Loneliness impact on healthcare utilization in primary care: A retrospective study

BACKGROUND

An increased number of patients seek help for loneliness in primary care.

OBJECTIVE

To analyze whether loneliness was associated with a higher utilization of healthcare facilities.

METHODS

Observational, retrospective study based on the review of routinely coded data in the digital medical record system in a random sample of patients aged 65 or older, stratified by population size of their residence area. A minimum sample size was estimated at 892 medical records. Loneliness was defined as the negative feeling that arises when there is a mismatch between the quantity and quality of a person's social relationships and those, they desire. Thirty-three primary care nurses (30 females and 3 males) were reviewing the data.

RESULTS

A total of 932 medical records of patients were reviewed (72% belonged to female patients). Of these, 657 individuals were living alone (71.9%). DeJong Scale average scores was 8.9 points (SD 3.1, 95CI 8.6-9.1). The average annual attendance to primary care ranged from 12.2 visits per year in the case of family practice, 10.7 nurse, 0.7 social workers. The average number of home visits was 3.2, and the urgent consultations attended at health centers were 1.5 per year. Higher feelings of loneliness were associated with extreme values in the frequency of healthcare resource usage. Compared to their peers of the same age, the additional healthcare resource consumption amounted to €802.18 per patient per year.

CONCLUSION

Loneliness is linked to higher healthcare resource usage in primary care, with individuals experiencing poorer physical and mental health utilizing these resources up to twice as much as their peers of the same age.

Clinical improvement after intraarticular and intraosseous injections of platelet rich plasma combined with hyaluronic acid for knee osteoarthritis. Case series

INTRODUCTION

knee osteoarthritis (KOA) is known as the most common form of osteoarthrosis with a 6% prevalence in people over 30 years old, and more than 40% in the population over 70 years old. The use of PRP led to diverse results and this disparity can be attributed to the dissimilar methods of PRP preparation. This study aims to assess the functional effects of intraosseous (IO) and intraarticular (IA) injections of platelet rich plasma (PRP) followed by IA injections of hyaluronic acid (HA).

OBJECTIVES

this study aimed to assess the functional effects of intraosseous (IO) and intraarticular (IA) injections of platelet rich plasma (PRP) followed by IA injections of hyaluronic acid (HA), administered 3 and 4 weeks after the initiation of treatment in 33 patients with grade II-III (Ahlback scale) knee osteoarthritis (KOA).

MATERIAL AND METHODS

retrospectively, 33 patients were assessed using the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index and visual analogue scale (VAS) score. They were followed-up for 12.92 months on average. Patients were divided into three groups based on age and four groups based on the follow-up period.

RESULTS

the pre-operative mean of the WOMAC index was 44.35 ± 20.20 and the post-operative mean was 22.81 ± 17.25 (p < 0.001). The pre-operative and post-operative mean of the VAS scores were 5.79 ± 2.01 and 2.41 ± 1.43 (p < 0.001), respectively. The largest improvement in WOMAC (from 42.86 to 13.69) was observed in the youngest patients (44 to 55 years old) and the largest reduction in VAS (from 6.89 to 2.22) was seen in patients aged 56 to 70 years.

CONCLUSION

the combination of IO and IA plasma rich in growth factor (PRGF) treatment with the IA-HA treatment yielded excellent results, diminishing pain and improving motor functionality in patients with KOA.

Unraveling Azospirillum's colonization ability through microbiological and molecular evidence

It is known that members of the bacterial genus Azospirillum can promote the growth of a great variety of plants, an ability harnessed by the industry to create bioproducts aimed to enhance the yield of economically relevant crops. Its versatile metabolism allows this bacterium to adapt to numerous environments, from optimal to extreme or highly polluted. The fact of having been isolated from soil and rhizosphere samples collected worldwide and many other habitats proves its remarkable ubiquity. Azospirillum rhizospheric and endophytic lifestyles are governed by several mechanisms, leading to efficient niche colonization. These mechanisms include cell aggregation and biofilm formation, motility, chemotaxis, phytohormone and other signaling molecules production, and cell-to-cell communication, in turn, involved in regulating Azospirillum interactions with the surrounding microbial community. Despite being infrequently mentioned in metagenomics studies after its introduction as an inoculant, an increasing number of studies detected Azospirillum through molecular tools (mostly 16S rRNA sequencing) as part of diverse, even unexpected, microbiomes. This review focuses on Azospirillum traceability and the performance of the available methods, both classical and molecular. An overview of Azospirillum occurrence in diverse microbiomes and the less-known features explaining its notorious ability to colonize niches and prevail in multiple environments is provided.

