Probability Test Research Articles

Clinical characteristics of patients infected with Chlamydia pneumoniae in Beijing from 2015 to 2019

Objective: To aralyze the clinical characteristics of Chlamydia pneumoniae infection in Beijing. Methods: Based on Beijing Respiratory Pathogen Surveillance System, acute respiratory infection patients were recruited from 35 different types of sentinel hospitals in Beijing. Their epidemiological and clinical data were systematically collected and clinical specimens were also obtained. Nuclear acid testing was performed for 30 types of respiratory pathogens (including Chlamydia pneumoniae). The identified patients of Chlamydia pneumoniae infection were divided into two groups, the acute upper respiratory tract infection (AURI) group and pneumoniae group. The differences in clinical characteristics, laboratory examination and prognosis were compared by using independent sample t test, Mann-Whitney U test, χ2 test or Fisher's exact probability test. Results: A total of 119 patients of Chlamydia pneumoniae infection were included, including 12 patients in the AURI group and 107 patients in pneumoniae group. Chlamydia pneumoniae infection mainly occurred in people aged from 5 to 44 years, accounting for 81.5% (97/119). The three most common clinical symptoms were cough (92.4%, 110/119), fever (88.8%, 95/107), and sputum production (76.5%, 91/119). White blood cell counts increased in 39.3% (46/117) of patients. Neutrophile granulocyte proportion increased in 39.7% (46/116) of patients. Platelet count increased in 36.9% (41/111) of patients. An increase of the creatine kinase MB isoenzyme (CKMB) was observed in 12 pneumonia patients (24.5%, 12/49). Radiological examination showed that 90.6% (87/105) of patients in the pneumoniae group had pulmonary parenchymal changes; the lesion occurred most commonly in the lower right lung lobe (34.3%, 36/105) and the lower left lung lobe (27.6%, 29/105). Although 73.8% (79/107) of patients in the pneumoniae group were hospitalized, no case received intensive care unit or mechanical ventilation. As to outcomes, one patient developed respiratory failure and 6 patients suffered myocardial injury. No death was observed in this study. The median days of hospitalization and course of illness for pneumonia patients M(P25,P75) were 10.0 (7.0, 13.0) days and 18.0 (13.5, 22.0) days, respectively. Conclusion: Generally, Chlamydia pneumoniae infections in Beijing from 2015 to 2019 were mild, and the main clinical manifestations were cough, fever and sputum. However, most patients in the pneumoniae group caused by Chlamydia pneumoniae still required hospitalization but with a better outcome.

Comparison of the Views of the General Dental Practitioners and Dental Interns in Asir, Saudi Arabia on Antibiotic Prescription for Endodontic Therapy: A Cross-Sectional Study.

AimTo assess the views of the dental interns (DIs) and general dental practitioners (GDPs) in the Asir region of Saudi Arabia on antibiotic prescription for endodontic therapy.MethodsThe link to a cross-sectional online survey with 16 quantitative and qualitative questions was e-mailed to 60 DIs at the College of Dentistry of King Khalid University (group 1 [G1]) and 60 GDPs at the governmental primary healthcare centers in the Asir region of Saudi Arabia (group 2 [G2]). The data obtained from the survey were then subjected to a comparative statistical analysis. The inter-group statistical comparison of the distribution of categorical variables was tested using the chi square test or the Fisher’s exact probability test if more than 20% of the cells had an expected frequency of less than 5. The p-values > 0.05 were considered statistically significant. The data were statistically analyzed using Statistical Package for Social Sciences (SPSS version 22.0, IBM Corporation, USA) for MS Windows.ResultsThe response rate was 83.3% for G1 and 63.33% for G2. Of the participants in G2, 39.5% had 1–5 years’ clinical experience (the participants in G1 had no clinical experience). The number of endodontic emergency patients seen per day was significantly higher in G1 (88% and 63.2% of the participants in G1 and G2, respectively, were seeing 0–3 endodontic emergency patients per day). There was an insignificant difference between G1 and G2 in awareness of the existence of antibiotic prescription guidelines in endodontic therapy (57.9% and 56.0%, respectively; p > 0.05). There was also an insignificant difference between the groups in the rate of antibiotic prescription for endodontic problems, with 84% of the G1 participants and 86.8% of the G2 participants prescribing antibiotics only for limited patients. In the analysis of the clinical-vignette items (Q11–16), it was found that the rate of antibiotic prescription did not significantly differ between G1 and G2 (p > 0.05). No significant difference was found in the rate of antibiotic prescription for symptomatic reversible pulpitis, symptomatic irreversible pulpitis, and chronic apical periodontitis cases (p > 0.05). In contrast, the rate of antibiotic prescription for the symptomatic apical periodontitis, acute apical abscess, and systemic complications cases differed significantly (8% for G1 and 18.4% for G2, 54% for G1 and 76.3% for G2, and 98% for G1 and 73.7% for G2, respectively).ConclusionNo significant difference in the rate of antibiotic prescription was found between the DIs and GDPs in this study. However, both groups showed an inappropriate rate of antibiotic prescription for some endodontic conditions. Further and more extensive studies involving a wider geographical region and different colleges of dentistry in Saudi Arabia are recommended.

Personality traits and body image in adults with oral piercing: a questionnaire analysis.

