROUND

No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge.

METHODS

The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing.

FINDINGS

2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters.

INTERPRETATION

The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials.

FUNDING

UK Research and Innovation and National Institute for Health Research.

Mammalian Target of Rapamycin Pathway Assessment in Antiphospholipid Antibody Positive Patients with Livedo

OBJECTIVE

In antiphospholipid antibody (aPL) nephropathy, activation of the mammalian target of rapamycin (mTOR) contributes to endothelial cell proliferation, a key finding of aPL microvascular disease. Here, we examined mTOR activation in the skin of aPL-positive patients with livedo.

METHODS

Three patient groups with livedo were studied: persistently aPL-positive with or without systemic lupus erythematosus (SLE), and aPL-negative SLE (control). After collecting aPL-related medical history, two 5-mm skin biopsies of livedo were performed on each patient: a) peripheral (erythematous-violaceous lesion), b) central (non-violaceous area). We stained specimens for phosphorylated protein kinase B (P-AKT) and S6 ribosomal protein (P-S6RP) as mTOR activity markers, CD31 to identify endothelial cells, and Ki-67 to show cellular proliferation. We counted cells in the epidermis and compared mTOR positive cell counts between peripheral and central samples, and between patient groups, using Freidman and Wilcoxon Rank tests.

RESULTS

Ten patients with livedo reticularis were enrolled (aPL-positive without SLE: 4 [APS classification met: 3], aPL-positive SLE: 4 [APS classification met: 3], and aPL-negative SLE [control]: 2). In all aPL-positive patients, epidermal P-AKT and P-S6RP staining were significantly increased in both peripheral and central skin samples when compared to aPL-negative SLE controls; both were more pronounced in the lower basal layers of epidermis.

CONCLUSION

Our study demonstrates increased mTOR activity in livedoid lesions of aPL-positive patients with or without SLE, compared to aPL-negative SLE patients, more profoundly in the lower basal layers of epidermis. These findings may serve as a basis for further investigating mTOR pathway in aPL-positive patients.

Probing the Performance of Glucose Oxidase Treated Graphene-Based Field Effect Transistors

Graphene due to its unique properties of biocompatibility has received considerable attention for biosensing applications. Here, we report the effect of glucose oxidase treatment on the graphene devices. Raman spectroscopy and the electrical transport measurements are performed to study the graphene intrinsic characteristics before glucose oxidase treatment. The absence of the defect peak in the Raman spectrum shows high-quality graphene. The modulation in the electrical properties is further investigated by different period of glucose oxidase treatment. Our results illustrate that the mobility of the graphene-based field effect transistor is gradually enhanced with the glucose oxidase treatment time. The enhancement in the electrical performance of graphene FET with the biomolecules could be the suitable route for the bioelectronic devices.

Abstract P3-03-03: Sentinel node biopsy (SNB) vs Low axillary sampling (LAS) in predicting nodal status of post-chemotherapy axilla in women with breast cancer

Introduction

There is no safe method of avoiding complete axillary lymph node dissection in women with breast cancer after neo-adjuvant chemotherapy. sentinel node biopsy (SNB) has had prohibitively high false negative rate. We tested low axillary sampling (LAS) and SNB performed in same patient to predict axillary lymph node status in clinically node negative women undergoing breast conservation or modified radical mastectomy after neo-adjuvant chemotherapy.

Methodology

Post neo-adjuvant chemotherapy 751 women who had no palpable axillary lymph node underwent LAS (all lymph nodes below intercosto-brachial nerve). Of these 751 women, 730 also underwent SNB by dual technique after injection of blue dye as well as radio-isotope. SN was identified within and outside axillary sampling specimen. SN as well as LAS specimens were distinctly examined for nodal metastasis. The rest of the axillary dissection was completed in all patients. Post NACT 292/751(38.9%) had residual positive lymph nodes on pathology. The identification rate, false negative rate (FNR), and negative predictive value (NPV) of SNB and LAS were compared for predicting negative axillary lymph node status.

Results

The median clinical tumor size was 5cm (1-15cm) and 533(71%) patients were N1 or N2 at presentation. The SNB identification rate was 87.1% (636 of 730), with a median of 5 nodes and node positive in 238 of 636 (37.4%). LAS identification rate was 98% (736 of 751), with a median of 7 nodes and node positive in 292 of 736 (39.6%). In all but one case, the SN was found within the LAS specimen. The FNR of SNB (blue, hot and adjacent palpable nodes) was 19.7% (47 of 238, one sided 95% upper CI 24.0) compared to LAS with FNR of 9.9% (29 of 292, one-sided 95% upper CI 12.8) (p&lt;0.001). Comparative NPV for SNB and LAS were 89.4% and 93.9% respectively. If SNB was confined to blue/hot node excluding adjacent palpable nodes, FNR was 31.6% (74 of 234, 95% upper CI 36.6).

