Control Group Mean Research Articles

Clarifying the effect of refractive errors and stereopsis on traumatic dental injuries in childhood.

Visual acuity and stereopsis both play an important role in developing posture and balance in children. The aim of this study was to investigate whether children with traumatic dental injuries (TDI) have abnormal stereopsis, due to a reduction in visual acuity, compared to children with good dental health. A total of 140 participants (75 with traumatic dental injuries resulting from falls and crashes, and 65 age-matched controls without dental trauma) were enrolled in this prospective, cross-sectional study. The participants underwent complete dental and ophthalmologic examinations. After the ophthalmologic examination, the stereo acuities were assessed by a Titmus stereo test at 40cm. Titmus test scores were significantly worse in the TDI group (mean score 252.46±629.12seconds of arc) compared to the control group (mean score 56±27.39seconds of arc) (P<.05). The percentage of subjects with abnormal Titmus test scores was higher in the TDI group (28%) than in the control group (3.1%). The mean anisometropia value was 3.03±2.37 D and 0.55±0.41 D in the TDI group and the control group, respectively (P<.001). The severity of anisometropia correlated with the degree of stereopsis (r=.83, P<.01). The presence of abnormal stereopsis may lead to postural instability which can lead to traumatic dental injuries. The prevalence of abnormal stereopsis in children with TDI was higher than in children with good binocular vision and stereopsis.

Effectiveness of Chemoradiotherapy for Metachronous Esophageal Squamous Cell Carcinoma

Introduction: Multiple Lugol-voiding lesions (LVLs) in the esophagus increase the risk of synchronous and metachronous development of esophageal squamous cell carcinoma (ESCC). Chemoradiotherapy (CRT) following endoscopic submucosal dissection (ESD) may reduce the incidence of metachronous ESCC, but few studies have investigated this. Therefore, we retrospectively examined the effect of CRT on metachronous ESCC and multiple esophageal dysplasias visible as multiple LVLs. Methods: This study reviewed 146 patients who underwent esophageal ESD and were determined pathologically to have noncurative resection. They were divided into 2 groups: those who received additional CRT (CRT group; n = 64) and those without additional treatment (control group; n = 82). Incidence of metachronous ESCC was analyzed using propensity scores to adjust for patient characteristics. The number of multiple LVLs was also examined. Results: The CRT group was significantly younger than the control group (mean 66.6 vs. 70.6 years, p = 0.011), had significantly deeper tumor invasion (p = 0.013), and had a significantly higher rate of lymphovascular invasion (47.8 vs. 12.2%, p < 0.001). The CRT group also had a significantly higher improvement rate of multiple LVLs (58.1 vs. 2.0%, p < 0.001). The LVLs after CRT had a distinctive irregular crack-shaped appearance. Metachronous ESCC was found in 7 patients (10.9%) in the CRT group and in 17 patients (20.7%) in the control group (p = 0.113). In propensity score-adjusted logistic regression analysis, the odds ratio for metachronous ESCC in the CRT group was 0.316 (p = 0.023). The occurrence rate was significantly lower in the CRT group than in the control group. Discussion/Conclusion: CRT may be effective in preventing metachronous ESCC.

Changes in Tendon Elongation and Muscle Atrophy Over Time After Achilles Tendon Rupture Repair: A Prospective Cohort Study on the Effects of Early Functional Mobilization

Background: Early functional mobilization (EFM) may improve patient outcome after Achilles tendon rupture (ATR). However, whether EFM affects patient outcome via changes in tendon elongation, thickening, or calf muscle atrophy is unknown. Purpose: To analyze differences in tendon and muscle morphology recovery over time between groups treated with EFM or standard treatment after ATR repair. Study Design: Cohort study; Level of evidence, 2. Methods: This prospective cohort study included 86 patients (20 women) with ATR repair who had a mean (SD) age of 39.3 (8.2) years and were part of a larger prospective randomized controlled trial. Patients were postoperatively randomized to immediate postoperative weightbearing and ankle motion (EFM group) or to immobilization in a below-knee plaster cast for 2 weeks (control group). Patient-reported and functional outcomes were assessed at 6 and 12 months with the Achilles Tendon Total Rupture Score and the heel-rise test for endurance. At 2 and 6 weeks and 6 and 12 months postoperatively, B-mode ultrasound imaging was performed to assess the length and cross-sectional area (CSA) of the Achilles tendon, the gastrocnemius CSA, as well as the thickness of soleus. Results: The Achilles Tendon Total Rupture Score for the EFM and control groups were 65.8 (18.7) and 56.8 (20.1; P = .045), respectively, at 6 months and 79.6 (15.8) and 78.9 (17.2; P = .87), respectively, at 12 months. At 2 weeks, tendon elongation was significantly more pronounced in the EFM group as compared with the control group (mean side-to-side difference, 1.88 cm vs 0.71 cm; P = .005). Subsequently, tendon elongation increased in the control group while it decreased in the EFM group so that at 6 and 12 months no significant differences between groups were found. Mean Achilles tendon elongation at 1 year was 1.73 (1.07) cm for the EFM group (n = 55) and 1.67 (0.92) cm for the control group (n = 27), with a mean difference of 0.06 cm (95% CI, 0.54 to –0.42; P = .80). Achilles tendon CSA and calf muscle atrophy displayed no significant differences between the groups; however, significant changes were demonstrated over time (P ≤ .001) in both groups. Conclusion: EFM results in more Achilles tendon elongation at early healing, but this difference subsides over time. EFM does not seem to affect patient outcome via changes in tendon elongation, thickening, or calf muscle atrophy. Registration: NCT02318472 (ClinicalTrials.gov identifier).

