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Background: Human brucellosis is an important zoonotic disease of public health and often remains neglected owing to lack of sensitive and efficient diagnostic methods. This study evaluates diagnostic utility of in-house designed enzyme-linked immunosorbent assay (ELISA) using whole-cell antigens of Brucella abortus (B. abortus) S19 against the commercially available kits. Methods: A prospective cohort study involving different populations within the Vidarbha regions of Maharashtra, India was conducted through camps organised from May 2009 to October 2015. A total of 568 serum samples were collected from high-risk people recruited as study cohorts based on inclusion criteria, additional risk factors and clinical symptoms. Samples were evaluated by indirect ELISA using the whole-cell antigens of B. abortus. The results were compared with the commercially available IgG detection ELISA kit to ascertain the specificity and sensitivity of the developed test. Results: Fever, body ache, joint pain, lower back pain, loss of appetite and weight loss were major symptoms associated with the disease. With the cut-off of > 0.8, the positivity of brucellosis infection was at 12.32% (70/568) compared to 9.33% (53/568) as detected by the commercial kit. The in-house developed ELISA method yielded a sensitivity of 87.5% and specificity of 99.18% as compared to the commercial kits (sensitivity –80.30% and specificity –99.6%). Discussion: The B. abortus S19-derived whole-cell protein-based ELISA is rapid and cost- effective and can be used for screening brucellosis infection in lieu of the commercially available ELISA kits.

Background: Bile acid diarrhoea (BAD) is common, often unrecognised, or thought to be irritable bowel syndrome with diarrhoea (IBS-D). It results from increased loss of bile acids (BAs) into the colon but mechanisms are unclear. The gut microbiota plays key roles in the metabolism of primary BAs to form secondary BAs, which have differing impacts on intestinal metabolism and homeostasis. The aim of this study was to profile the gut microbiome in BAD and to investigate the differences in bacterial metabolic products and specific bile acids. Methods: Patients with BAD diagnosed by SeHCAT testing, were compared with other IBS-D patients, and healthy controls. Faecal 16S ribosomal RNA gene analysis was undertaken. Faecal short chain fatty acid (SCFA) and urinary fermentation metabolite profiles (volatile organic compounds; VOCs) were measured. BAs were quantified in serum and faeces. Findings: Faecal bacterial diversity was significantly reduced in patients with BAD, but several taxa were enriched compared to IBS-D. SCFA amounts differed in BAD, controls and IBS-D, with significantly more propionate in BAD. Separation of VOC profiles was evident between all groups with the greatest discrimination between IBS-D and controls. Unconjugated and primary BA in serum and faeces were significantly higher in BAD. The proportion of faecal primary BA was inversely related to SeHCAT values. Interpretation: BAD results in dysbiosis, with differences in metabolites including VOC, SCFA and higher concentrations of primary BAs when compared to IBS-D. These findings provide new mechanistic insights into the pathophysiology of BAD. Funding Statement: Funding was from UHCW Trust’s charity as well as the Midlands Gastroenterology Society and Bardhan Research and Education Trust (BRET). Declaration of Interests: JW has been a consultant for, and reports institutional grant funding from GE Healthcare, and Prometheus diagnostics. RA has delivered educational talks for GE Healthcare. No disclosures are made by all authors Ethics Approval Statement: Scientific and ethical approval was acquired from the local Research and Development Office as well as Warwickshire Ethical committee ref: 09/H1211/38. Written informed consent was obtained from all participants in the study.