Conclusions

LAS is superior to SNB in identification rate, FNR and NPV in predicting node negative axilla post-neoadjuvant chemotherapy. LAS can be safely used to predict negative axilla with less than 10% chance of leaving residual disease.

Citation Format: Parmar V, Nair NS, Vanamali V, Hawaldar RW, Siddique S, Shet T, Desai SB, Rangarajan V, Patil A, Gupta S, Badwe RA. Sentinel node biopsy (SNB) vs Low axillary sampling (LAS) in predicting nodal status of post-chemotherapy axilla in women with breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-03-03.

Rituximab use in pediatric lupus anticoagulant hypoprothrombinemia syndrome - report of three cases and review of the literature

Lupus anticoagulant hypoprothrombinemia syndrome (LA-HPS) is a rare condition that may predispose both to thrombosis and bleeding due to positive lupus anticoagulant (LA) and factor II (FII) deficiency. It can be seen in association with infections or systemic lupus erythematosus (SLE) and may require glucocorticoids (GCs) and/or immunosuppressive medications. Pediatric LA-HPS cases in the literature and three cases that received only rituximab (RTX) for LA-HPS (in addition to GCs) at two institutions between January 2010 and June 2017 were analyzed descriptively. Pediatric LA-HPS cases (≤18 years) with bleeding or thrombotic events were included. Information obtained included demographics, presenting symptoms, diagnoses, treatments, pre-/post-treatment prothrombin time (PT)/partial thromboplastin time (PTT)/LA/FII levels, and outcomes. In addition to three LA-HPS cases identified at our institutions, as of June 2017, 37 articles reported 54 pediatric LA-HPS cases (mean age: 8 years (0.9-17 years); female/male: (2:1); viral illness 27 (50%), SLE 20 (37%), and other six (11%)). All cases had a positive LA and FII deficiency (range: 0%-40%). All cases presented with bleeding diathesis and were treated with various regimens, but there was no reported use of RTX. The purpose of this report is to describe the novel use of RTX as a steroid-sparing agent in three pediatric SLE cases and to systematically review the literature on pediatric cases of LA-HPS.

Vascular Manifestations in Antiphospholipid Syndrome (APS): Is APS a Thrombophilia or a Vasculopathy?

PURPOSE OF REVIEW

Antiphospholipid antibody syndrome (APS) is characterized primarily by thrombosis and pregnancy morbidity. Chronic vascular lesions can also occur. While the underlying mechanisms of these vascular lesions are not entirely known, there have been multiple theories describing the potential process of vasculopathy in APS and the various clinical manifestations associated with it.

RECENT FINDINGS

Recently, it has been demonstrated that endothelial proliferation in kidneys can be explained by the activation of the mammalian target of rapamycin complex (mTORC) pathway by antiphospholipid antibodies (aPL). These data support the existence of an APS-related vasculopathy in different locations which can explain-in part-the different manifestations of APS. This review focuses on the various manifestations of APS as a result of APS-related vasculopathy, as well as pathophysiology, current screening, and treatment options for clinicians to be aware of.

Proceedings of the 2016 Childhood Arthritis and Rheumatology Research Alliance (CARRA) Scientific Meeting : Toronto, Canada. 14-17 April 2016

