Multiscale design of cell-free biologically active architectural structures

Cell-free protein expression systems are here combined with 3D-printed structures to study the challenges and opportunities as biofabrication enters the spaces of architecture and design. Harnessing large-scale additive manufacturing of biological materials, we examined the addition of cell-free protein expression systems ("TXTL" i.e., biological transcription-translation machinery without the use of living cells) to printed structures. This allowed us to consider programmable, living-like, responsive systems for product design and indoor architectural applications. This emergent, pluripotent technology offers exciting potential in support of health, resource optimization, and reduction of energy use in the built environment, setting a new path to interactivity with mechanical, optical, and (bio) chemical properties throughout structures. We propose a roadmap towards creating healthier, functional and more durable systems by deploying a multiscale platform containing biologically-active components encapsulated within biopolymer lattices operating at three design scales: (i) supporting cell-free protein expression in a biopolymer matrix (microscale), (ii) varying material properties of porosity and strength within two-dimensional lattices to support biological and structural functions (mesoscale), and (iii) obtaining folded indoor surfaces that are structurally sound at the meter scale and biologically active (we label that regime macroscale). We embedded commercially available cell-free protein expression systems within silk fibroin and sodium alginate biopolymer matrices and used green fluorescent protein as the reporter to confirm their compatibility. We demonstrate mechanical attachment of freeze-dried bioactive pellets into printed foldable fibrous biopolymer lattices showing the first steps towards modular multiscale fabrication of large structures with biologically active zones. Our results discuss challenges to experimental setup affecting expression levels and show the potential of robust cell-free protein-expressing biosites within custom-printed structures at scales relevant to everyday consumer products and human habitats.

POS1150 ANATOMICAL LOCATIONS AND CORRELATES OF CALCIUM PYROPHOSPHATE CRYSTAL DEPOSITS OF THE SPINE – PATHOLOGIC EXAMINATION OF 77 SURGICAL CASES

Background:

Spinal involvement in calcium pyrophosphate deposition disease (CPPD) is thought to be a rare occurrence and is seen infrequently as crowned dens syndrome. Furthermore, data on anatomical locations and correlates of calcium pyrophosphate (CPP) deposits in spinal CPPD are scarce.

Objectives:

To describe the anatomical locations and correlates of pathologically confirmed CPPD of the spine.

Methods:

Consecutive patients with spinal CPPD were identified via retrospective chart review of individuals who underwent spine surgery for intractable chronic neck or back pain at Massachusetts General Hospital between 2009 and 2014. These deposits and surrounding anatomical structures were surgically resected and confirmed to have calcium pyrophosphate deposition upon pathologic review. We reviewed musculoskeletal imaging (CT, MRI, XR) and laboratory data from these pathologically confirmed cases.

Results:

From April 2009 to August 2014, we identified 77 individuals with pathologically confirmed CPPD of the spine. The mean age was 68 years; 41 (53%) were female; mean BMI was 28.7. Calcium pyrophosphate (CPP) was grossly identified intraoperatively by the surgeon in 38 cases (50%), typically as “chalky white deposits” (Figure 1). CPP deposits were seen most frequently in the ligamentum flavum (23%) and intervertebral disc (23%), followed by other less common locations (Table 1). Imaging findings in the soft tissue or intervertebral disc suggestive of CPPD were found in 5 cases (6%), whereas findings of spinal canal narrowing, facet arthropathy, or ligamentum flavum thickening were eventually correlative with CPP deposits in pathologic specimens. Only 7 (9%) experienced a prior episode of acute CPP arthritis (pseudogout). Chondrocalcinosis on x-ray was seen in 26 cases (34%), most commonly in the wrist and/or knees. Osteoarthritis was present in all spinal imaging, and 65% had comorbid scoliosis. Laboratory abnormalities associated with secondary causes of CPPD (hypercalcemia, hypomagnesemia, hyperparathyroidism) were not seen with spinal CPPD.

Conclusion:

Spinal CPPD may occur more frequently than previously perceived. The ligamentum flavum and intervertebral discs were common anatomical locations for spinal CPPD. Advanced imaging of the spine showed low sensitivity for detecting spinal CPPD. Only a small minority had typical peripheral joint involvement or imaging with peripheral joint chondrocalcinosis. Thus, without pathologic confirmation, the vast majority of cases would remain unidentified. These findings call for the need to seek pathologic confirmation to determine the robust epidemiology and also raise the potential role for preoperative CPPD treatment.

Table 1.

