Outgroup Research Articles

THU0109 DOES HIGH BASELINE LEVEL OF MATRIX METALLPROTEINASES 3 (MMP3) INDICATE MORE MTP5 JOINT EROSIONS IN EARLY RHEUMATOID ARTHRITIS PATIENTS? (THE 2-YEAR PROSPECTIVE ULTRASONOGRAPHIC STUDY)

Background:The serum MMP3 level is considered biomarker which reflects local inflammation of joints and correlates with joint damage progression in early rheumatoid arthritis (1).Objectives:To investigate the association of high baseline MMP3 serum levels with bone erosion finding at the level of typical location for rheumatoid arthritis (RA) in patients with early, treatment “naïve” RA, who has no radiographic visible erosions, using ultrasound method (US).Methods:Sixty-three pts. (9 males and 54 females; mean age 53.4 yrs 21-81 ± 14.1) with early RA according to EULAR/ACR 2010 criteria and symptom duration of ≤12 months (mean duration of 3.8 months) had baseline serum MMP3 levels tested. Serum levels of soluble MMP3 were performed blindly, without knowledge of the US data at the basal visit only, using the recommended normal cut-off range (a level above normal was rated as positive). Patients had been DMARDs/glucocorticoid naïve, with no visible X-ray erosions at the study entry. The lateral, dorsal and posterior part of styloid, MCP2, MCP5 and MTP5 joints of both side, were analyzed for presence of bone erosion (yes/no), according to OMERACT US group definition, using high frequency linear probe by ESAOTE My Lab 70 machine at baseline visit and after 24 months.Results:The 50 pts completed follow-up. 46 pts. had basal serum MMP3 level higher than normal (MMP3 +, mean value 185.1±241.0). US bone erosions were present in 55/63 (87.3%) pts, most often in MTP5 joints, both at the study entry and after 24 months of follow up (25 pts-39.6% and 32 pts-64% respectively). At baseline visit no significant difference was found between a group of MMP3+ and MMP3- pts. regarding to US bone erosion presence at the level of all analyzed joints (styloid process: 12 MMP3+/4 MMP3- pts.; p=0.836; MCP2: 14 MMP3+/6 MMP3- pts., p=0.713; MCP5:8 MMP3+/0 MMP3- pts, p=0.06; MTP5: 26 MMP3+/11 MMP3- pts, p=0.55). After 24 months, significant difference was found between a group of MMP3+ and negative pts for MTP5 US bone erosions finding (33 MMP3+/ 6 MMP3- pts, p=0.03) only, (styloid process:21 MMP3+/5 MMP3- pts, p=0.623; MCP2: 26 MMP3+/7 MMP3- pts, p=0.851, MCP5: 14 MMP3+/2 MMP3- pts, p=0.266).Conclusion:In our group of RA patients without initial X-ray changes, the high baseline serum level of MMP3 was significantly correlated with new MTP5 bone erosions by US after 2-year of follow-up.

Maize silage as enrichment material improves the welfare of growing-finishing pigs in environmentally-friendly pens

Provision of enrichment in welfare- and environmentally-friendly pig pens is important for sustainable pig production. The primary aim of the present experiment was to investigate the effects of maize silage as a singular enrichment compared to a combination of maize silage and chopped straw on behaviours important for determining pig welfare (play, locomotion, exploration, social contact, aggression, manipulation, eating, drinking, lying/sleeping, sitting/standing and nosing objects) in growing-finishing pigs (pigs, n = 432; batch, n = 2; pens n = 12 per batch). Secondly, the impact of drinker position (IN: two drinkers placed in the inside area; OUT: two drinkers in the outside area; IN_OUT: a drinker in each of the inside and outside areas; n = 8 pens per group) on pig behaviour was assessed. There were no statistically significant influences of enrichment treatments on behaviour. The OUT group performed less manipulation behaviour than the IN (mean difference = 2.65; 90 % highest density interval (HDI): 0.46, 4.84) and IN-OUT (mean difference = 2.88 HDI: 0.69, 5.15) groups, and drank more than the IN-OUT group (mean difference = -3.87; HDI: -6.76, -0.90). In addition, we found that a one standard deviation (∼ 2 days) increase in observation days/pig age significantly decreased manipulation (log coefficient = -0.32; HDI: -0.42, -0.22) and aggressive behaviours (log coefficient = -0.46; HDI: -0.57, -0.36), but there was an increase in drinking (log coefficient = 0.13; HDI: 0.09, 0.18) and nosing objects (log coefficient = 0.12; HDI: 0.06, 0.18). Significant associations were also found for batch (season), as well as correlations between behaviours. In summary, our results showed that pig behaviours during the growing-fattening period were similarly expressed in the maize silage and combined maize silage and chopped straw treatments, suggesting that maize silage in environmentally-friendly pig pens is adequate in ensuring welfare standards. Furthermore, placing drinkers in the outside area reduced manipulation between pen-mates, thus, could improve pig welfare.

