Higher Number Of Subjects Research Articles

Estimation of Cardiometabolic Risk Prediction Profile Without Known Cardiovascular and Metabolic Diseases in a Southern Gujarat Population

The prevalence of cardiometabolic disorders (CMDs) is increasing all around the world especially in India. The CMDs are a cluster of abnormalities linked to insulin resistance and high risk for cardiovascular diseases (CVDs). To estimate cardiometabolic risk prediction profile without known CVDs and metabolic disorders in a southern Gujarat population, a prospective cross-sectional study conducted in the rural areas of south Gujarat for 6 months. Undiagnosed subjects with age 20–80 years were included in the study, and the information regarding anthropometric measurements, sociodemographic details, socioeconomic status, blood pressure and fasting blood glucose was collected to estimate cardiometabolic risk using the Indian Diabetes Risk Score (IDRS) and WHO CVDs risk chart. Multivariate regression analysis was performed to assess cardiometabolic risk factors. For diabetes risk, amongst 200 respondents, 103 (51.5%) subjects were having moderate risk followed by 61 (30.5%) and 36 (18%) having high and low risk respectively. For CVD risk, as per SBP vs. BMI, the majority of the subjects (151, 75.5%) were found with low risk followed by moderate risk (33, 16.5%) and high risk (16, 8%) whereas for CVD risk, as per SBP vs. blood glucose, the highest number of subjects was found with low risk (172, 86%), followed by moderate risk (16, 8%) and high risk (12, 6%). Our study suggests that the IDRS and WHO CVD prediction charts are a convenient and affordable screening tool for the assessment of diabetes and CVD mortality risk, respectively, in the settings where limited resources are available.

Virtual surgical planning and cone beam computed tomography in reconstruction of head and neck tumors - pilot study.

<b>Introduction:</b> The aim of the study was to prove that a combination of visual surgical planning (VSP) and cone beam computed tomography (CBCT) is an optimal technique in fibular free flap reconstructions after complex tumor resections in the head and neck region and that it leads to better functional and aesthetic outcomes. <br><b>Material and method:</b> Six patients (3 females, 3 males) with head and neck tumors were included in the study. The region concerned midface in 2 cases and mandible in 4 patients. On the basis of computed tomography of the head, fibular free flap (FFF) reconstruction was planned with the VSP technique. The 3D-printed models were prepared. At the beginning of the operation and a few minutes after the reconstruction, an xCAT CBCT by XORAN was performed. Minor corrections of the angles of the reconstructed bony parts were made where needed. The time of the operation was assessed for each case. Functional and cosmetic results were evaluated in a 1-year follow-up. <br><b>Results:</b> The mean time of operation was 6 hours and 48 minutes, which was approximately 1hour and 40 minutes less than standard reconstructive surgery. Functional recovery was achieved in all patients. Aesthetic result was unsatisfactory for 2 patients due to insufficient soft tissue masses of FFF. <br><b>Conclusions:</b> The authors claim that intraoperative CBCT imaging, regardless of the cost, improves the accuracy of aesthetic outcome of reconstructive surgeries based on VSP, especially in the region of the midface and the mandible. Further studies on a higher number of subjects are required.

The Clinical Use of Platelet-Rich Plasma in Knee Disorders and Surgery-A Systematic Review and Meta-Analysis.

In recent years, the interest in biological treatment of knee lesions has increased, especially the application of platelet-rich plasma is of particular note. The number of articles evaluating platelet-rich plasma (PRP) efficacy in the recovery of knee disorders and during knee surgery has exponentially increased over the last decade. A systematic review with meta-analyses was performed by assessing selected studies of local PRP injections to the knee joint. The study was completed in accordance with 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A multistep search of PubMed, Embase, Cochrane Database of Systematic Reviews, and Clinicaltrials.gov was performed to identify studies on knee surgery and knee lesion treatment with PRP. Of the 4004 articles initially identified, 357 articles focusing on knee lesions were selected and, consequently, only 83 clinical trials were analyzed using the revised Cochrane risk-of-bias tool to evaluate risk. In total, seven areas of meta-analysis reported a positive effect of PRP. Among them, 10 sub-analyses demonstrated significant differences in favor of PRP when compared to the control groups (p < 0.05). This study showed the positive effects of PRP, both on the recovery of knee disorders and during knee surgery; however further prospective and randomized studies with a higher number of subjects and with lower biases are needed.

Efficacy of Single-Dose Radiotherapy in Preventing Posttraumatic Tendon Adhesion.

