UBC Neck C4-C5: An Anatomically and Biomechanically Accurate Surrogate C4-C5 Functional Spinal Unit

Millions of people worldwide suffer from spinal cord injuries (SCIs) and traumatic brain injuries (TBIs) annually. Safety devices meant to protect against SCIs and TBIs, such as helmets, airbags, seat belts, and compliant floors are often evaluated with the use of anthropometric test devices (ATD s); however, there are currently no neck surrogates appropriate for the multiplane loading that often occurs in real-world scenarios leading to injury. As such, our objective in this study was to design and create an anatomically correct functional spinal unit (FSU) that produces a repeatable and biofidelic response to lateral bending, axial rotation, and quasistatic flexion-extension motion. This is a critical step in developing a biofidelic omnidirectional surrogate that can be used in future evaluations of safety devices in transportation, occupational, and sports settings. To create a biofidelic C4-C5 FSU, anatomically accurate C4 and C5 vertebrae were designed and manufactured using a 3D printer using geometry derived from the CT scans of a healthy 31-year-old male. Potential intervertebral disc and ligament surrogate materials were tested in compression and tension, respectively, to select representative materials for the surrogate intervertebral disc and cervical ligaments. The C4-C5 FSU was assembled and tested repeatedly in quasistatic flexion-extension, axial rotation, and lateral bending. Kinematic results were captured and compared to previously published cadaver data. The surrogate disc showed excellent Biofidelity (ISO/TR 9790) in compression, and the surrogate ligaments were within 25 N/mm of linear cadaveric stiffness ranges. The assembled FSU named UBC Neck C4-C5 showed good biofidelity under quasistatic axial rotation, lateral bending, flexion-extension, and coupled motion (ISO/TR 9790). However, the instantaneous centre of rotation was not similar to ex vivo or in vivo published studies. The UBC Neck C4-C5 FSU resulted in good biofidelity ratings and will inform future construction of a full surrogate neck to be used in the testing of head and neck safety equipment.

Parental Knowledge about Healthy Sleep Hygiene practices in Children under 6 Year Old: an Exploratory Study

Introduction Children aged 5 to 12 years old needs, at least, 10-11 hours of sleep. Nowadays, children under 6 years old become more interested in TV, computers and in Internet which can lead to difficulty falling asleep. Parent knowledge about child sleep hygiene can influence parent capacity to promote healthy sleep habits, and should be supported by accurate information.

Objectives To analyse parents knowledge of children sleep practices.

Methodology A convenience sample of parents (n = 201) of children from three schools in a northern city of Portugal completed the "Sleep Ideas" Parent Survey on child sleep habits and parental basic sleep knowledge, beliefs and attitudes regarding sleep as a health behaviour.

Results Of the 201 analysed surveys (response rate 67 %), 33.8 % are from parents of children aged under 3 years old, 19.4 % of children with 3 years older, 24.4 % of children with 4 years old, 16.4 % of children with 5 years old and 6.0 % of children with 6 years old. In general, the percentage of correct answers was 84.8 %. Regarding children age, the percentage of correct answers ranged between 77.9 to 86.2 %, being the parents of children with 6 years old those who had the highest percentage of incorrect answers (22.1 %) and, on the other hand, the parents of children with 3 years old those who had the lowest percentage of incorrect answers (13.8 %). The answer with the highest percentage of incorrect answers, in all parents, was “Making a physical effort before going to sleep makes falling asleep easier” (46.8 %).

Conclusion In this study, parents revealed a very reasonable knowledge about sleep, which suggests a good capability to influence positively children’s habits. Parents with high sleep knowledge are more able to promote healthy sleep hygiene habits. Further studies are warranted to promote a better understanding of all the determinant dimensions for good sleeping habits.

Implementation of a Sleep Hygiene Program in 4 - 6 Year Old Portuguese Children: the “It is Time to Sleep” Project First Results

Introduction Sleep, as one of the most determining and present factors in our life, is fundamental for humans, and especially during childhood: it is indispensable for good cognitive, physical and emotional development.