Ultrasound guided lumbar puncture reduces failed punctures, spent time and number of attempts in emergency department

Introduction: The present study was an attempt to evaluate the role of ultrasonography on decreasing the number of attempts, failed punctures, time needed to perform the procedure and patients’ pain. Methods: This study is a prospective case-control. Patients were divided in two groups randomly. A two-dimensional probe was used to localize intervertebral space in the ultrasound guidance (US group). In manual palpation (MP group) however, insertion level was determined using the standard technique by manual palpation. The number of attempts (needle insertion) required for a successful tap and successful/unsuccessful attempts were considered as the primary outcome measures. Results: Male patients with an average age of 44.08±15.83 years accounted for 60% (30 individuals) of the population. Success rate was 92% in the US group and 34% in the MP group (P<0.001). It took 79.64± 19.91 and 85.4±11.62 minutes to identify the proper location in US and MP groups respectively (P=0.21). In the first attempt, it took 6.33±0.95 and 6.87±0.7 minutes to collect cerebrospinal fluid (CSF) in US and MP groups respectively (P=0.02). Average time taken to localize the sites in two attempts were 8.28±2.44 and 13.17±3.32 in US and MP groups respectively (P<0.001). Average number of attempts made in the US and MP groups were 1.08±0.27 and 1.64±0.66 (P<0.001) respectively. Conclusion: Ultrasonography has reduced the time needed for locating puncture to collect CSF, pain management in patients, determining the number of attempts, and defining the risk of traumatic puncture. Moreover, this technique is characterized by a higher success rate. Using ultrasonography in obese patients and people with lumbar problems is more important.

0548 Overnight Memory Consolidation in Insomnia versus Normal and Experimentally Disrupted Sleep

Abstract Introduction Healthy sleep is assumed to play an important role in the consolidation of newly acquired memories. Evidence suggest that periods of sleep after learning facilitates memory consolidation relative to wakefulness. Insomnia is associated with cognitive impairment but few studies have assessed overnight memory consolidation. We compared overnight consolidation in people with insomnia to a group of good sleepers who were randomised to either a normal night of sleep (uninterrupted sleep, US) or one night of sleep continuity disruption via forced awakenings (FA). Methods 51 good sleepers (37 female; mean age: 24 years, SD: 3.63), randomised to either one night of US (n=24) or one night of FA (n=27), were compared to 27 participants meeting criteria for insomnia disorder (23 female; mean age: 53 years, SD: 8.34) who were assessed at baseline as part of a randomised controlled trial of digital cognitive-behavioural therapy. Overnight memory consolidation (difference in correctly recalled word pairs between evening and morning recall) was assessed using the same word-pair task and protocol in the two lab-based studies. Results Overnight memory consolidation was significantly lower in the insomnia (mean: 5.4, SD: 5.8, p=0.001) and the FA (mean: 6.7, SD: 4.1, p<0.001) group compared to the US group (mean: 11.6, SD: 5.3). However, when adjusted for age only the FA group, but not the insomnia group, showed significantly lower memory performance than the US group. Conclusion While our findings suggest that overnight memory consolidation is impaired in insomnia relative to normal sleep we cannot rule out an age-related explanation given the difference in ages between the study samples. Future work will assess whether overnight consolidation improves following cognitive behavioural therapy. Support The research was supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC) and the Dr Mortimer and Theresa Sackler Foundation. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