P1 Serologic evidence of gut-driven systemic inflammation in juvenile idiopathic arthritis Lampros Fotis, Nur Shaikh, Kevin Baszis, Anthony French, Phillip Tarr P2 Oral health and anti-citrullinated peptide antibodies (ACPA) in juvenile idiopathic arthritis Sriharsha Grevich, Peggy Lee, Sarah Ringold, Brian Leroux, Hannah Leahey, Megan Yuasa, Jessica Foster, Jeremy Sokolove, Lauren Lahey, William Robinson, Joshua Newsom, Anne Stevens P3 Novel autoantigens for endothelial cell antibodies in pediatric rheumatic diseases identified by proteomics Rie Karasawa, Mayumi Tamaki, Megumi Tanaka, Toshiko Sato, Kazuo Yudoh, James N. Jarvis P4 Transcriptional profiling reveals monocyte signature associated with JIA patient poor response to methotrexate Halima Moncrieffe, Mark F. Bennett, Monica Tsoras, Lorie Luyrink, Huan Xu, Sampath Prahalad, Paula Morris, Jason Dare, Peter A. Nigrovic, Margalit Rosenkranz, Mara Becker, Kathleen M. O’Neil, Thomas Griffin, Daniel J. Lovell, Alexei A. Grom, Mario Medvedovic, Susan D. Thompson P5 A multi-dimensional genomic map for polyarticular juvenile idiopathic arthritis Lisha Zhu, Kaiyu Jiang, Laiping Wong, Michael J Buck, Yanmin Chen, Halima Moncrieffe, Laura Brungs, Tao Liu, Ting Wang, James N Jarvis P6 Tocilizumab for treatment of children with refractory JIA Khaled Alsaeid, Jasim Alfailakawi, Hamid Alenezi, Hazim Alsaeed P7 Clinical characteristics of the initial patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry Tim Beukelman, Marc Natter, Norm Ilowite, Kelly Mieszkalski, Grendel Burrell, Brian Best, Helen Bristow, Shannon Carr, Anne Dennos, Rachel Kaufmann, Yukiko Kimura, Laura Schanberg P8 Comparative performance of small and large clinical centers in a comprehensive pediatric rheumatology disease registry Peter R Blier P9 Clinical characteristics of children with membranous lupus nephritis: The Childhood Arthritis and Rheumatology Research Alliance Legacy Registry Alexis Boneparth, Scott E. Wenderfer, L. Nandini Moorthy, Suhas M. Radhakrishna, Anna Carmela P. Sagcal-Gironella, Emily von Scheven P10 Rituximab use in pediatric lupus anticoagulant hypoprothrombinemia syndrome - a two center experience Kader Cetin Gedik, Salma Siddique, Cassyanne L. Aguiar, Doruk Erkan P11 Predictors of complementary and alternative medicine use and response in children with musculoskeletal conditions Ezra Cohen, Yvonne Lee, Michelle Dossett, Darshan Mehta, Roger Davis P12 Comparison of pediatric rheumatology and nephrology survey results for the treatment of refractory proliferative lupus nephritis and renal flare in juvenile SLE Mileka Gilbert, Beatrice Goilav, Esra Meidan, Joyce Hsu, Alexis Boneparth, Anabelle Chua, Stacy Ardoin, Scott E. Wenderfer, Emily Von Scheven, Natasha M. Ruth P13 Transitioning lupus patients from pediatric to adult rheumatology Joyce Hui-Yuen, Kader Cetin Gedik, Liza Bermudez, Ashlea Cook, Lisa Imundo, Amy Starr, Andrew Eichenfield, Anca Askanase P14 The systemic juvenile idiopathic arthritis cohort of the Childhood Arthritis & Rheumatology Research Alliance Registry Ginger Janow, Laura E. Schanberg, Soko Setoguchi, Victor Hasselblad, Elizabeth D. Mellins, Rayfel Schneider, Yukiko Kimura, The CARRA Legacy Registry Investigators P15 Results of the pilot study of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) consensus treatment plans for new-onset systemic juvenile idiopathic arthritis Yukiko Kimura, Sriharsha Grevich, Timothy Beukelman, Esi Morgan, T Brent Graham, Maria Ibarra, Yonit Sterba Ruas, Marisa Klein-Gitelman, Karen Onel, Sampath Prahalad, Marilynn Punaro, Sarah Ringold, Dana Toib, Heather Van Mater, Jennifer E. Weiss, Pamela F. Weiss, Kelly Mieszkalski, Laura E. Schanberg P16 A systemic review of pain relief modalities in juvenile idiopathic arthritis: First step in developing a novel decision support intervention Timothy S. H. Kwok, Jacinthe Bisaillon, Christine Smith, Lucie Brosseau, Jennifer Stinson, Adam M. Huber, Ciaran M. Duffy, Karine Toupin April P17 Barriers and facilitators to care retention for pediatric systemic lupus erythematous patients in South Africa: A qualitative study Laura B Lewandowski, Christiaan