Background and AimPosttraumatic peritendinous adhesion is the greatest obstacle to achieve normal tendon function following lacerations of extrinsic flexor tendons of the hand. In this study, we aimed to evaluate whether single-dose radiotherapy (RT) has the potential to modulate intrasynovial tendon adhesions.Materials and MethodsA total of 80 tendons from the third to fourth flexor profundus of both hind paws of 20 adult New Zealand rabbits were used in this study. Rabbits in the RT group received 3 Gy of X-irradiation in a single fraction. Histopathological evaluation of longitudinal sections of tendons was made using the Tang grading system for peritendinous adhesions. Intratendinous quality of the healing tissue in the laceration zone was assessed using a modified Movin scale.ResultsAdhesion and inflammatory response were greater in the RT group (p˂0.001). Tendon healing in the radiation group was found to be more uniform and organized compared with the control group. However, this difference was not statistically significant. The nuclei of the tenocytes in the radiation group showed a closer resemblance to normal tendon tissue when compared with the control group (p=0.007).ConclusionsDespite RT’s certain advantages such as extracorporeal use, anti-inflammatory effect, and homogenous tissue penetration, 3-Gy X-irradiation resulted in increased peritendinous posttraumatic adhesion, possibly due to dose imbalance. Increased roundness in the tenocyte nuclei was present in the RT group. Studies with different dosing regimens and a higher number of subjects are necessary to establish an ideal dose suppressing the synovial response without compromising tendon healing.

Comparison of Different Visual Feedback Methods for SSVEP-Based BCIs.

In this paper we compared different visual feedback methods, informing users about classification progress in a steady-state visual evoked potential (SSVEP)-based brain–computer interface (BCI) speller application. According to results from our previous studies, changes in stimulus size and contrast as online feedback of classification progress have great impact on BCI performance in SSVEP-based spellers. In this experiment we further investigated these effects, and tested a 4-target SSVEP speller interface with a much higher number of subjects. Five different scenarios were used with variations in stimulus size and contrast, “no feedback”, “size increasing”, “size decreasing”, “contrast increasing”, and “contrast decreasing”. With each of the five scenarios, 24 participants had to spell six letter words (at least 18 selections with this three-steps speller). The fastest feedback modalities were different for the users, there was no visual feedback which was generally better than the others. With the used interface, six users achieved significantly better Information Transfer Rates (ITRs) compared to the “no feedback” condition. Their average improvement by using the individually fastest feedback method was 46.52%. This finding is very important for BCI experiments, as by determining the optimal feedback for the user, the speed of the BCI can be improved without impairing the accuracy.

Complementary horse-assisted therapy for substance use disorders: a randomized controlled trial

BackgroundTreatment completion is the greatest challenge for the treatment of substance use disorders (SUDs). A previous investigation showed that complementary horse-assisted therapy (cHAT) was associated with higher retention in treatment and completion than standard treatment alone. This randomized controlled trial further explored the benefits of cHAT for patients with SUDs.MethodsFifty patients in residential SUD treatment at the Department of Addiction Treatment, Oslo University Hospital, were randomly allocated to either cHAT (cHAT group) or treatment as usual alone (TAU-only group). The primary end-point was treatment completion. Secondary end-points were dropout, transfer to another treatment, and time in treatment.ResultsThe multinomial logistic regression analysis found no statistically significant association between intervention (cHAT) and treatment outcome (completion, dropout, transferred) among the 37 participants who were ultimately recruited to the study. Some unforeseen challenges were encountered in the study: a high number of subjects transferred to another treatment, variable attendance at cHAT sessions, and long temporary exits. Nevertheless, 44% of participants in the cHAT group completed their treatment, compared with 32% in the TAU-only group; this observation encourages further investigation in a larger sample.ConclusionsThough no association was identified between cHAT and treatment retention or completion, our study may have been underpowered. Further work in a larger clinical population is needed; observational studies with repeated measures may also be useful for investigating whether cHAT increases retention in treatment or rates of completion, two important factors for successful SUD treatment.Trial registration The trial was registered and approved on 14 October 2011 by the Regional Committee for Medical and Health Research Ethics with registration number 2011/1642 and registered at ClinicalTrials.gov on 21 February 2013 with registration number NCT01795755

Interventions aimed at loneliness and fall prevention reduce frailty in elderly urban population.