Pancreatic cancer prognosis is predicted by an ATAC-array technology for assessing chromatin accessibility

Unlike other malignancies, therapeutic options in pancreatic ductal adenocarcinoma (PDAC) are largely limited to cytotoxic chemotherapy without the benefit of molecular markers predicting response. Here we report tumor-cell-intrinsic chromatin accessibility patterns of treatment-naïve surgically resected PDAC tumors that were subsequently treated with (Gem)/Abraxane adjuvant chemotherapy. By ATAC-seq analyses of EpCAM+ PDAC malignant epithelial cells sorted from 54 freshly resected human tumors, we show here the discovery of a signature of 1092 chromatin loci displaying differential accessibility between patients with disease free survival (DFS) < 1 year and patients with DFS > 1 year. Analyzing transcription factor (TF) binding motifs within these loci, we identify two TFs (ZKSCAN1 and HNF1b) displaying differential nuclear localization between patients with short vs. long DFS. We further develop a chromatin accessibility microarray methodology termed "ATAC-array", an easy-to-use platform obviating the time and cost of next generation sequencing. Applying this methodology to the original ATAC-seq libraries as well as independent libraries generated from patient-derived organoids, we validate ATAC-array technology in both the original ATAC-seq cohort as well as in an independent validation cohort. We conclude that PDAC prognosis can be predicted by ATAC-array, which represents a low-cost, clinically feasible technology for assessing chromatin accessibility profiles.

Abstract PO-246: Supporting community health center patients in completing follow-up colonoscopy: A qualitative summary of patient navigation activities

Background Fecal immunochemical tests (FITs) are an acceptable and cost-effective way to identify patients at risk for colorectal cancer (CRC). However, patients who receive an abnormal FIT result must obtain a follow-up colonoscopy. Rates of follow- up colonoscopy are low in most healthcare settings, particularly in federally qualified health centers (FQHCs). Half of patients with an abnormal FIT result fail to complete this essential colonoscopy screening component. Patient navigation can provide much needed support for patients to complete the follow-up colonoscopy. Methods PRECISE is a patient-randomized trial of patient navigation vs usual care for follow-up colonoscopy that will enroll 1,200 patients across 28 community health center clinics in Washington State (anticipated 37% Latinx). For the study, we trained a bilingual (native Spanish speaker) patient navigator (PN) using an intensive 8-week program, based on the New Hampshire Colorectal Cancer Screening Program. As part of the recruitment and data tracking tool used by the PN, open text fields are available for documenting interactions with navigated patients. We present a qualitative content analysis of the open text fields of navigated patients. These findings identify a broad range of supportive interactions engaged in by the PN to assist patients in overcoming barriers to follow-up colonoscopy completion. Results To-date, 124 patients have been randomized to navigation, and 44 of these had open text field documentation. Our content analysis found slightly more than half (N=23) required more intensive navigation assistance for overcoming a variety of barriers such as fear of or misinformation about the colonoscopy; help with scheduling, transportation, and interpreter services; and assistance with obtaining and completing the bowel preparation. Those that needed less navigation (N=21) mostly required assistance with scheduling the colonoscopy and often had protective factors such as prior colonoscopy experience or support from family/friends for completing the procedure. Overall, the top three areas the PN tended to provide support for overcoming barriers included: contacting the gastroenterologist office to problem- solve issues like lack of referral, scheduling delays, or to obtain appointment information (40 instances); assisting the patient with obtaining, understanding, and completing the bowel preparation including diet restrictions, medication interaction, and preparing/consuming the mixture (25 instances); and verifying, coordinating, and offering transportation/escort support before and after the colonoscopy procedure (22 instances). Conclusion The PRECISE trial highlights the importance of targeted patient navigation to improve CRC screening completion. Our open text field findings demonstrate the necessary role of patient navigation for overcoming the multitude of educational and structural challenges facing FQHC patients when attempting to complete a follow-up colonoscopy.

