Significant Difference In Proportion Research Articles

Wilms tumor in Africa: A systematic review of management challenges and outcome in two decades (2000-2019).

We performed a systematic review to highlight trends in management and outcome of Wilms tumor (WT) in Africa in the past two decades (2000-2019). Twenty-seven studies involving 2250 patients were analyzed. Overall, barring regional variations, 57.7% of the cases presented with advanced disease, 57.3% completed planned treatment, and survival was 56.5%. The publications in the two decades did not show significant differences in proportions of cases with advanced disease, completion of treatment rate, and cases lost to follow up. However, significantly more cases received preoperative chemotherapy, and survival improved in the last decade (2010-2019) compared to the earlier decade (2000-2009). Survival of WT in Africa might have improved in the last decade, but challenges of delayed presentation and abandonment of treatment have persisted. Measures that will encourage early access to expert care as well as improve on treatment compliance may further improve survival of WT in Africa.

Double Burden of Malnutrition: Evidence from a Selected Nigerian Population.

Indices reflecting the double burden of malnutrition in sub-Saharan Africa are increasing. Evidence to support this claim in households of Africa's most populous country—Nigeria—is scant. This study, therefore, presents results from a study of mother-child pairs sampled from Akwa Ibom State in the southern region of Nigeria. Anthropometric measures for 660 mother-child pairs were collected according to standard procedures. Indices were expressed as the standard deviation of units from the median for the reference group. Chi-square analysis was used to test significant differences in proportion, and p < 0.05 was taken as significant. A total of 37.4% of the children were stunted out of which 19.8% were moderately stunted, and 17.6% were severely stunted. Prevalence of wasting was 13.1%, 6.2% were moderately wasted, and 6.9% were severely wasted. Mean maternal body mass index was (23.54 ± 4.60) kgm2. 9.0% were underweight mothers, 23.2% were overweight, and 9.3% were obese. The co-existence of undernutrition among children and overnutrition in women of child-bearing age is prevalent in this population. We recommend that more effort be placed on active nutrition surveillance to ascertain malnutrition prevalence and periodically reassess priority challenges.

Reason to doubt the ICHD-3 7-day inclusion criterion for mild TBI-related posttraumatic headache: A nested cohort study.

Posttraumatic headache is difficult to define and there is debate about the specificity of the 7-day headache onset criterion in the current definition. There is limited evidence available to guide decision making about this criterion. A nested cohort study of 193 treatment-seeking veterans who met criteria for persistent headache attributed to mild traumatic injury to the head, including some veterans with delayed headache onset up to 90 days post-injury, was undertaken. Survival analysis examined the proportion of participants reporting headache over time and differences in these proportions based on sex, headache phenotype, and mechanism of injury. 127 participants (66%; 95% CI: 59-72%) reported headache onset within 7 days of head injury and 65 (34%) reported headache onset between 8 days and 3 months after head injury. Fourteen percent of participants reported pre-existing migraine before head injury, and there was no difference in the proportion of veterans with pre-existing migraine based on headache onset. Headache onset times were not associated with sex, headache phenotype, or mechanism of injury. There were no significant differences in proportion of veterans with headache onset within 7 days of head injury based on headache phenotype (70% migraine onset within 7 days, 70% tension-type headache within 7 days, 56% cluster headache within 7 days; p ≥ .364). Similar findings were observed for head injury (64% blast, 60% blunt; p = .973). There were no significant differences observed between headache onset groups for psychiatric symptoms (Posttraumatic Stress Disorder Checklist for DSM-5 = 1.3, 95% CI = -27.5, 30.1; Patient Health Questionnaire-9 Item = 3.5, 95% CI = -6.3, 3.7; Generalized Anxiety Disorder Screener = 6.5, 95% CI = -2.7, 15.6). Although most of the sample reported headache onset within 7 days of head injury, one-third experienced an onset outside of the diagnostic range. Additionally, veterans with headache onset within 7 days of head injury were not meaningfully different from those with later onset based on sex, headache phenotype, or mechanism of head injury. The ICHD-3 diagnostic criteria for 7-day headache onset should be expanded to 3 months. NCT02419131.

