P326 Changes in left atrial dimensions during stress echocardiography: linear vs planimetric methods

OnBehalf

On behalf of the Stress Echo 2020 study group of the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI)

Background The measurement of left atrium (LA) can be obtained with simple linear or more complex biplane disk summation Simpson (S) method at rest and during stress echocardiography (SE). Although planimetric methods are mandatory to accurately assess resting LA volume, we sought to study if linear (L) methods can be equally valuable in assessing dynamic changes during SE.

Purpose

To assess accuracy of LA- SE with S compared to L method.

Methods

SE was performed in 34 patients (age 59 ± 16 years, 18 females) with known or suspected coronary artery disease. All had acceptable acoustic window at rest and were referred for clinically-driven SE (dobutamine in 21, dipyridamole in 13). LA was measured at rest and peak stress with both methods: 1- S biplane method from 4- and 2-chamber views; 2- L method with measurement of anteroposterior diameter from 2-D targeted M-mode in parasternal long-axis view. Two independent observers measured a set of 20 clips and repeated the measurements after 1 month on the same images. Stress-rest differences of L and S were compared with Spearman non-parametric correlation.

Results

LA measurement was obtained in all patients with L, 34/42 with S (feasibility 100%, and 80%, respectively). The off-line analysis time at each step (rest and stress) measured by stop-clock was 22.3 sec for L and 93 sec for S method (p < 0.001). The intra-rater intra-class correlation coefficient for L was 0.965 for single measures and 0.982 for average measures. For S, it was 0.830 in single measures and 0.907 for average measures. The inter-rater correlation coefficient for L was 0.920 for single measures and 0.958 for average measures. For S, it was 0.901 for single measures and 0.948 for average measures. Absolute LA dimensions were moderately correlated between S and L at rest (r = 0.61, p < 0.01), and during stress (r = 0.476, p < 0.01). Rest-stress variations were not correlated (r = 0.004, p = NS).

Conclusion LA measurement is highly feasible during SE with L and S methods. Absolute values with both are only moderately correlated at rest, less at peak stress, and not correlated when only rest-to-stress variations are considered. Although L is more feasible, less time-consuming, and more reproducible, S should be the first choice for more accurate assessment of rest-stress LA dimensions in pharmacologic SE.

Abstract P326 Figure. Correlation of LA rest-stress

Fecal microbiota transplantation in refractory ulcerative colitis - a case report

Studies comparing gut microbiota profiles of inflammatory bowel disease (IBD) patients have shown several changes in microbiota composition, with marked reduction of local biodiversity relative to that of healthy controls. Modulation of the bacterial community is a promising strategy to reduce the proportion of harmful microorganisms and increase the proportion of beneficial bacteria; this is expected to prevent or treat IBD. The exact mechanism of fecal microbiota transplantation (FMT) remains unknown; however, replacing the host microbiota can reestablish gut microbial composition and function in IBD patients. The present report describes an ulcerative colitis patient who underwent FMT. A 17-year-old male with moderate to severe clinical activity, which was refractory to mesalazine, azathioprine, and infliximab, underwent FMT as alternative therapy. The patient exhibited clinical improvement after the procedure; however, the symptoms returned. A second FMT was performed 8 months after the first procedure, but the patient did not improve. In conclusion, despite the FMT failure observed in this patient, the procedure is a promising therapeutic option for IBD patients, and more in-depth studies of this method are needed.

(Lu0.3Gd0.7)2SiO5:Y3+ single crystals grown by the laser floating zone method: structural and optical studies

Laser floating zone growth of transparent Y0.05:(Lu0.3Gd0.7)2SiO5 single crystals suitable as laser host materials.

Evidence-based management of adult trigger digits

The aim of this systematic review was to develop an evidence-based guideline to assist clinicians in the treatment of adult trigger digits. There is moderate evidence to suggest that local corticosteroid injection is a safe and effective short-term treatment and it may, therefore, be recommended as an initial treatment for this condition. However, when compared with surgery, there is strong evidence that corticosteroid injection is associated with increased rates of ongoing or recurrent symptoms at 6 months after intervention. There is strong evidence suggesting that trigger digit can be managed safely by surgical release. There is weak evidence to support the use of splinting or other non-operative modalities. Hence a single corticosteroid injection may be offered as the first line in treatment of adult trigger digits, but percutaneous release is a safe alternative. Surgery should be the next line if the injection fails, symptoms recur or the patient chooses.