Citation Format: Jennifer L. Schneider, Jennifer S. Rivelli, Jamie Thompson, Amanda Petrik, Neha Yadav, Hanna Dinh, Cindy Pulido, Shirley Mendez, DeeDee Torres, Gloria Coronado. Supporting community health center patients in completing follow-up colonoscopy: A qualitative summary of patient navigation activities [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-246.

Abstract PO-272: COVID-19 adaptations to patient navigation services for follow-up colonoscopy after an abnormal fecal test result in a community health center setting

The PRECISE study tests the effectiveness of a targeted patient navigation program for follow-up colonoscopy after an abnormal fecal test result in a community health center setting. We present adaptations and mid-study learnings related to the COVID-19 pandemic. Colorectal cancer (CRC) screening by annual fecal immunochemical test (FIT) is an accessible and cost-effective strategy to lower CRC incidence and mortality. However, this mode of screening depends on follow-up colonoscopy after an abnormal FIT result to prevent CRC or find it in early, treatable forms. Unfortunately, almost half of patients with an abnormal FIT result fail to complete this essential screening component, negating any benefit of FIT screening. Patient navigation can provide much needed support for patients to complete a follow-up colonoscopy. PRECISE is a patient-randomized trial of patient navigation vs usual care for follow-up colonoscopy that will enroll 1,200 patients across 28 community health center clinics in Washington state (anticipated 37% Latinx). As part of the study, we trained a bilingual (English and Spanish) patient navigator using an intensive 8-week program, based on the New Hampshire Colorectal Cancer Screening Program. The program included multiday trainings on CRC health

information, colonoscopy steps, patient navigator skills, the navigation protocol, data reporting; a full-day motivational interviewing training delivered by a professional trainer; and in-person meetings with schedulers at local gastroenterology (GI) offices. On March 13, 2020, study enrollment for PRECISE was suspended due to the COVID-19 pandemic during which time all non-urgent medical procedures, including colonoscopies, were canceled or delayed. We trained our patient navigator to outreach to all randomized patients for whom navigation was in process at the time of study suspension. We developed COVID-19-specific talking points, and the outreach protocol was modified to address colonoscopy scheduling delays. To-date, 252 patients have been randomized (124 to navigation and 128 to usual care).

Navigator conversations with local GI offices revealed several COVID-related GI practice changes: the pre-procedure consultation is generally delivered as a telehealth (phone-based) visit and COVID-19 testing is required prior to the colonoscopy. Furthermore, many practices mandate the use of face masks by patients and their escorts, and prohibit escorts from accompanying the patient in the pre-procedure area. We adapted navigator messages to address fear and anxiety about getting medical care during the peak COVID-19 pandemic. This innovative clinical trial highlights the importance of patient navigation to improve CRC screening in community health centers and examines COVID-19 adaptions to the navigation intervention.

Citation Format: Jamie Thompson, Jennifer Rivelli, Amanda Petrik, Jennifer Schneider, Neha Yadav, Hanna Dinh, Cindy Pulido, Shirley Mendez, DeeDee Torres, Lakshmi Penimarthi, Gloria Coronado. COVID-19 adaptations to patient navigation services for follow-up colonoscopy after an abnormal fecal test result in a community health center setting [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-272.

One stent versus two stents for distal LM PCI: insights from the experience of a high volume center

Introduction

Distal left main (LM) PCIremains a challenge. One of the most debated issues is whether to use a single vs 2 stent provisional strategy. While most studies and guidelines favour a single stent strategy, the recent DK-CRUSH V trial has shown better results with a 2 stent strategy.

Objective

To evaluate the performance of a single vs dual stent strategy for LM PCI in a real-world population setting.

Methods

Single-center procedural prospective registry of patients (pts) submitted to LM PCI from 2015–2018, with retrospective event analysis. Demographic, clinical data and procedure characteristics were analysed. Results were obtained with χ2 test, T student test, Kaplan-Meier survival analysis, logistic and Cox regression.