Association of plasma chromium with metabolic syndrome among Chinese adults: a case-control study

BackgroudChromium has been suggested playing a role in alleviating diabetes, insulin resistance and lipid anomalies, but the effect on metabolic syndrome (MetS) in humans remains controversial.MethodsWe conducted a matched case-control study in a Chinese population, involving 2141 MetS cases and 2141 healthy controls, which were 1:1 matched by age (±2 years) and sex. Plasma chromium was measured by inductively coupled plasma mass spectrometry.ResultsPlasma chromium levels were lower in MetS group than in control group (mean: 4.36 μg/L and 4.66 μg/L, respectively, P < 0.001), and progressively decreased with the number of MetS components (P for trend < 0.001). After adjustment for potential confounding factors, the odds ratios (95% confidence intervals) for MetS across increasing quartiles of plasma chromium levels were 1 (reference), 0.84 (0.67–1.05), 0.76 (0.61–0.95), and 0.62 (0.49–0.78), respectively (P for trend < 0.001). For the components of MetS (high waist circumference, high triglycerides and high blood glucose), the odds ratios (95% confidence intervals) of the highest quartiles were 0.77 (0.61–0.95), 0.67 (0.55–0.80), and 0.53 (0.44–0.64), respectively (P for trend < 0.05).ConclusionsOur results indicated that plasma chromium levels were inversely associated with MetS in Chinese adults. The association may be explained by the relations between plasma chromium levels and high waist circumference, and the triglycerides and blood glucose levels.

Loss of Mechanical Ankle Function Is Not Compensated by the Distal Foot Joints in Patients with Ankle Osteoarthritis.

Patients with isolated ankle osteoarthritis (OA) often demonstrate disturbed ankle biomechanics during walking. Clinicians often believe that this triggers the distal foot joints to compensate these altered ankle biomechanics and that these foot joints are consequently subjected to degenerative joint diseases due to overuse. Do patients with isolated ankle OA differ from those without ankle OA in terms of (1) ankle and foot joint kinematics and (2) ankle and foot joint kinetics as measured using three-dimensional (3-D) gait analysis? (3) Do these patients demonstrate compensatory strategies in their Chopart, Lisfranc, or first metatarsophalangeal joints in terms of increased joint kinematic and kinetic outputs? Between 2015 and 2018, we treated 110 patients with unilateral ankle OA, and invited all of them to participate in the gait analysis laboratory. Of those, 47% (52) of patients did so, and of these, 16 patients met the inclusion criteria for this study, which were (1) diagnosis of unilateral ankle OA; (2) absence of radiographical signs of OA in the contralateral foot or lower limbs; (3) ability to walk at least 100 m without rest; and (4) being older than 18 years of age. A control group (n = 25) was recruited through intranet advertisements at the University Hospitals of Leuven. Participants were included if their age matched the age-range of the patient group and if they had no history of OA in any of the lower limb joints. Patients were slightly older (55.9 ± 11.2 years), with a slightly higher BMI (28 ± 6 kg/m2) than the control group participants (47.2 ± 4.4 years; p = 0.01 and 25 ± 3 kg/m2; p = 0.05). All participants underwent a 3-D gait analysis, during which a multisegment foot model was used to quantify the kinematic parameters (joint angles and ROM) and the kinetic parameters (rotational forces or moments), as well as power generation and absorption in the ankle, Chopart, Lisfranc, and first metatarsophalangeal joints during the stance phase of walking. Peak values were the maximum and minimum values of waveforms and the latter were time-normalized to 100% of the stance phase. Regarding joint kinematics, patients demonstrated a sagittal plane ankle, Chopart, Lisfranc, and first metatarsophalangeal joint ROM of 11.4 ± 3.1°, 9.7 ± 2.7°, 8.6 ± 2.3° and 34.6 ± 8.1°, respectively, compared with 18.0 ± 2.7° (p < 0.001), 13.9 ± 3.2° (p < 0.001), 7.1 ± 2.0° (p = 0.046) and 38.1 ± 6.5° (p = 0.15), respectively, in the control group during the stance phase of walking. With regard to joint kinetics in the patient group, we found a mean decrease of 1.3 W/kg (95% CI confidence interval 1.0 to 1.6) (control group mean: 2.4 ± 0.4 W/kg, patient group mean: 1.1 ± 0.5 W/kg) and 0.8 W/kg (95% CI 0.4 to 1.0) (control group mean: 1.5 ± 0.3 W/kg, patient group mean: 0.7 ± 0.5 W/kg) of ankle (p < 0.001) and Chopart (p < 0.001) joint peak power generation. No changes in kinetic parameters (joint moment or power) were observed in any of the distal foot joints. The findings of this study showed a decrease in ankle kinematics and kinetics of patients with isolated ankle OA during walking, whereas no change in kinematic or kinetic functions were observed in the distal foot joints, demonstrating that these do not compensate for the mechanical dysfunction of the ankle. The current findings suggest that future experimental laboratory studies should look at whether tibiotalar joint fusion or total ankle replacement influence the biomechanical functioning of these distal joints.

