Dedicated Software Package Research Articles

Examining employer experiences in the polytechnic sector's industrial training program

Purpose: Industrial training, a structured educational program, provides supervised hands-on training within specified time frames and is available in both the private sector and government settings. Its primary aim was to bridge the gap between theoretical knowledge and practical skills, enabling participants to apply classroom learning in real-world scenarios. This experiential approach fosters competency development and a deeper understanding of industrial practices, teamwork, and professional ethics, ultimately preparing individuals for successful careers in various sectors. Research Methodology: Data analysis was conducted using a statistical software tool tailored for predictive modeling and analysis. This dedicated software package was employed to scrutinize and interpret the dataset, allowing for the extraction of meaningful insights and predictions. This analytical approach involves a series of statistical techniques, algorithms, and models to uncover patterns, correlations, and trends within the data. Results: From the perspective of instructors, industrial training has been noted as a catalyst for enhancing students' proficiency in both formal and informal communication, aiding them in identifying suitable research areas for their projects and honing their abilities in socialization and relationship-building. Limitations: The applicable and functional setting for the findings of this study lies within the realm of educational settings. Contribution: Our conclusions highlight the pivotal role of industrial training in enhancing students' abilities and knowledge following their training programs. We advocate recognizing industrial training as a valuable instrument for augmenting employees' skills and capabilities.

Multimodal ultrasound muscle assessment in patients with rheumatic diseases: a patient-based reliability study.

The aim was to explore the inter-reliability of a newly developed US scanning protocol (multimodal US) for the assessment of different aspects of sarcopenia-related muscle involvement, including muscle mass, muscle quality and muscle stiffness [using point shear-wave elastography (SWE)], in patients with rheumatic and musculoskeletal diseases (RMDs). Quadriceps muscle mass (i.e. muscle thickness), muscle quality (i.e. muscle echogenicity evaluated with both a visual semi-quantitative scale and a dedicated software package for image analysis, ImageJ) and point SWE measurements were obtained by two rheumatologists (blinded to each other's evaluation) in consecutive RMD patients without previous/current myositis or neuromuscular disorders.Inter-reliability was assessed using the intraclass correlation coefficient (ICC) for continuous variables and Cohen's kappa (κ) for categorical variables. A total of 45 RMD patients were enrolled [mean age 54.5 (16.0) years, male-to-female ratio 1:1.5, mean BMI 24.6 (4.6) kg/m2], 10 with PsA, 7 RA, 5 AS, 5 PMR, 4 SLE, 4 gout, 4 OA, 3 FM and 3 SSc. The grade of inter-rater reliability was excellent for muscle mass [ICC = 0.969 (0.953 < ICC < 0.979)]. Regarding muscle echogenicity, the agreement was substantial/almost perfect using the visual semi-quantitative scale (weighted linear = 0.793, weighted squared = 0.878) and excellent using ImageJ analysis [ICC = 0.916 (0.876 < ICC < 0.944)]. Finally, a good agreement was obtained for point SWE measurements [ICC = 0.76 (0.712 < ICC < 0.8)]. Multimodal US is a novel and reliable tool for the evaluation of different aspects of muscle involvement (muscle mass, muscle quality and muscle stiffness) in RMD patients.

Measurement of the radiation dose and radiation isocenter of the TrueBeam accelerator using 3D polymer gel dosimeters from the VIPAR family with different chemical history

This work describes the measurements of the ionizing radiation dose and the determination of the radiation isocenter using a tool consisting of three-dimensional polymer gel dosimeters and a dedicated software package. Specific polymer gel dosimeters were selected. Their inherent common feature is the possibility of high-resolution three-dimensional measurement of dose distribution in radiotherapy and the presence of the N-vinylpyrrolidone monomer in the composition alongside other substances such as the cross-linking agent N,N'-methylenebisacrylamide, oxygen scavengers, stabilizers and gel matrix. The aim of this study was to analyze the influence of the chemical history of N-vinylpyrrolidone (purity and aging) on the dose response of some dosimeters. In addition, this work seeks to answer the question of how important purity and aging of N-vinylpyrrolidone are in dosimetry applications, such as routine testing of medical accelerators.

Impact of Season on Incidence of Sinusitis-related Orbital Cellulitis.