Scott P18 Evaluating the feasibility of conducting comparative effectiveness studies in juvenile Localized Scleroderma (jLS) Suzanne C. Li, Kathryn S. Torok, C. Egla Rabinovich, Sandy D. Hong, Mara L Becker, Fatma Dedeoglu, Maria F. Ibarra, Polly J Ferguson, Rob C. Fuhbrigge, Katie G. Stewart, Elena Pope, Ronald M. Laxer, Thomas G. Mason, Gloria C. Higgins, Xiaohu Li, Marilynn G. Punaro, George Tomlinson, Eleanor Pullenayegum, John Matelski, Laura Schanberg, Brian M. Feldman P19 Tonsillar histology in patients with periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA) syndrome Kalpana Manthiram, Hernan Correa, Kathryn Edwards P20 Clinical course of juvenile dermatomyositis presenting as skin predominant disease Edward J. Oberle, Michelle Bayer, Dominic O. Co, Hatice Ezgi Baris, Yvonne Chiu, Adam Huber, Susan Kim P21 A Survey of musculoskeletal ultrasound practices of pediatric rheumatologists in North America Edward J Oberle, Timothy Beukelman P22 Assessment, classification and treatment of calcinosis as a complication of juvenile dermatomyositis: A survey of pediatric rheumatologists by the Childhood Arthritis and Rheumatology Research Alliance Amir B. Orandi, Kevin W. Baszis, Vikas Dharnidharka, Mark F. Hoeltzel, for the CARRA JDM Committee P23 CARRA dermatomyositis CTP pilot study Ann Reed, Adam Huber, George Tomlinson, Eleanor Pullenayegum, John Matelski, Y. Ingrid Goh, Laura Schanberg, Brian M. Feldman P24 Unexpectedly high incidences and prolonged disease activity in children with chronic non-bacterial osteomyelitis (CNO) as compared to bacterial osteomyelitis Anja Schnabel, Ursula Range, Gabriele Hahn, Timo Siepmann, Reinhard Berner, Christian Michael Hedrich P25 Juvenile systemic sclerosis cohort within the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Legacy Registry: Follow up characteristics Brandi Stevens, Kathryn S. Torok, Suzanne Li, Nicole Hershey, Megan Curran, Gloria Higgins, Katharine Moore, Egla Rabinovich, Anne M. Stevens, for the CARRA Registry Investigators P26 Development and usability testing of an iPad and desktop psycho-educational game for children with Juvenile Idiopathic Arthritis and their parents Jennifer Stinson, Mark Connelly, Adam Huber, Nadia Luca, Lynn Spiegel, Argerie Tsimicalis, Stephanie Luca, Naweed Tajuddin, Roberta Berard, Julia Barsalou, Sarah Campillo, Paul Dancey, Ciaran Duffy, Brian Feldman, Nicole Johnson, Patrick McGrath, Natalie Shiff, Shirley Tse, Lori Tucker, Charles Victor P27 iCanCope^TM: User-centred design and development of a smartphone app to support self-management for youth with arthritis pain Jennifer Stinson, Chitra Lalloo, Lauren Harris, Joseph Cafazzo, Lynn Spiegel, Brian Feldman, Nadia Luca, Ronald Laxer P28 Accessing pediatric rheumatology care: Despite barriers, few parents prefer telemedicine Danielle R. Bullock, Richard K. Vehe, Lei Zhang, Colleen K. Correll¹ P29 Exploration of factors contributing to time to achieve clinically inactive disease (CID) in juvenile idiopathic arthritis (JIA): A preliminary report Suhas Ganguli, Max Shenberger, Ritesh Korumilli, Beth Gottlieb P30 Pediatric rheumatology referral patterns: Presenting complaints of new patients at a large, urban academic center Martha Rodriguez, Deirdre de Ranieri, Karen Onel, Linda Wagner-Weiner, Melissa Tesher P31 Quality improvement (QI) initiatives in childhood systemic lupus erythematosus (cSLE) Elizabeth Roth Wojcicki, Kristyn L. Maletta, Dominic O. Co, Marsha Malloy, Sarah Thomson, Judyann C. Olson P32 Proliferative lupus nephritis in juvenile SLE: Support from the pediatric nephrology community for the definitions of responsiveness and flare in the 2012 consensus treatment plans Scott E. Wenderfer, Mileka Gilbert, Joyce Hsu, Sangeeta Sule, Tamar B. Rubinstein, Beatrice Goilav, Daryl M. Okamura, Annabelle Chua, Laurence A. Greenbaum, Jerome C. Lane, Emily von Scheven, Stacy P. Ardoin, Natasha M. Ruth P33 The steroid taper app: Making of a mobile app Jennifer M. P. Woo, Marsha M. Malloy, James A. Jegers, Dustin J. Hahn, Mary K. Hintermeyer, Stacey M. Martinetti, Gretchen R. Heckel, Elizabeth L. Roth-Wojcicki, Dominic O. Co