Objectives Designed in the scope of the Portuguese National School Health Program, the objectives of this project were to promote adequate sleep routines, raise awareness of children’s sleep deprivation and to the consequences of an abusive contact with technologies. At the end of this activity, children should be able to recognize the importance of these dimensions.

Methodology The formative activity, performed by 2 school nurses, was applied to 104 children (from 3 different schools from a northern city of Portugal), with 4 (41.3 %), 5 (44.2 %) and 6 years old (14.4 %), and lasted 45 minutes. The project comprises 4 stages: the first one relates to nurses and project theme presentation; the second one is the implementation of a theatre where major issues of the project are presented, namely the importance of sleep and nap, sleep hygiene rules, consequences of sleep deprivation and the influence of technologies on sleep; the third one is the discussion of the main ideas using the song "Sleep Hour"; at the end, a questionnaire was applied to assess children knowledge about sleep hygiene habits divided into six questions with two images each, in which one corresponds to a healthy practice and the other does not.

Results The percentage of correct answers ranged between 96.6 to 98.3 %, suggesting that the formative activity had a positive impact on children’s knowledge about healthy sleep hygiene habits. The 2 questions on which the rate of incorrect answers was higher relate to the fact that sleeping with parents is better than sleeping alone (6.3 %) and that watching TV before going to sleep is a better option than reading a story (4.4 %).

Conclusion This intervention has given children important knowledge about healthy sleep hygiene habits, resulting in its understanding through an approach tailored to their age.

Abstract P3-04-01: The value of stereotactic vacuum-assisted biopsy in the investigation of microcalcifications in 1354 patients in public Brazilian hospital

Background: The gold standard for breast biopsy procedures is currently an open excision of the suspected lesion. However, an excisional biopsy inevitably makes a scar. The cost and morbidity associated with this procedure has prompted many physicians to evaluate less invasive, alternative procedures. More recently, image-guided percutaneous core-needle biopsy has become a frequently used method for diagnosing palpable and non-palpable breast lesions. Although sensitivity rates for core-needle biopsy are high, it has the disadvantage of histological underestimation, which renders the management of atypical ductal hyperplasia, papillary lesions, and fibroepithelial lesions somewhat difficult. Stereotactic vacuum assisted breast biopsy (VABB) was developed to overcome some of these negative aspects of core-needle biopsy. VABB allows for a sufficient specimen to be obtained with a single insertion and can provide a more accurate diagnosis and completely remove the lesion under real-time ultrasonic guidance. The advantage of complete lesion removal with VABB is to reduce or eliminate sampling error, to decrease the likelihood of a histological underestimation, to decrease imaging-histological discordance, to decrease the re-biopsy rate, and to diminish the likelihood of subsequent growth on follow-up, especially when stereotactic VABB is used to investigate microcalcifications. This method is expensive but cost effective when used to investigate microcalcifications classified as BI-RADS 4 and 5.

Methodology: We performed a review in 1,354 patients with suspicious mammography microcalcifications, classified as BI-RADS 4 or 5 that were seen in Perola Byington Hospital from July 2012 to July 2017 in São Paulo-Brazil. We have used aHologic Lorad Multicare Platinum Stereotactic Prone Breast Biopsy and a Surus Pearl (Hologic, Malbolrough, Massachusetts, USA), with gauge 9 probe. Four to eight fragments (median of 6) were obtained with the placement of a metal clip in the bed that the biopsy was performed, and histopathological analysis was made.

Results:The histopathological study of the lesions revealed benign alterations in 956 (68%) of our patients. The findings were positive for malignancy in 358 patients (29%) and the precursor lesions were diagnosed in 40 (3%). In 81 cases (5.9%) the findings were discordant. The sensitivity of the method was 84.4%, specificity was 96.1%, false negative rate was 4.5%, positive predictive value (PPV) was 89.8%, negative predictive value (NPV) was 93.8%. In literature review the sensitivity varies 91.5-100%, specificity 81.9-110%, false negative rate 0-3.3%, PPV 92.2-100% and NPV 80.5-99.5%. All patients with positive or discordant cases underwent surgical treatment to increase the margin or complete removal of the lesion. Conclusions: The VABB is an outpatient procedure that avoids hospital admissions for diagnostic elucidation in most of cases suspected of malignancy. It has high predictive value in both benign and malignant lesions, guiding therapeutic planning. In addition to presenting the cost lower than the surgical biopsy it indirect increases the supply of hospital beds for cancer treatment.