To explore the impact of season on the incidence of presentation to emergency departments with sinusitis-related orbital cellulitis in the United States. The National Emergency Department Sample was queried to identify cases of patients with sinusitis-related orbital cellulitis. Patient's age, location, and the month of presentation were recorded. Statistical correlations were analyzed via a dedicated software package. A total of 439 patients with sinusitis-related orbital cellulitis were identified. The overall incidence was higher during the winter months ( p < 0.05); while children were more likely to develop this disease during the winter ( p < 0.05), season was not statistically correlated with its incidence among adults ( p = 0.16). The incidence of orbital cellulitis was higher during the winter in the midwest and south regions of the United States ( p < 0.05 for each region), although this correlation did not apply in the northeast and west ( p = 0.60 and 0.99, respectively). While sinusitis incidence increases during the winter, the relationship between season and orbital cellulitis is complex and varies by age and geographic location. These findings may help to facilitate screening protocols for this disease and to define staffing issues for emergent ophthalmic care.

Monitoring Posterior Cerebral Perfusion Changes With Dynamic Susceptibility Contrast-Enhanced Perfusion MRI After Anterior Revascularization Surgery in Pediatric Moyamoya Disease.

To determine whether dynamic susceptibility contrast-enhanced (DSC) perfusion magnetic resonance imaging (MRI) can be used to evaluate posterior cerebral circulation in pediatric patients with moyamoya disease (MMD) who underwent anterior revascularization. This study retrospectively included 73 patients with MMD who underwent DSC perfusion MRI (age, 12.2 ± 6.1 years) between January 2016 and December 2020, owing to recent-onset clinical symptoms during the follow-up period after completion of anterior revascularization. DSC perfusion images were analyzed using a dedicated software package (NordicICE; Nordic NeuroLab) for the middle cerebral artery (MCA), posterior cerebral artery (PCA), and posterior border zone between the two regions (PCA-MCA). Patients were divided into two groups; the PCA stenosis group included 30 patients with newly confirmed PCA involvement, while the no PCA stenosis group included 43 patients without PCA involvement. The relationship between DSC perfusion parameters and PCA stenosis, as well as the performance of the parameters in discriminating between groups, were analyzed. In the PCA stenosis group, the mean follow-up duration was 5.3 years after anterior revascularization, and visual disturbances were a common symptom. Normalized cerebral blood volume was increased, and both the normalized time-to-peak (nTTP) and mean transit time values were significantly delayed in the PCA stenosis group compared with those in the no PCA stenosis group in the PCA and PCA-MCA border zones. TTPPCA (odds ratio [OR] = 6.745; 95% confidence interval [CI] = 2.665-17.074; P < 0.001) and CBVPCA-MCA (OR = 1.567; 95% CI = 1.021-2.406; P = 0.040) were independently associated with PCA stenosis. TTPPCA showed the highest receiver operating characteristic curve area in discriminating for PCA stenosis (0.895; 95% CI = 0.803-0.986). nTTP can be used to effectively diagnose PCA stenosis. Therefore, DSC perfusion MRI may be a valuable tool for monitoring PCA stenosis in patients with MMD.