Due to the growing popularity of body modifications, dental practitioners are increasingly confronted with oral piercing and its implications. Successful consultation and subsequent change of patient behavior require an understanding of the patient's personality and the deep reasons that explain this self-injurious behavior. This is the first study evaluating personality traits and aspects of body perception in a cohort of adults with oral piercing. Sixty-two individuals with labial and/or tongue piercing completed three validated questionnaires assessing body perception and personality traits (Questionnaire for assessing one's own body; Sensation Seeking Scale; Big Five Inventory Scale). Fisher Exact probability test and Mann-Whitney U test were used to determine differences in frequency data and in psychologic parameters between subgroups. Eighteen single- and 44 multiple-pierced individuals completed the study (53 women, 9 men). The odds for being multiple pierced was significantly higher for tongue than for labial piercing (3.89 and 0.63, respectively; P = .003). In all psychologic parameters measured, the sample showed score distributions within reference norms. However, multiple-pierced individuals displayed a significantly lesser feeling of attractiveness, less self-confidence, and more uncertainty/anxiety towards their body than single-pierced probands (P < .05). Psychologic characteristics of individuals with oral piercing do not fundamentally differ from those of the average population. Therefore, dental practitioners should focus on the medical and dental implications of oral piercing in the counseling of patients who have or intend to have such done.

Primary angiosarcoma of aorta: A systematic review

To elucidate the epidemiology, anatomical, presentation, classification, pathology, investigative modalities, management and prognosis of primary angiosarcoma of the aorta. A systematic review of literature from the database inception to January 2021 in PubMed and Embase, CINAHL and Cochrane Library in accordance to PRISMA was conducted. Retrieval and extraction was performed by two independent reviewers. The hierarchy of the evidence was assessed through the National Institute for Health and Care Excellence Checklist. Data were subjected to pooled prevalence analysis, Kaplan-Meier survival and test of probability using log-rank analysis. This review is registered with International Prospective Register of Systematic Reviews: RD42021231314. 82 studies with n = 123 cases met the inclusion criterion. Abdominal (45%) aorta was the commonest anatomical site with female predominance in ascending aorta (4:1) and aortic arch (2:1). The longest survival was in the ascending aorta and the shortest in the abdominal aorta [540 (interquartile range [IQR], 7-1560days vs. 180 (IQR, 1-5730days)], respectively. The overall median survival was 210 days (IQR, 1-5730days) or 7months. Lack of metastasis (47%) was a marker of longer survival (p < 0.03) irrespective of other attributes. The pathophysiology appears to be a trend of increasing fatigue, fever and weight loss associated with segmental dysfunction of the aorta projecting occlusive or destructive phenotypes. Computed tomography angiography features of volume-occupying, bulky, polypoid (intraluminal), protrusive vegetation, hyper vascular without atherosclerotic lesions are extremely suggestive of PA of the aorta at 5th and 6th decades of life.

Comparison of technical success and safety of transbronchial versus percutaneous CT-guided fiducial placement for SBRT of lung tumors

ObjectiveTo evaluate the technical success and safety of transbronchial (bronchoscopic) fiducial placement compared to percutaneous CT-guided fiducial placement for stereotactic body radiotherapy (SBRT) of lung tumors. Materials and methodsThis IRB-approved, HIPAA-compliant retrospective study was performed at a single tertiary institution. Consecutive patients undergoing lung fiducial placement for purposes of guiding SBRT (CyberKnife®, Accuray, Inc.) between September 2005 to January 2013 were included in the study. Fiducial seeds were placed percutaneously with CT guidance or transbronchially with bronchoscopic guidance. We compared procedure-related complications (pneumothorax, chest tube placement), technical success (defined as implantation enabling adequate treatment planning with CT simulation) and migration rate. The need for repeat procedures and their mode was noted. Statistical analysis was performed using Fisher exact and Chi square probability tests. ResultsTwo hundred and forty-four patients with lung tumors and 272 fiducial seed placements were included in the study. Two hundred and twenty-one of the 272 (81.2%) fiducial markers were placed percutaneously and 51/272 (18.8%) were placed transbronchially. Pneumothorax was seen in 73/221 (33%) of percutaneously-placed fiducials and in 4/51 (7.8%) of transbronchial placements (p<0.001). No significant difference was seen in the rate of chest tube placement between the two groups: 20/221 (9%) of percutaneously placed fiducials and 2/51 (3.9%) of transbronchially placed fiducials (p=0.39). Fifteen of the 51 (29%) of fiducial placements with transbronchial approach were unsuccessful, as discovered at radiotherapy planning session, and required a repeat procedure. Nine of the 15 (60%) of repeat procedures were performed percutaneously, 5/15 (33%) were placed during repeat bronchoscopy, and 1/15 (7%) was placed at transesophageal endoscopic ultrasound. No repeat fiducial placements were required for patients who had the fiducials placed percutaneously (p<0.001), with a technical success rate of 100%. ConclusionTransbronchial fiducial marker placement has a significantly higher rate of failed seed placements requiring repeat procedures in comparison to percutaneous placement. Complication rate of pneumothorax requiring chest drain placement is similar between the two approaches.