The impact of communicating personal mental ill-health risk: Arandomized controlled non-inferiority trial.

Risk algorithms predicting personal mental ill-health will form an important component of digital and personalized preventive interventions, yet it is unknown whether informing people of personal risk may cause unintended harm. This trial evaluated the comparative effect of communicating personal mental ill-health risk profiles on psychological distress. Australian participants using a mood-monitoring app were randomly allocated to receiving their current personal mental ill-health risk profile (n=119), their achievable personal risk profile (n=118) or to a control group (n=118) in which no risk information was communicated, in a non-inferiority trial design. The primary outcome was psychological distress at four-weeks as assessed on the Kessler Psychological Distress Scale. There was high attrition in the trial with 64% of data missing at follow up. Per-protocol (completer) analysis found that the lower bounds of the confidence intervals of the estimated mean change of the current risk (m=0.19, 95% CI: -2.59- 2.98) and achievable risk (m=-0.09, 95% CI: -2.84 to 2.66) groups were within the non-inferiority margin of the control group's mean at follow up. Supplementary intention-to-treat analysis using Multivariate Imputation by Chained Equations (MICE) found that 98/100 imputed datasets of the current risk profile group, and all imputed datasets of the achievable risk profile group showed non-inferiority to the control group. This study provides preliminary support that providing personal mental health risk profiles does not lead to unacceptable worsening of distress compared to no risk feedback, although this needs to be replicated in a fully powered RCT.

Fetal Exposure to MR Imaging: Long-Term Neurodevelopmental Outcome.

Very few studies have investigated long-term neurodevelopment of children exposed to MR imaging antenatally. Thus, the purpose of our study was to evaluate long-term neurodevelopmental outcomes of children exposed to MR imaging during pregnancy. We conducted a historical prospective cohort study in a single tertiary medical center. Women exposed to 1.5T noncontrast MR imaging for maternal or fetal indications were matched to unexposed controls. Long-term neurodevelopmental outcomes were evaluated of their children, 2.5 to 6 years of age, according to the Vineland-II Adaptive Behavior Scale. The Vineland-II Adaptive Behavior Scale assesses communication, daily living skills, socialization, and motor skills. A composite score summarizes these 4 domains. A total of 131 exposed women matched our inclusion criteria and were included in the study group, and 771 unexposed women, in the control group. No difference was identified in the Vineland-II Adaptive Behavior Scale composite score between the children of the study and control groups (mean, 110.79 versus 108.18; P = .098). Differences were also not observed between the children of the 2 groups in 3 of the 4 questionnaire domains: communication (108.84 versus 109.10; P = .888), daily living skills (109.51 versus 108.28; P = .437), and motor skills (105.09 versus 104.42; P = .642). However, the socialization score was favorable for the study group (112.98 versus 106.47; P < .001). Exposure to 1.5T noncontrast MR imaging during pregnancy had no harmful effects on long-term neurodevelopmental outcomes. This study contributes to understanding the safety of MR imaging during pregnancy.