Frailty is a pronounced symptom of aging associated with multiple comorbid states and adverse outcomes. The aim of this study was to evaluate the impact of 2 interventions, one based on prevention of falls and the other on prevention of loneliness, on total frailty and dimensions of frailty in urban community-dwelling elderly as well as associations with independent living.This prospective interventional study followed up 410 persons aged 75 to 95. The participants of the control and intervention groups were monitored through a public health intervention programme. The level of frailty was measured by the Tilburg Frailty Indicator (TFI) questionnaire and the factors of independent living were analyzed using validated questionnaires.After 1 year, physical frailty measured in the control group showed a statistically significant increase (r = −0.11), while in the intervention groups physical frailty did not increase (both P > .05). Psychological frailty measured after 1 year in the control group was significantly higher (r = −0.19), as well as in the group where the public health interventions to reduce loneliness were carried out (r = −0.19). Psychological frailty did not increase in the group in which public health interventions to prevent falls were carried out, and social frailty did not increase at all in the study period. The total level of frailty in the control group after 1 year was significantly increased (r = −0.19), while no increase was seen in the overall frailty in the intervention group. Multivariate analysis has shown that both interventions where independently associated with lower end frailty. Additionally, higher baseline frailty and visit to a physician in the last year were positively associated with higher end-study frailty level, while higher number of subjects in the household and higher total psychological quality of life (SF-12) were independently associated with lower end-study frailty. Only in the prevention of falls group there was no increase in restriction in the activities of daily living throughout study follow-up.Public health interventions to prevent falls and to prevent loneliness have a positive effect on the frailty and independent living of the elderly living in their own homes in an urban community.

A large calibrated database of hand movements and grasps kinematics

Modelling hand kinematics is a challenging problem, crucial for several domains including robotics, 3D modelling, rehabilitation medicine and neuroscience. Currently available datasets are few and limited in the number of subjects and movements. The objective of this work is to advance the modelling of hand kinematics by releasing and validating a large publicly available kinematic dataset of hand movements and grasp kinematics. The dataset is based on the harmonization and calibration of the kinematics data of three multimodal datasets previously released (Ninapro DB1, DB2 and DB5, that include electromyography, inertial and dynamic data). The novelty of the dataset is related to the high number of subjects (77) and movements (40 movements, each repeated several times) for which we release for the first time calibrated kinematic data, resulting in the largest available kinematic dataset. Differently from the previous datasets, the data are also calibrated to avoid sensor nonlinearities. The validation confirms that the data are not affected by experimental procedures and that they are similar to data acquired in real-life conditions.

Auricular Anthropometry in South Western Nigeria Populace: Age and Sex Disparity, a Tool for Identification and Auricular Reconstruction among Nigerian Blacks

INTRODUCTION: There are population variations among people from different regions around the world in terms of auricle dimensions. This means it is not suitable to use foreign standards of auricle dimensions as a guideline for Nigerians undergoing plastic pinna reconstruction. Knowledge about the normal human ear dimensions and morphological features of various populations can be helpful from the anthropological and forensic point of view to provide data procedures for the inclusion and exclusion of persons for identification on the basis of ear variations collected from criminals. METHODOLOGY: This was a cross-sectional study conducted among the populace of South-West, Nigeria between. Two hundred subjects (100 males and 100 females) between 10 and 50 years of age were selected for the study. They are divided into four age range groups in years. Group A (10-20), B (21-30), C (31-40) and D (41-50). The anthropometric parameters of the external ear were measured by the indirect method and variation according to age and sex were studied. These are the Total length of the ear (TLE), the Total width of the ear (TWE), Total lobular length (TLL) and Total lobular width (TLW). RESULTS: Our study showed the distribution of age and sex into four groups(A-B) with most of the males falling in B (N=32) while the females in group A (N=36). The age range for the subjects enrolled in the study was between 10 to 50 years. Group B has the highest number of subjects (N=64), while Group D had the least number of subjects (N=32) as well as the least number of male subjects (N=12). CONCLUSION: This study has shown a significant difference between auricular anthropometry in relation to age and sex of the subjects studied with men having relatively higher mean values than women.