Novel approach to the measurement of antithyroglobulin antibodies in human serum – application of the quartz crystal microbalance sensors

Measurement of antithyroglobulin antibodies (TgAb) is an inevitable laboratory tool in the management of thyroid gland diseases. Currently available immunoassays still have limitations underlying the necessity of the introduction of fast, sensitive, and label-free technologies. Our aim was to develop a method for TgAb measurement in human serum based on the quartz crystal microbalance (QCM) technology. We immobilized thyroglobulin on the surface of Attana LNB Carboxyl sensor chip®, prepared standard curve covering the range of 1–50000 kIU/L, and established optimal measurement conditions. The validation included determination of the detection limit (LOD), functional sensitivity, linearity, precision, as well as the comparison with the results of the radioimmunoassay (RIA). The LOD and functional sensitivity were 4.2 kIU/L and 4.7 kIU/L, respectively. The method was linear in the range of 20–10000 kIU/L. The regression equation for comparison with RIA was CQCM= 1.0056 • CRIA– 24.2778, whereby no significant proportional or systematic difference was present. There was a good agreement with RIA in the classification of patients according to the clinical significance of the results. The developed method has advantages over currently available assays in terms of better LOQ, a higher upper limit of linearity, and precision.The characteristics of the developed method unambiguously show that the application of the QCM biosensors offers a highly reliable novel approach for the measurement of TgAb in human serum.

Neurological deficits are present in syndromic craniosynostosis patients with and without tonsillar herniation.

Children with syndromic craniosynostosis (sCS) have a higher incidence of cerebellar tonsillar herniation (TH) than the general population. In the general population, TH≥5mm below the foramen magnum is associated with typical neurological deficits but, in sCS, we do not know whether this degree of TH is required before such deficits occur. This prospective cohort study aimed to determine the association between findings on neurological assessment and cerebellar tonsillar position. Magnetic resonance imaging (MRI) was used to determine TH≥5mm and the presence of syringomyelia. In regard to the outcome of neurological deficits, these were categorized according to: A, cerebellar function; B, cranial nerve abnormalities; and C, sensory or motor dysfunction. Twenty of 63 patients with sCS (32% [95% confidence interval 21-45%]) had TH≥5mm and/or syringomyelia. There was no significant difference in proportion between individual forms of sCS: 16/34 Crouzon, 2/11 Muenke, 2/12 Apert, and 0/7 Saethre-Chotzen patients. Neurological deficits were prevalent (73% [95% confidence interval 60-83%]), and as frequent in patients with TH≥5mm and/or syringomyelia as those without. Surgery occurred in 3 patients overall, and only in Crouzon patients. Determining the effect of TH≥5mm on neurologic functioning in sCS patients is used to better determine when surgical intervention is warranted. However, we have found that neurological deficits are prevalent in sCS patients, irrespective of cerebellar tonsillar position, suggesting that such findings are developmental and, in part, syndrome-specific central nervous system features.

Molecular detection of Virulence Factors genes Associated with Immune Resistance in Klebsiella pneumonia