Results

100 pts (73 men; 69±11 years) were included. Co-morbidities were very frequent (85 had hypertension, 54 had diabetes, 71 had dyslipidemia and 39 were past smokers). 32 had reduced LVEF (&lt;40%) and 45 previous CABG. The decision to proceed to PCI vs surgery was undertaken individually by the local HeartTeam. Most of the procedures (57) were in an acute coronary syndrome setting (11 in STEMI, 7 with cardiogenic shock). The anatomical distribution of the lesions was: distal in 69 pts (61 involved the LAD and or Cx ostium), mid shaft in 7 pts, ostial in 18 pts and diffuse in 6 pts. Protected left main PCI encompassed 41% of the procedures.

The complication rate was 7%. During a mean follow-up of 866±400 days, there were 4 peri-procedural deaths, 1-year mortality rate of 10% and 22 pts died overall.

In pts submitted to distal LM PCI, a single stent was used in 49 pts (66%) versus a 2 stent approach in 23 pts (31%). The only significant difference between these groups were diabetes (66% in the single stent vs 32% in the 2 stent group, p=0.006) and protected LM (51% in the single stent vs 26.1% in the two stent group, p=0.046).

While a 2 stent strategy was associated with higher mortality by Kaplan Meyer analysis (LogRank = 11.07, p=0.001), it was not an independent predictor of mortality in Cox regression. Cox univariate analysis identified LVEF &lt;40% (OR 2.2, CI 1.01–4.9, p=0.047) and complications (OR 3.1, CI 1.4 – 6.9, p=0.004) as the only predictors of death. In multivariate analysis, only the latter was an independent predictor of mortality (OR 2.6, IC 1.1–5.9, p=0.028). The use of a 2 stent strategy was significantly associated with complications (χ2=5.1 p=0.024)) and was the only independent predictor of it (OR 3.8, IC 1.1–12.8, p=0.03). This was true even in the subgroup of protected LM PCI.

Conclusion

In a real-world setting of challenging LM PCI cases, a single stent strategy for distal LM PCI performed better. The use of 2 stents was an independent predictor of complications, strongly associated with increased risk of death. While a LM PCI must be undertaken on an individual basis, a single stent provisional strategy, whenever feasible, seems to be the best option.

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): Hospita Santa Maria

Consumption of ultra-processed foods on free sugar intake of Portuguese infants: The Upper Project

Background

The dietary share of ultra-processed foods (UPF) has been associated with low diet quality, including high content of free sugar, mainly in adults' populations. We aim to assess the influence of UPF consumption on free sugar intake of Portuguese infants.

Methods

Cross-sectional representative study including 573 infants (6-23 months old) who participated in the 2015-2016 National Food, Nutrition and Physical Activity Survey. Dietary intake was collected by two non-consecutive food diaries (time interval 8-15 days). Food items were classified according food processing degree by the NOVA system. Total energy intake and percentage provided by each NOVA food groups as well as the free sugar content of the overall diet were assessed. Mean free sugar intake was evaluated across quintiles (Q) of UPF consumption by linear regression adjusted for socioeconomic covariates.

Results

Mean energy intake was 935 kcal/day, in which 49.1% was derived from unprocessed/minimally processed foods, 7.2% from processed culinary ingredients, 7.0% from processed foods and 36.6% from UPF. The mean dietary share of UPF ranged from 12.5% (Q1) to 65.5% (Q5) of total energy. Within UPF, infant formulas (19.3%), milk-based drinks (6.7%) and sweet snacks (4.8%) contributed the most to energy intake. Mean free sugar intake in the overall diet accounted for 8.1% of total energy intake, in which 92.5% came from UPF. As the UPF consumption increased, the dietary content of free sugar increased significantly (β = 0.77; p &lt; 0.001). Contribution of free sugar in total energy intake raised from 2.9% to 12.7%, representing an increment of 338% from the lower to the upper quintile of the dietary share of UPF.

Conclusions

Portuguese infants had an important intake of free sugar. Nearly all of this intake came from UPF, which calls for public health efforts to avoid UPF consumption by this population group.

Funding

FAPESP 2018/07391-9, 2019/05972-7 (MCR), 2016/14302-7 (FR); POCI-01-0145-FEDER-032090.

Key messages

Ultra-processed foods contributed with 36.6% of total energy intake and 92.5% of free sugar in the diets of Portuguese infants. As the ultra-processed foods consumption increased, the dietary content of free sugar increased significantly from 2.9% (Q1) to 12.7% (Q5), representing an increment of 338%.