A LOOK BACK AT US GROUP: AN ANTI-RACIST INITIATIVE IN THE AGE OF DESEGREGATION

ABSTRACT In 1989, after an incident in which a white teacher used a derogatory word against three black students in a high school in Ann Arbor, Michigan, the school developed a program called “Understanding and Sharing Diversity” (US Group). Every two months, approximately 60 students participated in all-day forums, where they could speak freely about issues and experiences regarding race, racism, and identity in school. This research examines the origins and development of US Group as representative of a particular historical moment and space: a public high school in a progressive Midwestern town during the period of desegregation. It contributes to the literature on critical geographies of education and race through a historical analysis of desegregation policies and their impacts, while also providing a blueprint for antiracist educational initiatives. Keywords: desegregation, education policy, race, anti-racist initiatives

Phase II/III study of circulating tumor DNA as a predictive biomarker in adjuvant chemotherapy in patients with stage II colon cancer: NRG-GI005 (COBRA).

TPS4121 Background: There are currently no validated predictive biomarkers for stage II resected colon cancer (CC) after adjuvant chemotherapy. However, circulating tumor DNA (ctDNA) that is shed into the bloodstream represents a highly specific and sensitive approach for identifying microscopic or residual tumor cells. For patients (pts) with CC, the detection of ctDNA is associated with persistent disease after resection and may outperform traditional clinical and pathological features as a prognostic factor to assess risk for recurrence. We hypothesize that for pts whose stage II colon cancer has been resected and who have no traditional high-risk features, a positive ctDNA status may identify those who will benefit from adjuvant chemotherapy. Methods: In this prospective phase II/III clinical trial, pts (N=1,408) with resected stage II CC without traditional high-risk features and whom the evaluating oncologist deems suitable for no adjuvant chemotherapy will be randomized 1:1 into 2 arms: standard-of-care/observation (Arm A), or prospective testing for ctDNA (Arm B). Postoperative blood will be analyzed for ctDNA with the GuardantHealth LUNAR panel, covering CC-relevant mutations and CC-specific methylation profiling. Pts in Arm B with ctDNA detected will be treated with 6 months of adjuvant (FOLFOX) chemotherapy. For all pts in Arm A, ctDNA status will be analyzed retrospectively at the time of endpoint analysis. The primary endpoints are clearance of ctDNA with adjuvant chemotherapy (phase II) and recurrence-free survival (RFS) for “ctDNA-detected” pts treated with or without adjuvant chemotherapy (phase III). Secondary endpoints will include time-to-event outcomes (OS, RFS, TTR) by ctDNA marker status and treatment, prevalence of detectable ctDNA in stage II CC, and rates of compliance with assigned intervention. Archived normal and matched tumor and blood samples will be collected for exploratory correlative research. The trial is actively accruing towards the phase II endpoint across all US and Canadian cooperative groups. Support: U10-CA-180868, -180822; UG1CA-189867; GuardantHealth. Clinical trial information: NCT04068103 .

Circumpolar genetic population structure of polar cod, Boreogadus saida

Polar cod, Boreogadus saida, is an important part of Arctic and boreal marine ecosystems. Knowledge of polar cod population genetic structuring can provide insight into how the species may respond to environmental change, and allow for establishment of meaningful management units. To examine population genetic structure of B. saida, we analysed nine microsatellite DNA loci in 2269 fish collected at 19 locations across the species’ range. Genetic differentiation was detected (FST = 0.01, p < 0.01), which had concordance with geography. A Canada East group consisted of fish collected from Resolute Bay to the Gulf of St. Lawrence. Three additional groups were observed. These consisted of a Canada West group containing specimens from the Canadian Beaufort Sea and Amundsen Gulf, a Europe group containing specimens from the Greenland Sea, Iceland and the Laptev Sea, and a US group consisting of specimens collected in the North Bering, Chukchi and Western Beaufort seas. Very little genetic differentiation was detected within the identified groups. Physical distance, geophysical structure and oceanography all appeared to have the potential to influence levels of genetic divergence. The population genetic structure detected is likely to be important for the response of B. saida to environmental change, and should be considered in management of human activities that may impact this foundational species.

Support for the psychosocial, disease and brain disease models of addiction: A survey of treatment providers' attitudes in Australia, the UK, and U.S.

