Abstract T P271: Establishment of Stroke Ward Results in Immediate Reduction of Major Complications

Background and Purpose: Randomized controlled trials have consistently shown that stroke units decrease both mortality and morbidity compared with conventional care in general medical wards. There are however limited data on the specific types of in-hospital medical complications and their effect on outcomes. The objective of this study was to determine whether establishing a specialized geographically defined Stroke Ward results in reducing the major complications in patients suffering from acute stroke within the same hospital system.

Methods: This is a prospective study from January 2014 till July 2014. Data was collected from a web-based stroke registry in two phases. In phase 1 (from January 1, 2014 till March 08, 2014), we collected data of stroke patients admitted at in the medical wards. In phase 2, a protocol-based multidisciplinary care Stroke Ward became operational where most of the patients were admitted. Outcomes measures were number and type of complications, mortality, discharge disposition, and length of stay, and were adjusted for age, sex, and medical co-morbidities.

Results: There were 130 admissions in phase 1 and 345 in phase 2. Commonest complications included, aspiration pneumonia 29% vs 12% (p<0.001) and pressure ulcers in 35% vs 11% (p<0.001). Average length of stay decreased from 12 days to 4 days (p<0.001). In phase 1, 70 % of patients were discharged home, while 23% were transferred to rehabilitation while in phase 2, 75% of patients were discharged home, while 18% patients were sent to rehabilitation. Ninety percent of complications happened in medical wards, mainly in patients who over stayed in emergency department (more than 8 hours) waiting for bed in Stroke Ward or medical floor.

Conclusion: A protocol based multidisciplinary care Stroke Ward care significantly reduces common early complications of acute stroke. It also helps in significantly reducing the length of stay, saving total bed days at a tertiary care hospital, hence improving the overall care of these patients.

Proteomic and transcriptomic analysis of rice tranglutaminase and chloroplast-related proteins

The recently cloned rice transglutaminase gene (tgo) is the second plant transglutaminase identified to date (Campos et al. Plant Sci. 205-206 (2013) 97-110). Similarly to its counterpart in maize (tgz), this rice TGase was localized in the chloroplast, although in this case not exclusively. To further characterise plastidial tgo functionality, proteomic and transcriptomic studies were carried out to identify possible TGO-related proteins. Some LHCII antenna proteins were identified as TGO related using an in vitro proteomic approach, as well as ATPase and some PSII core proteins by mass spectrometry. To study the relationship between TGO and other plastidial proteins, a transcriptomic in vivo Dynamic Array (Fluidigm™) was used to analyse the mRNA expression of 30 plastidial genes with respect to that of tgo, in rice plants subjected to different periods of continuous illumination. The results indicated a gene-dependent tendency in the expression pattern that was related to tgo expression and to the illumination cycle. For certain genes, including tgo, significant differences between treatments, principally at the initiation and/or at the end of the illumination period, connected with the day/night cycling of gene expression, were observed. The tgo expression was especially related to plastidial proteins involved in photoprotection and the thylakoid electrochemical gradient.

How much can history constrain adaptive evolution? A real-time evolutionary approach of inversion polymorphisms in Drosophila subobscura

Chromosomal inversions are present in a wide range of animals and plants, having an important role in adaptation and speciation. Although empirical evidence of their adaptive value is abundant, the role of different processes underlying evolution of chromosomal polymorphisms is not fully understood. History and selection are likely to shape inversion polymorphism variation to an extent yet largely unknown. Here, we perform a real-time evolution study addressing the role of historical constraints and selection in the evolution of these polymorphisms. We founded laboratory populations of Drosophila subobscura derived from three locations along the European cline and followed the evolutionary dynamics of inversion polymorphisms throughout the first 40 generations. At the beginning, populations were highly differentiated and remained so throughout generations. We report evidence of positive selection for some inversions, variable between foundations. Signs of negative selection were more frequent, in particular for most cold-climate standard inversions across the three foundations. We found that previously observed convergence at the phenotypic level in these populations was not associated with convergence in inversion frequencies. In conclusion, our study shows that selection has shaped the evolutionary dynamics of inversion frequencies, but doing so within the constraints imposed by previous history. Both history and selection are therefore fundamental to predict the evolutionary potential of different populations to respond to global environmental changes.

Proteína bruta e energia metabolizável para codornas de corte de um a 14 dias de idade