Spinal Anatomic Locations of Pathologically Confirmed CPPD

Spinal Anatomic LocationNo. of Sites (%)*ligamentum flavum29 (23)Intervetebral Disc28 (23)Other Location19 (15)Posterior Elements18 (15)Facet14 (11)Synovium8 (6)Interspinous Ligament3 (2)Subarticular/Lateral Recess2 (2)Fibrocartilaginous Tissue1 (1)Inner Spine1 (1)Other Ligament1 (1)

*Some patients had more than one anatomic location where CPP was isolated

Figure 1.

Gross visualization of calcium pyrophosphate deposition (black arrow)

Disclosure of Interests:

Jonathan Dau: None declared, Gary Ho: None declared, Hyon Choi Consultant of: Ironwood, Selecta, Horizon, Takeda, Kowa, Vaxart, Grant/research support from: Ironwood, Horizon, Joseph Schwab: None declared, Minna Kohler Speakers bureau: Eli Lily, Consultant of: Novartis.

SERENA: Particle Instrument Suite for Determining the Sun-Mercury Interaction from BepiColombo

The ESA-JAXA BepiColombo mission to Mercury will provide simultaneous measurements from two spacecraft, offering an unprecedented opportunity to investigate magnetospheric and exospheric particle dynamics at Mercury as well as their interactions with solar wind, solar radiation, and interplanetary dust. The particle instrument suite SERENA (Search for Exospheric Refilling and Emitted Natural Abundances) is flying in space on-board the BepiColombo Mercury Planetary Orbiter (MPO) and is the only instrument for ion and neutral particle detection aboard the MPO. It comprises four independent sensors: ELENA for neutral particle flow detection, Strofio for neutral gas detection, PICAM for planetary ions observations, and MIPA, mostly for solar wind ion measurements. SERENA is managed by a System Control Unit located inside the ELENA box. In the present paper the scientific goals of this suite are described, and then the four units are detailed, as well as their major features and calibration results. Finally, the SERENA operational activities are shown during the orbital path around Mercury, with also some reference to the activities planned during the long cruise phase.

Catheter ablation of atrial fibrillation in patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis

Background

Catheter ablation improves clinical outcomes in symptomatic atrial fibrillation (AF) patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, the role of catheter ablation in HF patients with a preserved ejection fraction (HFpEF) is less clear.

Purpose

To determine the efficacy of catheter ablation of AF in patients with HFpEF relative to those with HFrEF.

Methods

We performed an extensive literature search and systematic review of studies that compared AF recurrence at one year after catheter ablation of AF in patients with HFpEF versus those with HFrEF. Risk ratio (RR) 95% confidence intervals were measured using the Mantel-Haenszel method for dichotomous variables, where a RR<1.0 favors the HFpEF group.

Results

Four studies with a total of 563 patients were included, of which 312 had HFpEF and 251 had HFrEF. All patients included were undergoing first time catheter ablation of AF. Patients with HFpEF experienced similar recurrence of AF one year after ablation on or off antiarrhythmic drugs compared to those with HFrEF (RR 0.87; 95% CI 0.69–1.10, p=0.24), as shown in Figure 1. Recurrence of AF was assessed with electrocardiography, Holter monitoring, and/or event monitoring at scheduled follow-up visits and final follow-up.

Conclusion

Based on the results of this meta-analysis, catheter ablation of AF in patients with HFpEF appears as efficacious in maintaining sinus rhythm as in those with HFrEF.

Funding Acknowledgement

Type of funding source: None

Effectiveness of Breast Care Nurse Led Video Orientation Programme on Information and Navigation for Newly Diagnosed Breast Cancer Patients at University Malaya Medical Center, Malaysia