843 QUANTIFICATION OF VENTRICULAR FUNCTIONAL MITRAL REGURGITATION USING THE VOLUMETRIC METHOD BY 3D-ECHOCARDIOGRAPHY

Abstract Background ventricular functional mitral regurgitation (v-FMR) is associated with an increased risk of mortality and hospitalization for heart failure. In this setting, the echocardiographic assessment of v-FMR severity using 2D proximal isovelocity surface area (PISA) yields several limitations, potentially leading to an underestimation of v-FMR severity. An alternative approach is to derive the regurgitant volume (RegVol) and the effective regurgitant orifice area (EROA) using the three-dimensional echocardiography (3DE) to estimate left ventricular volumes (volumetric method, VM). However, a direct comparison of these methods has never been tested. Accordingly, the aims of our study are: i; to compare both 2D PISA measurements of EROA and RegVol with those obtained by VM using 3DE, ii; to test their accuracy using the 3D planimetry of vena contracta area (3D-VCA) of MR jet, as reference. Methods we retrospectively analysed 82 (mean age 75±12, 48% men, 79% sinus rhythm, 85% with ischemic cardiomyopathy, 15% with dilated cardiomyopathy) consecutive patients with v-FMR and reduced left ventricular ejection fraction (LVEF &amp;lt;50%), acquired between July 2020 and October 2021. Exclusion criteria were: age &amp;lt; 18 years, primary MR, presence of intra-cardiac shunts, greater than mild aortic regurgitation, and inadequate acoustic window. PISA EROA was calculated using the formula: 6.28 r2×Va/Vp (where: r= PISA radius, Va= aliasing velocity, Vp= MR peak velocity). FMR regurgitant volume (RegVol) by PISA was calculated as EROA×VTIMR, where VTIMR represents the time–velocity integral of the CW Doppler MR jet tracing. FMR RegVol by 3DE volumetric method (VM) was calculated as: total LV stroke volume (LV SV) – forward LV SV (Ao SV). LV SV was obtained by subtracting the respective end-systolic (ESV) from the end-diastolic (EDV) volumes measured by 3DE. Ao SV was calculated by multiplying LV outflow area by LV outflow tract velocity time integral (VTI). EROA by VM was calculated as the MR RegVol divided by VTIMR. In a group of 10 patients, the quantification of 3D-VCA was performed by multiplanar reconstruction using a dedicated software package (EchoPAC 204 GE Vingmed, Horten, Norway). Results average LV end-diastolic and end-systolic volumes, total stroke volume, LVEF and global longitudinal strain were 211±25 mL, 134±17 mL, 73±9 mL, 36±8% and, 9.4±2.7% respectively. Median Ao SV was 50±12 mL. Left atrial volume and left atrial reservoir strain were respectively 99±19 mL and 10±16%. Both EROA and RegVol by VM were larger than EROA (0.17± 0.09 cm2 vs 0.11± 0.01 cm2; p&amp;lt;0.001) and RegVol (25.7±12.1 mL vs 17.2±9.9 mL; p&amp;lt;0.001) by PISA, respectively. Compared to 3D-VCA, EROA by VM resulted more accurate than EROA by PISA (bias= -0.15 cm2, LOA ±0.24 cm2 vs bias= -0.25 cm2, LOA ±0.29 cm2). Finally, VM EROA (r= 0.778) showed a better correlation than PISA EROA (r= 0.681) with the 3D-VCA (p&amp;lt;0.001). Conclusions in patients with v-FMR, the echocardiographic assessment of EROA and RegVol using the 3DE volumetric method showed larger values compared to the conventional PISA method, and a closer correlation with the 3D VCA. Accordingly, the 3DE VM could improve the accuracy of evaluation of v-FMR severity. Larger studies with longer clinical follow-up are needed to define if it translates into improved risk stratification and may address patients’ management.

227 THE PROGNOSTIC VALUE OF RIGHT ATRIAL STRAIN IN PATIENTS WITH SECONDARY TRICUSPID REGURGITATION

Abstract Background in secondary tricuspid regurgitation (STR), the remodeling of the right ventricle (RV) and the right atrium (RA) is associated with different outcomes. However, the potential prognostic role of right RA function in this setting, assessed by 2D-speckle tracking echocardiography (2D-STE), remains to be tested. Accordingly, the aim of our study is to assess the prognostic value of RA 2D-STE in patients with significant (i.e. moderate or severe) STR. Methods we retrospectively studied 227 (mean age 74±14, 40% men, 59% sinus rhythm) consecutive patients with significant STR, acquired between May 2012 and June 2021. RA 2D-STE was obtained from a dedicated, non-foreshortened RV-focused apical 4-ch view, using a dedicated software package (AFI LA, EchoPAC 204, GE Vingmed, Horten, Norway). Among the three longitudinal strain components provided by the software package (reservoir, conduit and, contraction), we focused on RA longitudinal strain during reservoir (RASR). Patients were divided into two groups according to the median value of RARS (12%). A combined endpoint of heart failure hospitalization and all-cause mortality was defined. Results after a median follow-up period of 14 months (IQR, 1-27), 93 patients (41%) reached the combined endpoint. The predictive power of RARS&amp;lt;12% (AUC 0.64 [IC 95% 0.56-0.71]), was significantly higher than RA maximum volume (AUC 0.38 [IC 95% 0.31-0.47]). Patients with RARS ≤ 12% were more symptomatic (according to NYHA class), had larger RA volumes (119 vs 89 mL, p&amp;lt;0.001) and, a reduced right ventricular systolic function (TAPSE: 14.7 vs 18.9 mm; FAC 37.7 vs 42.4%; RV free-wall strain: 17.5 vs 20.8%; all p&amp;lt;0.001). In addition, patients with RARS&amp;lt;12% had more severe TR (corrected EROA: 0.85 vs 0.41 cm2; p&amp;lt;0.05). Prevalence of atrial fibrillation (58 vs 61%), left ventricular ejection fraction, and right ventricular size were similar between the groups. Patients with RARS ≤12% had a significant risk for death (log rank, p&amp;lt;0.001), even after correcting for confounding variables. Moreover, RA strain was independently associated with the combined endopoint in multivariate analysis (p &amp;lt; 0.001) Conclusions in patients with significant STR, RARS is an independent predictor of the combined endpoint of heart failure hospitalization and all-cause mortality and provides incremental prognostic value over RA volume.