Aims: To assess and compare the technical radiographic quality of root canal fillings (RCF) and the occurrence of procedural errors in the endodontic treatment performed by 5th grade undergraduate and postgraduate students in the College of Dentistry/University of Baghdad- Baghdad- Iraq. Materials and methods: Records and periapical radiographs of 216 and 143 root-filled teeth treated by 5th year undergraduate and postgraduate students, respectively during 2018-2019 were collected. Periapical radiographs of 35 (16.2%) and 15 (10.4%) teeth, respectively excluded because of inadequacy in the radiographs. A final total periapical radiographs/records of 181 and 128 root-filled teeth were used to evaluate the technical quality of the root fillings in 197 and 275 root canals treated by 5th year undergraduate and postgraduate students, respectively. Outcome variables categorized as acceptable and not acceptable quality depending on the absence/presence of overfilling, underfilling, voids in the fillings and the absence/ presence of ledges, root perforation, transportation, and fractured instruments. Chi-square and 2 sample z tests were used for statistical analysis, significance level set at ?=0.05 Results: Acceptable RCF were in 49.3% and 63.3% of the canals treated by 5th year undergraduate and postgraduate students, respectively with a significant difference between them (z=2.99, p<0.05). 55.1% and 44.9% of RCF treated by undergraduate students were in anterior and premolars, respectively. 70.9%, 20.7% and 8.4% of RCF treated by postgraduate students were in molars, premolars and anterior teeth, respectively. Significantly more voids, ledges were observed in RCF performed by undergraduate compared to postgraduate students (z=4.6 and 2 respectively, p<0.05). In contrast, significantly more instrument separations were observed in RCF treated by postgraduate compared to undergraduate students (z=2.09, p<0.05). However, there was no significant difference in proportions of underfilling, overfilling, perforations, transportation between the two academic levels. Conclusion: Overall technical quality of RCF performed by postgraduates was better than that of 5th year undergraduate students, however, improvement in preclinical and clinical training is needed.

ULTRASOUND EVALUATION OF NON-PERFORATED AND PERFORATED APPENDICITIS

Background: Ultrasonography (USG) of abdomen remains one of the commonly asked investigations by the surgeon in patients with suspected acute abdomen. The advantage of USG over other radiological investigation is that it is easily available, cost effective, portable, no known side effects, non-invasive and requires minimal patient preparation for carrying out the examination. The present study aimed at evaluating ultrasonography findings of appendicitis and to correlate with operative and histo-pathological findings.&#x0D; Material and Methods: In our study, USG evaluation was done by the investigators for 61 clinically diagnosed patients, so as to achieve 50 radiologically confirmed appendicitis cases which was the required sample. The study was carried out from December 2013 to September 2015. Data was analysed using the statistical software SPSS version 21.0. Chi Square test was applied to test statistically significant difference in proportion.&#x0D; Results: In the present study the mean age the study participants was 26.42 years. Majority of the study participants were males 29 (58%) while females represented 42%.The average size of the appendix among the study participants was observed to be 7.08 mm with a standard deviation of ± 1.07 mm. Among all the study participants with acute appendicitis in our study 22% of the patients had perforation of appendix. In our study, we proved that all USG diagnosed appendicitis cases (100%) were histo-pathologically correct but the variations found in diagnosing the perforation status. We found that the USG had 73.33% and 100% sensitivity and specificity in finding the perforation status.

Minimum Dietary Diversity for Women of Reproductive Age (MDD-W) Data Collection: Validity of the List-Based and Open Recall Methods as Compared to Weighed Food Record.

Minimum dietary diversity for women of reproductive age (MDD-W) was validated as a population-level proxy of micronutrient adequacy, with indicator data collection proposed as either list-based or open recall. No study has assessed the validity of these two non-quantitative proxy methods against weighed food records (WFR). We assessed the measurement agreement of list-based and open recall methods as compared to WFR (i.e., reference method of individual quantitative dietary assessment) for achieving MDD-W and an ordinal food group diversity score. Applying a non-inferiority design, data were collected from non-pregnant women of reproductive age in Cambodia (n = 430), Ethiopia (n = 431), and Zambia (n = 476). For the pooled sample (n = 1337), proportions achieving MDD-W from both proxy methods were compared to WFR proportion by McNemar’s chi-square tests, Cohen’s kappa, and receiver operating characteristic (ROC) analysis. Ordinal food group diversity (0–10) was compared by Wilcoxon matched-pairs signed-rank tests, intraclass correlation coefficients (ICC), and weighted kappa. MDD-W food groups that were most frequently misreported (i.e., type I and II errors) by the proxy methods were determined. Our findings indicate statistically significant differences in proportions achieving MDD-W, ordinal food group diversity scores, and ROC curves between both proxy methods and WFR (p < 0.001). List-based and open recall methods overreported women achieving MDD-W by 16 and 10 percentage points, respectively, as compared to WFR (proportion achieving MDD-W: 30%). ICC values between list-based or open recall and WFR were 0.50 and 0.55, respectively. Simple and weighted kappa values both indicated moderate agreement between list-based or open recall against WFR. Food groups most likely to be misreported using proxy methods were beans and peas, dark green leafy vegetables, vitamin A-rich fruit and vegetables, and other fruits. Our study provides statistical evidence for overreporting of both list-based and open recall methods for assessing prevalence of MDD-W or ordinal food group diversity score in women of reproductive age in low- and middle-income countries. Operationalizing MDD-W through qualitative recall methods should consider potential trade-offs between accuracy and simplicity.