Iron Polymaltose Complex in the Treatment of Iron Deficiency Anemia in Pregnancy

Iron deficiency anaemia is a major public health problem in pregnancy. About 58% of pregnant women in developed countries are anaemic mainly due to iron deficiency resulting a serious negative consequences on children, mothers and eventually on the nation. This quasi-experimental multi centered study (Before after study) was done to evaluate the efficacy and tolerability of Iron Polymaltose Complex (IPC) in the treatment of iron deficiency anaemia and it was performed at the OPD of Bangladesh Medical College and two other clinics of Dhaka city from August 2011 to September 2013. A total of 80 (eighty) subjects were selected by purposive sampling as per inclusion and exclusion criteria. They were treated by Iron Polymaltose-IPC [47mg elemental iron + Folic Acid 0.5mg + Zinc 22.5mg - Once daily orally for 12 weeks]. At the beginning and after 12 weeks of intervention by Iron Polymaltose Complex (IPC) Hb%, Packed Cell Volume (PCV), Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin (MCH), Serum iron, and Serum ferritin were measured. Data were analyzed by SPSS version 13.0. Paired and unpaired 't' test was used to analyze differences within groups and between groups. Chi-square test was done to analyze primary efficacy parameters and adverse drug reactions (ADR). Most of the respondents were within the age group of 18-23 and 30-35 years (32.6% each). Significant differences were found by treatment with IPC for 12 weeks in Hb%, PCV, MCV, MCH, Serum iron, and Serum ferritin level. In iron deficiency anaemia during pregnancy IPC may be used as a safe and cost-effective therapeutic management.

Room temperature spin valve effect in NiFe/WS₂/Co junctions

The two-dimensional (2D) layered electronic materials of transition metal dichalcogenides (TMDCs) have been recently proposed as an emerging canddiate for spintronic applications. Here, we report the exfoliated single layer WS2-intelayer based spin valve effect in NiFe/WS2/Co junction from room temperature to 4.2 K. The ratio of relative magnetoresistance in spin valve effect increases from 0.18% at room temperature to 0.47% at 4.2 K. We observed that the junction resistance decreases monotonically as temperature is lowered. These results revealed that semiconducting WS2 thin film works as a metallic conducting interlayer between NiFe and Co electrodes.

Iso-uncertainty control in an experimental fluoroscopy system

PURPOSE

X-ray fluoroscopy remains an important imaging modality in a number of image-guided procedures due to its real-time nature and excellent spatial detail. However, the radiation dose delivered raises concerns about its use particularly in lengthy treatment procedures (>0.5 h). The authors have previously presented an algorithm that employs feedback of geometric uncertainty to control dose while maintaining a desired targeting uncertainty during fluoroscopic tracking of fiducials. The method was tested using simulations of motion against controlled noise fields. In this paper, the authors embody the previously reported method in a physical prototype and present changes to the controller required to function in a practical setting.

METHODS

The metric for feedback used in this study is based on the trace of the covariance of the state of the system, tr(C). The state is defined here as the 2D location of a fiducial on a plane parallel to the detector. A relationship between this metric and the tube current is first developed empirically. This relationship is extended to create a manifold that incorporates a latent variable representing the estimated background attenuation. The manifold is then used within the controller to dynamically adjust the tube current and maintain a specified targeting uncertainty. To evaluate the performance of the proposed method, an acrylic sphere (1.6 mm in diameter) was tracked at tube currents ranging from 0.5 to 0.9 mA (0.033 s) at a fixed energy of 80 kVp. The images were acquired on a Varian Paxscan 4030A (2048 × 1536 pixels, ∼ 100 cm source-to-axis distance, ∼ 160 cm source-to-detector distance). The sphere was tracked using a particle filter under two background conditions: (1) uniform sheets of acrylic and (2) an acrylic wedge. The measured tr(C) was used in conjunction with a learned manifold to modulate the tube current in order to maintain a specified uncertainty as the sphere traversed regions of varying thickness corresponding to the acrylic sheets in the background.

RESULTS

With feedback engaged, the tracking error was found to correlate well with the specified targeting uncertainty. Tracking of the fiducial was found to be robust to changes in the attenuation presented by the varying background conditions. For a desired uncertainty of 5.0 mm, comparison of the feedback framework with a comparable system employing fixed exposure demonstrated dose savings of 29%.

CONCLUSIONS

This work presents a relation between a state descriptor, tr(C), the x-ray tube current used, and an estimate of the background attenuation. This relation is leveraged to modulate the tube current in order to maintain a desired geometric uncertainty during fluoroscopy. The authors' work demonstrates the use of the method in a real x-ray fluoroscopy system with physical motion against varying backgrounds. The method offers potential savings in imaging dose to patients and staff while maintaining tracking uncertainty during fluoroscopy-guided treatment procedures.

Histo-pathological Features of Genital Tract Malignancies as Seen in a Tertiary Health Center in North-Western Nigeria: A 10-year Review

Background:

The pattern of gynecological malignancies varies among nations and even within health institution in the same country. Understanding the histo-pathological pattern of these malignancies will help in the management of the patient.