Introduction The diagnosis of bile acid diarrhoea (BAD) is often missed or misdiagnosed for irritable bowel syndrome – diarrhoea predominant (IBS-D) as these conditions have a similar clinical presentation. The principal hindrance to diagnosis of BAD is limited access to the diagnostic SeHCAT scan. Mechanisms of aetiology underlying BAD have not been fully elucidated but it has been accepted that bile acids (BAs) are metabolised by the gut microbiota, therefore their role as signalling molecules in regulating intestinal homeostasis is influenced primarily by the gut commensals. The aim was to profile the gut microbiome in BAD and investigate the mechanisms of how bacterial metabolic products may influence the development of disease. Methods 157 patients participated in the study after having a SeHCAT scan to either diagnose BAD or IBS-D (the latter with a negative scan). Exclusion criteria included recent use of antibiotics/probiotics and the diagnoses of coeliac disease, colorectal cancer and active inflammatory bowel disease (unremarkable levels of C-reactive protein and/or faecal calprotectin were required) in type 1 BAD patients. To examine the gut microbiome, 16S ribosomal RNA gene analysis was undertaken. Bacterial metabolites (short chain fatty acids-SCFAs and volatile organic compounds-VOCs) and BAs were measured using gas and liquid chromatography, mass and ion mobility spectrometry. Results Intestinal dysbiosis with reduced bacterial diversity was observed in patients with BAD compared with IBS-D (p=0.01). A greater total concentration of SCFAs (p=0.17) with increases in the concentrations of acetate (p=0.14) and propionate (p=0.08) were observed in BAD compared to IBS-D. An increase in the concentrations of faecal primary BAs (p=0.05) and serum CDCA (p=0.05) was observed in BAD compared to IBS-D. Conclusions Intestinal dysbiosis with altered fermentation and resultant BA dysmetabolism were observed in BAD. The metabolic output of the microbiota rather than abundance of specific bacterial taxa appears to be more important in the aetiology of BAD.

Current demand on resources have forced engineering sector to look at more efficient design and construction methods. Methods that will yield better designs that are cost effective and put less demand on decreasing resources. This study introduces applications of structural topology optimization to reinforced concrete structures. Structural topology optimization is a technique for finding the optimum material layout. Aerospace and automotive engineers routinely employ topology optimization and have reported significant structural performance gains as a result. Recently designers of buildings and structures have also started investigating the use of topology optimization, for the design of efficient and aesthetically pleasing developments. The main objective is to achieve a reduction in the weight of concrete structures. This is motivated by the need to reduce cement production which is a major source of CO2 emissions. Using this engineer can find the best concept design that meets the design requirements. In this paper a critical review on topology optimization of reinforced concrete structures are investigated based on different topology optimization techniques.

To evaluate the effects of probiotics on individuals’ perception of health and bowel frequency. The VSL#3 Probiotic (V3P; Visbiome in USA; Vivomixx in EU) contains eight strains of live, freeze-dried lactic acid bacteria. It has some therapeutic potential in ulcerative colitis and pouchitis.

Objective: Sjogren's syndrome (SS) patients may be affected by the neuromyelitis optica spectrum disorder (NMOSD), a severe demyelinating syndrome associated with anti-aquaporin 4 antibodies (anti-AQP4 antibodies). The relationship between SS and NMOSD has been a sustained focus of investigation. Among SS patients, anti-AQP4 antibodies have been detected exclusively in those with NMOSD. It has therefore been speculated that NMOSD is not a neurological complication of SS. However, such studies evaluated small numbers of SS patients, often admixed with other inflammatory disorders. Methods: We compared frequencies of anti-AQP4 and SS-associated antibodies in 109 SS patients, including 11 with NMOSD, 8 with non-NMOSD demyelinating syndromes, and 90 without demyelinating syndromes. Results: When assessed using a fluorescence-activated cell sorting (FACS) assay, anti-AQP4 antibodies were seen exclusively in those SS patients with NMOSD (72.7%), but not in SS patients without NMOSD (p

Gastrointestinal bleeding appears to be a common adverse event associated with dasatinib therapy. Here we present a case of a 59-year-old man with chronic myeloid leukaemia (CML) developing the rarest complication of haemorrhagic colitis with dasatinib therapy which resolved rapidly after treatment withdrawal.

Primary hyperoxaluria is an uncommon, inherited metabolic disorder due to hepatic enzyme deficiencies with consequent hepatic oxalate overproduction and attendant systemic complications. The diagnosis is established on a combination of clinical parameters, elevated urinary excretion of oxalate and glycolate and determination of alanine glyoxylate aminotransferase in the liver tissue. We describe a 45-year-old female with end-stage renal disease secondary to nephrolithiasis, who presented with a fulminating vascular syndrome before confirming the diagnosis of primary hyperoxaluria. This case illustrates that in this infrequent clinical entity, the diagnosis is often delayed with incorrect initial management.