Background: Advancement in medical treatment with wider treatment options have made breast cancer (BC) care more complex. Short consultation time with physicians, treatment complexities, patients' fears and poor coping skills at the time of diagnosis may affect patient´s decision that cause treatment delays and nonadherence. Main reasons for advance BC presentation in Malaysia are delay in taking treatment decision and poor breast health literacy on disease and treatment outcomes may contribute to nonadherence to treatments. To address this knowledge gap, a breast care nurse (BCN) led orientation video for new patients to navigate them through complex multimodal treatment processes. This audio-visual educational tool address multimodal treatments and its side effects and in addition navigating admission, discharge and follow-up, advice on diet and exercise to maintain a healthy life style during survivorship period was developed in layperson language in Malay, Mandarin and English. Aim: To assess the effectiveness of BCN led video orientation on the improvement of patient knowledge and satisfaction. Methods: A pilot study was carried out in 50 patients to assess the effectiveness of the video, and found that patients needed a face to face interaction to watch the video. Hence, a BCN led orientation was developed to use the video. A self-administered pre- and postsurvey on 246 newly diagnosed breast cancer patients in University Malaya Medical Center (UMMC) was performed to evaluate expectations, satisfactions and knowledge (a Likert scale response using items 4 number scale was used, 0 means “no knowledge” and 4 means “a great degree of knowledge”). The scoring was done before and after the video orientation was done. A Wilcoxon matched-paired signed-rank test was perform to analyze the changes in the scoring. Results: Among 247 patients, who received the BCN led video orientation program, 79.3% (n= 197) found that the video met or exceeded their expectations. 23.9% (n=59) and 56.3% (139) consecutively found the video very effective and effective in broadening their perspective on BC treatments. And 171 (69.2%) of them overall rated the video highly met their expectations. There were significant improvement in knowledge for treatment options for BC, mean scores (M=0.93 versus M=2.97) before and after watching the video ( P < 0.001). Similar findings were found in different types of operation for BC; procedure for admission in UMMC, information on chemotherapy; radiotherapy; hormone therapy and alternative medicine for BC. It also showed improved knowledge scores for healthy diet; physical activity after treatments and care of the arm after operation ( P < 0.001). Conclusion: Video-based information on treatments and navigating care through a BCN led service had effectively improved patients' knowledge and satisfaction. This approach can be used to educate cancer patients in a middle resource setting.

Biofilter for generation of concentrated sulphuric acid from H2S

Biofilters are used for the conversion of odorous hydrogen sulphide to odourless sulphate in wastewater treatment plants under the right conditions of moisture and pH. One of the consequences of maintaining the suitable pH and moisture content is the production of large volumes of weakly acidic leachate. This paper presents a biofilter with a maximum H2S elimination capacity of 16.3 g m(-3) h(-1) and removal efficiency greater than 95 % which produces small volumes (1 mL of solution L(-1) of reactor day(-1)) of sulphuric acid with a concentration greater than 5.5 M after 150 days of continuous operation. The concentrated sulphuric acid was produced by intermittently trickling a minimum amount of nutrient solution down the upflow biofilter which created a moisture and pH gradient within the biofilter resulting in an environment at the top for the bacterial conversion of H2S, while sulphuric acid was accumulated at the base. Genetic diversity profiling of samples taken from different sections of the biofilter confirms that the upper sections of the biofilter had the best environment for the bacteria to convert H2S to sulphate. The formation of concentrated sulphuric acid presents an opportunity for the recovery of sulphur from the waste stream as a usable product.

[Clinical case of the month. Amoebic liver abscess contracted in India with diagnosis confirmed by PCR]

Amoebiasis is a disease of parasitic origin responsible for dysentery and extra-intestinal complications. The infection is by Entamoeba histolytica, an amoeba whose geographical distribution is cosmopolitan, but that is more prevalent in tropical areas. Only a few infections are symptomatic and some of them may cause extra-intestinal complications. Hepatic amoebiasis is the most frequently observed. We report the case of a Belgian woman who developed an amoebic liver abscess after returning from a trip to India. The diagnosis was confirmed by PCR detection of E. histolytica DNA performed on the abscess fluid. The epidemiological, diagnosis and treatment aspects are discussed.

Enhancement of waste activated sludge anaerobic digestion by a novel chemical free acid/alkaline pretreatment using electrolysis

Anaerobic digestion of waste activated sludge (WAS) is relatively poor due to hydrolysis limitations. Acid and alkaline pretreatments are effective in enhancing hydrolysis leading to higher methane yields. However, chemical costs often prohibit full-scale application. In this study, 12 V two-chamber electrolysis using an anion exchange membrane alters sludge pH without chemical dosing. pH dropped from 6.9 to 2.5 in the anode chamber and increased to 10.1 in the cathode chamber within 15 h. The volatile suspended solids solubilisation of WAS was 31.1% in the anode chamber and 34.0% in the cathode chamber. As a result, dissolved chemical oxygen demand increased from 164 to 1,787 mg/L and 1,256 mg/L in the anode and cathode chambers, respectively. Remixing of sludge from the two chambers brought the pH back to 6.5, hence no chemical neutralisation was required prior to anaerobic digestion. Methane yield during anaerobic digestion at 20 d retention time was 31% higher than that of untreated sludge. An energy balance assessment indicated that the non-optimised process could approximately recover the energy (electricity) expended in the electrolysis process. With suitable optimisation of treatment time and voltages, significant energy savings would be expected in addition to the benefit of decreased sludge volume.