LEVEL OF EVIDENCE

I.

Geriatric nutritional risk index as a nutritional and survival risk assessment tool in stable outpatients with systolic heart failure

BACKGROUND AND AIMS

Malnutrition is frequent in heart failure (HF). However, the best tool for evaluating malnutrition in geriatric patients with HF with reduced ejection fraction (HFrEF) is unknown. This study aimed to evaluate the incremental prognostic value of the geriatric nutritional risk index (GNRI) in stable geriatric outpatients with HFrEF compared with a clinical/laboratory prognostic model.

METHODS AND RESULTS

A total of 143 outpatients with HFrEF, aged >65 years, a LVEF <40%, and who were stable and on optimal therapy were studied. Follow-up lasted 3 years. The outcome was all-cause death. The GNRI was calculated as follows: [(1.489 × serum albumin (g/L)) + (41.7 × (current body weight/ideal weight)]. The 3-year death rate was 36.4% and 16 (11.2%) patients were at risk of malnutrition (GNRI ≤98). Deceased patients had a lower GNRI (113.6 ± 9.1 vs. 105.6 ± 9.2; p < 0.001) than did survivors. Greater values of the GNRI (hazard ratio = 0.93, 95% confidence interval [CI] = 0.90-0.95; p < 0.001) and GNRI >98 (hazard ratio = 0.29, 95% CI 0.15-0.57; p < 0.001) were associated with better survival. These factors remained significant after adjustment of significant confounders. The GNRI was a better discriminator of death than weight and albumin. Adding the GNRI to the clinical/laboratory predictor survival model significantly increased the c-statistics from 0.93 to 0.95 (p < 0.001) and the chi-square likelihood ratio test from 106.15 to 119.9.

CONCLUSION

The risk of malnutrition, as assessed by the GNRI, in stable geriatric outpatients with HFrEF is a strong independent predictor of survival. The GNRI adds significant prognostic information to the clinical/laboratory model.

Intimate partner violence and cognitive aspects of the perpetrator

Introduction

Violence against women, committed by an intimate partner, is a serious public health problem. On an international scope it has been researched the relation between intimate partner violence and cognitive aspects of aggressors.

Objective

To investigate if couples use violence to resolve conflicts and if there are differences in cognitive aspects of men in couples where there is intimate partner violence when compared to couples who have a harmonious relationship.

Method

The Revised Conflict Tactics Scale (CTS2) was used. The cognitive aspects of male partners was investigated by Wechsler Adult Intelligence Scale (WAIS-III), certain factors such as verbal and executive functions, to compare the testing results of men who have committed violence against their partners with those who did not.

Results

Thirty-one couples with intimate partner violence police reports and 31 couples who, according to their own perceptions, said to maintain harmonious marital relationship. The comparisons between groups allowed observing that even among couples who judge to be in a peaceful relationship, violent behaviors were detected. These behaviors tend to be naturalized and not considered as violence by partners. In regard to men's cognitive aspects, especially those related to WAIS-III verbal skills and impulse control, they possibly exert some influence to intimate partner violence.

Conclusion

The possible influence of cognitive aspects of the perpetrator on violence against women could be reduced through long-term actions, especially those concerned to early education, since this is the appropriate way to culturally change and to develop satisfactory social and cognitive skills of the individual.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

School Violence: Characterization of Occurrence's Records of a Public High School Institution

Introduction

Acts of indiscipline, incivility and violence are common in the school environment and reflect on physical and mental health of those involved.

Objective

To characterize conflict records made by students, teachers/others and parents/guardians in a Brazilian high school institution.

Method

Qualitative research, exploratory documental. Studied 113 records from 2014 to 2016.