Abstract 4163: Genomic variation in PDAC-predisposing genes identified using the MCW germline exome panel

Abstract Recent evidence suggests that genomic variations in cancer predisposition genes are found at higher prevalence in the general population. However, currently, only a handful of genomic variants in these genes are classified as pathogenic with certainty, leaving a significant number classified as variant of unknown significance (VUS) in terms of their potential pathogenicity. Addressing this problem is of significant relevance for improving cancer screening, genetic counseling, and in some cases therapy. Consequently, the GOAL of the current study was to evaluate genomic variations in pancreatic ductal adenocarcinoma (PDAC) predisposition genes from affected patients. We developed and validated the MCW PDAC Germline AmpliSeq Panel, which assessed variation in 53 cancer predisposition genes, including those from hereditary cancers, chronic pancreatitis, DNA damage repair and metabolism. The target DNA panel was amplified and a library was prepared according to the AmpliSeq for Illumina Custom Panel kit. Paired-end, 2x300bp read sequencing was performed at a depth of at least 500X using the MiSeq platform. Variant calling was performed with the Genome Analysis Toolkit (GATK) v3.7 Haplotype Caller. The protein coding effect of genomic variants was annotated using SNPEff and Ensembl canonical transcripts. We annotated variants with their population allele frequency from GnomAD, cancer incidence from COSMIC, and hereditary disease association from ClinVar and HGMD, using the BioR toolkit.A total of 5,658 variants were found in 545 patients representing 4,087 single-nucleotide variants (SNVs) and 1,146 insertion/deletion variants (indels). Among these variants, we found that 483 were seen previously in the COSMIC database, most of which were associated with ‘carcinoma’ primary histology. When considering all variants regardless of their impact, the genes with variants in the highest number of subjects was POLE, followed by APC, BARD1, BRCA2, ATM, and PMS2. APChad the highest number of coding variants across all samples, followed by PMS2, BRCA1, ATM, BRCA2, and BARD1. Lastly, 18 variants (0.31%) have been previously identified as pathogenic, likely pathogenic, or disease-causing variations for pancreatic cancer, while 231 (4.08%) represented VUS. In summary, ourfindings support the existence of wide genomic variation in PDAC-predisposition genes. Identified variants include some of uncertain significance, which warrant future functional studies to better understand their pathogenic potential. Combined, these results raise the possibility that some VUS may predispose to PDAC. Citation Format: Jenica Abrudan, Susan Tsai, Wendy Demos, Michael T. Zimmermann, Michael Tschannen, Jennifer Geurts, Angela Mathison, Gwen Lomberk, Douglas Evans, Raul Urrutia. Genomic variation in PDAC-predisposing genes identified using the MCW germline exome panel [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4163.

Evaluation of systemic absorption and bronchodilator effect of glycopyrronium bromide delivered by nebulizer or a dry powder inhaler in subjects with chronic obstructive pulmonary disease

BackgroundEffective bronchodilator therapy depends upon adequate drug deposition in the lung. COPD patients who are unable to administer medications efficiently with conventional inhalers may benefit from the use of a nebulizer device. The aim of this study was to evaluate the systemic bioavailability and bronchodilator response of glycopyrronium bromide (GLY) administered by a novel nebulizer (eFlow® closed system [CS] vibrating membrane nebulizer) or dry powder inhaler (DPI) in subjects with moderate-to-severe chronic obstructive pulmonary disease (COPD).MethodsIn this randomized, open-label, single-dose, five-way crossover study, subjects received a sequence of either 50 μg GLY delivered by eFlow CS nebulizer (GLY/eFlow) or 63 μg GLY delivered by DPI (GLY/DPI), with and without activated charcoal, followed by intravenous infusion of 50 μg GLY with a washout period of 7 days between doses. Endpoints included plasma pharmacokinetics, safety and efficacy.ResultsThe mean (± SD) baseline predicted forced expiratory volume in 1 s (FEV1) of the 30 subjects who completed the study was 51 ± 15%, with a FEV1/forced vital capacity ratio of 50 ± 11%. Without charcoal, the absolute systemic bioavailability of GLY/eFlow and GLY/DPI were approximately 15 and 22%, respectively. Changes from baseline in FEV1 at 60 min post-dose, without administration of charcoal, were 0.180 L and 0.220 L for GLY/eFlow and GLY/DPI, respectively; FEV1 improvements were similar when charcoal was administered (0.220 L for both GLY/eFlow and GLY/DPI). There were no significant differences in spirometry between the two devices. Fewer subjects administered GLY/eFlow reported adverse events (n = 15) than GLY/DPI (n = 18).ConclusionsAfter single doses, GLY/DPI delivered numerically higher peak and steady state levels of drug than did GLY/eFlow. Nebulized GLY produced similar bronchodilation but lower systemic levels of drug than GLY/DPI. Slightly higher number of subjects reported adverse events with GLY/DPI than with GLY/eFlow. Nebulized GLY may offer an effective alternative to patients with COPD not adequately treated with other devices.Trial registrationNCT02512302 (ClinicalTrials.gov). Registered 28 May 2015.