Abstract C125: Identifying barriers to follow-up colonoscopy completion after an abnormal fecal test: Interviews with gastroenterology staff

Background Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. Fecal immunochemical tests (FITs) are an accepted way to identify patients at risk for CRC. However, patients who receive an abnormal FIT result must obtain a follow-up colonoscopy. Rates of follow-up colonoscopy are low in most healthcare settings, particularly in federally qualified health centers (FQHCs). FQHC patients who need a follow-up colonoscopy must undergo several steps, including obtaining a referral to a gastroenterology specialist (GIs), and preparing for and attending the procedure. Interventions such as patient navigation may improve follow-up colonoscopy adherence for FQHC patients, yet little is known about the system-level barriers to the colonoscopy process. Methods As part of the Predicting and Addressing Colonoscopy Non-adherence in Community Settings (PRECISE) study, we interviewed care coordinators and GIs who receive referrals from local FQHCs for follow-up colonoscopies from abnormal FIT tests. Our goal was to understand their referral processes and what they perceive to be the primary barriers for patients completing the follow-up colonoscopy. Two trained qualitative staff conducted the interviews by telephone, and content analyzed the data from interview notes and transcribed recordings. Results We interviewed 12 GI and care coordinator staff across 7 different GI practices. Six of the seven GI practices attempted to facilitate the follow-up colonoscopy by not making a pre-procedure visit mandatory but rather allowing completion by telephone, if the patient is healthy and of low risk. Most GI practices identified using the same type of bowel preparation with community referred patients as it is inexpensive, covered by most insurance plans, and considered safe. The greatest barrier to colonoscopy completion by referred community patients stated by all GI practices was not having transportation to and from the appointment or understanding the need for an escort to be present, particularly at the completion of the colonoscopy. Lack of understanding the bowel preparation process was also a very common barrier, including when to start the process, what foods to avoid, and the need to consume the entire preparation. Faxed referrals from FQHCs lacking proper documentation of the abnormal FIT or incomplete patient medical information for the referral was also cited as hindrances to timely follow-up colonoscopy completion. Most GI practices reported limited resources and time for helping patients address structural challenges pertaining to transportation, escorts, or a private place to complete the preparation. Conclusion Our findings identify key areas where patient navigated efforts are needed, and inform the educational and structural challenges facing FQHC patients when interfacing with GI specialists for a follow-up colonoscopy. These findings can further inform the design and implementation of patient navigation programs in the community health center setting.

Citation Format: Jennifer S Rivelli, Jennifer L Schneider, Jamie H Thompson, Amanda F Petrik, DeeDee Torres, Gloria D Coronado. Identifying barriers to follow-up colonoscopy completion after an abnormal fecal test: Interviews with gastroenterology staff [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C125.

Burden of disease associated with dietary exposure to carcinogenic aflatoxins in Portugal using human biomonitoring approach

Human biomonitoring is an important tool to assess human exposure to chemicals, contributing to describe trends of exposure over time and to identify population groups that could be under risk. Aflatoxins are genotoxic and carcinogenic food contaminants causing hepatocellular carcinoma, the third leading cause of cancer deaths worldwide. In Portugal, scarce data are available regarding exposure to aflatoxins and no previous study used human biomonitoring data to comprehensively characterize the associated burden of disease. 24 h urine and first-morning urine paired samples were collected by 94 participants and were analyzed by liquid chromatography-tandem mass spectrometry for the quantitative determination of aflatoxins (B₁, B₂, G₁, G₂ and M₁). Deterministic and probabilistic models were developed to assess the Portuguese exposure to aflatoxins and to estimate the health impact of this exposure, estimating the attributed Disability-Adjusted Life Years (DALYs). Aflatoxins were detected in a maximum of 13% (AFB₁), 16% (AFB₂), 1% (AFG₁), 2% (AFG₂) and 19% (AFM₁) of the urine samples. Data obtained through the probabilistic approach revealed an estimated mean probable daily intake of 13.43 ng/kg body weight per day resulting in 0.13 extra cases of hepatocellular carcinoma, corresponding to mean annual DALYs of 172.8 for the Portuguese population (10291027 inhabitants). The present study generated for the first time and within a human biomonitoring study, reliable and crucial data to characterize the burden associated to the exposure to aflatoxins of the Portuguese population. The obtained results constitute an imperative support to risk managers in the establishment of preventive policy measures that contribute to ensure public health protection.