511 INCREMENTAL VALUE OF RIGHT ATRIAL STRAIN ANALYSIS TO PREDICT ATRIAL FIBRILLATION RECURRENCE AFTER CARDIOVERSION

Abstract Background In patients with paroxysmal atrial fibrillation (AF), left atrial (LA) mechanics has been reported to be important to predict recurrences after cardioversion. However, the potential additive role of right atrial (RA) function in this setting remains to be tested. Accordingly, the aims of our study was to assess the added role of right atrial reservoir longitudinal strain (RARS) for prediction of AF recurrence after electrical cardioversion. Methods we prospectively studied 130 (mean age 69±14, 55% men) consecutive patients with persistent AF who underwent electrical cardioversion, acquired between June 2020 and December 2021. Exclusion criteria were: presence of pacemaker, more than moderate mitral and tricuspid regurgitation, left or right ventricular dysfunction, prior cardiac surgery, and, inadequate acoustic window. LA and RA 2D-speckle-tracking echocardiography analyses were obtained from dedicated, non-foreshortened 4-ch and RV-focused apical 4-ch views respectively, using a dedicated software package (AFI LA, EchoPAC 204, GE Vingmed, Horten, Norway). The primary endpoint was AF recurrence. Results after a follow-up period of 12 months, 60 patients (45%) reached the primary endpoint. The mean left ventricular ejection fraction (LVEF) was 56.5±8%, for all patients. No significant difference in LA (98±31 vs 94±30 mL, p= 0.333) and RA (68±26 vs 65±26 mL, p=0.286) volumes was detected between patients with and without AF recurrence, while left atrial reservoir strain (LARS, 10±6 vs 14±7%, p&amp;lt;0.001) and RA reservoir strain (RARS, 14±10 vs 16±8%, p&amp;lt;0.001) were significantly lower in patients with recurrent AF. Receiving operator characteristics curve analysis showed that the predictive power of LARS (AUC 0.68 [IC 95% 0.58-0.78]), was lower than RARS (AUC 0.75 [IC 95% 0.66-0.84]) (p&amp;lt;0.001, for all), with cut-off of 10.5% (sensitivity 62%, specificity 70%) and, 15.5% (sensitivity 75%, specificity 75%), respectively. Kaplan-Meier curve for time to primary endpoint showed that patients with LARS≤10.5% and RARS ≤15.5% had a significant risk for AF recurrences (log rank,p&amp;lt;0.001), even after correcting for confounding variables. However, at multivariable Cox regression RARS (HR 3.42 [CI 95% 1.72-6.8], p&amp;lt; 0.001) was the only parameter independently associated with the primary endpoint. Conclusions RARS is an independent predictor of the recurrences of AF after electrical cardioversion and provides an incremental prognostic value over LARS. This study highlights the pivotal role of the assessment of bi-atrial remodeling in patients with AF.

A new European service to share GNSS Data and Products

This paper describes the new GNSS data and product services that have been developed within the context of the EPOS (European Plate Observing System) European Research Infrastructure Consortium (ERIC), which is part of the European Strategy Forum on Research Infrastructures. These services, optimized for Solid Earth research applications, endeavour to harmonise, and standardise Global Navigation Satellite System (GNSS) data collection and processing. They have been implemented by the members of the GNSS Data &amp; Products (EPOS-GNSS), one of the Thematic Core Services (TCS) of EPOS with the active support of national and pan-European infrastructures (in particular the Regional Reference Frame Sub-Commission for Europe (EUREF) of the International Association of Geodesy). The optimized use of data from dozens of diverse European GNSS networks, installed not specifically for geodynamic studies, created additional requirements from an organizational and technical point of view, the solutions for which we describe in this article. The data flows from data suppliers and analysis centers to the various TCS Data &amp; Product Portals are described, as well as their integration into the overall EPOS system. This is made through GLASS (GNSS Linkage Advanced Software System), a dedicated software package developed since 2016, whose architecture and functionalities are detailed here. Time series and other GNSS products computed at the several analysis centers are described as are the quality control steps that are performed. Finally, several user cases are presented that demonstrate how different stakeholders (from data providers to scientists) can benefit from the efforts being carried out by the EPOS- GNSS community.