BackgroundHow addiction treatment providers view different models of addiction has implications for workforce development and addiction treatment, however research exploring their views is limited. This study examined Australian, UK and US treatment providers': (1) levels of support for the psychosocial, disease model of addiction (DMA) and brain disease model of addiction (BDMA); and, (2) individual demographic characteristics that were associated with support for these models. MethodsA total of 1438 treatment providers in Australia (n = 337), the UK (n = 165) and US (n = 936) completed an online survey. Support for the psychosocial and DMA were measured using the Short Understanding of Substance Abuse Scale (SUSS) (Humphreys et al., 1996) and BDMA support using a measure created by the authors. Hierarchical multiple linear regression analyses were used to analyze associations between treatment providers' demographic characteristics (i.e., previous addiction status, attended 12-step programmes, age, gender, education level) and level of support for each model. ResultsThere were no significant differences in treatment providers' support for the psychosocial model between the three country groups. US participants had significantly higher levels of support for the DMA than the UK group, and the UK group was higher than the Australian group. US participants had significantly higher levels of support for the BDMA than Australian and UK participants. Regression analyses found that being younger in all three country groups and a higher level of education in the UK group was associated with greater psychosocial model support. A personal experience of addiction and 12-step programmes was associated with stronger support for the DMA, as was older age in the Australian and US treatment provider groups. In the US group, a personal experience of addiction and 12-step programmes was associated with support for the BDMA. ConclusionTreatment providers from different backgrounds and in different countries vary in how they view the etiology of addiction. How differences in views about addiction impact service delivery and clients' experience of care remains an important topic for future research. Furthermore, policy makers should consider treatment providers' heterogenous views about addiction and the implications for service delivery and workforce policy development.

Non-vector-borne transmission of lumpy skin disease virus

The transmission of “lumpy skin disease virus” (LSDV) has prompted intensive research efforts due to the rapid spread and high impact of the disease in recent years, especially in Eastern Europe and Balkan countries. In this study, we experimentally evaluate the vaccine-derived virulent recombinant LSDV strain (Saratov/2017) and provide solid evidence on the capacity of the virus for transmission in a vector-proof environment. In the 60-day long experiment, we used inoculated bulls (IN group) and two groups of in-contact animals (C1 and C2), with the former (C1) being in contact with the inoculated animals at the onset of the trial and the latter (C2) being introduced at day 33 of the experiment. The infection in both groups of contact animals was confirmed clinically, serologically and virologically, and viremia was demonstrated in blood, nasal and ocular excretions, using molecular tools. Further studies into LSDV biology are a priority to gain insights into whether the hypothesized indirect contact mode evidenced in this study is a de novo-created feature, absent from both parental stains of the novel (recombinant) LSDV isolate used, or whether it was dormant, but then unlocked by the process of genetic recombination. Author summary: In global terms, LSD has been termed a “neglected disease” due to its historic natural occurrence of being restricted to Africa and, occasionally, Israel. However, after its slow spread throughout the Middle East, the disease is now experiencing a resurgence of research interest following a recent and rapid spread into more northern latitudes. Given the dearth of solid findings on potential transmission mechanisms, no efficient or reliable control program currently exists, which does not involve the use of live attenuated vaccines or stamping out policies – both of which are controversial for implementation in non-endemic regions or countries. The vector-borne mode is the only working concept currently available, but with scarce evidence to support the aggressive spread northwards – except for human-assisted spread, including legal or illegal animal transportation. The emergence of outbreaks is not consistently linked to weather conditions, with the potential for new outbreaks to occur and spread rapidly. Here, for the first time, we provide evidence for indirect contact-mode transmission for a naturally-occurring recombinant LSDV isolated from the field. In an insect-proof facility, we obtained solid evidence that the novel LSDV strain can pass to in-contact animals. Given the recombinant nature of the virus utilised, its genetic background relating to the observed transmission pattern within the study needs to be delineated.