Correlation of age and skeletal effects after miniscrew assisted rapid palatal expansion

Background

To evaluate the skeletal and dentoalveolar effects after miniscrew assisted rapid palatal expansion (MARPE) and their correlation with the age of the patients. Settings and sample population: Sample comprised 19 patients with maxillary atresia and posterior crossbite, treated with MARPE. Cone-beam computed tomographs (CBCT) were evaluated before and after expansion. Three patients were excluded since the midpalatal suture was not opened. Thus, 16 patients (11 female; 5 male) were evaluated, with a mean age of 24.92 years (s.d.=7.60). The time between the installation of MARPE and the second CBCT was, on average, 1.64 months (s.d.=1.12).

Material and Methods

Linear and angular measurements were performed: bone thickness and level, tooth inclination, transverse dental widths, and nasal base and jugula widths. Comparison was performed with dependent t-test and correlations with Pearson coefficient.

Results

MARPE was 84.2% successful. There was significant reduction in the buccal bone thickness of the first molars and an increase in the palatal bone thickness of all teeth. First molars showed significant buccal inclination. All transverse dimensions showed a significant increase. Older patients tended to show a less maxillary transverse skeletal increase. A greater maxillary transverse increase was accompanied by a greater intermolar width increase and also a greater buccal bone loss in the mesiobuccal roots of the maxillary first molars.

Conclusions

MARPE corrected the maxillary atresia in adult patients, with significant transverse increases, a slight decrease in buccal bone thickness and buccal inclination of the first molars, combining skeletal and dental effects. Older patients presented less transverse skeletal increases. Key words:Palatal expansion technique, skeletal anchorage, cone-beam computed tomography.

Burden of disease attributable to exposure to aflatoxins in Portugal using Human biomonitoring data

Key messages

Portuguese population is exposed to aflatoxins, chemical food contaminants that may be harmful (carcinogenic, immunotoxic, mutagenic, teratogenic, hepatotoxic) to humans. Human biomonitoring studies provide realistic data on internal exposure at individual level, contributing to a more accurate estimation of the burden derived from this exposure.

Risk assessment of Portuguese population to multiple mycotoxins: the human biomonitoring approach

Key messages

Portuguese population is exposed to mycotoxins, chemical food contaminants that may be harmful (carcinogenic, immunotoxic, mutagenic, teratogenic, hepatotoxic) for human health. Human biomonitoring studies provide realistic data on internal exposure at individual level, allowing a more accurate knowledge of the determinants of exposure to these contaminants.

Effect of photoperiod on ovarian maturation in Cheirodon interruptus (Teleostei: Characidae)

Cheirodon interruptus is a ubiquitous small characid that inhabits the Pampean region and commonly used as bait. Its vast market is supplied from the wild population causing a significant environmental impact. In this study, we assess the effect of photoperiod on ovarian maturation in order to evaluate its potential as a tool to manipulate reproduction under artificial conditions. Four treatments in triplicate (light: dark, L: D) were tested: 24L: 0D, 12L: 12D, 0L: 24D and a progressive photoperiod corresponding to the daily photoperiod increments in wild during winter-spring transition, accelerated three times. The experiment was conducted for 45 days. Gonadosomatic index (GSI), oocyte mean diameter, vitellogenic oocyte proportions, plasma estradiol concentrations (E2), condition factor (Kn) and standard length were estimated. Values of mean GSI, oocyte diameter, vitellogenic oocyte proportions and E2 concentration were maximum in the progressive treatment indicating vitellogenesis stimulation. In turn the same parameters were minimum in the 24L: 0D, revealing the vitellogenesis inhibition. This study showed that photoperiodic regime play an important role in the onset of ovarian maturation in C. interruptus.

Are «off hours» intubations a risk factor for complications during intubation? A prospective, observational study

OBJECTIVE

To compare the complications and the difficulty of orotracheal intubation procedures performed in the Intensive Care Unit during the off-hours period and the on-hours period.