Genetic etiology of newborn deaths

Objective: To explore the genetic etiologies of newborn deaths. Methods: A total of 98 newborns who were recruited to the Neonatal Genome Project of the Children's Hospital of Fudan University and died in the hospital from January 2018 to August 2020 were enrolled in this study. The genetic information and the interventions based on the genetic findings were retrospectively analyzed. T-test, Mann-Whitney U test, Chi square test and Fisher's exact probability test were used to compare the demographic features and clinical characteristics between the patients with or without a genetic finding. Results: Among 98 newborns (55 males and 43 females), there were 63 preterm and 35 term infants, with a gestational age of (33±5) weeks, a birth weight of (2 107±975) g and the age at death of 12 (2,34) days. Sixteen (16%)patients were identified with genetic variants, including 11 with single nucleotide variants, 4 with copy number variants and 1 with both single nucleotide variant and copy number variant. The detected single nucleotide variants were spanning 12 genes, among which 3 were multiple disorders-related, 2 metabolic disorder-related, 2 hematological disorder-related, 2 respiratory disorder-related, 2 cardiovascular disorder-related and 1 skeletal disorder-related. The patients with a positive genetic finding had significant differences in the birth weight ((2 605±940) vs. (2 009±957) g, t=2.283, P=0.025), the gestational age ((36±5) vs. (33±5) weeks, t=2.131, P=0.036), the age at death ((37 (5, 69) vs. 11 (2, 29) days, Ζ=-2.245, P=0.025) and the history of asphyxia at birth (1/16 vs. 46% (38/82), P=0.002)when compared to those without a genetic finding. In addition, the genetic etiology rates of patients who were born term or with a birth weight ≥ 2 000 g were significantly higher than those who were born preterm (29% (10/35) vs. 10% (6/63), P=0.022) or with a birth weight<2 000 g (25% (13/51) vs. 7% (3/46), χ2=5.016,P=0.025), respectively. Six cases were medically actionable based on the genetic findings and the treatments included special diet, applying specific medicine, hematopoietic stem cell transplantation and lung transplantation. Conclusions: Genetic etiologies are not rare in newborn deaths and mainly associated with metabolic disorder, multi-system disorders, hematological disorder, respiratory disorder, cardiovascular disorder and skeletal disorder. Some findings are medically actionable, based on which the specific treatments could be scheduled timely. A genetic etiology should be investigated in newborn deaths especially in those who are term birth or with a birth weight ≥2 000 g or without a history of asphyxia at birth.

Clinical characteristics and risk factors of deaths in patients with Wiskott-Aldrich syndrome

Objective: To explore the clinical characteristics and risk factors of pediatric patients with Wiskott-Aldrich syndrome (WAS). Methods: This was a case-control study. Clinical data of 165 cases of pediatric patients with WAS, who visited the Department of Rheumatology, Children's Hospital of Chongqing Medical University between January 2007 and August 2020 were retrospectively analyzed and divided into death group and survival group (control group) according to the prognosis in the follow-up. Two independent samples t-test, Welch approximate t-test, Mann-Whitney U test, Pearson χ² test, Yates corrected χ² test, or Fisher exact probability test were used for comparison between groups. Risk factors were analyzed by multivariate Logistic regression analysis. Results: A total of 165 patients with Wiskott-Aldrich syndrome were enrolled in this study, including 40 cases in the death group and 125 cases in the survival group. The WAS score was (4.1±0.8) score in the death group and (3.1±1.2) score in the survival group. The age was 19 (9, 28) months in the death group and 60 (36,86) in the survival group. The episode rates of recurrent infection and (or) severe infection, intracranial hemorrhage and eczema in the death group were significantly higher than those in the survival group (95.0% (38/40) vs.32.0% (40/125),25.0% (10/40) vs. 2.4% (3/125), 90.0% (36/40) vs. 72.0% (90/125), χ²=48.253, 18.325, 5.440, all P<0.05). Infection (22 cases, 55.0%) and intracerebral hemorrhage (15 cases, 37.5%) were the main causes of death, 3 cases (7.5%) died of severe graft-versus-host disease after transplantation. The Logistic regression model indicated that repeated infection and (or) severe infection and non-use of intravenous immunoglobulin (IVIG) replacement therapy were risk factors for death in Chinese WAS patients (OR values were 8.999 and 2.860, 95% CI were (2.041-39.667) and (1.375-5.950), respectively, all P<0.05). Conclusions: Recurrent and (or) severe infection is the main risk factor of death for WAS patietns. Regular IVIG treatment can improve the survival rate of patients with WAS.

Warranty Claim Quantity Forecasting via Multiple Linear Regressions

A concrete justification unavailability of the roughly estimated warranty claim quantity is leading to also inability to understand defect trend behavior and its effect upcoming warranty claim quantity. This is where an equation model is derived by considering the previous actual warranty data, to represent warranty claim defect quantity impact. Taking into consideration, identified parameters which link with pricing and cost, it also includes the observation and monitoring of warranty trend from the existing actual warranty data, by plotting cumulative defect quantity over Vehicle Line-off Date, as well as plotting cumulative defect quantity over Vehicle Submission Date. Multiple Linear Regression is deployed to define the best Multiple Regression Equation. Predictors, response and predictors’ validations defined by using normality and probability test. The successfully developed equation model, takes into account the existing warranty data and trend, As a result, the equation model managed to provide forecasted warranty claim quantity, based on a complete 36-month warranty period cycle, which has a significant impact on a reliable and convincing figure – a key factor in warranty budgeting and accrual task.

Gene polymorphism association studies in cluster headache: A field synopsis and systematic meta‐analyses