Left atrial function assessed by 3-dimensional echocardiography is an independent predictor for mortality in heart failure with reduced ejection fraction

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Grant TE 137/2020 Background. Patients with heart failure and reduced ejection fraction (HFrEF) are at high risk for death. So far, left ventricular ejection fraction (LVEF) measured by 2-dimensional echocardiography (2DE) has been considered the main predictor of mortality in HFrEF. However, there are new echo parameters reflecting cardiac remodeling, assessed by 3-dimensional echocardiography (3DE), that might improve risk stratification in HFrEF. Aim. To assess comparative prognostic value of left heart function and remodeling parameters, measured by 2DE versus 3DE, in patients with HFrEF. Methods. 142 consecutive patients (60 ± 17 years, 91 males), diagnosed with HFrEF, in sinus rhythm, were assessed by 2DE, using dedicated views for the LV and left atrium (LA), and by 3DE, with full-volume multi-beat acquisitions of the LV and LA. Left ventricular volumes (LVVs) were measured from 2DE views, using the modified Simpson biplane method, and from 3DE using dedicated software. Maximal and minimal indexed LAVs were measured from 2DE, using the biplane area-length formula (2D_LAVmax and 2D_LAVmin); and from 3DE, using dedicated software package (3D_LAVmax and 3D_LAVmin). Patients were followed for 5 years (57 ± 11 months) after the index event. Primary outcome was mortality. Secondary outcomes were a composite endpoint (CE) of death and hospitalization for heart failure (HHF); HHF; and a composite cardiac events end-point (MACE) of death, HHF, myocardial infarction, coronary revascularization, arrhythmias, or cardiac resynchronization therapy. Results. At 5 years we recorded 52 deaths, 70 CE, 36 HHF, and 73 MACE. At baseline, mean 2DE and 3DE LVEFs were 32 ± 10% and 32 ± 9%, respectively. There was no significant difference between the LVVs or LVEF by 2DE or 3DE between survivors and non-survivors. However, there was a significant difference for total and indexed 2D_LAVmax, 3D_LAVmax, and 3D_LAVmin (Table 1) between survivors and non-survivors. Similarly, there was no significant correlations with endpoints for the 2DE or 3DE LVVs. However, total and indexed 2D_LAVmax correlated with death, CE, HFH, and MACE, all with P &amp;lt; 0.03. Furthermore, total and indexed 3D_LAVmax, and 3D_LAVmin correlated with death, CE, HFH, and MACE, all with P &amp;lt; 0.05. In a linear multivariate regression model, that included 2DE and 3DE LVEF, indexed 2D and 3D LAV max and min, only indexed 3D_LAVmin was an independent predictor for death (p &amp;lt; 0.001), CE (p = 0.005), HFH (p = 0.009) and MACE (p = 0.006). Furthermore, by ROC analysis, an indexed LAV of 30 ml/m2 by 3DE was able to predict death ( Sb 94%, Sp 80%, AUC 0.70), CE (Sb 98%, Sp 80%, AUC 0.67), HFH (Sb 96%, Sp 80%, 0.67), and MACE (Sb 93%, Sp 76%, AUC 0.66). Conclusion. LVEF by 2DE and 3DE, while smaller in non-survivors, was unable to predict death in a small cohort of patients with HFrEF. However, LAVs, particularly by 3DE, were able to predict cardiac events, suggesting the potential key value of evolving cardiac substrate. Abstract Table 1

Skater: an R package for SNP-based kinship analysis, testing, and evaluation

Motivation: SNP-based kinship analysis with genome-wide relationship estimation and IBD segment analysis methods produces results that often require further downstream process- ing and manipulation. A dedicated software package that consistently and intuitively imple- ments this analysis functionality is needed. Results: Here we present the skater R package for SNP-based kinship analysis, testing, and evaluation with R. The skater package contains a suite of well-documented tools for importing, parsing, and analyzing pedigree data, performing relationship degree inference, benchmarking relationship degree classification, and summarizing IBD segment data. Availability: The skater package is implemented as an R package and is released under the MIT license at https://github.com/signaturescience/skater. Documentation is available at https://signaturescience.github.io/skater.