Sources of intraspecific morphological variation in Vipera seoanei: allometry, sex, and colour phenotype

Abstract Snakes frequently exhibit ontogenetic and sexual variation in head dimensions, as well as the occurrence of distinct colour morphotypes which might be fitness-related. In this study, we used linear biometry and geometric morphometrics to investigate intraspecific morphological variation related to allometry and sexual dimorphism in Vipera seoanei, a species that exhibits five colour morphotypes, potentially subjected to distinct ecological pressures. We measured body size (SVL), tail length and head dimensions in 391 specimens, and examined variation in biometric traits with respect to allometry, sex and colour morph. In addition, we analysed head shape variation by recording the position of 29 landmarks in 123 specimens and establishing a low-error protocol for implementing geometric morphometrics to European vipers. All head dimensions exhibited significant allometry, while sexual differences occurred for SVL, relative tail length and snout height. After considering size effects, we found significant differences in body proportions between the sexes and across colour morphs, which suggests an important influence of lowland and montane habitats in shaping morphological variation. By contrast, head shape did not exhibit significant variation across sexes or colour morphs. Instead it was mainly associated to allometric variation, where the supraocular and the rear regions of the head were the areas that varied the most throughout growth and across individuals. Overall, this study provides a thorough description of morphological variability in Vipera seoanei and highlights the relevance of combining different tools (i.e. linear and geometric morphometrics) and analyses to evaluate the relative contribution of different factors in shaping intraspecific variation.

The contribution of clinical subtype to survival differences among patients with de novo and recurrent metastatic breast cancer (dMBC).

1030 Background: Patients with de novo metastatic breast cancer (dMBC) have superior median overall survival (mOS) compared to recurrent metastatic breast cancer (rMBC). Whether patient characteristics, prior treatment, tumor stage and innate biological differences contribute to this observation is unknown. Methods: Clinical and pathological data from patients diagnosed with MBC from 2011 to 2017 at the University of North Carolina (UNC) was obtained from the prospective UNC Metastatic Breast Cancer Clinical Database (223 dMBC, 607 rMBC). Only patients with known survival status were included. Subtype was determined by hormone receptor (HR) and HER2 staining of the primary tumor. Pathologic staging results were used when available, otherwise clinical staging was used. Patient and tumor characteristics were compared using chi-square testing, and survival outcomes by Cox proportional hazards modeling. Results: 26.9% of patients with MBC presented with dMBC, with significant variation in the ratio of dMBC to rMBC across subtypes. In particular, there were more cases of HER2+ dMBC than rMBC (26.9% vs 14.0%) and fewer cases of triple negative dMBC (20.6% vs 35.3%)(p-value &lt; 0.001). Nearly half of all cases of HR-/HER2+ MBC were de novo (48.2%). dMBC was significantly associated with older age (p = 0.002), lower grade (p = 0.027), higher T and N stage (p &lt; 0.001) and African American race (30% vs 22%, p = 0.022). There was no significant difference in proportion of patients with visceral metastatic disease or in number of metastatic sites at diagnosis. Median follow up was 39 months in both cohorts. mOS was 12 months greater in dMBC than rMBC (34m vs 22m, p &lt; 0.001). These differences were significant across all subtypes except HR+/HER2+. The difference in mOS between dMBC and rMBC was greatest in the HR-/HER2+ subgroup (45m vs 15m, p = 0.006). In multivariable analysis, dMBC remained associated with improved survival (adjusted hazard ratio 0.59, p &lt; 0.001) independent of variables including age, race, subtype, grade and number of metastatic sites at diagnosis. Conclusions: Patients with dMBC have significantly better prognosis than those with rMBC. This improved outcome is in part due to subtype variation, with more triple negative and fewer HER2+ tumors in rMBC, however these differences largely remained when stratified by subtype. In multivariable analysis, de novo presentation of MBC remained an independently significant contributor to longer survival. Further investigation should focus on biologic differences between dMBC and rMBC.