SIGNIFICANCE OF SARCOPENIA IN INFANTS WITH PEDIATRIC LIVER TRANSPLANTATION FOR BILIARY ATRESIA

Background: While sarcopenia, the disproportionate loss of muscle mass, is a significant predictor of liver transplantation (LT) outcomes in adults, few studies have examined the association of sarcopenia in pediatric patients with LT for biliary atresia (BA). We hypothesized that the assessment of core muscle mass may serve as a new prognostic marker of LT outcomes and index of malnutrition in infants with BA. The present study aimed to investigate the clinical significance of sarcopenia for LT outcomes in infants with BA. Patients and Methods: To define sarcopenia in infants, the cross-sectional area of the total psoas muscle (PMA) in 93 healthy control infants was measured by computer tomography (Figure 1). Sarcopenia was defined as a total PMA lower than two standard deviations below the mean of the healthy control group. Eighty-nine infants with BA with the median age at LT of 7.6 months between 2005 and 2018 were enrolled. The patients were divided into the sarcopenia group (n=21) and non-sarcopenia group (n=68), and their preoperative characteristics, postoperative complications, incidence of infection, length of hospital stay, ICU stay, postoperative ventilator duration and the patient / graft survival rate were analyzed.Results: The patients’ weight and height and the proportion of z-scores < -1.5 for weight and height did not significantly differ between the two groups (Table 1).The rate of portal vein (PV) hypoplasia, retrograde PV flow, and preoperative ascites were significantly higher in the sarcopenia group (p=.005, 0.02 and .001 in each). The sarcopenia group had a significantly longer operation time and greater blood loss during LT (511.0 minutes vs. 476.0 minutes, p=0.03 and 108.8 g/kg vs. 76.4 g/kg, p=0.02) (Table 2).The incidence of PV stenosis and postoperative bacterial infection was also significantly higher in the sarcopenia group (23.8% vs. 4.4%, p=0.02 and 52.4% vs. 26.5%, p=0.03, respectively). The total length of hospital stay between the two groups did not differ significantly (p=0.87). The one-year patient and graft survival rates in the sarcopenia group tended to be lower (sarcopenia group: 90.5% vs. non-sarcopenia group: 98.5%, p=0.07 and 85.7% vs. 97.1%, p=0.05, respectively) (Figure 2).Conclusions: Sarcopenia in infants with BA before LT may be associated with patient survival and serve as a new and effective prognostic marker for growth retardation and postoperative outcomes of LT.

A Randomized Trial of Closed-Loop Control in Children with Type 1 Diabetes

BackgroundA closed-loop system of insulin delivery (also called an artificial pancreas) may improve glycemic outcomes in children with type 1 diabetes.MethodsIn a 16-week, multicenter, randomized, open-label, parallel-group trial, we assigned, in a 3:1 ratio, children 6 to 13 years of age who had type 1 diabetes to receive treatment with the use of either a closed-loop system of insulin delivery (closed-loop group) or a sensor-augmented insulin pump (control group). The primary outcome was the percentage of time that the glucose level was in the target range of 70 to 180 mg per deciliter, as measured by continuous glucose monitoring.ResultsA total of 101 children underwent randomization (78 to the closed-loop group and 23 to the control group); the glycated hemoglobin levels at baseline ranged from 5.7 to 10.1%. The mean (±SD) percentage of time that the glucose level was in the target range of 70 to 180 mg per deciliter increased from 53±17% at baseline to 67±10% (the mean over 16 weeks of treatment) in the closed-loop group and from 51±16% to 55±13% in the control group (mean adjusted difference, 11 percentage points [equivalent to 2.6 hours per day]; 95% confidence interval, 7 to 14; P<0.001). In both groups, the median percentage of time that the glucose level was below 70 mg per deciliter was low (1.6% in the closed-loop group and 1.8% in the control group). In the closed-loop group, the median percentage of time that the system was in the closed-loop mode was 93% (interquartile range, 91 to 95). No episodes of diabetic ketoacidosis or severe hypoglycemia occurred in either group.ConclusionsIn this 16-week trial involving children with type 1 diabetes, the glucose level was in the target range for a greater percentage of time with the use of a closed-loop system than with the use of a sensor-augmented insulin pump. (Funded by Tandem Diabetes Care and the National Institute of Diabetes and Digestive and Kidney Diseases; ClinicalTrials.gov number, NCT03844789.)