Mitigating ammonia inhibition of thermophilic anaerobic treatment of digested piggery wastewater: use of pH reduction, zeolite, biomass and humic acid

High free ammonia released during anaerobic digestion of livestock wastes is widely known to inhibit methanogenic microorganisms and result in low methane production. This was encountered during our earlier thermophilic semi-continuously fed continuously-stirred tank reactor (CSTR) treatment of piggery wastewater. This study explored chemical and biological means to mitigate ammonia inhibition on thermophilic anaerobic treatment of piggery wastewater with the aim to increase organic volatile carbon reduction and methane production. A series of thermophilic anaerobic batch experiments were conducted on the digested piggery effluent to investigate the effects of pH reduction (pH 8.3 to 7.5, 7.0 and 6.5) and additions of biomass (10% v/v and 19% v/v anaerobic digested piggery biomass and aerobic-anaerobic digested municipal biomass), natural zeolite (10, 15 and 20 g/L) and humic acid (1, 5 and 10 g/L) on methane production at 55 °C for 9-11 days. Reduction of the wastewater pH from its initial pH of 8.3 to 6.5 produced the greatest stimulation of methane production (3.4 fold) coupled with reductions in free ammonia (38 fold) and total volatile fatty acids (58% TVFA), particularly acetate and propionate. Addition of 10-20 g/L zeolite to piggery wastewater with and without pH reduction to 6.5 further enhanced total VFA reduction and methane production over their respective controls, with 20 g/L zeolite producing the highest enhancement effect despite the ammonia-nitrogen concentrations of the treated wastewaters remaining high. Without pH reduction, zeolite concentration up to 20 g/L was required to achieve comparable methane enhancement as the pH-reduced wastewater at pH 6.5. Although biomass (10% v/v piggery and municipal wastes) and low humic acid (1 and 5 g/L) additions enhanced total VFA reduction and methane production, they elevated the residual effluent total COD concentrations over the control wastewaters (pH-unadjusted and pH-reduced) unlike zeolite treatment. The outcomes from these batch experiments support the use of pH reduction to 6.5 and zeolite treatment (10-20 g/L) as effective strategies to mitigate ammonia inhibition of the thermophilic anaerobic treatment of piggery wastewater.

Ruptured abdominal aortic aneurysm: endovascular or open approach in a Dutch general hospital

AIM

We compared the outcomes of 56 patients with a ruptured abdominal aortic aneurysm (RAAA) who underwent either open repair or emergency endovascular aneurysm repair (eEVAR) in a general hospital. It seems feasible that the availability of eEVAR for treatment of RAAA could lead to a decrease in hospital mortality.

METHODS

We analyzed all admitted patients with a RAAA, between January 2006 and April 2008, eEVAR is compared to open repair. We studied 30 days mortality, intensive care unit stay, hospital stay, total blood loss and complications.

RESULTS

Fifteen eEVAR procedures (26.8%) were performed. Mortality in the eEVAR-group was 26%, in the open repair-group 46%. Mean intensive care unit stay was 3.9 days and 4.8 days in the eEVAR-group and open repair-group, respectively. Mean hospital stay was 13 days and 10.5 days. The average blood loss was 210cc and 2760cc. The amount of blood products for transfusion was significantly higher in the open repair. Overall complication rate was not significantly different in both treatment groups.

CONCLUSION

Treatment in a Dutch general hospital of a RAAA with an eEVAR procedure has a lower mortality in comparison to the open repair. Therefore, whenever possible the eEVAR is the preferred treatment method.

Blood, urine, and hair kinetic analysis following an acute lead intoxication

A case of lead exposure resulting from the accidental ingestion of a lead-containing solution is reported. Because of clinical management rapidly performed through chelation therapy by 2,3-dimercaptopropane sulfonate sodium and meso-2,3-dimercaptosuccinic acid, blood lead levels of this 51-year-old patient were moderate (412.9 μg/L) and no clinical symptoms were observed. Numerous blood and urine samples were collected for kinetic analysis of lead elimination. However, we report the first case in which hair samples were analyzed to determine the excretion level of lead after acute intoxication.