Results

“Indiscipline and Incivility”–75 records (66 by teachers/others and 9 by students) of students: improper use of clothes and accessories, cell phone use in class, not bringing material, dating in school, conversations during class, do not respect the timetables, inappropriate jokes, disrupting activities, theft of materials and disrespect toward authority figures. “School violence”–22 records (12 by students, 9 by teachers/others and 1 by parent/guardian) of school violence: physical violence between students, psychological/verbal between students/teachers/others, and a match of sexual abuse. Three records (by teachers/others) of violence against the school: students destroyed teaching and cleaning materials and caused damage to the patrimony. Fifteen records (12 by students, 2 by parents/guardians and 1 by teacher) of school's violence: teachers’ harassment (excessive rigor in regard to school performance, clutter in the ratings, refusal to clarify doubts and inappropriate criticism on student's behavior) and institutional negligence (teachers’ delay, lack of clarification on teaching organization and supervision in practical activities).

Conclusion

Some students’ acts of indiscipline and incivility can be protests against the social control of the school. Assistance in case of conflicts and violence as well as preventive measures must be based on interdisciplinary and inter-sectorial articulation practice.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Violence as object of interdisciplinary research: Characterization of a Brazilian group of studies

Introduction

The interdisciplinary group of studies on violence (GREIVI), created in 2006, develops teaching, research and community extension activities related to violence and its impact on individuals’ mental health (victims or perpetrators).

Objective

To describe the subjects studied, the participants and the activities developed in the GREIVI in the period of 8 years.

Aims

Knowing the GREIVI's activities.

Method

Qualitative exploratory documentary study. Analysed 90 group monitoring reports from 2009 to 2016. The records were subjected to content analysis.

Results

Production: completed 11 research projects of undergraduate and postgraduate students; 7 in progress; presented 9 works in international scientific events; published 9 articles; 1 extension project in elementary school (2009 to 2016). Established partnership with international research and education institution to articulate and implement new projects. Topics discussed: definition, types and nature of violence; ecological model of violence; violence against women; and school violence. Activities: directed reading; discussions and exchange of experiences between the participants; presentation, discussion and advice on research and community extension projects; production and dissemination of scientific papers; technical visits and activities’ structuring and planning. Participants: professionals and undergraduate and graduate students from different areas (nursing, psychiatry, psychology, social work, education, biology and political advisor who works with the theme of violence).

Conclusion

The GREIVI have provided interdisciplinary space for discussion of different aspects of violence and the construction of research and extension projects to the community.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Spectroscopic analysis of LYSO:Ce crystals

Rare earth orthosilicates are among the most widely used scintillator materials in the last decades. Particularly, lutetium-yttrium oxyorthosilicate (LYSO) is known to exhibit great potentialities in the field of radiation detectors for medical imaging. Consequently, an in-depth knowledge of the material properties is of utmost interest for the mentioned applications. In this work the spectroscopic properties of commercial cerium doped lutetium-yttrium oxyorthosilicate crystals (LYSO:Ce) were investigated by Raman spectroscopy, steady state photoluminescence, photoluminescence excitation and time resolved photoluminescence. Site selective excitation was used under steady state (325nm) and pulsed (266nm) conditions to separately investigate the temperature dependence of the 5d→4f Ce₁ and Ce₂ luminescence, allowing to establish the thermal quenching dependence of the Ce₂ optical center. In the case of the Ce₁ optical center, a luminescence quantum efficiency of 78% was obtained from 14K to room temperature with 266nm photon excitation.