Analysis of bleeding risk with concurrent treatment of VEGFR tyrosine kinase inhibitors (TKIs) and factor Xa inhibitors.

e19305 Background: Tyrosine kinase inhibitors (TKIs) of vascular endothelial growth factor receptor (VEGFR) may interfere with the coagulation system making patients susceptible to both hemorrhage and thromboembolism. Some cancer patients require dual treatment with VEGFR TKIs and factor Xa inhibitors. However, the safety of such combination treatment (e.g. bleeding risk) has not been well characterized in the literature. Methods: This retrospective study identified metastatic cancer patients who received VEGFR TKIs (pazopanib, sunitinib, sorafenib, axitinib, regorafenib, vandetanib, lenvatinib, cabozantinib, tivozanib) and Xa inhibitors (low-molecular weight heparin [LMWH] or direct oral anticoagulants [DOACs]- rivaroxaban or apixaban) from 2001 to 2018 at the Ohio State University. We assessed bleeding risks of dual therapy vs factor Xa inhibitors alone, using the same patients as self-controls. We defined bleeding based on criteria from the International Society on Thrombosis and Haemostasis. Fisher’s exact test was used to compare distribution of bleeding severities and the Cox model was used to analyze bleeding risk. Results: A total of 86 patients were included for analysis, with a median age of 56 (range, 34-88). The patient population was predominantly of male gender (69.7%), Caucasian race (89.3%) and renal cell cancer type (48.9%). As some patients had been on both LMWH and DOAC at different time periods, we found that 81 patients received concurrent TKI and LMWH; 19 patients had concurrent TKI and DOAC. Overall, 25 patients developed 29 clinically significant bleeding events (including 8 major bleeding) during concurrent treatment, and 15 patients developed 17 clinically significant bleeding events (4 major bleeding) during factor Xa inhibitor alone over a median follow up of 63 days. We found a statistically higher bleeding risk with concurrent treatment (HR = 2.23, 95% CI, 1.13–4.42, p = 0.02) compared with Xa inhibitor alone. In a stratified analysis, concurrent VEGFR TKI plus LMWH or DOAC both showed a strong trend for elevated bleeding risk. Although there were increased bleeding events with concurrent treatment, there was no significant difference in the proportion of major bleeding (27.6% vs 23.5%, p = 0.76). Median time to first bleeding event was 56 days for concurrent therapy and 72 days for Xa inhibitor alone. Conclusions: Concurrent treatment of VEGFR TKI and factor Xa inhibitors is associated with significantly increased bleeding risk when compared with factor Xa inhibitors alone in metastatic cancer patients.

Risk of chronic opioid use after radiation for head and neck cancer: A systematic review and meta-analysis.

