Brachymetatarsia

Brachymetatarsia involves a reduction in length of one or more metatarsals. The affected metatarsal is shortened by 5 mm or more, altering the normal metatarsal parabola. In addition to being an aesthetic deformity, it can present with pain due to transfer metatarsalgia. A possible association with genetic disorders needs to be investigated during clinical evaluation. Surgical treatment may involve a one-stage lengthening procedure or progressive distraction, each having its advantages and limitations.

Dynamic Control of Contractile Force in Engineered Heart Tissue

Three-dimensional engineered heart tissues (EHTs) derived from human induced pluripotent stem cells (iPSCs) have become an important resource for both drug toxicity screening and research on heart disease. A key metric of EHT phenotype is the contractile (twitch) force with which the tissue spontaneously beats. It is well-known that cardiac muscle contractility - its ability to do mechanical work - depends on tissue prestrain (preload) and external resistance (afterload).

OBJECTIVES

Here, we demonstrate a technique to control afterload while monitoring contractile force exerted by EHTs.

METHODS

We developed an apparatus that can regulate EHT boundary conditions using real-time feedback control. The system is comprised of a pair of piezoelectric actuators that can strain the scaffold and a microscope that can measure EHT force and length. Closed loop control allows dynamic regulation of effective EHT boundary stiffness.

RESULTS

When controlled to switch instantaneously from auxotonic to isometric boundary conditions, EHT twitch force immediately doubled. Changes in EHT twitch force as a function of effective boundary stiffness were characterized and compared to twitch force in auxotonic conditions.

CONCLUSION

EHT contractility can be regulated dynamically through feedback control of effective boundary stiffness.

SIGNIFICANCE

The capacity to alter the mechanical boundary conditions of an engineered tissue dynamically offers a new way to probe tissue mechanics. This could be used to mimic afterload changes that occur naturally in disease, or to improve mechanical techniques for EHT maturation.

Epigenetic regulation by metabolites from the gut microbiome

The gut microbiome can metabolise food components, such as dietary fibres and various phytochemicals; and the microbiome can also synthesise some nutrients, for example B vitamins. The metabolites produced by bacteria and other micro-organisms in the colon can have implications for health and disease risk. Some of these metabolites are epigenetically active, and can contribute to changes in the chemical modification and structure of chromatin by affecting the activity and expression of epigenetically-active enzymes, for example histone deacetylases and DNA methyltransferases. The epigenetic activity of such gut microbiome metabolites is reviewed herein.

Venous Sinus Stenting for Low Pressure Gradient Stenoses in Idiopathic Intracranial Hypertension

BACKGROUND

Medically refractory idiopathic intracranial hypertension (IIH) is frequently treated with venous sinus stenosis stenting with high success rates. Patient selection has been driven almost exclusively by identification of supraphysiological venous pressure gradients across stenotic regions based on theoretical assessment of likelihood of response.

OBJECTIVE

To explore the possibility of benefit in low venous pressure gradient patients.

METHODS

Using a single-center, prospectively maintained registry of patients with IIH undergoing venous stenting, we defined treatment groups by gradient pressures of ≤4, 5 to 8, and >8 mmHg based on the most frequently previously published thresholds for stenting. Baseline demographics, clinical, and neuro-ophthalmological outcomes (including optical coherence tomography and Humphrey visual fields) were compared.

RESULTS

Among 53 patients, the mean age was 32 years and 70% female with a mean body mass index was 36 kg/m 2 . Baseline characteristics were similar between groups. The mean change in lumbar puncture opening pressure at 6 months poststenting was similar between the 3 groups (≤4, 5-8, and >8 mmHg; 13.4, 12.9, and 12.4 cmH 2 O, P = .47). Papilledema improvement was observed across groups at 6 months (100, 93, and 86, P = .7) as were all clinical symptoms. The mean changes in optical coherence tomography retinal nerve fiber layer (-30, -54, and -104, P = .5) and mean deviation in Humphrey visual fields (60, 64, and 67, P = .5) at 6 weeks were not significantly different.

CONCLUSION

Patients with IH with low venous pressure gradient venous sinus stenosis seem to benefit equally from venous stenting compared with their higher gradient counterparts. Re-evaluation of our restrictive criteria for this potentially vision sparing intervention is warranted. Future prospective confirmatory studies are needed.