DESIGN

A prospective, observational and non-interventional cohort study covering a period of 27 months was carried out. Working days between 8:00 a. m. and 7:59 p. m. were considered «on-hours», while the remaining shifts were regarded as «off-hours».

SCOPE

An 18-bed surgical in a Intensive Care Unit of a third-level hospital.

PATIENTS

All orotracheal intubation patients admitted to the ICU from January 2015 to March 2017 were included. Patients were stratified into 2groups according to whether intubation was performed on-hours or off-hours.

INTERVENTIONS

Non-interventional study.

VARIABLES OF INTEREST

The reason for intubation, time and day on which intubation was performed, degree of intubation difficulty (number of attempts, Cormack-Lehane laryngoscopic vision, need for accessory material) and complications during intubation.

RESULTS

A total of 252 patients were intubated; of these, 132 were included in the on-hours group and 120 patients in the off-hours group. In the off-hours group we observed a greater percentage of urgent and emergent intubations compared to the on-hours group. However, no differences were found between the 2groups in relation to the other variables studied.

CONCLUSIONS

During the off-hours period, orotracheal intubation was not associated to a greater number of complications or to greater difficulty of the technique in our Unit.

Prevalence and Penetrance of BRCA1 and BRCA2 Germline Mutations in Colombian Breast Cancer Patients

Pathogenic BRCA1/2 germline mutations confer high risks of breast and ovarian cancer to women of European ancestry. Characterization of BRCA1/2 mutations in other ethnic groups is also medically important. We comprehensively screened 68 Colombian breast/ovarian cancer families for small-range mutations, 221 families for large-genomic rearrangements, and 1,022 unselected breast cancer cases for Colombian founder mutations in BRCA1/2. The risk of cancer among relatives of mutation carriers and the mutation penetrance were estimated by survival analysis. Identified BRCA2 mutations included 6310delGA and the recurrent 1991del4 mutations. A novel large BRCA2 deletion was found in 0.9% of the screened families. Among unselected breast cancer cases, 3.3% tested positive for BRCA1/3450del4, 2.2% for BRCA1/A1708E, 1.1% for BRCA2/3034del4, and 0.4% for BRCA2/1991del4. Female relatives of carriers of BRCA1/2 founder mutations showed a 5.90 times higher risk of breast cancer, when the woman herself carried a BRCA1 mutation compared to a non-carrier (95% CI 2.01–17.3). The estimated cumulative risk of breast cancer by age 70 years for BRCA1 mutations carriers was 14% (95% CI 5–38) compared to 3% for the general Colombian population (relative risk of breast cancer 4.05). Together with known founder mutations, reported novel variants may ease a cost-effective BRCA1/2 screening in women with Colombian ancestry.

Graphene quantum dots from fishbone carbon nanofibers

Photoluminescent graphene oxide quantum dots (GOQD) obtained from chemically oxidized fishbone carbon nanofibers (CNF) and separated by degressive differential centrifugation.

Drug-repositioning screening identified piperlongumine as a direct STAT3 inhibitor with potent activity against breast cancer

Signal transducer and activator of transcription (STAT) 3 regulates many cardinal features of cancer including cancer cell growth, apoptosis resistance, DNA damage response, metastasis, immune escape, tumor angiogenesis, the Warburg effect and oncogene addiction and has been validated as a drug target for cancer therapy. Several strategies have been used to identify agents that target Stat3 in breast cancer but none has yet entered into clinical use. We used a high-throughput fluorescence microscopy search strategy to identify compounds in a drug-repositioning library (Prestwick library) that block ligand-induced nuclear translocation of Stat3 and identified piperlongumine (PL), a natural product isolated from the fruit of the pepper Piper longum. PL inhibited Stat3 nuclear translocation, inhibited ligand-induced and constitutive Stat3 phosphorylation, and modulated expression of multiple Stat3-regulated genes. Surface plasmon resonance assay revealed that PL directly inhibited binding of Stat3 to its phosphotyrosyl peptide ligand. Phosphoprotein antibody array analysis revealed that PL does not modulate kinases known to activate Stat3 such as Janus kinases, Src kinase family members or receptor tyrosine kinases. PL inhibited anchorage-independent and anchorage-dependent growth of multiple breast cancer cell lines having increased pStat3 or total Stat3, and induced apoptosis. PL also inhibited mammosphere formation by tumor cells from patient-derived xenografts. PL's antitumorigenic function was causally linked to its Stat3-inhibitory effect. PL was non-toxic in mice up to a dose of 30 mg/kg/day for 14 days and caused regression of breast cancer cell line xenografts in nude mice. Thus, PL represents a promising new agent for rapid entry into the clinic for use in treating breast cancer, as well as other cancers in which Stat3 has a role.

