Inter- and intra-measurer error in the measurement of Reimers' hip migration percentage

Reimers' hip migration percentage is commonly used to document the extent of subluxation of the hip in children with spasticity. In this study, two measurers, with six months paediatric orthopaedic experience, measured the migration percentage on 44 pelvic radiographs of children with cerebral palsy, aged between two and eight years. Unknown to the measurers, each radiograph was duplicated, giving 22 non-identical radiographs (44 hips) which were measured twice at time 0 and twice six weeks later. The intra-measurer, intra-sessional absolute differences between the first and second measurements ranged from 0% to 23%, with median values of 2.5% to 3.6%. The intra-sessional median absolute differences were not statistically different between the two measurers and measuring sessions (p = 0.42, Kruskal-Wallis test). The inter-sessional absolute differences for measurements made by the same measurers ranged from 0% to 18% with a median absolute difference of 1.7% to 3.2%. Overall, only 5% of the intra-measurer measurement differences, within and between sessions, were above 13%. Repeated measurements by one measurer over time must, therefore, vary by more than 13% in order to be 95% confident of a true change. The inter-measurer error was higher with median absolute differences between the two measurers' measurements of the same hip of 3.25% to 5% (0% to 26%) and a 95th upper confidence interval of 21% to 23%. Averaging the four separate measurements over the two sessions reduced the inter-measurer error to a median absolute difference of 2.8%, but did not improve the 95th upper confidence interval, which measured 22.4%. Such inter-measurer errors may be clinically unacceptable.

Neuroblastoma chemotherapy can be augmented by immunotargeting O-acetyl-GD2 tumor-associated ganglioside

Despite recent advances in high-risk neuroblastoma therapy, the prognosis for patients remains poor. In addition, many patients suffer from complications related to available therapies that are highly detrimental to their quality of life. New treatment modalities are, thus, urgently needed to further improve the efficacy and reduce the toxicity of existing therapies. Since antibodies specific for O-acetyl GD2 ganglioside display pro-apoptotic activity against neuroblastoma cells, we hypothesized that combination of immunotherapy could enhance tumor efficacy of neuroblastoma chemotherapy. We demonstrate here that combination of anti-O-acetyl GD2 monoclonal antibody 8B6 with topotecan synergistically inhibited neuroblastoma cell proliferation, as shown by the combination index values. Mechanistically, we evidence that mAb 8B6 induced plasma cell membrane lesions, consistent with oncosis. Neuroblastoma tumour cells treated with mAb 8B6 indeed showed an increased uptake of topotecan by the tumor cells and a more profound tumor cell death evidenced by increased caspase-3 activation. We also found that the combination with topotecan plus monoclonal antibody 8B6 showed a more potent anti-tumor efficacy in vivo than either agent alone. Importantly, we used low-doses of topotecan with no noticeable side effect. Our data suggest that chemo-immunotherapy combinations may improve the clinical efficacy and safety profile of current chemotherapeutic modalities of neuroblastoma.

The radical soft-tissue mobilization (Kelly repair) for bladder exstrophy

The radical soft-tissue mobilization (RSTM) technique has been proposed as an alternative for staged reconstruction of bladder exstrophy. In this video, we demonstrate the successive steps of this technique.

METHODS

A newborn male with classic bladder exstrophy underwent bladder closure without pelvic osteotomies at birth; he then underwent RSTM at 1 year of age.

TECHNIQUE

Mobilization: The RSTM involved simultaneous intra-pelvic and perineal dissection, aiming at full mobilization of potential urethral sphincter striated structures, levatores ani muscles, pudendal pedicles and corpora cavernosa from their attachment on the pubic bones. From the perineal approach, a periosteum incision was performed on the antero-medial aspect of the pubic bones, and the periosteum was peeled from the ischio-pubic ramus, lifting the corpora from the bone and providing control on the pudendal pedicles. The attachments of all striated muscular structures on the lower aspects of the posterior corpora (transverse perinei, bulbo-spongiosus, ischio-cavernosus muscles) were released to allow adequate re-approximation around the reconstructed urethra. Reconstruction: After ureteric reimplantation, a funnel-shaped cervicoplasty was performed and continued by urethroplasty over an 8-Fr catheter. The muscular structures mobilized from the corpora and the bones were wrapped around the neo-urethra, which was transposed ventrally in the scrotal position, creating a temporary hypospadiac urethrostomy. After abdominal wall closure, the corpora were then de-rotated, and secured to the neo-symphisis with non-absorbable sutures, and the penile skin shaft was reconstructed.

RESULTS

At the 12-month follow-up, the boy was asymptomatic, still in nappies, with non-dilated upper-tracts on renal ultrasound, and dryness intervals of 90 min.

CONCLUSION

Radical soft-tissue mobilization allows a tension-free bladder-neck reconstruction, and may favour development of physiological continence mechanisms independent of the inevitable pubic symphisis re-enlargement. Creation of temporary hypospadias is most often needed to maximize penile length. This technically demanding procedure requires thorough knowledge of detailed anatomy of the bladder exstrophy pelvis, as demonstrated in this video.