Hybridization of Zinc Oxide Tetrapods for Selective Gas Sensing Applications

In this work, the exceptionally improved sensing capability of highly porous three-dimensional (3-D) hybrid ceramic networks toward reducing gases is demonstrated for the first time. The 3-D hybrid ceramic networks are based on doped metal oxides (Me_xO_y and Zn_xMe_1-xO_y, Me = Fe, Cu, Al) and alloyed zinc oxide tetrapods (ZnO-T) forming numerous junctions and heterojunctions. A change in morphology of the samples and formation of different complex microstructures is achieved by mixing the metallic (Fe, Cu, Al) microparticles with ZnO-T grown by the flame transport synthesis (FTS) in different weight ratios (ZnO-T:Me, e.g., 20:1) followed by subsequent thermal annealing in air. The gas sensing studies reveal the possibility to control and change/tune the selectivity of the materials, depending on the elemental content ratio and the type of added metal oxide in the 3-D ZnO-T hybrid networks. While pristine ZnO-T networks showed a good response to H₂ gas, a change/tune in selectivity to ethanol vapor with a decrease in optimal operating temperature was observed in the networks hybridized with Fe-oxide and Cu-oxide. In the case of hybridization with ZnAl₂O₄, an improvement of H₂ gas response (to ∼7.5) was reached at lower doping concentrations (20:1), whereas the increase in concentration of ZnAl₂O₄ (ZnO-T:Al, 10:1), the selectivity changes to methane CH₄ gas (response is about 28). Selectivity tuning to different gases is attributed to the catalytic properties of the metal oxides after hybridization, while the gas sensitivity improvement is mainly associated with additional modulation of the electrical resistance by the built-in potential barriers between n-n and n-p heterojunctions, during adsorption and desorption of gaseous species. Density functional theory based calculations provided the mechanistic insights into the interactions between different hybrid networks and gas molecules to support the experimentally observed results. The studied networked materials and sensor structures performances would provide particular advantages in the field of fundamental research, applied physics studies, and industrial and ecological applications.

A mixture toxicity approach to predict the toxicity of Ag decorated ZnO nanomaterials

Nanotechnology is a rising field and nanomaterials can now be found in a vast variety of products with different chemical compositions, sizes and shapes. New nanostructures combining different nanomaterials are being developed due to their enhancing characteristics when compared to nanomaterials alone. In the present study, the toxicity of a nanostructure composed by a ZnO nanomaterial with Ag nanomaterials on its surface (designated as ZnO/Ag nanostructure) was assessed using the model-organism Daphnia magna and its toxicity predicted based on the toxicity of the single components (Zn and Ag). For that ZnO and Ag nanomaterials as single components, along with its mixture prepared in the laboratory, were compared in terms of toxicity to ZnO/Ag nanostructures. Toxicity was assessed by immobilization and reproduction tests. A mixture toxicity approach was carried out using as starting point the conceptual model of Concentration Addition. The laboratory mixture of both nanomaterials showed that toxicity was dependent on the doses of ZnO and Ag used (immobilization) or presented a synergistic pattern (reproduction). The ZnO/Ag nanostructure toxicity prediction, based on the percentage of individual components, showed an increase in toxicity when compared to the expected (immobilization) and dependent on the concentration used (reproduction). This study demonstrates that the toxicity of the prepared mixture of ZnO and Ag and of the ZnO/Ag nanostructure cannot be predicted based on the toxicity of their components, highlighting the importance of taking into account the interaction between nanomaterials when assessing hazard and risk.

Hybridization of Zinc Oxide Tetrapods for Selective Gas Sensing Applications

In this work, the exceptionally improved sensing capability of highly porous three-dimensional (3-D) hybrid ceramic networks toward reducing gases is demonstrated for the first time. The 3-D hybrid ceramic networks are based on doped metal oxides (Me_xO_y and Zn_xMe_1-xO_y, Me = Fe, Cu, Al) and alloyed zinc oxide tetrapods (ZnO-T) forming numerous junctions and heterojunctions. A change in morphology of the samples and formation of different complex microstructures is achieved by mixing the metallic (Fe, Cu, Al) microparticles with ZnO-T grown by the flame transport synthesis (FTS) in different weight ratios (ZnO-T:Me, e.g., 20:1) followed by subsequent thermal annealing in air. The gas sensing studies reveal the possibility to control and change/tune the selectivity of the materials, depending on the elemental content ratio and the type of added metal oxide in the 3-D ZnO-T hybrid networks. While pristine ZnO-T networks showed a good response to H₂ gas, a change/tune in selectivity to ethanol vapor with a decrease in optimal operating temperature was observed in the networks hybridized with Fe-oxide and Cu-oxide. In the case of hybridization with ZnAl₂O₄, an improvement of H₂ gas response (to ∼7.5) was reached at lower doping concentrations (20:1), whereas the increase in concentration of ZnAl₂O₄ (ZnO-T:Al, 10:1), the selectivity changes to methane CH₄ gas (response is about 28). Selectivity tuning to different gases is attributed to the catalytic properties of the metal oxides after hybridization, while the gas sensitivity improvement is mainly associated with additional modulation of the electrical resistance by the built-in potential barriers between n-n and n-p heterojunctions, during adsorption and desorption of gaseous species. Density functional theory based calculations provided the mechanistic insights into the interactions between different hybrid networks and gas molecules to support the experimentally observed results. The studied networked materials and sensor structures performances would provide particular advantages in the field of fundamental research, applied physics studies, and industrial and ecological applications.