PB1952 ADDITIONAL CYTOGENETIC ABNORMALITIES IN RESOURCE CONSTRAINT COUNTRIES; AN ADDITIONAL BURDEN ON CHRONIC MYELOID LEUKEMIA PATIENTS?

Background:Chronic Myeloid Leukemia (CML) is a myeloproliferative neoplasm distinguished by the presence of philadelphia chromosome. Regardless of distinct cytogenetic and molecular features possessed by disease; the patients present diversely with respect to clinical presentation, treatment response and survival. In addition, the heterogeneous characteristics of CML are also evident at cytogenetic and molecular levels. Most CML patients harbor the classic Ph; however, 5% to 10% of patients have variant translocations in which at least a third chromosome is involved in the rearrangement addressed as additional cytogenetic abnormalities (ACA). Previous studies have reported a negative prognostic impact of these abnormalities on molecular/cytogenetic response and survival in patients but these findings are conflicting and ambiguous. The option to omit the cytogenetic assessment has been presented in 2013 ELN recommendation however they stated to perform cytogenetics until the achievement of complete cytogenetic and major molecular responses.Aims:The rationale of the study was to follow the patients identified with ACA at baseline before the initiation of therapy, assess their clinical outcome, response to treatment and observe if there is any difference in molecular response from the cohort not identified with ACAs at baseline.Methods:A case control study carried out at National Institute of Blood Diseases and Bone Marrow Transplant Karachi Pakistan from 2016 to 2018. Participants included 18 CML cases with additional cytogenetic abnormalities. For each case, 02 controls were taken. Controls were diagnosed CML patients without additional cytogenetic abnormalities. Response to treatment was assessed according to ELN recommendations 2013. The study was approved by institutional review board. Descriptive and inferential statistics including chi square and paired t test was applied by using SPSS version 23.0.Results:Fifty four participants were included in the study. Of these, 18 were diagnosed cases of CML having additional cytogenetic abnormalities, and 54 were taken as age, sex and sokal score matched controls CML patients without additional cytogenetic abnormalities. Post treatment response was assessed in cases and controls which revealed that both the groups had same response to treatment with respect to increment in Hemoglobin levels and normalization of TLC and platelet counts (P‐value &lt; 0.05.) Complete hematological response at 03 months was achieved by higher number of subjects in control group than cases (P‐value &lt; 0.05). Fifteen cases and 30 controls were evaluable for molecular response. Attainment of optimal response at 06 months was same in cases and controls (P‐value &gt;0.05) while at 12 months, those who had achieved optimal response were higher in numbers in controls than cases (P‐value &lt;0.05). Comparable percentage of participants in cases and controls sustained molecular response till their last follow up (P‐value &gt;0.05).Summary/Conclusion:Patients with additional cytogenetic abnormalities in our cohort showed similar hematological and molecular response as controls. In developing countries with limited resources, financial constraints and scarce medical facilities, omission of cytogenetic analysis at baseline when molecular level tests are available will create no difference in decisions to be taken in the management of CML patients. However, further perspective studies are needed in this regard.

The Impact of Backboard Placement on Chest Compression Quality: A Mannequin Study.

High-quality chest compressions (CCs) are associated with high survival rates and good neurological outcomes in cardiac arrest patients. The 2015 American Heart Association (AHA; Dallas, Texas USA) Guidelines for Resuscitation defined and recommended high-quality CCs during cardiopulmonary resuscitation (CPR). However, CPR providers struggle to achieve high-quality CCs. There is a debate about the use of backboards during CPR in literature. Some studies suggest backboards improve CC quality, whereas others suggest that backboards can cause delays. This is the first study to evaluate all three components of high-quality CCs: compression depth, recoil depth, and rate, at the same time with a high number of subjects. This study evaluated the impact of backboards on CC quality during CPR. The primary outcome was the difference in successful CC rates between two groups. This was a randomized, controlled, single-blinded study using a high-fidelity mannequin. The successful CC rates, means CC depths, recoil depths, and rates achieved by 6th-grade undergraduate medical students during two minutes of CPR were compared between two randomized groups: an experimental group (backboard present) and a control group (no backboard). Fifty-one of all 101 subjects (50.5%) were female, and the mean age was 23.9 (SD = 1.01) years. The number and the proportion of successful CCs were significantly higher in the experimental group (34; 66.7%) when compared to the control group (19; 38.0%; P = .0041). The difference in mean values of CC depth, recoil depth, and CC rate was significantly higher in the experiment group. The results suggest that using a backboard during CPR improves the quality of CCs in accordance with the 2015 AHA Guidelines.Sanri E, Karacabey S. The impact of backboard placement on chest compression quality: a mannequin study. Prehosp Disaster Med. 2019;34(2):182-187.