6579 Background: Opioid overuse is a major international public health concern. The prevalence and risk factors for chronic opioid use (COU) in radiation-induced head and neck pain are poorly understood. The aim of this study was to estimate the rates of COU and to identify risk factors for COU in head and neck cancer (HNC) patients undergoing curative-intent radiotherapy (RT) or chemoradiotherapy (CRT). Methods: We performed a systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, using the PubMed (Medline), EMBASE, and Cochrane library databases, queried from dates of inception until present. COU was defined as persistent opioid use ≥3 months after treatment completion. Studies in the English language that reported on COU in HNC patients who received RT/CRT were included. Meta-analyses were performed using random effects models. Heterogeneity was assessed using the I2 value. Results: A total of 134 studies were identified, with 7 retrospective studies (reporting on 1841 patients) meeting inclusion criteria. Median age was 59.4 years (range 56.0-62.0) with 1343 (72.9%) men and 498 (27.1%) women. Primary tumour locations included oropharynx (891, 48.4%), oral cavity (533, 29.0%), larynx (93, 5.1%), hypopharynx (32, 1.7%), and nasopharynx (29, 1.6%). 846 (46.0%) patients had stage I/II disease and 926 (50.3%) had stage III-IV disease. 301 (16.3%) patients had RT alone, 738 (40.1%) received CRT, and 594 (32.3%) underwent surgery followed by adjuvant RT/CRT. The proportion of HNC patients who received radiotherapy and developed COU was 40.7% at 3 months (95% CI 22.6%-61.7%, I2= 97.1%), 15.5% at 6 months (95% CI 7.3%-29.7%, I2= 94.3%) and 7.0% at 1 year. There were significant differences in COU based on primary tumor sites (P &lt; 0.0001), with the highest rate (46.6%) in oropharyngeal malignancies. Other factors associated with COU included history of psychiatric disorder (61.7%), former/current alcohol abuse (53.9%), and start of opioids prior to radiation treatment (51.6%). There was no significant difference in the proportion of COU by gender (P = 0.683), disease stage (I/II vs III/IV; P = 0.443), or treatment received (RT, CRT, or adjuvant RT/CRT; P = 0.711). Conclusions: A significant proportion of patients who undergo radiotherapy for head and neck cancer suffer from COU. High-risk factors for COU include an oropharyngeal primary tumour, history of psychiatric disorder, former/current alcohol abuse, and pre-treatment opioid use. New strategies to mitigate opioid use are needed.

Incidence of COVID-19 in a cohort of adult and paediatric patients with rheumatic diseases treated with targeted biologic and synthetic disease-modifying anti-rheumatic drugs

ObjectivesTo investigate the incidence of COVID-19 in a cohort of adult and paediatric patients with rheumatic diseases receiving targeted biologic and synthetic disease modifying anti-rheumatic drugs (tDMARDs) and to explore the possible effect of these treatments in the clinical expression of COVID-19. MethodsA cross-sectional study comprising of a telephone survey and electronic health records review was performed including all adult and paediatric patients with rheumatic diseases treated with tDMARDs in a large rheumatology tertiary centre in Barcelona, Spain. Demographics, disease activity, COVID-19 related symptoms and contact history data were obtained from the start of the 2020 pandemic. Cumulative incidence of confirmed cases (SARS-CoV-2 positive PCR test) was compared to the population estimates for the same city districts from a governmental COVID-19 health database. Suspected cases were defined following WHO criteria and compared to those without compatible symptoms. Results959 patients with rheumatic diseases treated with tDMARDs were included. We identified 11 confirmed SARS-CoV-2 positive cases in the adult cohort and no confirmed positive cases in the paediatric cohort. COVID-19 incidence rates of the rheumatic patient cohort were very similar to that of the general population [(0.48% (95% CI 0.09 to 0.87%)] and [0.58% (95% CI 0.56 to 0.60%)], respectively. We found significant differences in tDMARDs proportions between the suspected and non-suspected cases (p=0.002). ConclusionAdult and paediatric patients with rheumatic diseases on tDMARDs do not seem to present a higher risk of COVID-19 or a more severe disease outcome when compared to general population.

Characteristics of participants utilising a telephone-based coaching service for chronic disease health risk behaviours: A retrospective examination comparing those with and without a mental health condition.