A study on adatom transport through (√3 × √3)-R30°-CH3S self-assembled monolayers on Au(111) using first principles calculations

Self-assembled monolayers on Au(111) have outstanding chemical, electrical, and optical properties, and Au adatoms seem to play a key role in these properties. Still, the fundamental understanding of adatom transport inside the self-assembled structure is very thin. In this paper we use first-principles calculations to reveal new details about the migration mechanism of Au adatoms in the presence of a CH3S self-assembled structure on Au(111). We study the inclusion of Au adatoms inside a well-packed (√3 × √3)-R30°-CH3S self-assembled lattice and present atomistic models supporting adatom migration by means of a hopping mechanism between pairs of CH3S species. Our calculations reveal that the transport of Au adatoms is slowed down inside the molecular network where the kinetic barrier for adatom migration is larger than on the clean Au surface. We attribute the hindered mobility of Au adatoms to the fact that adatom transport involves the breaking and making of Au-S bonds. Our results form a basis for further understanding the role played by defect transport in the properties of molecular assemblies.

Salvage treatment with ganciclovir in a splenectomized, polytransfused patient affected by systemic inflammatory response syndrome

A 23-year-old man was admitted to hospital with a 12-day history of daily fever. A clinical history revealed that 10 months previously, the patient had been splenectomized and polytransfused for a severe blunt trauma. On admission, laboratory data revealed significant leukocytosis (33,230/ul). The patient's general clinical conditions rapidly worsened into a severe systemic inflammatory response syndrome in four days. After 10 days of broad-spectrum antibiotic treatment, the temperature curve was unmodified and severe leukocytosis persisted (44,300 ul) with absolute lymphocytosis. Laboratory tests ruled out hematological diseases, pneumonia, abscesses and endocarditis. In the light of IgM positivity for CMV (unconfirmed by PCR) and with the support of a PubMed search, we commenced a salvage treatment with intravenous ganciclovir, suspecting a viral infection or reactivation. After two days of therapy, an immediate defervescence was observed with a remarkable clinical improvement. After 10 days, the clinical syndrome had been completely resolved and the patient was discharged in good, general clinical health.

Obesity and iron deficiency anemia as risk factors for asymptomatic bacteriuria

BACKGROUND

Few studies examined the risk factors of asymptomatic bacteriuria, showing contradictory results. Our study aimed to examine the association between different clinical and laboratory parameters and asymptomatic bacteriuria in internal medicine patients.

MATERIALS AND METHODS

330 consecutive hospitalized subjects, asymptomatic for urinary tract infections (UTIs), underwent to microscopic examination of urine specimens. 100 subjects were positive for microscopic bacteriuria and were recruited into the study. At the quantitative urine culture 31 subjects of study population were positive while 69 subjects were negative for bacteriuria.

RESULTS

The analysis of clinical characteristics showed that the two groups of subjects (positive and negative urine culture for bacteriuria) were significant different (p<0.05) about obesity (76.7% vs 42% respectively), metabolic syndrome (80.6% vs 44,9%), cholelithiasis (35.5% vs 13,2%) and iron deficiency anemia (80.6% vs 53,6%). The univariate analysis showed that only obesity, cholelithiasis and iron deficiency anemia were positively associated with positive urine culture for bacteriuria (Odds Ratios [OR]=3.79, p=0.0003; OR=2,65, p=0.0091; OR=2.63, p=0.0097; respectively). However, the multivariate analysis by logistic regression showed that only obesity and iron deficiency anemia, independently associated with positive urine culture for bacteriuria (OR=3.9695, p=0.0075; OR=3.1569, p=0.03420 respectively).

CONCLUSIONS

This study shows that obesity and iron deficiency anemia are independent risk factors for asymptomatic bacteriuria.