Do different sit–stand workstations influence lumbar kinematics, lumbar muscle activity and musculoskeletal pain in office workers? A secondary analysis of a randomized controlled trial

Purpose. This study investigated the effect of different sit–stand workstations on lumbar spine kinematics, lumbar muscle activity and musculoskeletal pain. Methods. Thirty-two office workers were randomized to one of three sit–stand workstations (Group 1, ratio of minutes spent sitting to standing each hour at work 40:20, n = 8; Group 2, 30:30, n = 6; Group 3, 20:40, n = 7) and a control group (usual sitting, n = 11). Intervention groups (Groups 1, 2 and 3) were collapsed into one group for analysis (n = 21). Data on lumbar kinematics and muscle activity were only collected for 25 participants due to equipment availability. Results. Participants in the intervention group had lower overall lumbar spine flexion angles during the workday compared to the control group (mean difference 10.6°; 95% confidence interval [−18.1, −3.2]; p = 0.008; Cohen’s d = 1.5). There were no between-group differences for the remaining kinematic measures (i.e., mean flexion angle in standing and sitting, mean side flexion angle in standing and sitting, and percentage of time in upright sitting), muscle activity or presence of musculoskeletal pain. Conclusions. Sit–stand workstations reduced overall lumbar spine flexion angles over the course of a workday but had no effect on other kinematic measures, lumbar spine muscle activity or musculoskeletal pain. Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12615001018505..

Association between shoulder coracoacromial arch morphology and anterior instability of the shoulder

BackgroundGlenohumeral instability is a common condition of the shoulder. Glenoid bone loss and humeral head bone loss are well recognized as risk factors for recurrent instability. There are few studies in the literature that examine the role of coracoacromial arch anatomy in the pathogenesis of glenohumeral instability. Previous reports found an association between posterior acromial coverage (PAC) and posterior instability. We hypothesize that coracoacromial arch anatomy is related to anterior shoulder instability.MethodsIn this retrospective cohort study, 50 patients with unidirectional anterior shoulder instability were matched to a control group of 50 glenohumeral arthritis patients without any history of shoulder instability. Radiographic measurements of the coracoacromial arch anatomy were made: shoulder arch angle, scapular Y angle, anterior coracoid tilt (ACT), posterior acromial tilt, anterior acromial coverage angle, PAC angle, coracoid height, posterior acromial height, and critical shoulder angle were determined using standard lateral scapular and anteroposterior radiographs.ResultsLogistic regression analyses found a significant association between the presence of anterior instability and flatter coracoacromial arch angles (mean, 124.1°) vs. the arthritis control group (mean, 120.6°) (odds ratios [OR] = 1.113; 95% confidence interval [CI] = 1.039-1.191; P = .002). There was a significant association between anterior instability and ACT (OR = 1.144; 95% CI = 1.053-1.243; P = .001), whereas a negative association was found between anterior instability and PAC (OR = 0.909; 95% CI = 0.853-0.969; P = .004) and posterior acromial tilt (OR = 0.878; 95% CI = 0.773-0.998; P = .046). Lower critical shoulder angle values were associated with the arthritis group (28.2° vs. 33.9°) (OR = 1.555; 95% CI = 1.202-2.012; P = .001).ConclusionsShoulder coracoacromial arch morphology may play a role in the stability of the shoulder joint and development of recurrent anterior instability. Shoulders with a decreased shoulder arch angle, a less contained and flatter coracoacromial arch and larger ACT, were associated with anterior instability. This study identifies the shoulder coracoacromial arch angle and anterior coracoid tile angles as risk factors for anterior shoulder instability. Our findings suggest that measuring these angles may help orthopedic surgeons understand the risk of anterior instability and analyze risk factors to improve clinical decision making.

Effectiveness of dry hydrogen peroxide on reducing environmental microbial bioburden risk in a pediatric oncology intensive care unit

Routine manual cleaning and disinfection of the health care environment is often suboptimal. Residual contamination poses an infection risk, particularly for immunocompromised patients. This study evaluates the efficacy of dry hydrogen peroxide (DHP) on microbial surface contamination in a pediatric oncology intensive care unit. Surface samples from 5 high-touch and 2 low-touch surfaces were obtained for culture and adenosine triphosphate readings after manual cleaning on multiple days in 4 intensive care unit rooms, before and after DHP was deployed. Air samples were collected as well at the study site. Data outcomes were measured in terms of total colony-forming units for the cultures and relative light units for adenosine triphosphate. The overall mean surface microbial burden was significantly reduced in the intervention group compared to the control group (mean 5.50 vs 11.77, P<.001). These reductions in colony-forming units were seen across all sampling sites in the intervention group. A reduction in the mean relative light units levels was also noted in the intervention group when compared to the control group (172.08 vs 225.83, P <.006). Reductions with the air samples were also noted (P = .139). Study demonstrates that DHP was effective in reducing microbial surface contamination and improves quality of environmental cleaning.