The prime objective of this paper is to understand the human gait in biometric and biomedical applications. Human gait recognition is recognizing people from the way they walk. It is related to acquiring biometric information such as identity, gender, ethnicity and age from people walking patterns. Also, biomedical information can be acquired like person's illness, body abnormality. In the walking process, the human body shows regular periodic motion, especially upper and lower limbs, which reflect the individual's unique movement pattern. Compared to other biometrics modalities, gait can be obtained from distance and is difficult to hide and camouflage. Gait has been topic in computer vision with great progress achieved in recent ten years. In this paper, we give an overview over state-ofart gait technology; focus on various factors in gait modality, recent progresses and its applications in biomedical engineering.

Liver transplantation has transformed survival for children with liver disease necessitating the transfer of a growing number of patients to the adult healthcare service. The impact of transfer on outcomes remains unclear. The aim of this single-center study of 137 consecutive pediatric liver transplant recipients was to examine the effect of transfer on patient and graft survival. The median time from transplant to transfer was 10.4 years and the median age of the patients at transfer was 18.6 years. After transfer, there were 5 re-transplants and 12 deaths in 14 patients. The estimated posttransfer 10-year patient and graft survival was 89.9% and 86.2%, respectively. Overall, 4 patients demonstrated graft loss as a consequence of chronic rejection. Graft loss was associated with older age at first transplant (p = 0.008). When compared to young adult patients transplanted in the adult center, the transferred patients did not have inferior graft survival from the point of transfer (HR 0.28; 95% CI 0.10-0.77, p = 0.014). This suggests that transfer did not impact significantly on graft longevity. In conclusion, pediatric liver transplant recipients who undergo transfer to the adult service have good long-term outcomes.

Introduction Mortality at six weeks for patients with variceal bleeding approaches 10–20%. International and local guidelines state all liver cirrhotic patients should be screened for varices at diagnosis. For primary prophylaxis, non-selective beta-blockers (NSBB) are recommended in patients with small oesophageal varices (OV) with red wale signs or Child C class as well as for patients with gastric varices (GV). Either NSBB or endoscopic band ligation (EBL) is advised for medium sized OVs.1We aim to audit primary prophylaxis in patients on the transplant waiting list. Method 77 consecutive cirrhotic patients on the liver transplant waiting list from January 2013 to January 2014 were evaluated. Of these 77 patients, 36 (47%) did not live locally therefore had missing data and were excluded from the study. The remaining 41 (53%) patients local to the area were studied. Results 64% of patients were male, 36% female. The most common aetiologies of liver disease were alcoholic liver disease (30%), Hepatitis C (17%) and PSC (17%). 28 (68%) patients had OVs at screening of which 5 (18%) had at least grade 2 OVs and all patients received either NSBB (40%) or EBL (60%). 8 (29%) patients had OVs which were less than grade 2. Grading of OVs was not specified in 15 (54%) patients, with 8 (53%) of these patients receiving NSBB, 4 (27%) EBL, 2 (13%) both NSBB and EBL and 1 (7%) untreated. GVs were evident in 3 (7%) patients, 1 of whom had a TIPPS, 1 NSBB and 1 was untreated. Both OVs and GVs were present in 1 (2%) patient who received a TIPPS. There were no varices demonstrated in 9 (22%) patients however 2 (22%) received NSBB and 7 (78%) were left untreated. Out of the 77 patients on the transplant waiting list, there were 12 (16%) deaths, 2 of which were secondary to variceal bleeding. One of these patients had received a TIPSS for GVs and another had EBL for OVs of an unknown grade. Conclusion Our data demonstrates that reporting of the size of varices could be improved (grading of OVs not specified in 54% of patients). This would have implications of primary prophylaxis being offered to the appropriate patients. Secondly, there was some evidence of lack of adherence with regards to primary prophylaxis but good adherence to current guidelines was demonstrated in patients with grade 2 or larger OVs, which bears the greatest clinical relevance. Disclosure of interest None Declared. Reference de Franchis R; Baveno V Faculty. Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2010 Oct;53(4):762–8