A plethora of studies have attempted to identify genetic determinants of disease susceptibility and treatment response of patients with cluster headache (CH), but results are often conflicting, and no comprehensive overview with a quantitative summary of the evidence in this field is available. A systematic search of relevant publications was performed without any language restrictions on PubMed, Web of Knowledge, Cochrane Library, and OpenGrey, up to December 2020. A standardized data extraction form was used to collect relevant data from each included study. Meta-analyses were conducted for gene polymorphisms investigated in at least two studies and the Bayesian false discovery probability (BFDP) test was applied to the pooled odds ratios (ORs) to assess the credibility of the observed associations. Among the 27 articles identified by the systematic review, 17studies evaluating 12single nucleotide polymorphisms (SNPs) were included in the quantitative data analysis. The pooled results showed no significant association with CH risk of 10 SNPs, including five SNPs of HCRTR2 (rs2653349, rs2653342, rs3122156, rs10498801, and rs3800539), two SNPs of ADH4 (rs1800759 and rs1126671), CLOCK rs1801260, and two SNPs (rs1006417 and ADCYAP1R1 rs12668955) previously identified by a genome-wide association study (GWAS). Conversely, the pooled results revealed the association of the HCRTR2 rs9357855 A allele with a higher risk of CH (A vs. G, OR: 1.33, 95% CI: 1.04-1.72, p=0.026), and of GNB3 rs5443 with a higher response rate of patients with CH to triptan drugs (CT+TT vs. CC, OR: 1.96, 95% CI: 1.04-3.72, p=0.038). However, assuming a prior probability of 0.001, the respective BFDP values being higher than 0.8 (BFDPrs9357855 =0.998; BFDPrs5443 =0.998) revealed lack of noteworthy results. Well-designed GWASs and large replication studies are still needed to identify reliable genetic variants of disease susceptibility and treatment response of patients with CH.

The Effect of one Year of Inactivity Caused by Covid-19 on the Motor Function of the Elderly Living in Care Centers

Background and Aims Although the outbreak of coronavirus has caused problems in all aspects of human life. Still, this disease has caused severe damage to the health of the elderly community and the level of physical activity and free movement of the elderly. This study aimed to investigate the effect of one year of coronavirus limitation on the motor function of the elderly living in care centers. Methods The present study was a cohort study that was conducted in the field. The statistical population of this study was male and female elderly over 60 years of age from two nursing homes in Rash City. Berg functional balance tests evaluated the motor function of the elderly, Timed Up and Go (TUG) Test or fall probability test and walking speed test or 10-meter walk test. Shapiro-Wilk test was used to check the normality of the data, descriptive statistics were used to determine the mean and standard deviation, and paired t-test and McNemar was used to analyze the data and examine the intra-group differences between the data in SPSS software version 26. Results The results of the correlated t-test showed that the time up and go test in the elderly under the influence of one year of movement limitation in the post-coronary period had a significant increase (p=0.001), also in functional balance index (p=0.03) significant changes according to For a year, the elderly had limited mobility. There was a significant decrease in the walking variable (p=0.001) following this period. It also showed a significant increase in the probability of falling index (p=0.021). Conclusion According to the findings of the present study, elderly cares centers and families with the elderly should pay close attention to the need for a level of physical activity and exercise in this critical period of coronation for these people and in addition to planning to increase the level of physical activity These people, they are encouraged to participate in physical activity.

Evidence-Based Diagnosis of Venous Thromboembolism: A Systematic Review

Introduction: Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common, potentially lethal condition with acute morbidity. The purpose of this systematic review is to evaluate the literature for the evidence supporting the use of algorithms for the diagnosis of DVT and PE with a goal of a) ensuring the evidence is robust, b) determining if diagnostic approaches that don't use algorithms are acceptable, and c) identifying knowledge gaps that require further research.Methods: this systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search of PubMed, EMBASE and MEDLINE (1990-May 2017) was conducted. The search was restricted to English-language only. The full text of all abstracts that met the basic eligibility criteria were assessed for inclusion or exclusion by two investigators independently. Disagreements were resolved by consensus.The key inclusion criteria were that the study was a high quality randomized clinical trial (RCT), meta-analysis, systematic review or prospective cohort study. The target outcomes of interest were the overall quality of development of the algorithms for the diagnosis of DVT and PE, the strength of evidence supporting their use, an assessment of the supporting evidence for diagnostic approaches that don't use algorithms, and the strengths and limitations of the body of evidence. The Scottish Intercollegiate Guidelines Network and the Consolidated Standards of Reporting Trials checklists were used to assess the quality of included RCTs and prospective studies. Assessing the Methodological Quality of Systematic Reviews tool was used to rate the quality of meta-analyses or systematic reviews. Low quality studies were excluded.Results: Twenty-six meta-analyses or systematic reviews, 8 RCTs and 24 well-performed prospective studies informed our review. The approach to the diagnosis of VTE has evolved over the years. There is considerable high quality evidence that an algorithmic approach, which uses a combination of pretest clinical probability and D-dimer testing followed by accurate imaging tests in selected patients, will enable the safest and most cost-effective diagnostic approach in outpatients with suspected VTE. However, these algorithms have not been extensively studied in hospitalized patients, although a few moderate quality studies have shown that imaging without the use of probability and D-dimer could be appropriate in the hospitalized population until further research is available. Imaging tests alone are reasonably accurate but their use without consideration of pretest probability and D-dimer results in over testing with the associated costs and risks. Many other imaging techniques, such as magnetic resonance imaging and single-photon emission computed tomography, have been studied in the diagnosis of PE, however, studies assessing their accuracy and direct comparisons to computed tomography pulmonary angiogram (CTPA) are limited. The widespread availability of CTPA and ultrasound, coupled with the potentially fatal nature of VTE, has resulted in a dramatic increase in the number of patients tested for PE and DVT, resulting in lower rates of positive tests but without a reduction in mortality rates. This increased use of diagnostic imaging could be avoided as many good quality studies have proven that algorithm-based strategies allow for rapid and safe exclusion of DVT or PE, often without diagnostic imaging. For suspected recurrent DVT, ultrasound can result in a false positive test, especially in the setting of prior DVT. The best criteria for diagnosing DVT in patients with prior DVT in the symptomatic leg are not established yet. Since ultrasound abnormalities may persist indefinitely with DVT, the criterion of vein compressibility may not distinguish patients with acute recurrent DVT from patients with chronic findings.Conclusion: The use of clinical decision rules in combination with D-dimer has standardized the diagnostic approaches for VTE. Currently, in most cases, the use of algorithmic strategies is supported by strong evidence as they allow for safe, convenient and cost-effective investigation of outpatients. However, the algorithmic strategies are less useful in hospitalized patients. Further research is also desperately needed in patients with suspected upper extremity DVT and pregnant patients. DisclosuresWells:Bayer Healthcare: Other: Speaker Fees, Ad Board Meeting, Research Funding; Itreas: Other: Writing Committee; Janssen Scientific Affairs, LLC: Consultancy; BMS: Other: Grant Support; Pfizer: Other: Grant Support; Daiichi Sankyo: Other: Speaker Fees.

