Characteristics of polypoidal choroidal vasculopathy in the Malaysian population

Introduction: Polypoidal choroidal vasculopathy (PCV) is a distinct clinical entity, characterized by focal hyperfluorescence in the early phase of indocyanine green angiography (ICGA), with or without its associated branching vascular network (BVN).Purpose: To report the angiographic characteristics of PCV on ICGA in presumed PCV patients.Study design: Descriptive cross-sectional study.Materials and methods: This study involved 36 suspected PCV patients who attended the Ophthalmology Clinic, Universiti Kebangsaan Malaysia Medical Centre from June 1, 2012 to May 31, 2013. All patients underwent complete ophthalmologic examination including colour fundus photography, ICGA, and fundus fluorescein angiography. ICGA images of confirmed PCV patients were analysed.Results: Twenty-five out of 36 eyes (69.4%) were diagnosed to have PCV based on ICGA. Mean age of confirmed PCV patients was 66.4 ± 8.42 years, with predominance of males (n = 17) and Chinese ethnicity (n = 19). Best-corrected visual acuity (BCVA) was between 6/6 and 6/18 in 64%. All 25 patients had unilateral disease. Average size of PCV lesions was 1461.4 ± 864.4 μm. The lesions were mostly concentrated in the extrafoveal region (n = 15, 60%). Lesion formation was cluster in 56% (n = 14), single in 32% (n = 8), string in 4% (n = 1), and combination in 8% (n = 2). The majority involved a single discrete area. Polyp pulsation was detected in six eyes, while seven eyes revealed nodular hyperfluorescence when viewed stereoscopically. BVN was evident in 56% (n = 14). Fifteen eyes demonstrated the hypofluorescent halo, while no hyperfluorescent ring was seen in this study population. Late geographical hyperfluorescence (LGH) was noted in seven eyes (28%). There was no significant association between the morphological characteristics of PCV, i.e., size of lesion, location, formation, discrete area involved, and LGH with BCVA.Conclusion: The demographic, clinical, and angiographic features observed in this study were in agreement with other previously published Asian studies. However, we found no association between the morphological characteristics of PCV with BCVA.

677 Quick, Simple and just as Effective – Comparing PM:L3 Ratio to NELA, P-POSSUM and NSQIP Scores for Emergency Laparotomy

Aim Multiple tools (NELA, P-POSSUM, ACS-NSQIP) are available to assess mortality risks in patients requiring emergency laparotomy(1–3), but they are time-consuming to perform and have had limited uptake in routine clinical practice in many countries(4). Simpler measures, including psoas muscle:L3 vertebrae (PM:L3) ratio(5,6), may be useful alternates. This measure is quick to perform, requiring no special skills or equipment apart from basic CT viewing software. Method We performed an analysis on all patients in the Hunter Emergency Laparotomy Audit (HELA) database, from January 2016 to December 2017. HELA is a retrospective review of all emergency laparotomy undertaken in a discrete area in NSW, Australia. Patients with an available CT abdomen were included (N = 500/562). A single slice axial CT image at the L3 endplate level was analysed using ImageJ® software to measure the area of L3 and bilateral psoas muscles. This can be done using normal PACS software in routine practice. Results PM:L3 ratios in this cohort have a mean of 1.082 (95%CI 1.042-1.122; range 0.141-3.934). PM:L3 ratio is significantly lower (p < 0.00001) in those patients who did not survive beyond 30 days (mean 0.865 [95% CI 0.746-0.984 ]) and 90 days (mean 0.888 [95%CI 0.768-1.008]) compared to patients that survived these periods (30 day mean 1.106 [95% vs. 1.033-1.179], 90 day mean 1.112 [95% CI 1.070-1.154]) . These associations are similar to those calculated by established risk assessment models. Conclusions PM:L3 ratio is a reliable, quick and easy risk assessment tool to identify high risk patients undergoing emergency laparotomy.