Citation Format: Mattar A, Amorim AG, Ramos MdNM, Shida JY, Fonseca GR, Hegg R, Gebrim LH. The value of stereotactic vacuum-assisted biopsy in the investigation of microcalcifications in 1354 patients in public Brazilian hospital [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-04-01.

Inhibition of the Platelet Reaction by a High Molecular Weight Phosphoglycoprotein Isolated from Human Platelet Plasma Membranes

The effect of a phospho-glycoprotein (HMW-GP), obtained from human platelet plasma membranes, on the aggregation and secretion of human platelets was studied. Incubation of PRP with 4 to 16 μg/ml of HMW-GP results in inhibition of ADP-, Epinephrine-, Collagen-, and Thrombin-induced platelet aggregation. The effect is mainly reflected on the secondary wave of aggregation. The inhibitory effect is partially overcome by higher concentration of the inducers, however, even under these conditions, a clear tendency towards disaggregation is observed. 5HT release (Col-induced) is strongly decreased from 50% to 4.5. The inhibitory effect on Thrombin-induced aggregation is markedly dependent on external calcium, being maximal at 5 mM calcium. The HMW-GP does not bind ADP or Thrombin. Membrane conformation is markedly affected, as evidenced by the effect of HMW-GP on the iodination of surface polypeptides of intact platelets. It is suggested that interaction of HMW-GP with the platelet membrane blocks the signal(s) transmission that links stimulus to activation. The inhibition observed might just represent an experimental amplification of the endogenous modulatory function that has been proposed for this high molecular weight phosphoglycoprotein.

Comprehensive exercise training improves ventilatory muscle function and reduces dyspnea perception in patients with COPD

BACKGROUND

Comprehensive exercise training (CET) is an efficient strategy to decrease dyspnea perception in chronic obstructive pulmonary disease (COPD) and may result in significant improvement in ventilatory muscles function. Our aim was to evaluate the effects of general exercise training on dyspnea perception and on respiratory muscles strength in COPD patients.

METHODS

Consecutive COPD patients were enrolled to complete a CET programme. The patients underwent a routine that included a global warm up, upper and lower limbs endurance exercise as well as stretching and relaxation. Before and after the CET programme, patients completed maximal inspiratory (PImax) and expiratory (PEmax) pressures measurements, maximal incremental test, endurance test, and 6-min walk distance (6MWD).

RESULTS

71 patients (52 male). Mean age 67.6 +/- 8.6 years, FEV1 (%) 44.2 +/- 16.2 and Mahler dyspnea scale 6.4 +/- 1.8. The results before and after the exercise programme were: PImax 64.7 +/- 22.9 vs. 75.5 +/- 23.7 cmH2O (p=0.001), PEmax 110.8 +/- 28.1 vs. 120.4 +/- 28.1 cmH2O (p=0.004), 6MWD 510.6 +/- 90.3 vs. 528.2 +/- 99.7 metres (p=0.88), time of incremental test 672 +/- 135 vs. 856 +/- 226 sec (p<0.0001). Compared with the pre exercise programme, we observed a significant reduction on Borg dyspnea scale (6.1 +/- 2.8 to 3.6 +/- 2.3, p<0.0001) as well as a longer test time (504 +/- 218 to 1.038 +/- 841, p<0.0001) at the end of the endurance test after CET programme. Improvement of PImax correlated negatively with dyspnea perception at iso-time during the endurance test (r = -0.33, p=0.03).

CONCLUSIONS

Our results confirm that CET is associated with significant improvement in PImax, PEmax and provide evidence demonstrating that CET reduces dyspnea perception in patients with COPD.