Com o objetivo de avaliar diferentes níveis de proteína bruta e de energia metabolizável para codornas de corte de um a 14 dias de idade, foi realizado um estudo utilizando 840 codornas de corte, mistas. As aves foram distribuídas em arranjo fatorial (2x5) constituído por 10 tratamentos (dois níveis de energia metabolizável - 2800 e 3000kcal/kg e cinco níveis de proteína bruta - 22,0; 24,0; 26,0; 28,0 e 30,0%), sete repetições com 12 aves cada. Foram avaliados os seguintes parâmetros: consumo de ração, ganho em peso aos sete e 14 dias de idade, conversão alimentar aos 14 dias e viabilidade. Verificou-se que codornas alimentadas com dietas com o nível energético mais baixo, 2800kcal/kg, apresentaram maior consumo. As aves que consumiram ração com menor nível de energia apresentaram maior peso aos sete dias de idade independentemente do nível de proteína bruta utilizado. O peso aos 14 dias de idade apresentou resposta quadrática com o acréscimo de proteína bruta na ração, sendo que dietas contendo 28,86% de PB proporcionaram melhor ganho independentemente do nível de energia utilizado. A conversão alimentar apresentou melhores resultados com o aumento do nível de proteína bruta da ração, independentemente do nível de energia metabolizável utilizado. Não foram observados efeitos significativos dos níveis de proteína e energia ou de sua interação sobre a viabilidade das aves. Rações contendo 30,0% de proteína bruta e 2800 ou 3000kcal/kg de energia metabolizável proporcionam satisfatórios resultados de desempenho para codornas de corte de um a 14 dias de idade.

Morphology effect of bioglass-reinforced hydroxyapatite (Bonelike(®) ) on osteoregeneration

In the last decades, the well-known disadvantages of autografts and allografts have driven to the development of synthetic bone grafts for bone regeneration. Bonelike(®) , a glass-reinforced hydroxyapatite (HA) composite was developed and registered for bone grafting. This biomaterial is composed by a modified HA matrix, with α- and β-tricalcium phosphate secondary phases. Aiming to improve the biological characteristics of Bonelike(®) , new spherical pelleted granules, of different shape and size, were developed with controlled micro and macrostructure. In the present study, it was compared the physicochemical properties and in vivo performance of different Bonelike(®) granule presentations-Bonelike(®) polygonal (500-1000 µm size) and Bonelike spherical (250-500 µm; 500-1000 µm size). For the in vivo study, Bonelike(®) was implanted on sheep femurs, with various implantation times (30 days, 60 days, 120 days, and 180 days). X-ray diffraction analysis revealed that the phase composition of different granules presentations was similar. Bonelike(®) spherical 500-1000 µm was the most porous material (global porosity and intraporosity) and Bonelike(®) polygonal 500-1000 µm the less porous. Considering the in vivo study, both polygonal and spherical granules presented osteoconductive proprieties. The spherical granules showed several advantages, including easier medical application through syringe and improved osteointegration, osteoconduction, and degradation, by the presence of larger pores, controlled micro- and macrosctructure and suitable particle format that adapts to bone growth. Bonelike(®) spherical 500-1000 µm showed improved new bone invasion throughout the material's structure and Bonelike(®) spherical 250-500 µm appeared to induce faster bone regeneration, presenting less unfilled areas and less lacunae in the histological analysis.

[Severe ametropia in children in Lomé (Togo)]

AIMS

To determine the features of severe ametropia (refractive errors, including myopia, hyperopia, and astigmatism) in children in general practice in Lomé.

PATIENTS AND METHODS

We conducted a retrospective study based on records of patients aged 5-16 years seen in a private clinic in Lomé from 1 January, 2001, to 31 December, 2010. We analyzed subjective refraction after automated refraction or retinoscopy.

RESULTS

Among 1303 cases of ametropia in children, 58 cases were severe, for a frequency of 4.5%. The mean age of these patients was 12.7 years. The sex ratio (M/F) was 0.7. Among these severe cases, astigmatism was most frequent, accounting for 46.6%, followed by myopia (27.6%) and hyperopia (25.6%). Among children with hyperopia, 80% were assessed at +3.50 D to +6.50 D and 20% from +6.75 D to +9.50 D; among those with myopia, 75% were assessed at -6D to -9.50 D and 25% from -10 D to -14 D. Bilateral amblyopia was found in 9 cases for a frequency of 0.45%. The amblyopia was caused by astigmatism in 1 case, hyperopia in 4 cases, and by myopia in 4 cases.

CONCLUSION

The relative frequency of severe ametropia underlines the importance of a routine ophthalmology examination for children starting school.

Successful endoscopic ultrasound-guided overstenting biliary drainage through a pre-existing proximal migrated metal biliary stent

Biliary endoscopic drainage using metallic self-expanded stents has become a well-established method for palliative treatment of malignant biliary obstruction. However, its occlusion, mainly by tumor overgrowth, is still the main complication without a standard treatment. We here describe a new method of treatment for biliary metallic stent occlusion, through the echo guided biliary drainage. We present a 68-year-old patient with metastatic pancreatic cancer previously treated for jaundice with ERCP and self-expandable metallic stent insertion. Four weeks later, the patient developed jaundice and symptoms of gastric outlet obstruction. A new ERCP confirmed obstruction of the second portion of the duodenum, due to diffuse tumor growth. EUS was performed, and the previous metal biliary stent was seen occluded at the distal portion in the common bile duct. A EUS-guided choledocododenostomy was performed and then, an overlapping self-expanding metal enteral stent was placed through the malignant obstruction. There were no early complications and the procedure was also clinically effective in relieving jaundice and gastric outlet obstruction symptoms. If ERCP fails in the management of occluded biliary metallic stents, EUS biliary drain can provide effective biliary decompression and should be considered an alternative to other endoscopic techniques.