Abstract 1745: Application of BET/CBP/p300 multi-bromodomain inhibitors as a novel therapeutic strategy for MLL-rearranged acute lymphoblastic leukemia

Abstract Acute lymphoblastic leukemia (ALL) is the most common form of childhood leukemia. While the prognosis of patients with ALL has improved significantly, ALL with chromosomal rearrangements involving mixed-lineage leukemia (MLL) gene remains an incurable disease. Thus, development of a safe and efficacious therapeutic agent based on the biology of MLL rearrangement is of high importance to address this unmet medical need. Bromodomains are protein motifs that bind to acetylated histones and are recognized as new epigenetic drug targets in recent years. Bromodomain and extra-terminal motif proteins (“BET proteins”) are epigenetic ‘reader' proteins that are characterized by containing two of such bromodomains. BRD4, a member of BET protein family, is a key component of multi-protein complex that induce oncogene transcription at Super-Enhancers. Currently, small-molecule BET inhibitors are being investigated in the clinic as potential therapeutics for hematological cancers. CBP and p300, two paralogous histone acetyltransferases, also contain bromodomains and are considered as drug targets for cancer. Because BET and CBP/p300 proteins are key components of the etiology of MLL-rearranged (MLL-r) leukemia, an agent that simultaneously target both classes of proteins may have therapeutic advantages. We previously demonstrated that a novel BET inhibitor, CG13250, suppressed multiple myeloma cell proliferation in vitro and in vivo (Biochem Biophys Res Commun, 484:262-268, 2017) and subsequently synthesized additional BET inhibitors (Bioorg Med Chem Lett, 29:1220-1226, 2019). In the present study, we demonstrate that some of our BET inhibitors can also inhibit bromodomains of CBP/p300 proteins. One such compound, CN470, potently suppresses BRD4, CBP, and p300 with BROMOscan KD values of 33, 32, and 20 nM, respectively, and suppressed mRNA and protein expression of c-MYC as expected. CN470 potently inhibited the growth of MLL-r ALL cell lines in a dose-dependent manner and flow cytometric analyses showed that CN470 caused apoptosis in MLL-r ALL cells following a cell cycle arrest at the G1 phase. Moreover, co-immunoprecipitation assay demonstrated that CN470 reduced the binding of BRD4 to acetylated H3 (H3K27), an effect absent with a reference BET inhibitor, OTX-015. Taken together, CN470 may represent an effective strategy against MLL-r ALL cells. As a confirmatory study, we investigated the in vivo effects of CN470 by using SEMLuc/GFP cells in an orthotopic mouse model of MLL-AF4 leukemia. Mice were orally administered with CN470 (10 mg/kg) once daily resulting in a prolonged survival compared to vehicle control group (mean 37 days vs. 28 days; p=0.0246). In conclusion, simultaneous inhibition of BET/CBP/p300 with a multi-bromodomain inhibitor represents a promising novel therapeutic approach against MLL-r ALL. Citation Format: Natsuki Imayoshi, Makoto Yoshioka, Shyh-Ming Yang, Koshi Akahane, Yuki Toda, Shigekuni Hosogi, Takeshi Inukai, Seiji Okada, David J. Maloney, Jefferey W. Strovel, Eishi Ashihara. Application of BET/CBP/p300 multi-bromodomain inhibitors as a novel therapeutic strategy for MLL-rearranged acute lymphoblastic leukemia [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1745.

Increased serum BDNF and ProBDNF levels in children with irritable bowel syndrome

Objective: Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders among the pediatric population. Recently, neurotrophins have been suggested to be etiological factors or causes of symptoms of IBS. In the present study, the aim was to research the serum brain-derived neurotrophic factor (BDNF) and proBDNF levels in children with IBS.Methods: The study group was selected from pediatric gastroenterology outpatient clinic and control group was recruited from healthy children outpatient clinic. Based on the inclusion and exclusion criteria, 29 children with IBS and 55 healthy children were included in the study. The data were obtained from all participants, and if needed, from their parents. All participants were assessed in terms of anthropometric measurements. The serum (BDNF) and proBDNF levels were compared between the groups.Results: The proBDNF levels in IBS patients were higher compared with the control group in covariance analysis (IBS patients group mean 492.4, SD 534.1; control group mean 332.8, SD 406.7) (p = 0.02; Cohen's d = 0.45). The serum BDNF levels of IBS patients were also higher compared with the control group (IBS patients group mean 3.1, SD 4.3; control group mean 1.7, SD 2.7) (p = 0.02; Cohen's d = 0.51).Conclusions: The present study is the first to demonstrate that there is a higher level of serum BDNF in children with IBS. Moreover, it is the first to demonstrate an increased level of proBDNF in IBS. Additional research is needed to confirm the preliminary results.