Prevalence of Bone Marrow Fibrosis in 47 Cases of Autoimmune Hemolytic Anemia Patients: Clinical and Biologic Relationships

AIHA is an uncommon and heterogeneous disease caused by autoantibodies directed against erythrocytes and classified as warm (direct antiglobulin test DAT typically positive with anti-IgG antisera and seldom with anti C3d), cold (CAD, usually IgM driven with DAT positive for C3d), mixed (DAT positive for both IgG and high titer C3d), and atypical (DAT negative and IgA driven) forms. The disease is generally benign, but some cases show refractoriness to/relapse after first and further therapy lines, with a correlation with low Hb and inadequate bone marrow compensatory response at onset. Here we aimed to evaluate bone marrow histology (BMH) in 47 primary AIHA patients followed at our Institution, focusing on fibrosis, cellularity, dyserytrhopoiesis, and lymphocyte infiltrate, and their relationship with clinical, laboratory and immunological parameters, collected at enrolment (from January 2017), along with informed consent. BMH samples were revised by an expert hemopathologist and fibrosis graded (MF0 to MF3) according WHO 2016. The number of therapy lines (steroids, immunesuppressors, rituximab, splenectomy) were retrospectively collected. Serum levels of TGF-beta, IL-6, IL-10, IL-17, TNF-alpha, and IFN-gamma were evaluated in patients and in 40 age and sex matched healthy controls, using ELISA kits. Statistical analysis was performed using Student' t test for continuous variables and chi-square or Fischer exact probability test for categorical ones. Figure 1 shows main data of patients (14 males and 33 females; mean age 57 years; 26 CAD, 4 warm, 7 warm with C3d+, 5 mixed, and 5 atypical AIHA), divided according to bone marrow fibrosis (BMF) grade: BMF MF1 was observed in 36% of cases with no relationship with AIHA type, nor with mean Hb values, LDH levels, and the presence of splenomegaly; reticulocyte counts were higher in MF1 cases (p=0.02), although the incidence of inadequate reticulocytosis was comparable in the two groups (82% vs 93%). MF1 cases showed significantly increased cellularity (p=0.005) and dyserythropoiesis (p=0.04), without differences in lymphocyte infiltrate. Concerning cytokine levels, MF1 patients showed increased TGF-beta serum levels and reduced IL-6 (p=0.033), IL-10, IL-17, TNF-alpha, and IFN-gamma compared with MF0 cases. As regards treatment, no differences were observed among MF0 and MF1 cases considering the frequency of steroid and rituximab administration and their efficacy. Splenectomy was performed in 3 cases, all MF0, with 100% response, and cytotoxic immunesuppressors were given to both MF0 and MF1 with a response in the former patients only (67% vs 0%). Of note, MF1 cases more frequently required 2nd or further therapy lines (70 vs 53%), and displayed AIHA related complications (infections, acute renal failure and concomitant thrombocytopenia); at variance the occurrence of thrombosis was more common in MF0 cases.This is the first observation of BMF MF1 in more than 1/3 of AIHA cases. Although the number of patients is limited and the results preliminary, our data suggest that this subgroup is characterized by a hypercellular dyserythropoietic bone marrow and a higher rate of relapse and treatment requirement. Consistently, in MF1 cases, TFG-beta was the only cytokine increased among those tested. These chronic refractory cases may show clinical/pathologic features similar to low-risk myelodysplastic syndromes and recently described idiopathic cytopenia/dysplasia of unknown significance. On the other hand, MF0 AIHA patients seemed to present with a more florid hemolytic disease characterized by increased immune activation and cytokine release, more frequent thrombotic events, and a better response to immunesuppression.Figure1. Clinical and laboratory features of AIHA patients divided according to bone marrow fibrosis grade. Upper panel consists of a table showing clinical and laboratory parameters at diagnosis, therapy lines and complications. Lower panel consists of a graph showing cytokine levels in patients with or without bone marrow fibrosis. Data are given as median (range), if not better specified. TGF-β transforming growth factor beta; IL interleukin; TNF-α tumor necrosis factor alpha; IFN-γ interferon gamma. [Display omitted] DisclosuresBarcellini:Alexion: Honoraria; Agios: Honoraria, Research Funding; Novartis: Honoraria.