P75 PRELIMINARY FINDINGS OF THE DAVIDS REGISTRY (DYEVERT TO AVOID UNNECESSARY CONTRAST MEDIA DELIVERY DURING PCI SANREMO REGISTRY)

Background

Contrast–induced acute kidney injury (CI–AKI) is a percutaneous coronary intervention’s (PCI) feared complication, linked to increased morbidity and mortality. Many risk factors have been identified. Amongst procedural variables contrast media (CM) volume is one of the most predictive. An easy–to–use and effective CM sparing device would represent a valuable tool in the cath–lab armamentarium.

Aim

To evaluate the effectiveness of the DyeVert Power XT system in reducing CM delivery during PCI in pts at high risk of CI–AKI, consequently reducing the risk itself. Methods We collected clinical, laboratory, instrumental, procedural and outcome data of 75 consecutive patients (pts) who underwent PCI with the use of the DyeVert system between September 2020 and December 2021. We also compared these data in two groups of patients, divided according to CI–AKI onset. Inclusion criteria were reduced estimated glomerular filtration rate (eGFR) – defined as creatinine clearance (CrCl) <60 mL/min/m2 – and/or need for a complex PCI – chronic total occlusion (CTO), previous coronary artery bypass graft (CABG) or diffuse multivessel disease (MVD) – with the likelihood to receive a high amount of CM.

Results

Clinical data are shown in Table 1. Lab and instrumental data are shown in Table 2. Procedural data are shown in Table 3. In–hospital events are shown in Table 4. CI–AKI predictors at multivariate analysis are shown in Table 5. Median dose of CM delivered was 255 ml while CM spared with DyeVert was 110 ml (43% volume reduction, median 1 point reduction in Mehran score). Turning to outcomes 11 pts (14.7%) experienced AKI stage I according to Kidney Disease – Improving Global Outcomes (KDIGO) definition, whilst only 3 pts (4%) and 2 pts (2.7%) experienced stage 2 and 3 AKI. At follow–up there were 4 in–hospital deaths, none linked to deteriorating renal function.

Conclusions

DyeVert use was simple and effective in cutting delivered CM amount, with preserved image quality according to the operators judgement, however the reduction in Mehran score was not sufficient to affect risk class in pts experiencing CI–AKI versus those who did not.

Metrology techniques for the verification of the alignment of the EU gyrotron prototype for ITER

The EU gyrotron for the ITER Electron Cyclotron (EC) heating system has been developed in coordinated efforts of the EGYC Consortium, Thales ED (TED) and Fusion for Energy (F4E) and under the supervision of ITER Organization Central Team. After the successful verification of the design of the 1MW, 170 GHz hollow cylindrical cavity gyrotron operating at the nominal TE32,9 mode with a short pulse gyrotron prototype at KIT, an industrial CW gyrotron prototype was manufactured by TED and tested at ~0.8 MW output power and 180 s pulse duration, which is the limit of the HV power supply currently available at KIT. The experiments are being continued at SPC in 2018 to extend further the pulse duration, taking advantage of the existing CW full-power capabilities of the gyrotron test facility recently upgraded for the FALCON project. The gyrotron cavity interaction is very sensitive to the alignment of the internal mechanical parts of the gyrotron tube with the magnetic field generated by the superconducting magnet within a typical range of 0.2 – 0.5 mm. The control of the tolerances and deformations becomes therefore critical to achieving the target performances. With the EU gyrotron prototype it was possible to adjust the alignment of the gyrotron tube with respect to the magnetic field axis during the installation and commissioning phase. The actual shift and tilt movements were verified using advanced metrology methods such as photogrammetry. In this paper, the alignment control techniques and procedures will be discussed also in view of enhancing the reproducibility of gyrotron performance during series production.

The Brönsted Equation: The Universal Equation?

This review shows that, taking the Brönsted equation as a starting point, the equations describing the kinetic effects of added salts, micelles, solvent, catalysts (homogeneous and heterogeneous catalysis), change in the electrode potential, and substituents can be established through thermodynamic considerations of these effects. In this sense, the Brönsted equation can be considered as the universal equation describing chemical reactivity.