THE CORRELATION BETWEEN BACTERIAL COLONIZATION AND INTERLEUKIN-8 SERUM LEVELS IN ACUTE EXACERBATION OF COPD

Background: One of the causes of AECOPD is bacterial infection. Increased bacterial colonization may trigger activation of macrophages so that there is an increase in the number of inflammatory mediators, one of which is Interleukin-8 (IL-8). Elevation of IL-8 serum levels may worsen the symptoms of COPD. This study measured IL-8 serum levels in subjects who had exacerbations. Methods: An analytical research with Cross Sectional design. The reseacrh subjects were AECOPD patients who visited Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia. Sputum culture was examined to assess the type of bacterial colonization and serum examinated to asses the Interleukin-8 serum levels. Results: The subjects were 65 patients. AECOPD is generally found in 62 men (95.4%), most were age>60 years 48 patients (73.8%). For severity we found 52 patients were categorized as group D (80%). The highest number of subjects with bacterial colonization was 55 (84.65). From the subjects with bacterial colonization we found Gram negative 36 (55.4%). The most types of bacterials were Pseudomonas Aeroginosa with 16 patients (24.65) and Klebsiella Pneumonia in 12 patients (18.5%). Mean IL-8 serum levels 187.5±68.3. IL-8 serum levels were found highest in subjects who had bacterial colonization 9197.7 ± 68.5; p0.05). Discussion: In this research, there was a significant correlation between colonization of Gram-negative bacteria with high IL-8 serum levels. These results are consistent with several studies which report that bacterial colonization is associated with an increased IL-8 serum levels and correlates with deterioration in pulmonary function and severity of COPD.

Age estimation from third molar teeth in an urban population of North India

Identification of age reliably is one of the challenging arena and has multitude significance in civil and criminal issues. Among the many available ways dentition is most commonly used but most of the dentition is complete by early teens except for third molar. Clinically as well as radiologically third molar eruption can be used for estimation between middle teens and adults, third molar age estimation takes a significant role. In this study 280 students between 14–28 years of age from various academic institutions of Rohtak, Haryana were subjected to clinical and radiological examination to estimate dental age by stages of eruption clinically and Orthopantogram of third molar. Females were found to have higher number of unerupted third molar in comparison to males. Higher number of subjects had unerupted tooth in age less than 18 years. The mean age for partially erupted teeth for males and females lies in the range of 17.83–18.40 years and 16.9–18 years respectively and for completely erupted teeth was 21.07–21.87 years and 21.03–21.64 years for males and females respectively. Earliest mean age for eruption of third molar for males was 14 years while for females was 14.88 years. The study concluded earlier eruption of third molar in male to female and there was statistically significant positive linear relationship seen among the four quadrants and dental age.

English

Ultrasound scanning (USS) and high vaginal swab culture and urine microscopy culture and sensitivity (m/c/s) tests are the most common investigations used for the diagnosis of pelvic inflammatory disease (PID) in our locality. The aim of this study was to determine the diagnostic accuracy of ultrasound in the diagnosis of PID keeping laboratory high vaginal swab/urine microscopy, culture as gold standard. The USS, high vaginal swab and urine m/c/s reports of patients referred with PID conditions between January 2010 to April 2013 were obtained from the medical records departments of Nnamdi Azikiwe University teaching hospital, Nnewi, Anambra state. The diagnostic accuracy was determined by calculating sensitivity, specificity, positive predictive value and negative predictive value using performance characteristics test. Descriptive and inferential statistics were also used. Spearman rho’s non parametric analysis and statistical package for social sciences (SPSS) version 17.0 was equally used. The total number of subjects that were scanned for PID was 120. The highest number of subjects 80 (66.6%) was seen in 21 to 30 years age group. The sensitivity, specificity, accuracy, negative predictive value and positive predictive value of ultrasound in PID diagnosis was found to be 100, 65.3, 89.2, 100 and 86.3%, respectively. There was no significant correlation between USS diagnosis of PID and HVS/urine culture findings (p > 0.01). Ultrasound is valuable as the first line of investigation (screening tool) in the diagnosis of PID and should be used in conjunction with other medical investigations to facilitate accurate diagnosis of PID. Key words: Ultrasound, pelvic inflammatory disease, urine culture, high vaginal swab culture, diagnostic accuracy.