Evolution of Monoclonal Gammopathy of Undetermined Significance in Kidney Transplant Recipients at the CHUM (Centre Hospitalier de l'Université de Montréal) — a Single-Institution Retrospective Study

IntroductionRecommendations guiding the care of patients with monoclonal gammopathy of undetermined significance (MGUS) in the setting of kidney transplant are scarce. Nevertheless, monoclonal gammopathies carry a risk of neoplastic progression to hematologic malignancies and may induce renal injury from their deposition in the kidney (monoclonal gammopathy of renal significance - MGRS). However, it remains largely uncertain if these considerations translate into adverse outcomes in the setting of transplantation, as immunosuppression might favor malignant evolution of MGUS or, alternatively, a nephrotoxic paraprotein could lead to graft loss.MethodsWe conducted a retrospective review of the medical records of patients who received a kidney transplant at our institution between Jan 1, 2000 and Jan 1, 2016. We included patients with at least one available serum protein electrophoresis at any time before or after transplantation. Exclusion criteria consisted of age < 18 years at the time of transplant, no follow-up at our center, multiorgan transplant (liver, lung, pancreas, heart), as well as first transplant prior to study period or presence of any plasma cell malignancy before transplant. Outcomes of interest included paraprotein evolution, appearance of hematologic malignancy, graft rejection and loss. Chi-square tests and Fischer's exact probability test for categorical data and Student's t test for continuous variables were used to assess statistical significance.ResultsOut of 1009 eligible transplant recipients, 755 patients were included in our study based on our inclusion and exclusion criteria. Thirteen patients were found to have MGUS prior to transplant and a monoclonal gammopathy appeared in 43 patients after transplant corresponding to a 5-year incidence rate of 2.7%. Median patient follow-up was 7.5 years. Of the patients with MGUS prior to transplant, 2 developed light chain deposition disease (LCDD) after a follow-up of 1 and 2 years and 2 evolved to smoldering multiple myeloma (SMM) at 1 month and 4 years post-transplant. Of the 43 patients who developed MGUS after transplant, 1 transformed into multiple myeloma (MM) 8 years later and 1 progressed to LCDD 2 months after transplant. None of the 6 patients who evolved to malignancy after transplantation had a systematic hematologic workup prior to allograft implantation questioning whether SMM or MGRS may have already been present before transplant. Figure 1 summarizes the evolution of monoclonal gammopathies in our study population. Of monoclonal gammopathies appearing after transplantation, most remained stable (n=26, 60%) and 9 (21%) were found to be transient. Median size was 0.76 g/L (range 0.1 - 21.6 g/L). Twenty-two (74%) were of IgG isotype and an abnormal kappa/lambda ratio was present in 6 cases (14%). We conducted a univariate analysis to compare allograft outcomes between patients who developed post-transplant MGUS (n=43) and patients who did not (n=699). No differences in induction immunosuppression, occurrence of graft loss (18% and 11%, p=0.14) and acute rejection rates (26% and 27%, p=0.866) were observed between these two groups, respectively. However, the former were found to have an increased risk of CMV (26% and 12%, p=0.01) and polyoma BK virus (26% and 14%, p=0.04). Of note, 7 cases of post-transplant lymphoproliferative disorder (PTLD) were identified in our study population and none was preceded by MGUS.ConclusionOur study suggests a reassuring evolution of true MGUS in the setting of renal transplantation. Indeed, the cases of plasma cell malignancies diagnosed in transplant recipients may have already been present before transplant, yet undetected from lack of systematic investigation. We therefore highlight the importance of identifying and diligently investigating monoclonal immunoglobulins in transplant candidates. If a paraprotein is found before transplant, further investigations with bone marrow biopsy and review of native kidney biopsy appear warranted in order to identify cases of plasma cell dyscrasias (such as SMM) and MGRS prior to transplant. Additionally, MGUS arising after transplant appear to carry a favorable evolution. They also tend to be transient and their appearance may be related to prior CMV and BK virus infections. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Challenges in the diagnostic approach of suspected pulmonary embolism in COVID-19 patients

ABSTRACT Accumulating studies on COVID-19 patients report high incidences of thrombotic complications, but guidance on the best diagnostic approach for suspected pulmonary embolism (PE) in COVID-19 patients is lacking. Diagnosing PE in these patients is challenging as signs and symptoms of PE and COVID-19 show wide overlap, D-dimer levels are often elevated in the absence of thrombosis and computed tomography pulmonary angiography (CTPA) may be unfeasible in the case of severe renal impairment and/or hemodynamic instability. This narrative review discusses available literature and guidelines on current diagnostic algorithms for suspected PE in special patient populations, in particular COVID-19. A special focus is on reviewing the literature aimed at identifying symptoms with a high suspicion for PE and on the diagnostic performance of diagnostic algorithms for suspected PE in the setting of COVID-19. Based on available literature, the index of suspicion for PE should be high in the case of unexplained abrupt worsening of respiratory status, typical symptoms of deep-vein thrombosis and/or acute unexplained right ventricular dysfunction. Despite the lack of prospective diagnostic management studies, we propose to adhere to current diagnostic algorithms applying assessment of pretest probability and D-dimer testing as available evidence suggests that these might be considered safe. Preferably, algorithms using adjusted D-dimer thresholds are recommended as it likely improves the yield of the clinical decision rule/D-dimer combination.

ANALISIS PENGARUH CR DAN ROE TERHADAP PER PADA PT. INDOFOOD SUKSES MAKMUR TBK TAHUN 2011-2018

PER is an important ratio in analyzing stocks, research was conducted at PT. Indofood Sukses Makmur Tbk by using two ratios as analysis tools, namely CR and ROE. The author chooses to conduct research at PT. Indofood Sukses Makmur Tbk because it is the largest consumer food company compared to its peers in Indonesia. This research was conducted to see the effect of CR and ROE simultaneously, partially and dominantly on PER using quantitative descriptive methods. The results showed that the data used were normal using the normal probability test plot. If using multiple linear regression test, the CR has a unidirectional relationship, while the ROE is not in the same direction as the PER. The results of hypothesis testing using the F test and t test. The F test states that the CR and ROE have a simultaneous effect and the t test partially affects the PER. To see how much influence the independent variable has on the dependent variable, a determination coefficient test is carried out with the result that the independent variable is quite influential on the dependent variable by 79.5%, and finally the dominant test with the results of ROE which has the most influence on the PER

Meta-analysis of the Major Clinical Results of the Treatment with 1-Point Fixation in Fractures in the Zygomatic-Maxillary Complex: Success Rate and Complications.