Report of recent experiments with the European 1 MW, 170 GHz CW and SP prototype gyrotrons for ITER

The European 1 MW, 170 GHz industrial CW prototype gyrotron has been designed within EGYC (European GYrotron Consortium) in collaboration with the industrial partner Thales Electron Devices (TED) and under the coordination of Fusion for Energy (F4E). This is a conventional (hollow) cavity gyrotron that is based on the 1 MW, 170 GHz short-pulse (SP) modular gyrotron, which has been designed and manufactured by KIT in collaboration with TED. The SP prototype has been tested in multiple experimental campaigns since 2015 and the nominal cavity mode TE32,9 is exited at 170.1 GHz, producing RF power above 1 MW with 35 % interaction efficiency. The first phase of the experiments with the CW industrial gyrotron was successfully completed at KIT in 2016, verifying most of the ITER specifications. Short pulses (<10ms) deliver RF power higher than 0.9 MW with a total efficiency of 26 % (in non-depressed collector operation). The Gaussian mode content of the RF beam is 97 %. Pulses with duration of 180 s (limited by the high-voltage power supply at KIT) produce power more than 0.8 MW with maximum efficiency 38 % (in depressed collector operation). In this work the achievements with the SP and the CW prototype gyrotrons are summarized.

Role of Muscarinic Acetylcholine Receptors in Breast Cancer: Design of Metronomic Chemotherapy

BACKGROUND

muscarinic acetylcholine receptors (mAChRs) have attracted interest as targets for therapeutic interventions in different illnesses like Alzheimer´s disease, viral infections and different tumors. Regarding the latter, many authors have studied each subtype of mAChRs, which seem to be involved in the progression of distinct types of malignancies.

METHODS

We carefully revised research literature focused on mAChRs expression and signaling as well as in their involvement in cancer progression and treatment. The characteristics of screened papers were described using the mentioned conceptual framework.

RESULTS

Muscarinic antagonists and agonists have been assayed for the treatment of tumors established in lung, brain and breast with beneficial effects. We described an up-regulation of mAChRs in mammary tumors and the lack of expression in non-tumorigenic breast cells and normal mammary tissues. We and others demonstrated that muscarinic agonists can trigger anti-tumor actions in a dose-dependent manner on tumors originated in different organs like brain or breast. At pharmacological concentrations, they exert similar effects to traditional chemotherapeutic agents. Metronomic chemotherapy refers to the administration of anti-cancer drugs at low doses with short intervals among them, and it is a different regimen applied in cancer treatment reducing malignant growth and angiogenesis, and very low incidence of adverse effects.

CONCLUSION

The usage of subthreshold concentrations of muscarinic agonists combined with conventional chemotherapeutic agents could be a promising tool for breast cancer therapy.

Thalamus volume change and cognitive impairment in early relapsing-remitting multiple sclerosis patients

Aims The objective of the study was to assess whether changes in the volume of the thalamus during the onset of multiple sclerosis predict cognitive impairment after accounting for the effects of brain volume loss. Methods A prospective study included patients with relapsing-remitting multiple sclerosis less than 3 years after disease onset (defined as the first demyelinating symptom), Expanded Disability Status Scale of 3 or less, no history of cognitive impairment and at least 2 years of follow-up. Patients were clinically followed up with annual brain magnetic resonance imaging and neuropsychological evaluations for 2 years. Measures of memory, information processing speed and executive function were evaluated at baseline and follow-up with a comprehensive neuropsychological test battery. After 2 years, the patients were classified into two groups, one with and the other without cognitive impairment. Brain dual-echo, high-resolution three-dimensional T1-weighted magnetic resonance imaging scans were acquired at baseline and every 12 months for 2 years. Between-group differences in thalamus volume, total and neocortical grey matter and white matter volumes were assessed using FIRST, SIENA, SIENAXr, FIRST software (logistic regression analysis P < 0.05 significant). Results Sixty-one patients, mean age 38.4 years, 35 (57%) women were included. At 2 years of follow-up, 17 (28%) had cognitive impairment. Cognitive impairment patients exhibited significantly slower information processing speed and attentional deficits compared with patients without cognitive impairment ( P < 0.001 and P = 0.02, respectively). In the cognitive impairment group a significant reduction in the percentage of thalamus volume ( P < 0.001) was observed compared with the group without cognitive impairment. Conclusion We observed a significant decrease in thalamus volume in multiple sclerosis-related cognitive impairment.