Analysis of lymphocyte and oral mucosa cell micronuclei in Cuban paint industry workers

Twenty-one workers exposed to complex mixtures in the paint industry were compared with a control group of 19 persons from a blood bank in regard to micronuclei frequency in peripheral blood lymphocytes and in oral mucosa cells. The exposed persons showed significantly increased levels of micronuclei frequencies in both types of cells.

Studies on the photostability and phototoxicity of aloe-emodin, emodin and rhein

Aloe-emodin (1), emodin (2) and rhein (3) were found to be photolabile by visible (390-500 nm) light under aerobic conditions. The drugs 1, 2 and 3 were phototoxic in vitro when examined by the photohemolysis test under both oxygen and argon atmospheres, although the photohemolysis rate was markedly lower under anaerobic conditions. The experiments were also carried out in the presence of butylated hydroxyanisole (BHA), reduced glutathione (GSH), sodium azide (NaN3) and superoxide dismutase (SOD). Based on the inhibition of this process on addition of BHA, GSH, SOD and NaN3, there would seem to be involvement of free radicals (type I mechanism) and singlet oxygen in the process (type II mechanism). The in vitro phototoxicity of this anthraquinone series was also verified in a lipid-photoperoxidation test with linoleic acid. In summary, this anthraquinone series is phototoxic in vitro. This behavior can be explained through the involvement of singlet oxygen and stable photoproducts.

Visceral leishmaniasis in a Brazilian child infected perinatally with human immunodeficiency virus

This report describes a Brazilian child perinatally infected by HIV who presented visceral leishmaniasis. She showed the classic clinical features, and diagnosis was made by demonstration of amastigote forms of Leishmania in bone marrow aspirate. She responded well to traditional treatment with meglubine.

First Report of Fusarium Wilt of Babaco (Carica × heilbornii var. pentagona) in Ecuador

Babaco, Carica × heilbornii V.M. Badillo var. pentagona (Heilborn) V.M. Badillo, is a fruit native to Ecuador that has great potential as a cultivated crop. Local market demand and strong potential as an export crop have greatly increased interest in babaco production in Ecuador. Although the crop can be produced in open fields, the majority of crop production is in plastic greenhouses. In 1996, a serious wilt disease developed on babaco in several greenhouses, resulting in up to 100% loss of plants. Symptoms first appeared as chlorosis of the lower leaves, followed by defoliation progressing up the stem until the entire plant was defoliated. When cut in cross section, vascular discoloration was observed in the stem. Eventually necrosis and soft rot of the stem occurred and entire plants collapsed. Fungal isolations were conducted from fine feeder roots of diseased plants by soaking root pieces (2 cm long) in a 0.5% solution of sodium hypochlorite for 3 min. Root pieces were cut into smaller sections and placed on potato dextrose (PDA) or corn meal (CMA) agar in petri dishes. Isolations from larger roots, crowns, stems and fruits were made by soaking tissue sections of each plant part in a 2.87% solution of sodium hypochlorite for 3 min. Tissue sections were rinsed three times in sterile distilled water. Smaller tissue sections (≈0.125 cm³) were cut from surface-disinfested pieces and placed on PDA and CMA in petri dishes. Cultures were incubated at 20°C. A fungus resembling Fusarium sp. was isolated consistently from infected tissues from all infected plant parts. Based on the morphology of the fungal colony and conidia from monosporic isolations, the fungus was identified as Fusarium oxysporum Schlechtend:Fr. (1). Pathogenicity tests were conducted by growing babaco plants in pots containing an equal mixture of sterilized soil, compost, and sand in the greenhouse. Eight 7-month-old plants were inoculated by placing 40 ml of a suspension (10⁶ conidia per ml) of F. oxysporum in four plastic straws placed in the soil (5 cm depth) at equal distances (5 cm) from the base of each plant. Straws around noninoculated control plants received sterile water. Plants were watered with 400 ml of sterile water daily. Pathogenicity tests were repeated once as described. All inoculated plants developed typical wilt symptoms within 45 days after inoculation. No symptoms developed on uninoculated control plants. F. oxysporum was successfully reisolated from infected stem tissues of inoculated plants. Incidence of Fusarium vascular wilt of babaco has continued to increase since 1996 and is currently the major constraint to production. References: (1) P. E. Nelson et al. 1981. Fusarium: Diseases, Biology, and Taxonomy. The Pennsylvania State University Press, University Park.