Skater: an R package for SNP-based kinship analysis, testing, and evaluation.

Motivation: SNP-based kinship analysis with genome-wide relationship estimation and IBD segment analysis methods produces results that often require further downstream process- ing and manipulation. A dedicated software package that consistently and intuitively imple- ments this analysis functionality is needed. Results: Here we present the skater R package for SNP-based kinship analysis, testing, and evaluation with R. The skater package contains a suite of well-documented tools for importing, parsing, and analyzing pedigree data, performing relationship degree inference, benchmarking relationship degree classification, and summarizing IBD segment data. Availability: The skater package is implemented as an R package and is released under the MIT license at https://github.com/signaturescience/skater. Documentation is available at https://signaturescience.github.io/skater.

Analyse Accuracy of Glucose Monitors without any Dedicated Software Package.

Analyse Accuracy of Glucose Monitors without any Dedicated Software Package.

How to Conduct Descriptive Statistics Online

Background: Descriptive statistics is the first step of data analysis. In biomedical researches, inferential statistical tests are invariably conducted after descriptive statistical tests for getting a summary of the data. Many resource-limited settings may not have dedicated software for carrying out these tests. Aim: This article aimed to provide a brief technical guide about the conduct of descriptive statistics with visualization that can be done without any dedicated statistical software package. Methods: We searched for online tools that provide free service for the conduct of descriptive statistics. The example data were fabricated for the conduct of the test online. The visualization of the data (i.e., figures) was explained in brief, wherever necessary. Results: We described the method to graph and summarize the data using a pie chart, frequency table, stem and leaf display, histogram, frequency polygon, box plot, bar chart, stacked bar chart, line graph, dot plot, central tendency, variance, quantile-quantile plot, scatter plot, and Venn diagram. All these tests and visualization were done online without any installed dedicated software package. Conclusion: This article provides a brief technical guide for conducting common descriptive statistical tests online. Researchers in any resource-limited settings may use these services to summarize and visualize the data online from public domain websites.

Metabolic profiling of Peperoni di Senise PGI bell peppers with ultra-high resolution absorption mode Fourier transform ion cyclotron resonance mass spectrometry

Bell peppers (genus Capsicum) are an excellent source of health-related compounds, such as ascorbic acid (vitamin C), carotenoids (provitamin A), tocopherols (vitamin E), flavonoids and capsaicinoids. These compounds are known for their biological activities, including antioxidant, anti-inflammatory and anticarcinogenic properties. Over the past decade, there has been an increasing number of studies focused on metabolite profiling of bell peppers. However, none of the direct analysis methods exploited in these studies were capable of simultaneously detecting compounds belonging to more than four metabolite classes (and possible derivatives of model compounds) present in bell peppers, i.e. mainly amino acids, sugars, polyphenols and organic acids. We have attempted to profile a higher number of metabolite classes by performing a direct-injection analysis with a Fourier transform ion cyclotron resonance mass spectrometry (FT-ICR MS), on Peperoni di Senise bell peppers (Capsicum annuum L.). These bell peppers are a typical food product cultivated in Basilicata (Southern Italy), protected with a protected geographical indication (PGI) quality mark and known for their unique taste. To increase the performance of the FT-ICR MS method, we processed the recorded time-domain ion signals (transients) into the absorption mode FT-ICR mass spectra. The latter was achieved by the use of the dedicated software package, AutoVectis Pro. Mass spectral representation in absorption mode produced a more comprehensive description of the metabolic profile of Peperoni di Senise PGI by improving results reliability via artifacts removal and identifying a higher number of compounds.

Myeloid differentiation factor 88 expression in eyelid specimens of rosacea

ABSTRACT Purpose Rosacea is a common cause of ocular surface disease. Specific immunologic features have been implicated in its pathogenesis, including toll-like receptors, mitogen-associated kinase, and nuclear factor kappa-B. Myeolid differentiation factor 88 (MYD88) has been associated with these elements, suggesting a role for this protein in rosacea. This study was designed to compare the expression of MYD88 in the eyelids of patients with and without this disease. Methods Western blotting for MYD88 was performed in 14 control patients and 15 patients with rosacea. Bands were quantified and normalized to actin. Immunohistochemical staining for MYD88 was performed in a different cohort of 12 patients with rosacea and 12 controls, and positively-staining cells were counted across five consecutive 40x fields. Statistical analyses compared the differences between the two groups via a dedicated software package. Results On western blotting, the mean ratios of MYD88 to actin were 13.8 (standard deviation = 14.1) and 44.3 (standard deviation = 39.6) in control and rosacea patients, respectively (p = .002). On immunohistochemistry, the mean numbers of positively-staining cells were 12.1/40x field (standard deviation = 9.61/40x field) and 27.4/40x (standard deviation = 18.7/40x field) in control and rosacea patients, respectively (p = .0438). Conclusions MYD88 is enriched in eyelid specimens of rosacea. This finding further implicates the innate immune system in the pathogenesis of rosacea, and is consistent with previous reports regarding the role of this protein in ocular surface disease and the previously-implicated cellular features of the disease. Inhibition of MYD88 may be a successful treatment strategy to manage rosacea.