Reliability and reproducibility of a clinical application of a simple technique for repeated circumferential leg measurements

Objective

The aim of this study is to determine the reliability and reproducibility of repeated tape measurements to assess the leg circumference during a long period.

Methods

A tape measure is a simple instrument that is applicable in the presence of oedema. Measurements were performed by four observers on 11 volunteers. Four measurements were done in the first week (short term), a fifth measurement at two weeks (medium term) and a sixth measurement was done at 12 weeks (long term).

Results

The short-, medium- and long-term intra-class correlation coefficients for repeated measurements were 0.90, 0.89 and 0.78, respectively. The short-term and long-term reproducibility indices equalled 4.4% and 6.5%. If only a single observer would be involved, the short-term intra-class correlation coefficients would improve to 0.94 (reproducibility index 3.3%).

Conclusion

Tape measurements have been proved to be a reliable and reproducible method to asses the lower limb circumference.

In vivo imaging of retinal gliosis: a platform for diagnosis of PD and Screening of anti-PD compounds

Parkinson's disease (PD) is the second most frequent degenerative disorder after Alzheimer's disease. It is characterized by the depletion of mesenchephalic dopaminergic (DA) neurons in the substantia nigra pars compacta (SNpc) and striatal dopamine. Oxidative stress plays a major role in the pathogenesis of Parkinson's disease where DA neurons are especially vulnerable to excessive production of the H2O2 reactive oxygen species. Unfortunately, the first clinical symptoms of PD occur after at least 60-80% of nigro-striatal dopaminergic neurons have lost their function. Therefore, early detection of PD is critical in slowing down the progression of the disease and enabling the development of therapeutic compounds which could intervene at an earlier stage. Here, we employ in vivo molecular imaging of astrocytic retinal gliosis in a transgenic mice to longitudinally monitor the progression of MPTP-induced PD. We have quantitatively evaluated, via this imaging platform, the efficacy of a synthetic antioxidant, 1,3- bisbenzylimidazolium bromide (DBZIM), in protecting the DA neurons and scavenging the ROS. We show here that MPTPinduced PD results in an upregulation of glial fibrillary acidic protein (GFAP), a marker for gliosis, by 36% relative to saline whereas gliosis is normalized in MPTP-induced PD mice treated with DBZIM.

Updating the profile of C-terminal MECP2 deletions in Rett syndrome

OBJECTIVES

This study aimed to compare the phenotype of Rett syndrome cases with C-terminal deletions to that of cases with different MECP2 mutations and to examine the phenotypic variation within C-terminal deletions.

METHODS

Cases were selected from InterRett, an international database and from the population-based Australian Rett Syndrome Database. Cases (n=832) were included if they had a pathogenic MECP2 mutation in which the nature of the amino acid change was known. Three severity scale systems were used, and individual aspects of the phenotype were also compared.

RESULTS

Lower severity was associated with C-terminal deletions (n=79) compared to all other MECP2 mutations (e.g. Pineda scale C-terminals mean 15.0 (95% CI 14.0-16.0) vs 16.2 (15.9-16.5). Cases with C-terminal deletions were more likely to have a normal head circumference (odds ratio 3.22, 95% CI 1.53 - 6.79) and weight (odds ratio 2.97, 95% CI 1.25-5.76). Onset of stereotypies tended to be later (median age 2.5 years vs 2 years, p<0.001 from survival analysis), and age of learning to walk tended to be earlier (median age 1.6 years vs 2 years, p=0.002 from survival analysis). Those with C-terminal deletions occurring later in the region had lower average severity scores than those occurring earlier in the region.

CONCLUSION

In terms of overall severity C-terminal deletion cases would appear to be in the middle of the range. In terms of individual aspects of phenotype growth and ability to ambulate appear to be particular strengths. By pooling data internationally this study has achieved the case numbers to provide a phenotypic profile of C-terminal deletions in Rett syndrome.

The risk of sodium toxicity from bed accumulation to key species in the vermifiltration wastewater treatment process

This study was undertaken to assess the toxicological risks from sodium accumulation in a vermifiltration wastewater treatment system to the key worm species, Eisenia fetida. The study found that sodium chloride (NaCl) is the more toxic of the common sodium salts found in wastewater to the worms. The research further found that the worms have an ability to detoxify NaCl although reproduction will be impaired if the worms are exposed to moderate concentrations of NaCl for a long period of time. The actual risk from NaCl toxicity in the vermifiltration process was low however. The low risk was due to the low solid-water partitioning constant of NaCl, which led to a very low predicted environmental concentration (PEC) for NaCl.