Alpha Lipoic Acid: A Therapeutic Strategy that Tend to Limit the Action of Free Radicals in Transplantation

Organ replacement is an option to mitigate irreversible organ damage. This procedure has achieved a considerable degree of acceptance. However, several factors significantly limit its effectiveness. Among them, the initial inflammatory graft reaction due to ischemia-reperfusion injury (IRI) has a fundamental influence on the short and long term organ function. The reactive oxygen species (ROS) produced during the IRI actively participates in these adverse events. Therapeutic strategies that tend to limit the action of free radicals could result in beneficial effects in transplantation outcome. Accordingly, the anti-oxidant α-lipoic acid (ALA) have been proved to be protective in several animal experimental models and humans. In a clinical trial, ALA was found to decrease hepatic IRI after hepatic occlusion and resection. Furthermore, the treatment of cadaveric donor and recipient with ALA had a protective effect in the short-term outcome in simultaneous kidney and pancreas transplanted patients. These studies support ALA as a drug to mitigate the damage caused by IRI and reinforce the knowledge about the deleterious consequences of ROS on graft injury in transplantation. The goal of this review is to overview the current knowledge about ROS in transplantation and the use of ALA to mitigate it.

Aligning the flow cytometric evaluation with the diagnostic need: an evidence-based approach

Aims

Elimination of non-value added testing without compromising high-quality clinical care is an important mandate for laboratories in a value-based reimbursement system. The goal of this study was to determine the optimal combination of flow cytometric markers for a screening approach that balances efficiency and accuracy.

Methods

An audit over 9 months of flow cytometric testing was performed, including rereview of all dot plots from positive cases.

Results

Of the 807 cases in which leukaemia/lymphoma testing was performed, 23 were non-diagnostic and 189 represented bronchoalveolar lavage specimens. Of the remaining 595 cases, 137 (23%) were positive for an abnormal haematolymphoid population. Review of the positive cases identified minimum requirements for a screening tube as well as analysis strategies to overcome the diagnostic pitfalls noted. It is estimated that 38% fewer antibodies would be used in a screening approach, representing an opportunity for significant cost savings.

Conclusions

We provide a framework for developing an evidence-based screening combination for cost-effective characterisation of haematolymphoid malignancies, promoting adoption of ‘just-in-time’ testing systems that tailor the evaluation to the diagnostic need.

Derogation, Exclusion, and Unfair Treatment of Persons with Social Flaws

The effect of controllability of stigma on the attribution of prejudice was investigated in a series of five experiments. In prior prejudice attribution research, the stigma that made the victim subject to discrimination was a characteristic beyond the individual's control, such as age or race. In the present research, controllability of the stigma was systematically varied. Subjects read scenarios in which persons with flaws of speech or appearance were subject to discriminatory behaviors of derogation, exclusion, or unfair treatment. The flaws were either within or beyond the control of the individual possessing them. More prejudice was attributed to those who behaved in a discriminatory way toward persons whose flaws were beyond their control. The theoretical explanation offered for the outcome is that discrimination can be thought of as form of harmdoing, and prejudice attribution as a form of blame attribution.

Enhanced singlet oxygen production by photodynamic therapy and a novel method for its intracellular measurement

The generation of singlet oxygen (SO) in the presence of specific photosensitizers (PSs) or semiconductor quantum dots (QDs) and its application in photodynamic therapy (PDT) is of great interest to develop cancer therapies with no need of surgery, chemotherapy, and/or radiotherapy. This work was focused on the identification of the main factors leading to the enhancement of SO production using Rose Bengal (RB), and Methylene Blue (MB) as PS species in organic and aqueous mediums. Subsequently, the capacity of zinc oxide (ZnO), zinc sulfide (ZnS), and ZnO/ZnS core-shell QDs as well as manganese (Mn(+2)) doped ZnO and ZnS nanoparticles (NPs) as potential PS was also investigated. Many variable parameters such as type of quencher, PSs, NPs, as well as its different concentrations, light source, excitation wavelength, reaction time, distance from light source, and nature of solvent were used. The degradation kinetics of the quenchers generated by SO species and the corresponding quantum yields were determined by monitoring the photo-oxidation of the chemical quencher and measuring its disappearance by fluorometry and spectrophotometry in the presence of NPs. Small intracellular changes of SO induced by these metal Zn (zinc) NPs and PDT could execute and accelerate deadly programs in these leukemic cells, providing in this way an innovative modality of treatment. In order to perform further more specific in vitro cytotoxic studies on B-chronic lymphocytic leukemia cells exposed to Zn NPs and PDT, we needed first to measure and ascertain those possible intracellular SO variations generated by this type of treatment; for this purpose, we have also developed and tested a novel method first described by us.

