Acceptability of extending HPV-based cervical screening intervals from 3 to 5 years: An interview study with women in England

Objectives: The introduction of primary HPV testing in the NHS Cervical Screening Programme in England means the screening interval for 25-49-year-olds can be extended from 3 to 5 years. We explored womens responses to the proposed interval extension. Methods: We conducted semi-structured phone/video interviews with 22 women aged 25-49 years. Participants were selected to vary in age, socioeconomics, and screening history. We explored attitudes to the current 3-year interval, then acceptability of a 5-year interval. Interviews were transcribed verbatim and analysed using Framework Analysis. Results: Attitudes to the current 3-year interval varied; some wanted more frequent screening, believing cancer develops quickly. Some participants worried about the proposed change; others trusted it was evidence-based. Frequent questions concerned the rationale and safety of longer intervals, speed of cancer development, the possibility of HPV being missed or cell changes occurring between screens. Many participants felt reassured when the interval change was explained alongside the move to HPV primary screening, of which most had previously been unaware. Conclusions: Communication of the interval change should be done in the context of broader information about HPV primary screening, emphasising that people who test negative for HPV are at lower risk of cell changes so can safely be screened every 5 years. The long time needed for HPV to develop into cervical cancer provides reassurance about safety, but it is important to be transparent that no screening test is perfect.

Pseudo-insular glioma syndrome: illustrative cases

BACKGROUND Lower-grade insular gliomas often appear as expansile and infiltrative masses on magnetic resonance imaging (MRI). However, there are nonneoplastic lesions of the insula, such as demyelinating disease and vasculopathies, that can mimic insular gliomas. OBSERVATIONS The authors report two patients who presented with headaches and were found to have mass lesions concerning for lower-grade insular glioma based on MRI obtained at initial presentation. However, on the immediate preoperative MRI obtained a few weeks later, both patients had spontaneous and complete resolution of the insular lesions. LESSONS Tumor mimics should always be in the differential diagnosis of brain masses, including those involving the insula. The immediate preoperative MRI (within 24–48 hours of surgery) must be compared carefully with the initial presentation MRI to assess interval change that suggests tumor mimics to avoid unnecessary surgical intervention.

THROUGHPUT INCREASE IN THE OFFICE LI-FI SYSTEM

Background. Wi-Fi has many disadvantages, such as how the maximum bandwidth is limited by the frequency of the range. The work uses Li-Fi technology, which uses visible light for data transmission. The frequency range of Li-Fi is 1000 times greater than the entire radio range. Feedback is used to increase the throughput. But the feedback decreases the bandwidth of the downstream signal. Objective. The purpose of the paper is to analyse what parameters are advisable to change to increase the throughput of the Li-Fi system. Methods. Study of the simulated dependence of the optimal interval change for using the feedback, and using this interval plot the dependence of the throughput on the change in the parameters of the Li-Fi system with a mobile user. Results. With an increase in the area of the photodiode and its refractive index, the throughput increases. As the receiver speed increases, the throughput decreases slightly <0.1%. Reducing the angle of the photodiode field of view and the half-angle of radiation significantly increases the throughput (by 50%) only when decreasing to small angles (<10 °). Conclusions. It is advisable to make photodiode from a material with a high refractive index, with a big area. Since mobile devices are often used in the office Li-Fi network, it is not advisable to reduce the receiver's viewing angle, as well as to reduce the half-angle of radiation. It may also be beneficial to give mobile users more download throughput than upload throughput.

P-BN20 An evaluation of the accuracy of sonography for the measurements of gallbladder polyps across 3 UK hospital trusts: should the surveillance guidelines be revised?

Background Transabdominal ultrasound scan (USS) is recommended for surveillance of gallbladder polyps (GBP), this is to stratify risk for premalignant potential. European Society of Gastrointestinal and Abdominal Radiology make recommendations based on increases of as small 2mm during sequential USS surveillance. Our aim is to determine the accuracy of USS in diagnosis and measurement of GBP. Methods Measurement data for all GBPs were gathered for three hospital trusts across a 12 year period and retrospectively reviewed. USS findings (diagnosis of GBP and GBP size) were compared with histological diagnosis and measurements, when both reports were available, in those patients who had underwent cholecystectomy at the time of data collection. Results For the first two hospital trusts, 778 USS were reviewed which identified patients with GBP. 78 patients had undergone cholecystectomy at time of data collection. Only 17/78 of patients had histological evidence of GBP. Of those without GBP, 37/61 had gallstones. For the third hospital trust, 41 GBP histological reports were identified, 20 could be directly compared with USS. Collectively 29 USS reports were directly compared with GBP histology reports. Only, 31% had results which were in agreement to within 1mm. The mean measurement discrepancy between both modalities was 5.41mm. Conclusions USS does not provide an accurate diagnosis of GBP, it is likely that USS misdiagnoses gallstones as GBP. Moreover, when comparing USS measurements with histological data, there is 31% accuracy of measurement to within 1mm in this cohort. Current guidelines recommend cholecystectomy if there is an interval change of 2mm or more; this data shows a measurement error of more than this.