Aim:

The aim of the following study is to establish the frequency, histo-pathological features, and distribution of genital tract malignancies as seen in a tertiary health institution in North - western Nigeria.

Materials and Methods:

A retrospective analysis of data from ward admissions and discharge records, surgical biopsy materials from the theater and the histopathology laboratory results of slides. The study was carried out at the Usmanu Dan-Fodiyo University Teaching Hospital Sokoto, Nigeria. Data were entered into a study proforma and analysis was through SPSS version 15 (Chicago IL) for windows. The results were expressed in simple percentages, tables and charts.

Results:

During the study period (2000-2009), there were 404 cases of gynecological malignancies recorded in the hospital. Cervical cancer was the most common gynecological malignancy 274/404 (69%), followed by choriocarcinoma 52/404 (13.1%), ovarian cancer 46/404 (11.4%) while the least common was vaginal cancer 1/404 (0.3%). The mean age of the cancers was 54 years (28.3). The mean age of incidence of all ovarian cancers was 52.5 years (SD ± 16.2). Epithelial ovarian tumors had a mean age incidence of 67 (12) years, while that of ovarian germ cell tumors was 18.5 (8) years. The incidence of cervical cancer showed a rising trend. Moderately differentiated squamous cell carcinoma was the most common histological variant of cervical carcinoma 170/252 (67.5%). Among the ovarian tumors, epithelial cancers were the most common 38/46 (82.6%), and were followed by the germ cell tumors 5/46 (10.9%). Dysgerminoma was the predominant ovarian germ cell tumour 4/5 (80%). There were 50 deaths from these cancers in our hospital.

Conclusion:

Cervical cancer is the most common gynecological malignancy in our centerand it was followed by Choriocarcinoma. Efforts to reduce the cancer burden should focus on heath education of the masses, national organized screening especially for cervical cancer and establishing regional centers for monitoring and evaluation of these programs.

Measurement of a reaction-diffusion crossover in exciton-exciton recombination inside carbon nanotubes using femtosecond optical absorption

Exciton-exciton recombination in isolated semiconducting single-walled carbon nanotubes was studied using femtosecond transient absorption. Under sufficient excitation to saturate the optical absorption, we observed an abrupt transition between reaction- and diffusion-limited kinetics, arising from reactions between incoherent localized excitons with a finite probability of ~0.2 per encounter. This represents the first experimental observation of a crossover between classical and critical kinetics in a 1D coalescing random walk, which is a paradigm for the study of nonequilibrium systems.

Composition and Antimicrobial Activity of the Essential Oil from Leaves of Curcuma longa L. Kasur Variety

The essential oil from the leaves of Curcuma longa L. Kasur variety grown in Pakistan was extracted by hydro-distillation. Chemical constituents of the essential oil were identified by gas chromatography/mass spectrometry. The chromatographic analysis of oil showed 25 constituents, out of which nine chemical constituents were identified. The eucalyptol (10.27%) was the major component of the essential oil. α-pinene (1.50%), β-phellandrene (2.49%), β-pinene (3.57%), limonene (2.73%), 1,3,8-p-menthatriene (1.76%), ascaridole epoxide (1.452%), 2-methylisoborneol (2.92%), 5-isopropyl-6-methyl-hepta-3, dien-2-ol (2.07%) were also present in considerable quantity. The antimicrobial properties of leaves of Curcuma longa were tested by disc diffusion method against various human pathogens, including eight fungal and five bacterial strains. Essential oil showed maximum resistance against Fusarium miniformes MAY 3629 followed by Bacillus subtilis ATCC 6633 whereas; it exhibited least resistance against Fusarium oxysporium ATCC 48122. The results of the antimicrobial assay revealed that essential oil showed significant inhibitory activity against the tested organisms.

Azacitidine fails to eradicate leukemic stem/progenitor cell populations in patients with acute myeloid leukemia and myelodysplasia

Epigenetic therapies demonstrate significant clinical activity in acute myeloid leukemia (AML) and myelodysplasia (MDS) and constitute an important new class of therapeutic agents. However hematological responses are not durable and disease relapse appears inevitable. Experimentally, leukemic stem/progenitor cells (LSC) propagate disease in animal models of AML and it has been postulated that their relative chemo-resistance contributes to disease relapse. We serially measured LSC numbers in patients with high-risk AML and MDS treated with 5'-azacitidine and sodium valproate (VAL-AZA). Fifteen out of seventy-nine patients achieved a complete remission (CR) or complete remission with incomplete blood count recovery (CRi) with VAL-AZA therapy. There was no significant reduction in the size of the LSC-containing population in non-responders. While the LSC-containing population was substantially reduced in all patients achieving a CR/CRi it was never eradicated and expansion of this population antedated morphological relapse. Similar studies were performed in seven patients with newly diagnosed AML treated with induction chemotherapy. Eradication of the LSC-containing population was observed in three patients all of whom achieved a durable CR in contrast to patients with resistant disease where LSC persistence was observed. LSC quantitation provides a novel biomarker of disease response and relapse in patients with AML treated with epigenetic therapies. New drugs that target this cellular population in vivo are required.