Fractures of the zygomatic-maxillary complex (ZMC) are common facial fractures. After adequate fracture reduction, it is important to maintain stability and rigid fixation to avoid functional impairment and aesthetic sequelae. In this sense, the fixation of just one point can provide sufficient stability of the ZMC fracture when the ZMC fracture is not crushed. To analyze the success rates of fracture stability of the ZMC, incidences of complications, and aesthetic satisfaction after 1-point fixation. This study followed the rules of PRISMA, with publications from 2010 to 2020. The chi-square test and the Poisson probability test were performed to the occurrence of complications Low = 1, Moderate = 2, and NO = 0, adopting the α-level less than 0.05 with a statistical difference for 95% CI. The R-sq (R 2) value was also analyzed among the complications variables. The results of these studies showed in a general way that the use of 1-point fixation with open reduction presented good results in the short, medium, and long term, showing fracture stability. Complication rates were low and patients' satisfaction with aesthetics was considerable. The success rate of the 1-point fixation procedure for the zygomatic-maxillary complex is high, with minimal complications.

Optimal Time Period of Wearing Protective Collar after Anterior Cervical Discectomy and Fusion

Objective: There is still no consensus on the time period of wearing protective collar after Anterior Cervical Discectomy and Fusion (ACDF). We aim to investigate the optimal time period of wearing collar after ACDF. Methods: We retrospectively reviewed patients with cervical spondylosis who underwent one or two segment ACDF during January 2016 and December 2017, and included 97 patients who met inclusion and exclusion criteria. Patients were divided into three groups, 1-4 week group, 5-8 week group and 9-12 week group, according to the actual time period of wearing collar after ACDF. We analyzed Japanese Orthopedic Association (JOA) score, Axial Symptom (AS) score and Neck Disability Index (NDI) before surgery and at post-operative 3 months to investigate the optimal time period of wearing collar after ACDF procedure. Results: 1) JOA score: All three groups have a better post-operative JOA score compared with that before surgery (paired t test, p&lt;0.05). There is no significant difference among the three groups with respect to post-operative JOA (ANOVA, p&gt;0.05). 2) AS score: The post-operative AS scores of 1-4 week group and 5-8 week group were significantly better than that before surgery (paired t test, p&gt;0.05). While the post-operative AS score of 9-12 week group was significantly worse than preoperative AS score (paired t test, p&lt;0.05). 3) NDI: All three groups have a better post-operative NDI compared with that before surgery (McNemar test, p&lt;0.05). Of note, in 5-8 weeks group, the percentage of no deficit increased by 45%, and the percentage of mild deficit decreased by 45% accordingly. That percentage is 26% and 31% in 1-4 week group and 9-12 week group, respectively. There was significant difference among these three groups (Fisher’s exact probability test, p&lt;0.05). Conclusion: For cervical spondylosis patients who underwent 1 or 2 segment ACDF, the optimal time period of wearing protective is 5-8 weeks. This time period results in comparable neurological outcome, least risk of axial symptoms, and highest chance of no deficit with neck function.

Analysis of pathogen distribution and drug resistance of acute,delayed and chronic periprosthetic joint infection

Objective: To analyze the pathogen distribution and drug resistance in acute,delayed and chronic periprosthetic joint infection (PJI). Methods: The clinical data of 316 patients with periprosthetic infection after primary hip and knee arthroplasty admitted to the Department of Arthroplasty,the First Affiliated Hospital,Xinjiang Medical University from August 2010 to August 2020 were retrospectively analyzed.There were 146 males and 170 females,aged (62.3±14.2) years (range:22 to 89 years).One hundred and sixty one patients underwent total hip arthroplasty and 155 patients underwent total knee arthroplasty.According to the time of postoperative infection,the patients were divided into acute PJI group (65 cases),delayed PJI group (83 cases) and chronic PJI group (168 cases).The results of pathogen species,composition ratio and drug susceptibility tests were collected,and the independent sample t test,Chi-square test or Fisher's exact probability test were used for comparison. Results: Gram-positive bacteria were the main pathogens of PJI (49.7%,157/316),and the positive rates of culture in patients with acute PJI,delayed PJI and chronic PJI were 33.8% (22/65),55.4% (46/83) and 53.0% (89/168),and the difference was statistically significant(χ²=8.343,P=0.015).The common bacteria were coagulase-negative Staphylococcus (54.8%,86/157) and Staphylococcus aureus (30.6%,48/157),The drug-sensitivity to linezolid,vancomycin and tigacycline was 100%.The gram-negative bacteria were mainly Escherichia coli and Enterobacter cloacae,and the drug resistance rate to carbapenems was low,ranging from 0 to 9.09%.The drug resistance rates of acute PJI patients to rifampicin,ciprofloxacin and erythromycin were significantly higher than those of late onset and chronic PJI patients,the difference was statistically significant(rifampicin:χ²=14.332,P=0.001;ciprofloxacin:χ²=12.086,P=0.002;erythromycin:χ²=9.096,P=0.010);The drug resistance rate of acute PJI patients to levofloxacin,clindamycin and tetracycline was higher than that of chronic PJI patients,and the difference was statistically significant(levofloxacin:χ²=10.500,P=0.002; clindamycin: χ²=7.103,P=0.007; tetracycline: χ²=6.909,P =0.012).The resistance rate of ampicillin/sulbactam in acute PJI (60.0%) was significantly higher than that in chronic PJI (16.7%),and the difference was statistically significant(χ²= 5.853,P=0.040). Conclusion: Gram-positive bacteria are the main pathogens of PJI,and the resistance rate of pathogens of acute PJI is higher than that of late onset and chronic PJI.