678 Can patients have their old life back? Using PM:L3 ratio to predict discharge destination of emergency laparotomy survivors

Aim Psoas muscle:L3 vertebra (PM:L3) ratio is a relatively new risk assessment tool for emergency laparotomy(1,2) based upon the proven concept that sarcopenia – as diagnosed by low skeletal muscle index(3–6), psoas muscle density(7–9) or total psoas area(10–13) in a single axial slice CT image – correlates with increasing risks of bad outcomes in surgery. This study looks into the association between PM:L3 ratio of emergency laparotomy patients from home and their discharge destination. Method We performed an analysis on patients in the Hunter Emergency Laparotomy Audit (HELA) database, from January 2016 to December 2017. HELA is a retrospective review of all emergency laparotomy undertaken in a discrete area in NSW, Australia. All patients admitted from home, survived to be discharged from hospital and had an available CT abdomen were included (N = 433/562). A single slice axial CT image at the L3 endplate level was analysed using ImageJ® software to measure the area of L3 and bilateral psoas muscles. Results PM:L3 ratio is significantly lower in the group of patient discharged to a care facility than the group discharging back to their previous home residence (mean 0.951 vs. mean 1.128, p < 0.001). Upon further analysis, the PM:L3s are divided into quartiles and stratified by sex. There is an association between lower PM:L3 and risk of discharging into a care facility (Q1 22.45%, Q2 19.59%, Q3 19.10%, Q4 5.71%). Conclusions PM:L3 ratio can predict the discharge destination of patients undergoing emergency laparotomy.

Development of a semi-automated method for tumor budding assessment in colorectal cancer and comparison with manual methods

Tumor budding is an established prognostic feature in multiple cancers but routine assessment has not yet been incorporated into clinical pathology practice. Recent efforts to standardize and automate assessment have shifted away from haematoxylin and eosin (H&E)-stained images towards cytokeratin (CK) immunohistochemistry. In this study, we compare established manual H&E and cytokeratin budding assessment methods with a new, semi-automated approach built within the QuPath open-source software. We applied our method to tissue cores from the advancing tumor edge in a cohort of stage II/III colon cancers (n=186). The total number of buds detected by each method, over the 186 TMA cores, were as follows; manual H&E (n=503), manual CK (n=2290) and semi-automated (n=5138). More than four times the number of buds were detected using CK compared to H&E. A total of 1734 individual buds were identified both using manual assessment and semi-automated detection on CK images, representing 75.7% of the total buds identified manually (n=2290) and 33.7% of the total buds detected using our proposed semi-automated method (n=5138). Higher bud scores by the semi-automated method were due to any discrete area of CK immunopositivity within an accepted area range being identified as a bud, regardless of shape or crispness of definition, and to inclusion of tumor cell clusters within glandular lumina ('luminal pseudobuds'). Although absolute numbers differed, semi-automated and manual bud counts were strongly correlated across cores (ρ=0.81, p<0.0001). Despite the random, rather than 'hotspot', nature of tumor core sampling, all methods of budding assessment demonstrated poorer survival associated with higher budding scores. In conclusion, we present a new QuPath-based approach to tumor budding assessment, which compares favorably to current established methods and offers a freely-available, rapid and transparent tool that is also applicable to whole slide images.

Educational and Economic Aspects of Mentoring

The OECD's skills strategy and policy highlights skills ahead of formal qualifications and draws attention to the importance of work-based learning (apprenticeships). In the economy, given the utilisation of the skill set of individuals at the workplace level, the conscious management of the knowledge and skills of the organisation now appears to be an efficiency-increasing factor. One way to do this is to involve and mentor economically inactive groups (students / new entrants, low-skilled social groups and pensioners) in the labour market. Mentoring should be treated as a discrete area, but one that is still a part of the organisation's strategically defined human resource management and knowledge management system, in which the goals, roles, processes, responsibilities and benefits, as well as the possibilities for development, are clarified. This study analyses the educational and economic context of mentoring, the nature of mentoring and the possibility of its application; its conclusions provide an appropriate framework for developing a mentoring programme.

Megafauna community assessment of polymetallic-nodule fields with cameras: platform and methodology comparison

With the mining of polymetallic nodules from the deep-sea seafloor once more evoking commercial interest, decisions must be taken on how to most efficiently regulate and monitor physical and community disturbance in these remote ecosystems. Image-based approaches allow non-destructive assessment of the abundance of larger fauna to be derived from survey data, with repeat surveys of areas possible to allow time series data collection. At the time of writing, key underwater imaging platforms commonly used to map seafloor fauna abundances are autonomous underwater vehicles (AUVs), remotely operated vehicles (ROVs) and towed camera “ocean floor observation systems” (OFOSs). These systems are highly customisable, with cameras, illumination sources and deployment protocols changing rapidly, even during a survey cruise. In this study, eight image datasets were collected from a discrete area of polymetallic-nodule-rich seafloor by an AUV and several OFOSs deployed at various altitudes above the seafloor. A fauna identification catalogue was used by five annotators to estimate the abundances of 20 fauna categories from the different datasets. Results show that, for many categories of megafauna, differences in image resolution greatly influenced the estimations of fauna abundance determined by the annotators. This is an important finding for the development of future monitoring legislation for these areas. When and if commercial exploitation of these marine resources commences, robust and verifiable standards which incorporate developing technological advances in camera-based monitoring surveys should be key to developing appropriate management regulations for these regions.