Introduction Despite open-access endoscopy, previous series have suggested that between 8–20% of early gastric cancers (GC) are potentially missed at prior endoscopy. 1,2 Although upper gastrointestinal alarm symptoms are more frequently associated with malignancy, this may represent advanced cancer with poorer survival rates, as patients with early GCs may be asymptomatic. The false-negative rate for the diagnosis of GC may also be a measure of quality for endoscopy services. This is based on a reported median duration of 37 months between endoscopic diagnosis of early GC and progression to advanced GC, 2,3 so we assessed all oesophagogastroduodenoscopy (OGD) findings to assess detection of GC in a large tertiary hospital in the West Midlands. Methods Patients with histologically confirmed GC were identified from histopathology and endoscopy records. Patients who had undergone at least one OGD before the diagnosis were studied. Detection of GC within 3 years of a negative OGD was interpreted as a false negative. Results Between September 2009 and September 2013, 16823 OGDs were performed. GC was diagnosed in 75 (0.45%) patients (male/female ratio 1.78; median age 74; 85% Caucasian). Sixty-seven (89%) of the 75 patients with GC presented with alarm symptoms. 33% (25) were done as inpatients, with 43% (at least 32 of 50 outpatients) being referred as urgent outpatients. Five of the 75 (7%) patients had previous OGDs within three years preceding diagnosis. Only one of these was planned because of a suspicious gastric ulcerative lesion at the same site, with other causes being gastric polyps (2); normal (1) and gastritis (1). There were 53 (71%) deaths in total, 47 (89%) of these patients had alarm symptoms at diagnosis of GC. Conclusion The absolute rates of GC are low (0.1%/OGD/year) and false-negative rates of 5% (within 3 years) for diagnosis of GC are reassuring with only a minority of preceding OGDs in this series demonstrating suspicious lesions. Whilst GC presents with alarm symptoms in the vast majority, the prognosis remains very poor, so continued quality measures in endoscopy will be required to ensure that early gastric cancers are not missed. References Vradelis S, Maynard N, Warren BF et al . Quality control in upper gastrointestinal endoscopy: detection rates of gastric cancer in Oxford 2005–2008. Postgrad Med J . 2011 May;87(1027):335–9 Hosokawa O, Tsuda S, Kidani E, et al . Diagnosis of gastric cancer up to three years after negative upper gastrointestinal endoscopy. Endoscopy 1998:30:669–74 Tsukuma H, Mishima T, Oshima A. Prospective study of “early” gastric cancer. Int J Cancer 1983:31:421–6 Disclosure of Interest None Declared.

Introduction Given the success of paediatric transplantation, there is now a growing population of patients that undergo transition from paediatric to adult healthcare services. In the renal transplant setting, these patients appear to be at increased risk of short-term graft loss. 1 However, the outcome of liver transplant patients who undergo transition remains unclear. Our aim was, therefore, to examine the patient and graft survival of liver transplant patients who undergo paediatric to adult healthcare transition. Methods Single-centre retrospective study of 85 liver transplant recipients who underwent transition from paediatric to adult healthcare services between March 2001 and August 2011 (median follow-up time from transition 4.1 (range 0.2–10.7) years). Results During the 10-year period, there were 48 (56.5%) males and 37 (43.5%) females. The median age at time of transplant was 8.4 (range 0.6–17.9) years. The initial indications for transplantation were: biliary atresia (27.1%), Wilson9s (14.1%), other acute liver failure (11.8%), cystic fibrosis (9.4%), autoimmune hepatitis (8.2%), cryptogenic cirrhosis (4.7%), oxalosis (4.7%), other (20.0%). At the time of transition, the median age of the patients was 18.9 (range 16.6–23.1) years. 84.7% of patients were on their first graft, 12.9% were on their second and 2.4% were on their third at this point. The immunosuppression at transition was calcineurin inhibitor (CNI) monotherapy in 38.2%, a CNI combination regimen in 20.6%, and a CNI free regimen in 41.2%. Following transition, the estimated 1-, 5- and 10-year patient survival was 98.6%, 96.8% and 91.4%, respectively, and the estimated 1-, 5- and 10-year graft survival was 98.6%, 95.0% and 89.4%. Conclusion Our results demonstrate that paediatric liver transplant recipients have a better outcome than previously reported in renal transplant recipients after transition. 1 This may suggest that this group of patients are more tolerant of their graft or that transition was adequately managed. Competing interests None declared. Reference 1. Watson AR . Non-compliance and transfer from paediatric to adult transplant unit. Pediatr Nephrol 2000; 14 :469–72.