Minimizing dose during fluoroscopic tracking through geometric performance feedback

PURPOSE

There is a growing concern regarding the dose delivered during x-ray fluoroscopy guided procedures, particularly in interventional cardiology and neuroradiology, and in real-time tumor tracking radiotherapy and radiosurgery. Many of these procedures involve long treatment times, and as such, there is cause for concern regarding the dose delivered and the associated radiation related risks. An insufficient dose, however, may convey less geometric information, which may lead to inaccuracy and imprecision in intervention placement. The purpose of this study is to investigate a method for achieving the required tracking uncertainty for a given interventional procedure using minimal dose.

METHODS

A simple model is used to demonstrate that a relationship exists between imaging dose and tracking uncertainty. A feedback framework is introduced that exploits this relationship to modulate the tube current (and hence the dose) in order to maintain the required uncertainty for a given interventional procedure. This framework is evaluated in the context of a fiducial tracking problem associated with image-guided radiotherapy in the lung. A particle filter algorithm is used to robustly track the fiducial as it traverses through regions of high and low quantum noise. Published motion models are incorporated in a tracking test suite to evaluate the dose-localization performance trade-offs.

RESULTS

It is shown that using this framework, the entrance surface exposure can be reduced by up to 28.6% when feedback is employed to operate at a geometric tracking uncertainty of 0.3 mm.

CONCLUSIONS

The analysis reveals a potentially powerful technique for dynamic optimization of fluoroscopic imaging parameters to control the applied dose by exploiting the trade-off between tracking uncertainty and x-ray exposure per frame.

Children with significant cervical lymphadenopathy: clinicopathological analysis and role of fine-needle aspiration in Indian setup

OBJECTIVE

To study the clinicopathological profile of children from India with cervical lymphadenopathy and the role of fine-needle aspiration cytology with special emphasis on tuberculosis as a cause.

METHODS

A total of 89 children in the age group of 10 months to 12 years, presenting to our hospital from April 2004 to March 2005, were included. All the patients underwent thorough clinical and investigational assessment vis-à-vis cervical lymphadenopathy. Outcome measurements included clinical status and ability of conventional tests to categorize different types of lymphadenopathy and their utility in diagnosing tubercular lymphadenitis. Interobserver variability was analyzed measuring kappa test and was found to be in agreement.

RESULTS

Reactive hyperplasia was the most common type of lymphadenitis, followed by granulomatous involvement. Unilateral posterior triangle lymph nodes were the most commonly affected in the tubercular cervical lymphadenopathy group. Fine-needle aspiration followed by Ziehl-Neelsen staining, histopathology and culture in combination were able to perform the diagnosis in 85.7% of cases affected with tubercular etiology.

CONCLUSIONS

Fine-needle aspiration is a valuable diagnostic tool in the management of children with the clinical presentation of enlarged cervical lymph nodes. The technique reduces the need for more invasive and costly procedures, especially in a Third World country. Culture and histopathology, however, should be considered in cases where repeated fine-needle aspiration cytology is non-diagnostic.

Platelet activation, upregulation of CD11b/ CD18 expression on leukocytes and increase in circulating leukocyte-platelet aggregates in Indian women chronically exposed to biomass smoke

The majority of households in rural India still rely on unprocessed solid biomass for domestic energy. The aim of this study was to investigate whether chronic exposure to biomass smoke causes activation of leukocytes and the formation of leukocyte-platelet aggregates. We conducted flow cytometric analysis of beta2 Mac-1 integrin (CD11b/CD18) expression on polymorphonuclear leukocytes (PMN) and monocytes, and P-selectin (CD62P) expression on the platelets of 165 women from eastern India, who cook solely with wood, dung and agricultural wastes, and 155 age- and socio-economic condition-matched control subjects, who used relatively cleaner fuel, liquefied petroleum gas (LPG). Leukocyte-platelet aggregates were defined as CD11b-positive PMN and monocytes co-expressing platelet-specific markers CD41 or CD62P. A significant increase in leukocyte-platelet aggregates was found in women who used biomass as cooking fuel. In addition, they showed increased surface expression of CD11b/CD18 in circulating PMN and monocytes and CD62P expression on platelets. The mean fluorescence intensity (MFI) of CD11b on the surface of circulating monocytes and PMN of biomass users increased by 50 and 68%, respectively. Similarly, a 62 and 48% increase in MFI was observed in CD18 expression on the surface of these cells in biomass users. The results show that chronic biomass smoke exposure activates circulating platelets, PMN and monocytes, and increases the number of leukocyte-platelet aggregates, which are considered a risk factor for thrombosis.