Phase II trial of docetaxel and ramucirumab combination therapy as second-line treatment in patients with metastatic or advanced gastric cancer (HGCSG1903).

TPS4152 Background: Paclitaxel and ramucirumab combination therapy had become a standard regimen in the second-line treatment of advanced gastric cancer, since RAINBOW trial showed paclitaxel and ramucirumab combination therapy increased overall survival compared with paclitaxel monotherapy. However, the incidence of neuropathy in paclitaxel and ramucirumab combination therapy has been reported 70.6% and 38.3% in Japanese and western patients, and the toxicity sometimes disturbs treatment continuation. Whereas docetaxel monotherapy used to be one of standard second-line treatment of advanced gastric cancer as well as paclitaxel monotherapy because the phase III trial, COUGAR-2 showed clinical benefit of docetaxel monotherapy. In addition, the combination therapy of docetaxel and ramucirumab was reported to cause neuropathy at an incidence of 21.3% in patients with lung cancer. Based on these results, we hypothesized that the combination therapy of docetaxel and ramucirumab for patients with gastric cancer could be as effective as the paclitaxel and ramucirumab combination therapy and could reduce the incidence of neuropathy. Therefore, we planned to develop new combination chemotherapy with docetaxel and ramucirumab for advanced gastric cancer. Methods: To evaluate efficacy and safety of docetaxel and ramucirumab combination therapy, HGCSG1903 study started as a multicenter, non-randomized, single arm, prospective, phase II study in November 2020. The patients with metastatic gastric adenocarcinoma that were refractory or intolerant to initial chemotherapy are eligible. Docetaxel and ramucirumab combination therapy is administered as follows; an intravenous infusion of docetaxel at 60 mg/m2 on day 1, an intravenous infusion of ramucirumab at 8 mg/kg on day 1 and day 15 of each 4-week cycle is performed. The therapy is repeated until disease progression, unacceptable toxicity, or patient refusal. The primary endpoint is response rate, and the secondary endpoints are overall survival, progression-free survival, safety, and dose intensity for each drug. The response rate is calculated based on the RECIST version 1.1 criteria. Adverse events are evaluated using the CTCAE v5.0 criteria. A hypothesis test of binary probability was performed, with condition that threshold of response rate was set to 10.7% of docetaxel monotherapy in phase III trial and the expected response rate was set to 27.9% of paclitaxel and ramucirumab combination therapy in RAINBOW trial. A minimum number of cases that achieved a detection power of 80% at a one-sided significance level of 5% was calculated to be 32 cases. In anticipation of dropouts, the total number of registration cases was set to 35. Sixteen institutions are participated, and the registration period is 2 years. This study is registered with Japan Registry of Clinical Trials (jRCTs011200010). Clinical trial information: jRCTs011200010.

A multicenter prospective randomized controlled clinical study of 5-fluorouracil in different mass concentrations combined with triamcinolone in the treatment of keloids

Objective: To evaluate the clinical effects of 5-fluorouracil in different mass concentrations combined with triamcinolone in the treatment of keloids. Methods: From March 2018 to March 2019, 29 patients with 31 keloids receipted in the Department of Plastic Surgery of Fujian Medical University Union Hospital, 11 patients with 20 keloids receipted in the Department of Dermatology of Pingtan Comprehensive Experimental Area Hospital, and 9 patients with 9 keloids receipted in the Fuzhou Heisey-Dea Aesthetic Clinic were included in this prospectively randomized control study, with 27 males and 22 females, aged (30±9) years. According to the random number table, the keloids were divided into low mass concentration group (19 keloids, 17 patients), medium mass concentration group (21 keloids, 19 patients), and high mass concentration group (20 keloids, 17 patients). Then 5-fluorouracil at mass concentrations of 0.5, 5.0, and 12.5 mg/mL combined with triamcinolone acetonide were injected respectively, once every 4 weeks, for a total of 3 times. Before the first treatment and in 3 months after the last treatment, the appearance of keloids was evaluated by Vancouver Scar Scale (VSS) and pain and pruritus of keloids were evaluated by Visual Analogue Scale (VAS). Then the score differences before and after the treatment were calculated. In 6 months after the last treatment, the patients' efficacy satisfaction was evaluated by efficacy satisfaction rating scale. Adverse reactions during the treatment were recorded. In the follow-up of one year after the last treatment, the recurrence rates of keloids were counted. Data were statistically analyzed with chi-square test, one-way analysis of variance, paired sample t test, least significant difference t test, Wilcoxon rank sum test, Kruskal-Wallis rank sum test, or Fisher's exact probability test. Results: Before the first treatment, the appearance VSS scores of appearance of keloids in the three groups were similar (F=0.039, P>0.05). In 3 months after the last treatment, the appearance VSS scores of keloids in low mass concentration group were significantly higher than those in medium mass concentration group and high mass concentration group (t=2.267, 4.086, P 0.05). In 3 months after the last treatment, the pain and pruritus VAS scores of keloids in low mass concentration group were significantly higher than those in medium mass concentration group and high mass concentration group (Z=2.191, 4.386, P 0.05). Conclusions: After treating keloids with high mass concentration of 5-fluorouracil combined with triamcinolone acetonide, the symptoms were significantly improved, the efficacy satisfaction of patients was increased, with no obvious adverse reactions but long lasting efficacy. Their overall effects are better than treatment using medium and low mass concentrations of 5-fluorouracil, which is worthy of clinical promotion.