Assessment of Congenital Vascular and Organ Anomalies in Subjects With Thalidomide Embryopathy Using Non-Contrast Magnetic Resonance Angiography.

To determine the type and frequency of vascular and organ malformations in adults with thalidomide embryopathy (TE) using non-contrast magnetic resonance angiography (MRA) and to assess the effect of the observed malformations on renal function. Methods and Results: The institutional ethics committee approved this prospective study and written informed consent was given by all 78 subjects (50 females) with TE (mean age: 55±1.1 years), who were examined by non-contrast MRA at 3T. ECG-triggered balanced turbo field echo images of the chest, abdomen and pelvis were obtained in coronal and sagittal orientations. Two observers assessed the frequency of vascular and organ malformations. Serum creatinine and estimated glomerular filtration rate (eGFR) were obtained to assess renal function. In 58 subjects, 99 vascular anomalies were observed, including 68 arterial (69%) and 31 venous anomalies (31%); 15 patients had 16 abdominal organ malformations including 12 kidney anomalies and 4 cases of gallbladder agenesis. Most vascular anomalies affected the renal vessels (n=66, 67%) or supraaortic arteries (n=28, 28%). Serum creatinine and eGFR revealed normal renal function in all subjects. Vascular and organ anomalies occurred in a high number of subjects with TE without evidence of renal dysfunction. Information about the presence of malformations may be important for future surgical interventions in subjects with TE.

Influence of MBL2 and NOS3 polymorphisms on spontaneous preterm birth in North East Brazil: genetics and preterm birth

Background: The mannose-binding lectin (MBL2) and nitric oxide synthase 3 (NOS3) genes are associated with the immune response against inflammatory processes, have been reported as possibly related with premature birth. Until now, most of the researches regarding the genetic influence of prematurity have revealed limited results because only investigating the child or the mothers’ genotypes, thus not exploring the possible effects of interactions between these genotypes or the interactions with environmental factors related to the duration of pregnancy.Objective: We performed a replica study investigating the influence of single nucleotide polymorphisms (SNPs) in MBL2 and NOS3 genes on premature birth, also considering socioeconomic, demographic, and gestational factors.Materials and methods: We conducted a case–control study with 189 mother–infant dyads, with 104 spontaneous preterm births and 85 term births from Recife, Brazil. We used peripheral blood samples and umbilical cord samples to extract DNA. Functional SNPs at exon 1 and promoter region of MBL2 and NOS3 RS1799983 SNP were genotyped using direct sequencing and fluorescent allelic specific TaqMan® assays respectively. Data were analyzed using the Statistical Package for the Social Sciences (SPSS®) program with bivariate association and logistic multivariate regression tests.Results: We observed a prevalence of MBL2 wild-type genotype in the mother–infant dyad of the preterm group and polymorphic genotype in the mother–infant dyad of term birth. The haplotype LYA predominated in our sample, being more frequent in the preterm group, while the haplotype LYB, correlated with lower levels of MBL protein, was more frequent in the term birth group. About NOS3 RS1799983 SNP, the G/G genotype was more frequent throughout the sample. The heterozygous genotype predominated among women from the preterm group, showed a borderline difference between the groups. When MBL2 genotypes of the mother and son were analyzed together, codon 54 of MBL2 remained associated with prematurity. When the variables with p value lower than .20 in the bivariate analysis were analyzed by logistic regression, the low weight of the pregnant woman in relation to the gestational age, the occurrence of preterm premature rupture of membranes, urinary tract infection during birth and maternal history of other premature births were risk factors to prematurity. On the other hand, the presence of B allele at codon 54 of maternal MBL2 was a protective factor for the occurrence of spontaneous premature birth. In contrast, a borderline association was established between the maternal genetic variation within NOS3 gene and the outcome studied.Conclusions: Our study, limited by the small number of patients enrolled, indicates that MBL2 and NOS3 functional SNPs are associated with the occurrence of spontaneous prematurity and the regulation of the maternal inflammatory response. Despite these results are in agreement with previously reports, our findings do not replicate the ones reported in a large genome-wide association study performed on quite high number of subjects. Thus, we can conclude that MBL2 and NOS3 functional SNPs are plausible candidate risk factors just in few preterm birth cases, and consequently they cannot be included in the general diagnostic practice.