Drivers and dynamics of brand prominence preferences among the Chinese little emperors residing in the US

PurposeThis study investigates drivers and dynamics of preferences for brand prominence among the Chinese little emperors (LEs) residing in the US, a unique but powerful consumer group with dual-cultural characteristics.Design/methodology/approachUsing an online survey, the proposed model was tested with a convenience sample of the Chinese LE generation residing in the USFindingsSusceptibility to normative influence was a significant cultural driver of conspicuous, social, and unique value perceptions of luxury consumption among the Chinese LE generation residing in the US Perceived conspicuous and social values of luxury consumption were the primary drivers of this group's brand prominence preference for luxury fashion bags. However, perceived unique value of luxury consumption did not necessarily lead these consumers to prefer prominent logos or marks on a luxury bag. Furthermore, sociodemographic factors (gender, age, and time lived in the US) significantly affected perceptions and preferences related to luxury consumption among this consumer group.Research limitations/implicationsThis study advances the luxury literature by examining the drivers and dynamics of brand prominence preference among the Chinese LE generation residing in the US By testing the role of different sociodemographic factors, we demonstrate heterogeneity within this group and the evolving nature of their perceptions and preferences related to luxury consumption as they are acculturated to Western culture. We used a convenient sample and focused on luxury fashion bags for measuring preference for brand prominence, limiting the generalizability of the findings.Practical implicationsLuxury brands should effectively convey conspicuous and social values in product designs, advertising and promotions as these values play integral roles in determining the Chinese LE generation's preference for brand prominence. Our findings also highlight the importance of fine-tuned approaches to different segments within the LE generation cohort.Originality/valueThis study fills several gaps in the luxury literature by empirically investigating various factors affecting preference for brand prominence among the Chinese LE generation residing in the US, an important but under-researched luxury segment.

Hemocompatibility-related Adverse Events Following HeartMate II Left Ventricular Assist Device Implantation between Japan and United States.

Background: Left ventricular assist device (LVAD) therapy has improved the clinical outcomes in advanced heart failure patients, however, this may differ between countries. We aimed to compare outcomes between Japanese and US LVAD cohorts. Methods: For 416 consecutive LVAD patients who received HeartMate II LVAD implantation and completed a one-year follow-up, age-matched Japanese patients (the Japanese registry for mechanically assisted circulatory support (J-MACS) group) and the US patients were compared for their clinical outcomes. Results: 154 J-MACS patients and 77 US patients were compared. Survival, free from hemocompatibility-related adverse events (HRAEs) in the J-MACS was statistically comparable with the US (75% vs. 63%, p = 0.79). J-MACS had more disabling strokes than the US (0.221 vs. 0.052/patient-year, p = 0.005), whereas there was less nonsurgical bleeding (0.045 vs. 0.117/patient-year, p = 0.024). The net hemocompatibility score was statistically comparable between the groups (1.54 vs. 1.19 points/patient, p = 0.99). Post-LVAD prothrombin time with international normalized ratio (INR) <1.5 (odds ratio 4.07) was a risk factor for HRAEs in J-MACS, whereas INR >3.0 (odds ratio 5.71) was a risk factor in the US (p < 0.05 for both). Conclusion: In the age-matched cohorts, the J-MACS group experienced more strokes, while the US group had more bleedings. “Tailor-made” therapeutic strategy might be required for each country, given the unique variation of HRAE incidence among each country.

Sources of Inducing Shame versus Anger at In-group Failure and Consumption Type

Sources of Inducing Shame versus Anger at In-group Failure and Consumption Type

Current status of metformin in addition to insulin therapy in adult patients with type 1 diabetes mellitus: An analysis from the Guangdong Type 1 Diabetes Mellitus Translational Medicine Study

Limited data on the efficacy of the additional metformin therapy in patients with type 1 diabetes mellitus (T1DM) under real-life conditions have been available so far. Patients aged ≥18 years with a duration of T1DM for at least 1 year were included in this multicenter observational study. Patients with insulin combined with metformin therapy (MET group) were compared with those with insulin therapy only (INS group). A total of 76 patients in the MET group were compared with 655 patients in the INS group. At baseline, patients with dyslipidemia were more prevalent in the MET group (17.6% vs 9.0%; P = .006), and they also had a higher body mass index (BMI) (21.7 ± 3.2 kg/m2 vs 20.4 ± 2.6 kg/m2 ; P < .001) than those in the INS group. But glycosylated hemoglobin (HbA1c) and daily insulin dose were not significantly different between the two groups. After 1-year follow-up, HbA1c decreased in both groups, while the daily insulin dose decreased in the MET group, but did not change in the INS group (-0.02 IU/kg [-0.16, 0.09] vs 0 IU/kg [-0.09, 0.09]; P = .029). The additional metformin therapy led to no change of BMI and weight in the MET group, while the body weight increased from 53.7 ± 8.6 kg to 55.0 ± 7.9 kg in the INS group (P < .001). Metformin is initiated more in T1DM patients with dyslipidemia or higher BMI in current practice in China. The addition of metformin is effective in maintaining weight and reducing the insulin dosage without improving glycemic control in patients with T1DM.