Biodiesel production from crude Jatropha oil catalyzed by non-commercial immobilized heterologous Rhizopus oryzae and Carica papaya lipases

The aim of this study was to evaluate the feasibility of biodiesel production by transesterification of Jatropha oil with methanol, catalyzed by non-commercial sn-1,3-regioselective lipases. Using these lipases, fatty acid methyl esters (FAME) and monoacylglycerols are produced, avoiding the formation of glycerol as byproduct. Heterologous Rhizopus oryzae lipase (rROL) immobilized on different synthetic resins and Carica papaya lipase (rCPL) immobilized on Lewatit VP OC 1600 were tested. Reactions were performed at 30°C, with seven stepwise methanol additions. For all biocatalysts, 51-65% FAME (theoretical maximum=67%, w/w) was obtained after 4h transesterification. Stability tests were performed in 8 or 10 successive 4h-batches, either with or without rehydration of the biocatalyst between each two consecutive batches. Activity loss was much faster when biocatalysts were rehydrated. For rROL, half-life times varied from 16 to 579h. rROL on Lewatit VPOC 1600 was more stable than for rCPL on the same support.

Validity of the Disabilities of the Arm, Shoulder and Hand patient-reported outcome measure (DASH) and the Quickdash when used in Dupuytren's disease

This study investigated aspects of the validity and reliability of the 30-item Disabilities of the Arm, Shoulder and Hand patient-reported outcome measure (DASH) and its relationship with the shorter 11-item QuickDASH in patients with Dupuytren's disease.Seven hundred and fifty-nine DASH questionnaires were studied, covering pre- and postoperative patients undergoing different treatments for Dupuytren's disease. Items related to pain rose early after treatment before returning to baseline, suggesting that studying pain is relevant during postoperative recovery. Across all 759 sets of responses, the QuickDASH agreed closely with the DASH. In exploratory factor analysis, the DASH was not unidimensional, questioning the validity of the DASH summary score in Dupuytren's disease.Further validation of existing PROMs for use in Dupuytren's disease is needed. These data suggest that pain is a relevant symptom to study during postoperative recovery following treatment for Dupuytren's disease.

LEVEL OF EVIDENCE

III.

Efficacy of Tolypocladium cylindrosporum against Aedes aegypti eggs, larvae and adults

AIMS

The aim of this study was to test the activity of seven Tolypocladium cylindrosporum isolates against different developmental stages of Aedes aegypti.

METHODS AND RESULTS

Ovicidal activity (≤30% of eclosion; at a 84% eclosion of control eggs) and lowest cumulative emergence of adults (≤30%; at a 66·3% control emergence) originating from eclosing larvae was found 15 and 30 days, respectively, after applying conidia of ARSEF 962 or 1580 onto the eggs. All isolates induced larval mortality when third-instar larvae were treated with conidia (≤5% control mortality); the lowest lethal concentration (LC50) at 5 days after treatment was found with ARSEF 1580 (9·2 × 10(5) conidia ml(-1)), and the shortest lethal time (LT50 ) with ARSEF 2912 (2·8 days at 3·3 × 10(6) conidia ml(-1)). The pathogenicity of T. cylindrosporum to A. aegypti adults is corroborated. ARSEF 1027, 1580 and 2912 induced the highest cumulative mortality in adults (≥90%) 15 days after application (≤5% control mortality).

CONCLUSIONS

Findings emphasized an isolate- and developmental stage-related virulence of T. cylindrosporum.

SIGNIFICANCE AND IMPACT OF THE STUDY

ARSEF 1580, in the group of tested isolates, is the most promising isolate for use against terrestrial eggs, aquatic larvae and adults of this important vector.