Abstract 1122‐000135: Application of the Berenstein‐DeLeacy Grading Scale to Assess Treatment Outcome in Orbital Lymphatic Malformations

Introduction : Lymphatic malformations (LMs) are low‐flow vascular malformations that arise as a result of erroneous vascular development during embryogenesis. Prior to the advent of the Berenstein‐De Leacy (BDL) scale, no reproducible grading system had been designed to compare sclerotherapy outcomes on the basis of radiologic findings. The soft‐tissue detail, absence of ionizing radiation, safety profile, and ubiquity of MR imaging made it an ideal technique on which the imaging‐based criteria was developed. The BDL scale ranges from 1–7 denoting complete obliteration to significant progression respectively. A “B” modifier is assigned for identification of granulation tissue in the treatment bed. We examine and validate the BDL scale on a cohort of 16 orbital LMs from our practice. Methods : Orbital LMs treated with sclerotherapy at our practice between 2000 and 2021 were assessed by an attending physician prior to initial and after final treatment to assign scale scores. The assigned scores represent changes in the orbit as defined by pre‐ and post‐septal spaces, above and below eyelids, and intra/extraconal spaces going to the coronal apex without the cavernous sinus. Results : The median age at initial imaging was 24 months (range: 1–445 months) and 108 months (range 12–528) at final imaging. The median imaging interval was 61 month. Males and females were represented in our cohort equally. Six cases presented with right orbital LMs (37.5%) and 10 presented on the left (62.5%). Six cases presented with macrocystic malformations (37.5%), five cases with microcystic (31.25%), and five cases with mixed (31.25%). 11 patients were treated with bleomycin and 5 patients were treated with bleomycin and doxycycline. BDL scale scores ranged from 2–7 with one case assigned the “B” modifier. Two cases were labelled as BDL7, or gross interval progression of the LM. Four cases were labelled as BDL6, or regression of the LM in one region with progression into a previously uninvolved/untreated area. Three cases were labelled as BDL5 with minimal or no gross interval change. One case was labelled as BDL4 and assigned the “B” modifier for partial regression with >50% estimated volume of residual malformation and granulation tissue in the treatment bed. Three cases were labelled as BDL3, or partial repression with <50% estimated volume of residual malformation. One case was labelled as BDL2 with near‐complete regression with trace residual of the lesion. No cases were labelled as BDL1, or complete regression of the lesion. Conclusions : The BDL scale was applied to a series of 16 orbital LMs to demonstrate its versatility in describing the treatment progression of this historically difficult‐to‐classify malformation. We hope visualization of BDL scores for orbital LMs will assist other interventionalists with incorporating this scale as a metric for treatment progression and outcomes.

IoT terminal security assessment system based on improved assessment method

The Internet of Things (IoT) technology is widely used and has been improved in research. However, due to the extensiveness of IoT technology, the heterogeneity and diversity of the device structure, the number of attacks against IoT has increased dramatically, so we need a method that can effectively and actively determine safety. Considering the diversity of the terminal structure of IoT, a security method for the IoT terminal based on structural balance, method objectivity, and reliability is currently a challenging task. This paper introduces the idea of rate of change in mathematics into trust analysis, and forms three attribute sets based on trust interval and rate of change: discrete interval, change range, and change frequency. By calculating the above attributes of the entity’s trust value, the entity’s trust situation is obtained, and an overall assessment of the terminal entity’s trust situation is made from the three levels of completeness, accuracy and objectivity. Under the premise of reducing encryption and other means, the above method can evaluate the trust state of the IoT terminal from the perspective of the data, and this evaluation method can provide a basis for the judgment of the IoT terminal more objectively and accurately.