Diagnostic value of low dose dual-source CT cerebral perfusion imaging in patients with hyperacute cerebral infarction

Objective To evaluate image quality and radiation dosage of CT cerebral perfusion (CTP) imaging of 70 kV with different tube current and scanning passes and its diagnostic value for hyperacute cerebral infarction. Methods A total of 190 patients with suspected hyperacute cerebral infarction in Lishui Central Hospital of Zhejiang Province from December 2017 to February 2019 were selected prospectively, and all patients were divided into 4 groups according to random number table and received non-contrast CT examination and dual-source CT cerebral perfusion imaging with 70 kV protocol simultaneously within 6 hours after the onset of symptoms: group A, 120 mA, 21 scanning time points; group B, 100 mA, 21 scanning time points; group C, 100 mA, 17 scanning time points; group D, 80 mA, 21 scanning time points. The values of perfusion parameters such as cerebral blood flow (CBF), crerbral blood volume (CBV), mean transit time (MTT), time to peak (TTP) were acquired. Image quality was evaluated and effective dose (ED) was recorded. The quantitative variables of image quality and radiation dosage were compared between four groups using one-way analysis of variance test. Results There was no differences between groups on the CBF, CBV, MTT, TTP maps for all CTP values (P>0.05), and all images could meet the diagnostic requirements. The subjective image quality score of vessel sharpness and overall image quality of both internal carotid artery and middle cerebral artery and the degree of noise of internal carotid in artery in group A was higher than that in group D (P<0.05). The score of vessel sharpness of internal carotid in artery ingroup A was higher than those in both groups B and C (P<0.05). The scores of vessel sharpness of both internal carotid artery and middle cerebral artery internal carotid in artery ingroups B and C were higher than that in group A (P<0.05). The mean EDs of non-contrast CT in group A, B, C, D were 1.10, 2.11, 1.76, 1.42, 1.40 mSv; compared to group A, ED was reduced approximately 16.6% (0.35/2.11), 32.7% (0.69/2.11) and 33.6% (0.71/2.11), respectively (P<0.05). The diagnostic accuracy of low dose dual source CTP for detecting hyperacute cerebral infarction was 93.5% (172/184), while that of non-contrast CT was 52.2% (96/184);for detecting hyperacutelacunar cerebral infarction, it was 72.1% (31/43) and 16.3% (7/43) respectively (P<0.05). Conclusion Appropriate reduction of tube current (100 mA) and scanning passes (17 scanning time points) can reduce the radiation dosage and acquire comparable image quality for 70 kV protocol CTP. Compared with non-contrast CT, low dose dual-source CTP is more sensitive to hyperacute cerebral infarction, especially hyperacute lacunar cerebral infarction. Key words: Cerebral infarction; Radiation dosage; Tomography, X-ray computed

A real-world evidence analysis of periampullary cancers in an academic hospital in Chile.