New-Onset Psychosis Associated With a Lesion Localized in the Rostral Tectum: Insights Into Pathway-Specific Connectivity Disrupted in Psychosis

Objective To investigate pathway-specific connectivity disrupted in psychosis. Methods We carried out a case study of a middle-aged patient who presented with new-onset psychosis associated with a space-occupying lesion localized in the right superior colliculus/periaqueductal gray. The study sought to investigate potential connectivity deficits related to the lesion by the use of diffusion tensor imaging and resting-state functional magnetic resonance imaging. To this aim, we generated a functional connectivity map of the patient’s brain, centered on the lesion area, and compared this map with the corresponding map of 10 sex- and age-matched control individuals identified from the Max Planck Institute–Leipzig Mind–Brain–Body database. Results Our analysis revealed a discrete area in the right rostral tectum, in the immediate vicinity of the lesion, whose activity is inversely correlated with the activity of left amygdala, whereas left amygdala is functionally associated with select areas of the temporal, parietal, and occipital lobes. Based on a comparative analysis of the patient with 10 control individuals, the lesion has impacted on the connectivity of rostral tectum (superior colliculus/periaqueductal gray) with left amygdala as well as on the connectivity of left amygdala with subcortical and cortical areas. Conclusions The superior colliculus/periaqueductal gray might play important roles in the initiation and perpetuation of psychosis, at least partially through dysregulation of left amygdala activity.

4 Criminal Prosecutions by Regulators—Procedural Considerations

This chapter examines the role of the FCA and the PRA as prosecuting authorities and their right to bring criminal proceedings in pursuit of their regulatory objectives as enshrined in the Financial Services and Markets Act 2000 (FSMA). The FCA and the PRA are not the only agencies responsible for the prosecution of criminal offences in the financial services sector; the jurisdiction of the Serious Fraud Office (SFO) in particular often overlaps with that of the FCA and the two agencies can work in tandem. Meanwhile, although a discrete area of criminal practice, the regulators’ powers to administer a caution to an offender should not be overlooked—particularly in the context of ongoing investigations. Acceptance of a caution can provide an offender with a way of avoiding conviction and sanction whilst offering the prosecutor an ‘easy win’ without the need for costly court proceedings. The chapter then considers key procedural issues as well as the importance of evidence collection and deployment in financial services prosecutions.

Megafauna community assessment of polymetallic nodule fields with cameras: Platform and methodology comparison

With the mining of polymetallic nodules from the deep sea seafloor again approaching commercial viability, decisions must be taken on how to most efficiently regulate and monitor physical and community disturbance in these remote ecosystems. Image based approaches allow non-destructive assessment of larger fauna abundances to be derived from survey data, with repeat surveys of areas possible to allow time series data collection. At time of writing key underwater imaging platforms commonly used to map seafloor fauna abundances are Automated Underwater Vehicles (AUVs), Remotely Operated Vehicles (ROVs) and towed camera Ocean Floor Observation Systems (OFOSs). These systems are highly customisable, with mounted cameras, illumination systems and deployment protocols rapidly changing over time, and even within survey cruises. In this study 8 image datasets were collected from a discrete area of polymetallic nodule rich seafloor by an AUV and several OFOSs deployed at various altitudes above the seafloor. A fauna identification catalogue was used by 5 annotators to estimate the abundances of 20 fauna categories from the different data sets. Results show that for many categories of megafauna differences in image resolution greatly influenced the estimations of fauna abundance determined by the annotators. This is an important finding for the development of future monitoring legislation for these areas. When and if commercial exploitation of these marine resources commences, to ensure best monitoring practice, unambiguous rules on how camera-based monitoring surveys should be conducted, and with what equipment, must be put in place.