Per-protocol analysis of the ZINC trial for HIV disease among alcohol users

Background The Zinc for INflammation and Chronic disease in HIV (ZINC) trial randomized person who live with HIV (PLWH) who engage in heavy drinking to either daily zinc supplementation or placebo. The primary outcome was change in the Veterans Aging Cohort Study (VACS) index, a predictor of mortality, between baseline and 18 months. Because adherence and follow-up were suboptimal, the intention-to-treat analysis, which was not statistically significant, may have underestimated the effect of the zinc supplementation. Objective We estimated the per-protocol effect of zinc versus placebo in the ZINC trial (i.e., the effect that would have been observed if all participants had had high adherence and none was lost to follow-up). Methods Adherence was measured as the self-reported percentage of pills taken in the previous 6 weeks and assessed at all post-baseline visits. We used inverse probability weighting to estimate and compare the change in the VACS index at 18 months in the zinc and placebo groups, had all the trial participants had high adherence (i.e., cumulative adherence ≥80% at 18 months). To examine trends by level of adherence, we rerun the analyses using thresholds for high adherence of 70% and 90% of average self-reported pill coverage. Results The estimated (95% confidence interval) change in the VACS index was − 2.16 (− 8.07, 3.59) and 5.84 (0.73, 11.80) under high adherence and no loss to follow-up in the zinc and placebo groups, respectively. The per-protocol effect estimate of the mean difference in the change between the zinc and placebo groups was − 8.01 (− 16.42, 0.01), somewhat larger than the intention-to-treat effect difference in change (− 4.68 (− 9.62, 0.25)), but it was still not statistically significant. The mean difference in the change between individuals in the zinc and placebo groups was − 4.07 (− 11.5, 2.75) and −12.34 (− 20.14, −4.14) for high adherence defined as 70% and 90% of pill coverage, respectively. Conclusions Overall, high adherence to zinc was associated with a lower VACS score, but confidence intervals were wide and crossed 0. Further studies with a larger sample size are needed to quantify the benefits of zinc supplementation in this population. Trial registration ClinicalTrials.gov NCT01934803. Registered on August 30, 2013

A Network Meta-analysis and Systematic Review of Left Bundle Branch Pacing, His Bundle Pacing, Biventricular Pacing or RV Pacing in Patients Requiring Permanent Pacemaker

Background: Cardiac dyssynchronization is the proposed mechanism for pacemaker-induced cardiomyopathy. The standard of treatment is biventricular pacing. Left bundle branch pacing and His bundle pacing are novel interventions that imitate the natural conductionof the heart with, theoretically, less interventricular dysynchrony. One of the surrogate markers of interventricular synchrony is QRS duration. Our study aimed to compare the change of QRS duration before and after implantation between types of cardiac implantable electronic device (CIED): left bundle branch pacing versus His bundle pacing versus biventricular pacing and conventional right ventricular pacing. Methods: A literature search for studies that reported an interval change of QRS duration after CIED implantation was conducted utilizing the MEDLINE, EMBASE, and Cochrane databases. All relevant work through September 2020 from these databases was included in this analysis. A random-effects model network meta-analysis was used to analyze QRS duration changes (i.e., electrical cardiac synchronization) across different CIED implantations. Results: The mean study sample size, from 16 included studies, was 185 subjects. According to SUCRA analysis for the studies analyzed, the His bundle pacing intervention resulted in the most dramatic decline in QRS duration (mean difference -53 ms, 95% CI -67, -39), followed by left bundle branch pacing (mean difference -46 ms, 95% CI -60, -33) and biventricular pacing (mean difference -19 ms, 95% CI -37, -1.8), when compared to conventional right ventricle apical lead placement. Conclusion: Our network meta-analysis found that His bundle branch pacing devices have the greatest effect on QRS duration reduction after implantation, followed by left bundle branch pacing. Physiologic pacing interventions result in improved electrocardiography markers of cardiac synchronicity, narrower QRS duration, and might lower electromechanical dyssynchrony.

Podocyte Infolding Glomerulopathy, First Case Report From North America

Rationale: Podocyte infolding glomerulopathy (PIG) is a newly described condition with only 37 cases reported worldwide. Due to its rarity, the pathogenesis and evolution of this disease is unclear. This case report contributes to our collective knowledge about the clinical and histological progression of this disease. Presenting concerns of the patient: Over the course of a year, a 52-year-old Malaysian woman with no known prior medical history developed progressively worsening edema and other findings consistent with nephrotic syndrome. Diagnosis: Unlike most patients with PIG, this patient did not have any autoimmune disease. She was Hepatitis B core antibody positive with a Hepatitis B surface antibody >1000, suggesting prior Hepatitis B infection with immunity. A renal biopsy was performed which was consistent with PIG. A second renal biopsy was done 2 years later which again showed characteristic findings of PIG with worsened podocyte effacement but no interval change in chronicity. Interventions: The patient was treated with blood pressure control and renin-angiotensin-aldosterone system (RAAS) blockade with irbesartan and spironolactone. She was also treated with prednisone at 1 mg/kg for 2 months followed by a taper for a total of 7 months of prednisone treatment. Outcomes: The patient had a partial response to a course of prednisone. However, since stopping steroids, her proteinuria and renal function has been gradually worsening. Teaching points: PIG is mostly found in patients of East Asian descent. It presents as proteinuria and is often associated with autoimmune disease but can be idiopathic. It is characterized on renal biopsy by infolding or protrusion of podocyte cytoplasm into glomerular basement membrane, as well as intramembranous cytoplasmic microspherules or microtubules. Atypical membranous nephropathy should be ruled out prior to diagnosis. Unlike membranous nephropathy, PIG usually responds at least partially to steroid monotherapy. To our knowledge, this is the first reported case of PIG from North America. Furthermore, it is the first case of PIG with repeat biopsy showing interval worsening of PIG rather than either resolution of PIG or transformation of PIG to a different diagnosis.