F152. N-ACETYL-CYSTEINE SUPPLEMENTATION IMPROVES FUNCTIONAL CONNECTIVITY IN THE CINGULATE CORTEX IN EARLY PSYCHOSIS

BackgroundIn schizophrenic patients, increasing evidence suggests that oxidative stress is involved on the disease pathophysiology. Estimation of the level of glutathione (GSH), main actor of the brain redox dysregulation, has revealed a decreased GSH levels in early psychosis patients (EPP). N-Acetyl-Cysteine (NAC) is an antioxidant and precursor of GSH, almost devoid of side effects. In chronic patients, add-on of NAC improved negative symptoms and reduced side effects of antipsychotics. In a recent double-blind randomized placebo-controlled trial, early psychosis patients received NAC supplementation. Whether NAC treatment leads to improvement in FC in EPP is unknown. Given the known connectivity disruptions in schizophrenia and given that GSH levels correlated with FC within the cingulate cortex, we investigate the effect of NAC supplementation during 6 months in EPP on cingulum cortex FC.Methods20 EPP which constitutes a subgroup of the double-blind randomized placebo-controlled trial by [7] were scanned. T1-weighted volumes (1 mm in-plane, 1.2 mm slice thickness, TR/TE/TI 2300/2.98/900ms) and resting-state fMRI (gradient-echo-EPI sequence, 3.3x3.3x3.3 mm3, TR/TE 1920/30ms) recording were acquired on a Siemens-3T scanner in EPP who received either NAC (n=9) or placebo (n=11) as add-on treatment at baseline (T1) and follow-up (T2) after 6 months. A control group (n=93) was scanned in the same conditions. Data were processed with CMTK using a 68 regions parcellation according to a state-of-the-art pipeline. Time series were averaged over the Freesurfer regions and Pearson’s correlation was used as FC measure. We investigated FC changes occurring in the cingular cortices between T1 and T2 for NAC and placebo EPP and between EPP and CTRL by looking at the FC strength of these regions. Moreover, we assessed global efficiency and edge betweenness centrality (BC) for the whole brain network.ResultsFC between caudal and isthmus cingulate cortices increases significantly after 6 months for patients who received NAC supplementation (p=0.01) but not for patients who received the placebo. FC of these regions was also higher in patients after 6 months of NAC supplementation (but not in placebo or baseline patients). Regarding the local network measures, BC differences are observed for the same regions. Indeed, edge BC increases between caudal and isthmus cingulate regions after NAC supplementation compared to placebo (p=0.015). At the nodal level, the increase of BC can be mainly ascribed to the isthmus cingulate cortex (p=0.01).DiscussionNAC supplementation has an impact on FC between caudal and isthmus cingulate regions in our dataset. NAC increases FC strength between these two regions. This strength is significantly higher than for matched control subjects. NAC has a stimulating effect on FC in regions along the cingulum bundle. This FC change could be partially explained by the changes in BC. The edge BC of the caudal and isthmus cingulate connection is increased for NAC subjects: a highest number of shortest paths go through this connection. It shows a growing importance of this edge in connecting the frontal and posterior regions of the brain network. A higher number of subjects would allow to confirming the robustness of these findings. This is a first study assessing the impact of NAC treatment on FC in a sample of EPP. After 6 months, NAC improves FC in caudal anterior and isthmus cingulate cortices. This FC increase is characterized by a higher BC in these brain areas, improving the connection between the frontal and posterior regions along the cingulum bundle. These results suggest that FC along the cingulum may be a biomarker for NAC treatment response.

Implications and challenges of the ACE trial

ACE is an important clinical trial. It attracted much attention in the field of diabetes and cardiology worldwide. Acarbose did not increase the number of cardiovascular events in ACE, which demonstrated it′s safety in pre-diabetes people who experienced a cardiovascular disease previously. But this agent also did not reduce the composite CVD endpoints, shedding a challenge to the notion that postprandial glucose rise is a specific risk factor to predict cardiovascular events. ACE trial successfully confirmed the effect of acarbose on the prevention of diabetes in subjects with impaired glucose tolerance, bnt to a less extent compared with the STOP-NIDDM trial. The higher number of subjects needed to be treated for the prevention of diabetes in ACE trial than that seen in other intervention trials should be taken into account in the decision making for using acarbose to prevent diabetes in a large scale population as far as the cost-effectiveness is concerned. (Chin J Endocrinol Metab, 2018, 34: 8-10) Key words: ACE trial; Acarbose; Diabetes mellitus; Cardiovascular disease