Orbital cellulitis secondary to sinusitis in upstate New York: current incidence, seasonality, severity, management and outcomes

ABSTRACT Purpose While sinusitis carries a seasonal variation, the temporal features of sinusitis-related orbital cellulitis (SRC) are unclear. This study analyzes the incidence, seasonality, management, and outcomes of SRC in northeastern New York. Methods A retrospective review of 79 patients was performed from January 2008 – December 2018. Cases of orbital cellulitis without comitant sinusitis were excluded. Demographic, radiographic, clinical features, month at presentation, interventions (surgical and nonsurgical), microbiology, and hospitalization duration were recorded. Fisher-exact test, Mann–Whitney test, and Kruskal Wallis test statistical analyses were performed in consultation with our institution’s statistician via a dedicated software package (vassarstats.net). Results 79 patients were admitted for SRC. 25 patients were treated with antibiotics only, 31 underwent orbitotomy exclusively and 23 received combined orbitotomy and functional endoscopic sinus surgery (FESS). Of the 31 patients who underwent orbitotomy only, 8 (26%) returned to the operating room. In contrast, of those who underwent concomitant orbitotomy and FESS, only one patient (4.3%) required re-operation (fisher exact test, p = .021). The median length of stay for the antibiotic-only group (4 days), orbitotomy-only group (6 days), and combined surgery group (5 days) were statistically different (Kruskal Wallis, p = .004, Figure 3). Interestingly, there was no significant relationship of incidence or severity of SRC related to seasonality (fisher-exact test, p = .76). Conclusion Our findings suggest that cases requiring surgical management for SRC should undergo coinitial orbitotomy with FESS to reduce re-operation rates. Additionally, SRC incidence and severity did not correlate with season.

Sex differences in the natural history of plaque progression by serial coronary computed tomography angiography

Abstract Background Sex related differences exist for coronary artery disease (CAD). Women tend to be older when presenting with CAD and have lower rates of obstructive disease. Invasive intravascular ultrasound studies have shown differences in plaque composition between males and females. However, these studies were performed in a high risk population needing invasive imaging. Coronary computed tomography angiography (CTA) allows for a fast and non-invasive quantification of CAD in low risk patients. Sex differences and quantitative analysis of plaque progression and changes in plaque composition have not been studied intensively. Purpose To evaluate the role of sex on long term plaque progression and on the change of plaque composition in a population with low-intermediate risk. Methods Patients that received a coronary CTA were prospectively included in the SMARTool study to receive a follow-up coronary CTA. In total, 275 patients from 5 European countries were recruited in 7 centers. Baseline and follow-up coronary CTA were quantitative analyzed on a per-lesion basis using dedicated software package. Patients without coronary plaques at follow-up or with uninterpretable coronary CTA results were excluded. Total plaque volume and compositional volumes, calcified or non-calcified (defined as fibrous, fibro-fatty or necrotic core), were normalized using the vessel volume to calculate a percentage atheroma volume (PAV). Lesions between males and females were compared using linear mixed models. We further classified patients into age groups &amp;lt;55 and ≥55 years to evaluate the influence of menopause on plaque progression. Results In total, 211 patients were included in this analysis, 146 (69%) were male and 65 (31%) were female. Mean interscan period was 6.2±1.4 years. Females were older (64±7 vs 61±8 years; p&amp;lt;0.001), had higher HDL levels (56±15 vs 49±15 mg/dL; p=0.003) and presented more often with atypical chest pain (62 vs 38%; p=0.017). Males had 434 plaque sites and females 156. On a per-lesion analysis females had less fibro-fatty PAV compared to males (β −1.3±0.4%; p&amp;lt;0.001), no other differences were seen (p&amp;gt;0.05). When stratifying the patients in above and below 55 years old, females still had less fibro-fatty PAV compared to males in both age groups (p&amp;lt;0.05). However, females in the age group &amp;lt;55 years showed more regression of fibrous PAV compared to males (β −0.8±0.3% per year; p=0.002) and non-calcified plaque PAV (β −0.7±0.3% per year; p=0.027) (Figure). Conclusions Males have larger fibro-fatty PAV compared to females, however the rate of change did not differ. Younger women showed more regression of fibrous PAV and non-calcified PAV compared to males. No differences in the rate of plaque progression or plaque composition changes were seen between males and females in the older age group. Figure plaque progression and sex diff Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): EU H2020 research and innovation program