[Appendicovesicostomy (Mitrofanoff procedure) in children: Long-term follow-up and specific complications]

OBJECTIVE

In children, intermittent catheterization by appendicovesicostomy according to Mitrofanoff is an interesting alternative to the urethral approach. Objective of the study was to evaluate the rate of appendicovesicostomy's specific complications.

METHOD

From 1997 to 2017, data on children treated and followed for an appendicovesicostomy in an academic institution were collected retrospectively. Rates of surgical complications specifically encountered on appendicovesicostomy, time of onset, frequency, and necessity of surgical reinterventions have been reported.

RESULTS

Thirty-four patients were operated on and followed for a median of 6.2 years [0.3-24]. Fifty percent had a complication, occurring after a median of 8 months [2-90], and 38% required at least one surgical revision. If complication occurred, adjustment of medical treatment and intermittent catheterization was effective in 12% of patients, endoscopic or over-fascial surgery was necessary in 17% of cases, and under-fascial revision in 21% of cases. Median time to complication was 4 months [1-90] after creation or revision of appendicovesicostomy. Thirty-height percent of difficult channel catheterization were reported, of which 46% were over or under-fascial stenosis. Inaugural urinary incontinence was 18%, and only 9% if using the appendix. At the end, 97% of appendicovesicostomy were continent.

CONCLUSIONS

Appendicovesicostomy is a high risk of complications and postoperative revisions surgery, in order to have a functional continent channel.

LEVEL OF EVIDENCE

4.

[Incidence and evolution of thrombotic images within the internal jugular vein following Swan-Ganz catheter insertion in cardiac surgery]

OBJECTIVES

Insertion of Swan-Ganz catheter for a few days may be necessary in cardiac surgery. This study was aimed at determining the incidence and the evolution of thrombotic images within the internal jugular vein as well as assessing their association with the presence of a prolonged fever at postoperative day 7 in the lack of any documented infection.

MATERIAL AND METHODS

All the patients undergoing cardiac surgery had a two-dimensional ultrasonography of internal jugular veins preoperatively, at discharge (day 7) and at postoperative day 90 if thrombotic images were seen at day 7.

RESULTS

Sleeve-like and compact thrombotic images have been observed in site of venipuncture in 52 patients (70.3%). None had any residual thrombotic image 90 days after the operation. No clinical thromboembolic migration has been observed. There was no statistical association between the presence of a thrombotic image at the ultrasonography and the duration of catheterization. Moreover, there was no association between the anticoagulation before, during and after the surgery and the presence of a thrombotic image. We found a non-significant association between fever at day 7 and the presence of a thrombotic image within the internal jugular vein.

CONCLUSION

Thrombotic images in the internal jugular vein after catheterization are frequent and disappear at day 90. The limited sample size of this study does not provide strong evidence of the role of jugular thrombi in the prolongation of fever after cardiac surgery.

MPharm students’ response to pharmacy staff shortages during lockdown

Introduction

During the first lockdown period of the COVID-19 pandemic, pharmacy students, particularly those with previous experience, were encouraged to help address staff shortages in pharmacy practice (1).

Aim

This study investigated the response of pharmacy students at Keele University to the request for help to address staff shortages in practice during lockdown.

Methods

An online survey using Google Forms was developed based on addressing the aim of the study and a working knowledge of pharmacy practice. The survey was piloted on academic pharmacists, and after minor amendments, was disseminated to all students in years 2, 3 and 4 of the MPharm course, along with a participant information sheet. Questions regarding consent were incorporated into the Google Form. The survey consisted of a range of question types: tick-box, Likert scale, multiple-choice and free text. A reminder email was sent out to increase response rate. The data were analysed using descriptive and inferential statistics, using Microsoft Excel and SPSS version 24.0.

Results

The online survey was distributed to 352 students. A total of 106 responses were collected; providing a response rate of 30.1%. Fifty-nine (55.7%) of these students did not undertake paid employment in a pharmacy during lockdown, compared to 47 (44.3%) who did. Of the 47 who did, most obtained paid employment in a community pharmacy (n=42; 89%), the rest in hospital. Seventy percent of respondents (n = 74) had undertaken work experience in a community pharmacy prior to lockdown. A number of reasons were given for choosing not to work in a pharmacy, including needing time to study for exams or living with a vulnerable family member, but the most frequent reason reported (40.7%) was that students found it difficult to find work. For those students who did work in a pharmacy during lockdown, the reported reasons varied, with the most frequent being to gain experience (n = 35; 74.5%), followed by a sense of duty to help the community (n=31; 66.0%). The time spent working ranged from 8 to 40 hours per week. The majority of students reported working in the dispensary and on the medicines counter, undertaking a wide range of activities. Final year students and those who had previously undertaken work experience in a pharmacy were statistically more likely to obtain paid employment during lockdown. Perceived advantages to working during lockdown included the opportunity to improve communication and clinical skills and apply theory to practice, as well as being able to ‘give back’ to the community. 97.9% (n= 46) reported feeling under pressure whilst working, although 72.3% (n=34) reported that they enjoyed working despite this.