The NSW Get Healthy Service® (GHS) is a free telephone-based coaching service in NSW, Australia, which supports behaviour change around healthy eating and physical activity. The aims of this study were to 1) assess the proportion of coaching participants within GHS who report having had a mental health condition, and 2) describe and compare the health risk profiles and confidence for behaviour change of coaching participants with and without a mental health condition. Secondary data analysis was conducted on information collected via participant self-report as a part of the coaching process for 11,925 participants who enrolled in a GHS coaching program for the first time between January 2015 and December 2017. Twenty six percent (n=3106) of participants reported having had a significant mental health condition that required treatment from a health professional. Participants who reported a mental health condition were significantly less likely (54%) to be meeting guidelines for physical activity than participants without a mental health condition (64%); more likely to be overweight/obese (89%) compared to those without (81%); and reported lower confidence for changing exercise, nutrition and weight. There were no significant differences in proportions meeting fruit or vegetable intake recommendations. People with a mental health condition represent approximately a quarter of GHS participants. This group of participants presented higher levels of health risks and expressed lower confidence in behaviour change than program participants without such a condition. Future service planning and development may consider this variation in participant profiles.

Ileal or Colonic Histologic Activity Is Not Associated With Clinical Relapse in Patients With Crohn’s Disease in Endoscopic Remission

Goals of treatment for Crohn's disease (CD) are clinical and endoscopic remission. It is not clear whether histologic markers of healing associate with endoscopic remission in patients with CD. We identified patients with CD from a single institutional registry, and collected data from 129 patients (46.5% female; mean age 25 y; mean CD duration 14.5 y) who underwent colonoscopy evaluation and had simple endoscopic scores for CD below 3 (the definition of endoscopic remission). Histologic signs of CD activity were graded in 192 biopsies (90 ileum and 102 colon), and disease was classified as active (presence of crypt destruction, neutrophils, erosions or ulcerations), quiescent (presence of architectural distortion and chronic inflammatory infiltrate), or normal histology (none of these). The primary outcome was clinical relapse within 2 y (dose escalation, change in therapy, need for systemic steroids, or CD-related hospitalization or surgery). We performed multivariable regression adjusting for relevant confounders to examine the independent predictive value of histologic activity. Within 2 y of endoscopic evaluation, 42 patients (32.6%) had a clinical relapse. There were no significant differences in proportions of patients with active ileal CD (23.8%), quiescent CD (28.6%), or normal histology (37%) between those who relapsed and those remaining in remission (P = .43). There were no significant differences in proportions of relapses among patients with active colonic disease (38.1%), quiescent disease (35.0%), or normal histology (27.9%, P = .73). A linear regression analysis found no association between histologic features of active disease in ileal histology biopsies and symptom scores (Harvey Bradshaw index and simple inflammatory bowel disease questionnaire scores). In an analysis of biopsies from patients with CD who had achieved clinical and endoscopic remission, histologic remission was not associated with clinical relapse within 2 years.

Body size at birth in babies born during World War II: The evidence from Poland.

The objective of the study was to determine whether exposure of pregnant women to stresses caused by World War II (WWII) negatively affected pregnancy and perinatal outcomes. Individual medical documents deposited in the Gynaecology and Obstetrics Clinic of Medical University, Poznań (1934-1943; N = 7058) were evaluated. These were divided into two birth cohorts: before WWII and during it. Frequency tables were constructed for the numbers of pregnancy outcomes: miscarriages, stillbirths, live births, and neonatal deaths, according to the period of birth and sex of a child. The numbers of recorded days were standardized and the numbers of cases per day were computed. Statistical differences in the averages (medians) between periods and years under study were tested. Birth weight, length, and body mass index (BMI) were compared according to the periods related to WWII. Significant differences in proportions of males, females, and subjects with unknown sex were found between the periods: a higher proportion of males and different structure of/within negative outcomes were found during WWII. Children born during WWII were heavier and longer than those born before it. As an explanation, adverse conditions of WWII, related to the psychological stress and food shortages, could have influenced greater elimination of fetuses and neonates of male sex during pregnancy and shortly after delivery. Higher average body size in newborns recorded during WWI could be explained by a hidden process of increased early prenatal mortality of weaker individuals, differences in average gestation length between the periods, differences in parity, or some undocumented differences in social/ethnic composition of the sample.