663 Background: Periampullary cancers can originate in the pancreas, duodenum, bile duct or structures of the ampullary complex. The treatment of choice in early stages is pancreatoduodenectomy. The management post-surgery can depend on the histology pattern, and the overall survival can vary in different subgroups. Methods: A retrospective cohort study. We examined patients (pts) with invasive periampullary cancer undergoing pancreatoduodenectomy at the Hospital Clinico Universidad de Chile between 2002 to 2018. We analyzed epidemiological, clinical, surgical, and histological data. OS and the hazard ratio (HR) were established by GraphPad Prism 8.0. Results: Thirty-seven cases were registered. Twenty-two (59%) pts were men. The mean age was 62.5 (43-83 years). The histological subtypes were: 15 pts (40.5%) intestinal group (IN), 20 pts (54%) pancreatobiliary group (PB), 1 pt (2.7%) mixed and 1 pt (2.7%) signet ring cell type. A full concordance between histology and immunohistochemistry (CK20, CK7, CDX2, MUC1, and MUC2) patterns was 66% of the PB group, and 0% of the IN group. The stage IB was most frequent in all of the group (36,4%). The most frequent stages were IB (66,6%) in the IN type and IIIA (46%) in the PB type. The level of Ca19-9 was higher the PB group than IN group (629.7 versus 41.5 U/ml, respectively). Seven pts received postoperative adjuvant treatment such as FOLFOX, capecitabine, and gemcitabine. The median OS was 133,5 months (mo) in the intestinal group and 32,6 mo in PB group (P-value = 0.021). The HR was 0.38 (95% CI of ratio 0.1332 to 1.084). The 5-year OS was 75,2% and 45,7% in the IN and PB group, respectively. Conclusions: Periampullary cancer remains very challenging because it is a rare malignancy and present diverse histological pattern. These factors influence the behavior and OS of the disease. Our results showed clinically and statistically relevant differences in the staging, levels of Ca19-9, and OS of the IN and PB subtypes. Our patients received few post-operatory therapies such as chemotherapy; this factor could influence the OS in the high-risk group. According to our data, a personalized treatment by histological type should consider in this disease.

Standard ultra-staging compared to one-step nucleic acid amplification for the detection of sentinel lymph node metastasis in endometrial cancer patients: a retrospective cohort comparison

IntroductionThe objective of this study was to compared standard ultra-staging (SU) with one-step nucleic acid amplification (OSNA) for the detection of sentinel lymph node (SLN) metastasis in women with apparent...

African walnuts attenuate ectopic fat accumulation and associated peroxidation and oxidative stress in monosodium glutamate-obese Wistar rats

AimsAfrican walnuts were previously shown to modulate hepatic lipid bio-accumulation in obesity. Herein, we investigated the impact of the nuts on fat accumulation in adipose and ectopic regions, and associated oxidatiive stress status in obese rats. Materials and methodsWhole ethanol extract (WE) of the nuts, and its liquid-liquid fractions-ethyl acetate (ET) and residue (RES) were separately administered to obese rats for 6 weeks. The normal (NC) and obese (OC) controls received normal saline and the standard control (SC), orlistat (5.14 mg/kg b.w.), during the same period. Thereafter, the animals were euthanized and the adipose, brain, kidneys and heart tissues were studied. ResultsThe change in body weight to naso-anal length which increased by 63.52 % in OC compared to NC (p < 0.05), decreased by 57.88, 85.80 and 70.20 % in WE, ET and RES-treated groups, respectively, relative to the OC (p < 0.05). Also, adipose tissue weights were lowered upon treatment with the extracts and fractions versus OC (p < 0.05). Total lipids, phospholipids, triacylglycerol and cholesterol concentrations in the studied tissues which were higher in OC (p < 0.05) were lowered (p < 0.05) and compared favorably with SC. Further, malondialdehyde levels in the tissues were lowered upon treatment, compared to the OC (p < 0.05). Glutathione level and activities of glutathione peroxidase, superoxide dismutase and glutathione-S-transferase which were decreased (p < 0.05) in OC, were restored upon treatment with the extracts, relative to the obese control (p < 0.05). SignificanceAfrican walnuts assuaged lipogenesis, oxidative stress and peroxidation in extra-hepatic tissues of obese rats, hence, may attenuate ectopic fat accumulation and its associated pathogenesis.

A Statistically Significant Reduction in Length of Stay and Hospital Costs with Equivalent Quality of Care Metrics for ERCPs Performed During the Weekend Versus Postponed to Weekdays: A 6-Year Study of 533 ERCPs at Four Teaching Hospitals.

Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic/therapeutic endoscopic procedure for numerous pancreaticobiliary diseases. Data regarding performing ERCP on weekend (WE; Saturday/Sunday) versus postponing ERCP to first two available weekdays (WD; Monday/Tuesday) are scarce. ERCP requires costly resources including specialized nurses, endoscopy room equipped with fluoroscopy, anesthesia services, and highly trained therapeutic endoscopists. Hospitals frequently do not have these resources readily available during WE, leading to postponing ERCPs to WD. This study analyzes the effect of performing ERCP on WE versus postponement to WD on hospital efficiency, and on patient safety/outcomes. A computerized search of electronic medical records, January 2011-December 2016, at four Beaumont Hospitals retrospectively identified all gastroenterology consults performed on Friday or Saturday before 12:00 noon, which resulted in ERCP performed for any indication on WE versus postponing ERCP to WD. Length of stay (LOS), hospital costs, hospital charges, and hospital reimbursements were compared between both groups, as were quality of care measures. Among 5196 patients undergoing ERCPs, 533 patients were identified, including 315 patients in the WE group and 218 patients in the WD group. Comparing WE versus WD groups, median LOS was shorter (4.5days vs. 6.9days, p < 0.0001); median hospital costs were less ($9208 vs. $11,657, p < 0.0001); and median hospital charges were less ($28,026 vs. $37,899, p < 0.0001). Median hospital reimbursements were not significantly different in WE versus WD groups ($10,277 vs. $10,362, p = 0.65). Median hospital charges were lower than median hospital reimbursements (net profit) in WE but not in WD. WE versus WD had no significant differences in morbidity, mortality, ≤ 30-day readmission rates, need for repeat ERCP ≤ 30days, or post-ERCP complications. This is a retrospective study. Performing ERCPs during weekends significantly reduced LOS, hospital costs, and hospital charges compared to postponing ERCP to WD and resulted in net hospital profits, without impairing quality of medical care.

Quality of Information About Bariatric Surgery on the Internet: A Two-Continent Comparison of Website Content.

Many patients considering bariatric surgery will obtain medical information through the Internet. The type and quality of information patients access may vary significantly by geographic region. Searches were performed using commercial search engines in both the United States of America (USA) and United Arab Emirates (UAE) using search terms "bariatric surgery" and "weight loss surgery." Quality was assessed using the scoring systems previously published by DISCERN (United Kingdom (UK)), the Journal of the American Medical Association Benchmark (JAMA; USA), and Expanded Ensuring Quality Information for Patients (EQIP) (UK). Website types were more evenly distributed in UAE, though physician websites were also the most common (n = 25, 25%). Within the USA, most websites analyzed were from physicians (n = 32, 32%), followed by academic sources (n = 26, 26%). Academic websites were the highest average quality in the USA (p < .00001). The overall mean DISCERN scores for all websites in the UAE group and US group had no statistically significance differences (p = .950). The overall mean JAMA Benchmark for all websites in the UAE group and USA had no statistically significance differences (p = 0.202). There were no major differences between the USA and UAE in Expanded EQIP scores. The overall quality of information regarding bariatric surgery is poor to fair in both the USA and UAE. Additionally, there are differences in the types of sites retrieved by the most commonly used search engines in each region. The lack of high-quality, evidence-based, information regarding bariatric surgery online is a potential target to improve public education.

Effects of 12 weeks combined weight and chain versus combined weight and elastic band variable resistance training on upper and lower body muscular strength and endurance among untrained males in Iran

Several studies have shown a positive association between variable resistance training and improvement of muscular performance. However, the most effective type of variable resistance training to improve muscular performance (such as; strength and endurance) in untrained individuals remains unclear. The objective of this research was to examine the effects of 12 weeks combined weight and chain versus combined weight and elastic band variable resistance training on muscular strength and endurance among untrained male adults. Fifty healthy untrained males (age: 21.5 ± 1.95 years) were randomly selected and assigned into three groups: combined weight and chain (WC), combined weight and elastic band (WE), and free-weight (CG). From week 1 until week 12 all groups trained with 3 to 4 sets of 8 - 12 repetitions with 70% to 80% of 1RM for 2 days per week. Approximately 65% of the resistance was provided by free-weights and 35% of the resistance was provided by chains and elastic bands for the WC and WE groups. Upper and lower body muscular strength and endurance using one-repetition maximum, and maximum repetitions were measured before, in the middle and after the intervention. Results reported there were significant increases in upper and lower body muscular strength and endurance in all groups in the middle and after the intervention (p &lt; 0.05), and these variables increased more and faster significantly in WC and WE groups compared with CG group. Finally, although in the middle and after the intervention there were not significant differences in upper and lower body muscular strength and endurance between WE and WC groups (p &gt; 0.05), the results showed WE variable resistance training had a better effect insignificantly to improve upper and lower body muscular strength and endurance in the middle and after 12 weeks of variable resistance training among untrained males.