Conclusion

Pharmacy students had various reasons for choosing to work in practice or not during lockdown. Those who did work reported benefiting from the experience in a number of ways. This suggests that pharmacy students with prior experience of pharmacy working, should be encouraged to offer their support in times of staff shortages if future lockdowns occur.

Reference

(1) Supporting the COVID-19 response: Joint Guidance: Facilitating deployment of pharmacy undergraduate students to support the pharmacy workforce. Health Education England, NHS Education for Scotland, Health Education and Improvement Wales, Pharmacy Schools Council, Royal Pharmaceutical Society and the British Pharmaceutical Students’ Association. 09 April 2020, pp.1–9. Available at: https://www.hee.nhs.uk/sites/default/files/documents/MPharm%20student%20deployment%20joint%20guidance%20FINAL.pdf [Accessed 14 October 2021].

The Transcript Levels and the Serum Profile of Biomarkers Associated with Clinical Endometritis Susceptibility in Buffalo Cows

Determining the gene expression and serum profile of the indicators linked to clinical endometritis susceptibility in Egyptian buffalo cows was the aim of this investigation. The buffalo cows that were enrolled were divided into two groups: forty infected buffalo cows with clinical endometritis and forty seemingly healthy buffalo cows that served as the control group. For the purposes of gene expression and biochemical analysis, ten milliliters of blood was obtained via jugular venipuncture from each buffalo cow. TLR4, IL-8, IL-17, NFKB, SLCA11A1, NCF4, Keap1, HMOX1, OXSR1, ST1P1, and SERP1 were manifestly expressed at much higher levels in the buffaloes with endometritis. On the other hand, the genes that encode SOD, CAT, NDUFS6, Nrf2, and PRDX2 were down-regulated. There was a significant (p < 0.05) elevation of the serum levels of non-esterified fatty acids (NEFAs), beta hydroxy butyric acid (BHBA), triglycerides (TGs), globulin, creatinine, and cortisol, along with a reduction in the serum levels of glucose, cholesterol, total protein albumin, urea, estrogen (E2), progesterone (P4), follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroxine (T4), prostaglandin F2 α (PGF2α), calcium, iron, and selenium, in the endometritis group in comparison with the control. However, no significant change was observed in the values of phosphorus, magnesium, copper, or zinc in either group. Within the selective breeding of naturally resistant animals, the variation in the genes under study and the changes in the serum profiles of the indicators under investigation may serve as a reference guide for reducing endometritis in Egyptian buffalo cows.

Analysis of Potential Genes, Oxidative, Metabolic, and Hormonal Markers Associated with Postpartum Disorder Susceptibility in Barki Sheep (Ovis aries)

This study purpose was to determine the gene expression as well as serum profile of acute phase proteins (APPs) and hormonal indicators linked to Barki sheep's susceptibility to postpartum issues. Three equal-sized groups (each with fifty ewes) were created from the blood of 150 adult Barki ewes: the control group (CG), the inflammatory postpartum disorders group (IPG), and the non-inflammatory postpartum disorders group (NIPG). The expression levels of the oxidative stress (PGC-1α, SIRT1, GCLC, GCLM, and EPAS1) and metabolic (FBXL12, KPNA7, and LRRK1) genes were significantly higher in postpartum disorders sheep than in resistant ones. Ewes with inflammatory postpartum illnesses showed significantly higher levels of the examined markers than did the non-inflammatory and control groups. The serum profile analysis also revealed that the levels of Fb, Cp, Hp, SAA, cortisol, TIBC, UIBC, and ferritin were significantly higher in the IPG than in the NIPG and CG. Serum insulin, iron, transferrin, and Tf Sat.% levels, however, were all markedly lower. On the basis of the variance in the genes being studied and the modulation in the serum indicators being studied, it should be possible to monitor the health status in postpartum problems of sheep.

Technical aspects of the Koff procedure (urethral mobilization) in anterior hypospadias

INTRODUCTION

In our center the level of division of the corpus spongiosum as the determinant to classifying hypospadias. The hypospadias with a distal division is less severe and they present a little curvature.

MATERIAL AND METHODS

We present a case of distal hypospadias corrected by Koff technique and we showed our tricks for avoiding curvature.

RESULTS

In this selected case a Koff procedure are preferred because it has the main advantage of exicing the dysplastic tissues and avoiding a urethroplasty using nonurethral tissues. Late penile curvature is a source of concerns for some, but in our experience no significant curvature was found at follow up.

DISCUSSION

We believe that some tricks, showed in our video, are necessary to avoid iatrogenic curvature and to obtain a good cosmetic result.

CONCLUSIONS

Koff technique is a good technique for hypospadias with distal division of corpus spongiosum, without significant curvature at follow up.