A forgácsolóerő vizsgálata korrózióálló acél homlokmarásánál

Állandó fogásmélység és állandó fordulatszám (forgácsoló sebesség) mellett ötféle fogankénti előtolást alkalmazva vizsgáltam az előtolás hatását a forgácsolóerőkre korrózióálló acél homlokmarásakor. A forgácsolóerő és a fajlagos forgácsolóerő változása azt mutatta, hogy mind nagyságában, mind az erőösszetevők változásának arányában jelentős az eltérés a különböző előtolás értékek mellett. Bizonyítottam, hogy korrózióálló acél esetében is a nagyobb előtolások alkalmazása energetikailag előnyösebb.

Evaluation of the Reticulocyte Production Index in the Pediatric Population.

Since hematologic values vary with age in children, we evaluated the agreement between the "traditional" reticulocyte production index (RPI) and an RPI by age (RPI/A)-adjusted normal values. A retrospective, observational, and analytical study was performed on CBCs of children with anemia younger than 18 years. The agreement and clinical repercussions of the RPI values were analyzed with an RPI/A developed with theoretical values for different ages. A total of 5,503 tests were analyzed and no systematic error between the two indices was found; however, there were significant proportional differences at higher values that resulted in lower RPI/A in children younger than 15 days and higher RPI/A in children aged 15 days and older. No agreement was observed at any age. The proportion of arregenerative anemia diagnosed using RPI/A was higher in children younger than 15 days and lower in those 15 days and older. RPI is not an adequate tool for evaluating the erythropoietic capacity of bone marrow in the pediatric population. The disagreement between the results can be explained by the difference in normal hematologic values between children and adults.

Peripheral Blood Lymphocyte Phenotype Differentiates Secondary Antibody Deficiency in Rheumatic Disease from Primary Antibody Deficiency.

The phenotype of primary immunodeficiency disorders (PID), and especially common variable immunodeficiency (CVID), may be dominated by symptoms of autoimmune disorders. Furthermore, autoimmunity may be the first manifestation of PID, frequently preceding infections and the diagnosis of hypogammaglobulinemia, which occurs later on. In this case, distinguishing PID from hypogammaglobulinemia secondary to anti-inflammatory treatment of autoimmunity may become challenging. The aim of this study was to evaluate the diagnostic accuracy of peripheral blood lymphocyte phenotyping in resolving the diagnostic dilemma between primary and secondary hypogammaglobulinemia. Comparison of B and T cell subsets from patients with PID and patients with rheumatic disease, who developed hypogammaglobulinemia as a consequence of anti-inflammatory regimes, revealed significant differences in proportion of naïve B cells, class-switched memory B cells and CD21low B cells among B cells as well as in CD4+ memory T cells and CD4+ T follicular cells among CD4+ T cells. Identified differences in B cell and T cell subsets, and especially in the proportion of class-switched memory B cells and CD4+ T follicular cells, display a considerable diagnostic efficacy in distinguishing PID from secondary hypogammaglobulinemia due to anti-inflammatory regimens for rheumatic disease.

Outbreak of Mycobacterium tuberculosis Beijing Strain in a High School in Yunnan, China.

In this study, we report an investigation of a tuberculosis (TB) outbreak in a high school in China. Eleven students with active TB were identified. A culture-negative 17-year-old girl was considered as index case affected by pulmonary and meningeal TB. Screening results indicated latent TB in 32.8% of the students in the classroom of index case, whereas a significantly decreased prevalence of TB infection was found among students on the same floor, ranging from 1.3 to 8.2%. Genotyping revealed that all the Mycobacterium tuberculosis (MTB) isolates belonged to Beijing spoligotype international types 1 (SIT1). In conclusion, a diagnostic delay for the culture-negative index case played an important role in the transmission of Beijing genotype MTB strain in the boarding school in Yunnan. The separate locations of classrooms and sufficient air ventilation contributed to the significant difference in proportions of TB infection between classmates and other students in this outbreak.