Sex, body size and right atrial volume are the main determinants of tricuspid annulus geometry in healthy volunteers. A 3D echo study using a novel, commercially-available dedicated software package

Abstract Tricuspid annulus (TA) sizing is essential for percutaneous and surgical procedures. Guidelines recommend to assess TA size by 2D echo (2DE) linear dimension; but TA is a complex 3D structure. Aim To identify physiological determinants of TA geometry parameters and their reference values using 3D echo (3DE) and a novel, commercially-available software in healthy volunteers. Methods 254 healthy volunteers (113 men, mean age 47±11 years) were evaluated by 2D and 3DE. 3DE TA analysis was made in 228 of them (feasibility=90%). TA 3DE area, perimeter, diameters, sphericity index and coaptation (Figure) were assessed at mid-systole using a dedicated software package (4D AutoTVQ, GE Healthcare, Horton, N). 3D right atrial (RA) and ventricular (RV) volumes were measured. Results Normal values of 3D TA geometry parameters, RV and RA volumes are presented in table. 3D TA area, perimeter and diameters correlated with BSA (r=0.33 to 0.5, p&amp;lt;0.001) and were larger in men, independently of BSA (p&amp;lt;0.0001). There were no age-related changes in TA parameters (r&amp;lt;0.25, p=0.0001). 2D TA diameters measured in apical 4ch and RV focused views were significantly smaller than 3DE 4ch diameter (16±2 and 16±3 vs 17±3, p&amp;lt;0.0001). RA maximal volumes had the strongest correlation with 3D TA area (r=0.65), compared with RV end-diastolic (r=0.55) and end-systolic (r=0.51) volumes (p&amp;lt;0.0001). By multivariable linear regression, RA maximal volume, sex and BSA, but not RV volumes, were independent predictors of 3D TA area (R2=0.46, p&amp;lt;0.0001). Conclusions Reference values for TA metrics should be sex-specific and indexed to BSA. 2DE underestimates TA dimensions. Even if both RA and RV volumes correlate significantly with TA area, only RA maximum volume was an independent predictor of its size at mid-systole. 3D tricuspid annulus parameters Funding Acknowledgement Type of funding source: None

Intravenous Ketorolac Reduces Pain Score and Opioid Requirement in Orbital Surgery

Intravenous ketorolac (IVK) is an effective agent to reduce postoperative pain without the risks inherent to opioid analgesics. However, many clinicians avoid using this agent due to concerns regarding hemorrhagic complications. This study was performed to assess the efficacy and safety of IVK in the setting of orbital surgery. In a single dose prospective study, patients either received IVK immediately before orbital surgery (n = 50) or acted as controls (n = 50). Postoperative pain was evaluated via a numerical scale (range = 0-10) immediately after surgery, before discharge to home, and on the first postoperative day (POD1). The requirements for opioid analgesic and anti-emetic medications were determined by the nursing staff and recorded. Statistical analyses were performed via a dedicated software package. Fifty patients received IVK (24 males, 26 females, mean age = 54 years, SD = 18 years) and 50 patients acted as controls (26 males, 24 females, mean age = 50 years, SD = 19 years) immediately before orbital surgery. Mean pain scores were lower in patients who received IVK than in controls immediately after surgery (3.08 vs. 5.44, p = 0.0001) and on POD1 (1.04 vs. 2.66, respectively, p = 0.0001). Four patients (8%) who received IVK and 12 patients who did not (24%) required opioid analgesics to control pain (p = 0.03). No patient experienced a hemorrhagic complication or required an emergent return to the operating room. In the setting of orbital surgery, IVK safely and effectively reduces pain and the requirement for opioid analgesics. Within the limits of the study size, increased risks of bleeding-related complications were not identified.