A New Formulation for Quenching Processes under Restricted Geometry Conditions in the Slow Exchange Limit

A quantitative treatment of quenching processes under restricted geometry conditions in the Slow Exchange Limit is presented. The expressions for KSV have been obtained for this limit in some common situations that can arise in studies under restricted geometry conditions, such as an inhomogeneous quencher distribution in the solution, the presence of oxygen in solution, or the case of solutions containing a mixture of receptors. These situations have been considered and incorporated into the treatment.

Cardiac autonomic control mechanisms in the pathogenesis of chagas' heart disease

Primary abnormalities of the autonomic nervous system had been postulated as the pathogenic mechanisms of myocardial damage, in patients with Chagas disease. However, recent investigations indicate that these abnormalities are secondary and amenable to treatment with beta-adrenergic blockers. Moreover, muscarinic cardiac autoantibodies appear to enhance parasympathetic activity on the sinus node. Therefore, the purpose of this paper is to analyze how knowledge on Chagas' disease evolved from being initially considered as a primary cardioneuromyopathy to the current status of a congestive cardiomyopathy of parasitic origin.

Determination of Reaction and Reorganization Free Energies of Electron Transfer Reactions under Restricted Geometry Conditions

In this paper, different methods of obtaining the two parameters controlling the rate of electron transfer processes (reaction and reorganization free energies, Λ and Δ G0’, respectively) under restricted geometry conditions are considered. The main difficulty of accomplishing this comes from lack of knowledge of the properties in the interfacial region, where the reaction occurs. A general method has been presented and illustrated with the study of intermolecular processes in micelles. This method is optimized when the free energies for (at least) the three reactions required are quite different. For excited state electron transfer, the general approach is based on the appearance of the so-called Marcus inverted region: at the starting point of this region the value of Δ G0’ gives the value of Λ directly. These reaction free energies also present some uncertainties because in their calculation it is necessary to know the value of the local dielectric constant. Finally, it should be mentioned that some authors have suggested that the treatments for electron transfer reactions could not be applicable under restricted conditions. However, experiments do seem to show the applicability of the Marcus-Hush treatment under these conditions.

[Natalizumab and reduction of carbonylated proteins in patients with multiple sclerosis]

INTRODUCTION

The sensitivity of the central nervous system to oxidative damage and its relationship with inflammatory response are well known. Recent studies have shown that oxidative stress is present in the establishment and development of multiple sclerosis (MS). One of the most recent treatments in this process is natalizumab, a monoclonal antibody.

AIM

To evaluate whether the therapeutic effect of natalizumab is associated with the severity of the disease and the oxidative damage.

PATIENTS AND METHODS

Researchers recruited twenty patients with relapsing-remitting MS (RRMS) undergoing therapy with natalizumab and distributed, according to the Expanded Disability Status Scale (EDSS), in two groups: RRMS-1 (EDSS < 5) and RRMS-2 (EDSS ≥ 5). Blood samples were taken for an oxidative profile study.

RESULTS

Data showed a decrease in carbonylated proteins following treatment with natalizumab. The reduction in oxidative damage rated as protein oxidation is significant between the previous (baseline) situation of the patient and after 14 months' treatment. The most significant decrease coincided with the patients with the highest levels of severity in the process. Although it has not been possible to establish a correlation, the statistical significance is higher for patients in the RRMS-2 group treated with natalizumab. The antioxidant systems, on the other hand, did not display any statistically significant changes.

CONCLUSIONS

Natalizumab brings about a reduction in carbonylated protein levels.