[Radiation therapy and cardiac pacemakers]

The number of patients with cardiac pacemakers submitted annually to radiation therapy is increasing. Radiation therapy causes interference in the normal functioning processes, directly by chemical changes in the structure of the device and also by electromagnetic disturbances generated in the process of treatment. The changes in the technology used in the manufacture of cardiac pacemakers after the 70's, with the introduction of complementary metal-oxide semi-conductors (CMOS) in the circuits, drastically increased the chance of dangerous interference in the normal function of cardiac pacemakers occurring when in contact with an ionizing radiation source. The authors briefly describe the mechanisms underlying the radio-induced damage usually observed. A review of the literature on this issue is made and solutions are pointed out to perform safe radiation therapy and minimize the risk of device malfunction.

[Pubic hair in children and late onset congenital adrenal hyperplasia]

Before the age of 8 in females and 9 in males, the presence of pubic hair can be the first sign of a gonadal or adrenal disease. In order to identify the late onset type of congenital adrenal hyperplasia in premature pubescence, we did the adrenal short stimulation test with Synacthen, on 30 children. Five girls and one boy showed a 21-hydroxylase deficiency, in which the seric 17-OH Progesterone at 60 minutes is 28.8 +/- 15.2 ng/ml, being in a control group 2.30 +/- 0.8 ng/ml [p less than 0.01]. The 20% incidence we have found, justifies the testing of every premature pubescent child.

Mutagenicity of N-nitrosomorpholine biosynthesized from morpholine in the presence of nitrate and its inhibition by ascorbic acid

N-nitrosomorpholine biosynthesis and inhibition in mice treated with nitrate, morpholine and ascorbic acid, was studied by means of the mutagenic activity in urine samples. The preincubation method was used and Salmonella typhimurium TA 1535 was the test strain. The results suggest that N-nitrosomorpholine biosynthesis was carried out when the animals were fed high doses of nitrate, however ascorbic acid was an inhibitor of this process.

[Zinc and porphyria cutanea tarda]

In 30 patients affected by Porphyria Cutanea Tarda we determined: plasmatic, erythrocytary and urinary zinc (by atomic absorption spectrophotometry); total porphyrins in plasma and in urines, coproporphyrins and protoporphyrins in erythrocytes (by spectrophotometric methods); haptoglobin, hemopexin, alpha 2-macroglobulin and albumin (by immunological methods). The results obtained were compared with those of normal subjects. In addition, the variables under consideration were statistically analyzed to bring out possible correlations (both simple and partial). The most interesting result (besides the documentation of an increase in the urinary and plasmatic zinc in porphyric patients) was the finding of correlations between plasmatic zinc, plasmatic porphyrins and alpha 2-macroglobulin.

Inhibition of the platelet reaction by a high molecular weight phosphoglycoprotein isolated from human platelet plasma membranes

The effect of phospho-glycoprotein (HMW-GP), obtained from human platelet plasma membranes, on the aggregation and secretion of human platelets was studied. Incubation of PRP with 4 to 16 micrograms/ml of HMW-GP results in inhibition of ADP-, Epinephrine-, Collagen-, and Thrombin-induced platelet aggregation. The effect is mainly reflected on the secondary wave of aggregation. The inhibitory effect is partially overcome by higher concentrations of inducers, however, even under these conditions, a clear tendency towards disaggregation is observed. 5HT release (Col-induced) is strongly decreased from 50% to 4.5. The inhibitory effect on Thrombin-induced aggregation is markedly dependent on external calcium, being maximal at 5 mM calcium. The HMW-GP does not bind ADP or Thrombin. Membrane conformation is markedly affected, as evidenced by the effect of HMW-GP on the iodination of surface polypeptides of intact platelets. It is suggested that interaction of HMW-GP with the platelet membrane blocks the signal(s) transmission that links stimulus to activation. The inhibition observed might just represent an experimental amplification of the endogenous modulatory function that has been proposed for this high molecular weight phosphoglycoprotein.