Global electrical heterogeneity associated with drug-induced torsades de pointes

Drugs belonging to diverse therapeutic classes can prolong myocardial refractoriness or slow conduction. These drugs may be effective and well-tolerated, but the risk of sudden cardiac death from torsades de pointes (TdP) remains a major concern. The corrected QT interval has significant limitations when used for risk stratification. Measurement of global electrical heterogeneity (GEH) could help identify the substrate vulnerable to drug-induced ventricular arrhythmias. The purpose of this study was to improve risk stratification for drug-induced TdP by measuring GEH on the electrocardiogram (ECG). We analyzed ECG data from a case-control study of patients with a history of drug-induced TdP as well as age- and sex-matched controls. Vectorcardiograms were constructed from ECGs. GEH was measured via the spatial ventricular gradient (SVG) vector (magnitude, azimuth, and elevation). Log odds coefficients for TdP were estimated using multivariable logistic regression. Among 17 cases (47% male; age 58.9 ± 12.5 years) and 17 controls (29% male; age 61.0 ± 12.2 years), 34 ECGs were analyzed. SVG azimuth was significantly different between cases and controls (3.4 vs 22.0 degrees, respectively; P = 0.02). After adjusting for sex and QTc interval, odds of TdP increased by a factor of 3.2 for each 1 SD change in SVG azimuth from the control group mean (95% confidence interval 1.07-9.14; P = .04). QTc was not significant in the multivariable analysis (P = .20). SVG azimuth is correlated with a history of drug-induced TdP independent of QTc. GEH measurement may help identify patients at high risk for drug-induced arrhythmias.

Impact of an Electronic Health Service on Child Participation in Pediatric Oncology Care: Quasiexperimental Study

BackgroundFor children 6-12 years old, there is a shortage of electronic Health (eHealth) services that promote their participation in health care. Therefore, a digital communication tool, called Sisom, was developed to give children a voice in their health care. Children with long-term diseases want to be more involved in their health care and have the right to receive information, be listened to, express their opinions, and participate in decision making in health care. However, the outcomes of using Sisom in practice at pediatric oncology clinics have not been investigated.ObjectiveThe aim of this study was to investigate children’s participation during appointments with pediatricians at pediatric oncology clinics, with or without the use of the eHealth service Sisom.MethodsA quasiexperimental design with mixed methods was used. We analyzed 27 filmed appointments with pediatricians for 14 children (8 girls and 6 boys) aged 6-12 years (mean 8.3 years) with a cancer diagnosis. The intervention group consisted of children who used Sisom prior to their appointments with pediatricians at a pediatric oncology clinic, and the control group consisted of children who had appointments with pediatricians at 4 pediatric oncology clinics. Data from observations from the videos were quantitatively and qualitatively analyzed. The quantitative analysis included manual calculations of how many times the pediatricians spoke directly to the children, the proportion of the appointment time that the children were talking, and levels of participation by the children. For the qualitative analysis, we used directed content analysis to analyze the children’s levels of participation guided by a framework based on Shier’s model of participation.ResultsPediatricians directed a greater proportion of their discussion toward the child in the intervention group (731 occasions) than in the control group (624 occasions), but the proportion of the appointment time the children talked was almost the same for both the intervention and control groups (mean 17.0 minutes vs 17.6 minutes). The levels of participation corresponded to the first three levels of Shier’s participation model: children were listened to, children were supported to express their views, and children’s views were taken into account. The results showed an increased level of participation by the children in the intervention group. Several codes that were found did not fit into any of the existing categories, and a new category was thus formed: children received information.ConclusionsThis study shows that the eHealth service Sisom can increase children’s participation during appointments with health care professionals. Further studies employing a randomized control design focusing on the effects of eHealth services on children’s health outcomes, perceived participation, and cost-effectiveness could make a significant contribution to guiding the implementation of eHealth services in pediatric care.

Angiotensin-converting enzyme inhibitor and angiotensin II type 1 receptor blocker: Potential agents to reduce post-surgical scar formation in humans.

Studies on the effectiveness and mechanisms of reducing scar formation by interfering with the renin-angiotensin-aldosterone-system (RAAS) have been demonstrated in animals, but not in humans due to the lack of clinical support. Our aim was to investigate whether angiotensin-converting enzyme inhibitor (ACEI) and angiotensin II type 1 receptor blocker (ARB) could inhibit scar formation in humans. Thus, an observational and hypothesis-generating study using a designed questionnaire was carried out. A total of 347 patients with postoperative scars secondary to thyroid tumours were enrolled. They were divided into four groups: ACEI group, ARB group, other antihypertensive drugs control group and blank control group according to the administration of antihypertensive drugs. The width of scar was measured, and the Scar Cosmesis Assessment and Rating (SCAR) Scale was filled out. Results showed that patients of ACEI group (mean scar width 1.60mm) and ARB group (mean scar width 1.57mm) formed smaller scars than those of other antihypertensive drugs control group (mean scar width 2.09mm) and blank control group (mean scar width 2.0mm). Oral administration of ACEI and ARB may be associated with better post-surgical scar formation in humans. These two kinds of antihypertensive drugs may be active components of anti-scar medicine.