Tuberculosis among healthcare workers in a tertiary-care hospital in South India

It is possible that tuberculosis is transmitted from patients to healthcare workers (HCWs). However, there are few data on this from developing countries. The object of this study was to document the incidence of tuberculosis among HCWs in the Christian Medical College (CMC), Vellore, India during a 10-year period (January 1992-December 2001). Data were collected from records maintained in the staff and students health services of CMC. A total of 125 cases were diagnosed during the period of study. The overall incidence of sputum positive cases was similar to that observed in the general population, during most years. However, it appears that focal outbreaks occur with transmission between HCWs. The chance of developing extra-pulmonary tuberculosis was higher in HCWs compared with the general population.

Comparison of protein carbonyl and antioxidant levels in brain tissue from intracerebral haemorrhage and control cases

BACKGROUND

In an attempt to develop a clearer understanding of the pathological mechanisms underlying intracerebral haemorrhage (ICH), the objective of this investigation was to obtain evidence for free radical-induced oxidative damage in brain tissue following intracerebral haemorrhage.

METHODS

Brain cortex samples were obtained from the ischaemic penumbra (overlying the haematoma) from 10 patients with spontaneous ICH and from six control cases (normal tissue obtained during tumour removal or aneurysm repair). Following extraction via homogenization and subsequent derivatization with dinitrophenylhydrazine (DNPH), tissue samples were analysed for the presence of protein carbonyl moieties (a hallmark of tissue protein oxidation). This procedure involved SDS-polyacrylamide gel electrophoresis and Western immunoblotting using a commercially available primary monoclonal antibody to DNPH, with final visualization of oxidized protein bands via enhanced chemiluminescence.

RESULTS

Samples from ICH cases showed a number (10-15) of well-defined bands of medium to strong staining intensity (not present in nonderivatized samples), corresponding to proteins of molecular mass 25-200 kDa, indicating the presence of oxidatively damaged proteins in these samples. However, tissue samples from control cases also showed the presence of oxidized protein bands, with fractionation patterns for individual ICH or control samples being qualitatively and quantitatively similar. In addition, there was no significant difference in the levels of the following antioxidants (as additional indirect markers of free radical activity) in ICH or control brain tissue: glutathione, glutathione peroxidase, glutathione reductase, catalase, superoxide dismutase, and total antioxidant status.

CONCLUSIONS

It is concluded from the above data that (i) evidence for free radical involvement in ICH based on protein carbonyl analysis should be interpreted with caution, since normal brain tissue contains a surprisingly high proportion of oxidized proteins; (ii) since there is no evidence for increased protein oxidative damage or decreased tissue antioxidant levels in ICH, therapeutic strategies aimed at salvage of potentially viable tissue would not benefit from inclusion of protein protecting antioxidants.

Continuous monitoring of ICP and CPP following ICH and its relationship to clinical, radiological and surgical parameters

Sixty-two patients with a spontaneous supratentorial haemorrhage had continuous Intracranial Pressure (ICP) and Cerebral Perfusion Pressure (CPP) monitoring. In addition to the recordings of physiological data their past medical history, presenting neurological state, Computed Tomograph (CT) findings, daily Glasgow Coma Score (GCS) and outcome were noted. The mean age was 57.6 years (sd 13.3). Onset of recording, after ictus was at a mean of 32.6 hours (sd 26.0). Average length of recording was 62.0 hours (sd 39.8). Thirty-one patients had evacuation of haematoma, 6 insertion of External Ventricular Drain (EVD). Preoperative measures of ICP were significantly related to delayed neurological deterioration, death within three days and Glasgow Outcome Scale (GOS) at neurosurgical discharge. No such relationships existed with preoperative measures of CPP and neither ICP nor CPP was related to outcome at 6 months. Post-operative measures of both ICP and CPP demonstrated a significant relationship with death within three days of ictus and GOS at neurosurgical discharge. Again no relationship existed with these parameters and outcome at six months. Surgical evacuation of haematoma acted to significantly reduce ICP and improve CPP. Given that these factors seem to be related to deterioration, death and early outcome, it would seem that surgery could play a role in reducing mortality and improving outcome following Intra cerebral Haemorrhage (ICH).