The Effectiveness of Booklets and Animation Videos on Increasing the Danger of Post Partum Signs Knowledge on the Husband

The success of health education in the society, depends on the learning component. Attractive media will provide confidence, so the cognitive changes of affection and psychomotor can be accelerated (Siti Zulaekah, 2013). Print media that can be used in the EIC program for the postpartum mother family is a pocket book or booklet (Notoatmodjo, 2012). Audiovisual is one of the media that provide information or messages in audio and visual (Setiawati and Dermawan, 2008). The purpose of this research is to know the effectiveness of the booklet and video animation towards the increasing of puerperal sign knowledge on the husband. This research was conducted in Gayamsari Polyclinic. The type of this research is experimental research, research method in the form of quasi experiment using control group design pretest posttest design. The research population is the husband of postpartum mother period March-April 2018 and the sample was 30 respondents. The Sampling technique by using the purposive sampling, the group determination by using simple random technique (drawing technique). The result of this research using Mann Whitney with Sig 0,268 0,05, mean of control group with booklet was 17,27 higher than intervention group with videos animation, so booklet more effective to increase knowledge husband than used videos animation. The explanation of health education can use a variety of media such as animated videos. Health workers may also actively involve the role of the husbands of the puerperal mother in performing care for the puerperal mother.

The effectiveness of ‘Student Team Achievement Divisions’ (STAD) model towards students’ achievement in the Principles of Accounting subject

The purpose of this study was to determine the effectiveness of the STAD model towards students’ achievement in the Principles of Accounting subject, specifically in the Ledger topics. This study also evaluated students' understanding, motivation, attitude and interest in learning Principles of Accounting after using the STAD model. A quantitative approach with a quasi-experimental design was used. The sample selection involved Form 4 students from the social science stream comprising 30 students in the treatment group and 30 students in the control group. The research instruments used were pre-test, post-test and a survey questionnaire. The data was analyzed using the descriptive and inferential analysis. The descriptive analysis was used to describe students' perceptions of learning Principles of Accounting after using the STAD model. The inferential analysis involved analysis such as independent sample t-tests, paired sample t-tests and Pearson correlation analysis to explain the differences and relationships between the variables of the study. The findings showed that there was a significant difference between the treatment group and the control group in the post-test whereby the treatment group showed a significant and higher improvement (mean score= 18.267) compared to the control group (mean score= 15.133). The Pearson correlation analysis also showed a strong relationship (r= 0.745) between the STAD model and student achievement in post-test analysis. The results of the students' perceptions of Principles of Accounting after using the STAD model showed that their levels of understanding and motivation were high. The findings of this study showed that the STAD model improved students' achievement, understanding and motivation in Principles of Accounting subject. The implications of this study indicated that the STAD model could enhance the learning effectiveness of Principles of Accounting.

Enhanced recovery after surgery (ERAS) protocol reduces LOS without additional adverse events in spine surgery

BackgroundEnhanced recovery after surgery (ERAS) protocols aim to reduce the physiological stress induced by surgery. These protocols are persistently associated with improved outcomes and reduced costs in several orthopaedic subspecialties. Recently, spine surgery has been explored in the literature as a potential and beneficial domain for ERAS protocols. The aim of this study was to compare the short-term postoperative spine surgery follow-up between patients who underwent the ERAS protocol and those who recovered conventionally. HypothesisThe ERAS protocol developed in our department since 2016 is beneficial to patients undergoing spinal surgery. Patients and methodsA retrospective analysis of data collected prospectively was performed to include all patients who underwent spinal surgery and went through the ERAS protocol in our clinic between January 2017 and January 2018. A control group was paired using a propensity score. Length of hospital stay (LOS), complications, rate of readmissions, postoperative pain, function and satisfaction were compared between the two groups. ResultsA total of 193 patients received the ERAS protocol during the study period. After pairing, 193 couples were selected resulting in a final database of 386 patients for the analysis. There was a significant difference in mean LOS, defined as the average number of days spent in hospital, between the two groups (ERAS group, mean LOS=2.6 days [median 2 days, range 1–7], control group mean LOS=4.4 days [median 4 days, range 2–14]; p<0.0001). Complications, rate of readmissions, postoperative pain, function and satisfaction were similar in the two groups. DiscussionThe ERAS protocol decreased hospital LOS, without resulting in additional adverse events after spinal surgery. These findings support the application of our ERAS protocol after spinal surgery. Level of evidenceIII, retrospective analysis.