Brain Pathology in COVID-19: Clinical Manifestations and Potential Mechanisms

Neurological manifestations of coronavirus disease 2019 (COVID-19) are less noticeable than the respiratory symptoms, but they may be associated with disability and mortality in COVID-19. Even though Omicron caused less severe disease than Delta, the incidence of neurological manifestations is similar. More than 30% of patients experienced "brain fog", delirium, stroke, and cognitive impairment, and over half of these patients presented abnormal neuroimaging outcomes. In this review, we summarize current advances in the clinical findings of neurological manifestations in COVID-19 patients and compare them with those in patients with influenza infection. We also illustrate the structure and cellular invasion mechanisms of SARS-CoV-2 and describe the pathway for central SARS-CoV-2 invasion. In addition, we discuss direct damage and other pathological conditions caused by SARS-CoV-2, such as an aberrant interferon response, cytokine storm, lymphopenia, and hypercoagulation, to provide treatment ideas. This review may offer new insights into preventing or treating brain damage in COVID-19.

[The non-bacterial pathogenic and clinical characteristics of acute respiratory tract infection in children in a hospital of pediatric in Sichuan Province from 2019 to 2021]

Objective: To explore the non-bacterial pathogen distribution, epidemiological characteristics, and clinical features of acute respiratory infections in children in Sichuan Province. Methods: Using a retrospective cohort study method, this study selected hospitalized children diagnosed with acute respiratory infections at West China Second Hospital of Sichuan University from February 2019 to January 2021, and tested 13 pathogens using polymerase chain reaction (PCR)-fragment analysis. The children were divided into infant group (<1 year old), toddler group (1 year old ≤ age <3 years old), preschool group (3 years old ≤ age <6 years old) and school-age group (6 years old ≤ age <18 years old). The distribution of pathogen positive rates, seasonal epidemic characteristics, clinical characteristics, and some laboratory test indicators were analyzed in children. Statistical analysis was performed on the results using SPSS 22.0 software, with count data expressed as percentages and inter group comparisons using SPSS 22.0 software χ2 Inspection. Results: A total of 2 922 pediatric patients were included in this study, with 1 748 (59.8%) positive for pathogens detected. Among them, 1 391 (79.6%) were detected as a single pathogen, and 357 (20.4%) were detected as a mixture of two or more pathogens. The most commonly detected pathogens were rhinovirus (HRV) (39.7%), syncytial virus (RSV) (22.8%), and parainfluenza virus (PIV) (12.5%). Pathogen positivity is more common in children under 6 years old (χ2=146.59, P<0.001), with a slightly higher positivity rate in male children (61.3%, 1 047/1 707) than in female children (57.7%, 701/1 215) (χ2=3.91, P=0.048), and compared with pathogen negative children, positive children are more prone to symptoms such as cough, wheezing, and shortness of breath (χ2=259.15, 366.06, 12.48, P<0.001). The distribution of different pathogens varies among children of different age groups, and HRV is more common in children aged 1-3 and 3-6 years old (χ2=9.74, P<0.001), while RSV is more common in children under 1 year old (χ2=178.63, P<0.001), while mycoplasma pneumoniae (MP) and influenza virus (InfA/B) are less common in children under 1 year old (χ2=92.54, 12.90,22.21, P<0.01). The prevalence of multiple pathogens showed seasonal changes. HRV showed a high prevalence trend in spring and autumn, while the prevalence of RSV infection was mainly seen in autumn and winter festivals. The positive rate of different pathogens after the outbreak of novel coronavirus pneumonia was significantly lower than that before the outbreak (χ2=252.68, P<0.001). Conclusion: The detection rate of non-bacterial respiratory pathogens in children in Sichuan Province from 2019 to 2021 is high, which is prone to symptoms such as cough, wheezing, and shortness of breath, with HRV and RSV being the main types. The positive rate of respiratory pathogens varies among different age groups, genders, and seasons.

Effectiveness of sleep interventions to reduce delirium in critically ill patients: A systematic review and meta-analysis

PURPOSE

To analyze the effectiveness of sleep interventions in reducing the incidence and duration of delirium in the ICU.

MATERIALS AND METHODS

We searched the PubMed, Embase, CINAHL, Web of Science, Scopus, and Cochrane databases for relevant randomized controlled trials from inception to August 2022. Literature screening, data extraction, and quality assessment were performed independently by two investigators. Data from the included studies were analyzed using Stata and TSA software.

RESULTS

Fifteen randomized controlled trials were eligible. Meta-analysis showed that the sleep intervention was associated with a reduced incidence of delirium in the ICU (RR = 0.73, 95% CI = 0.58 to 0.93, p < 0.001) compared to the control group. The results of the trial sequence analysis further confirm that sleep interventions are effective in reducing the occurrence of delirium. Pooled data from the three dexmedetomidine trials showed significant differences in the incidence of ICU delirium between groups (RR = 0.43, 95% CI = 0.32 to 0.59, p < 0.001). The respective pooled results of other sleep interventions (e.g., light therapy, earplugs, melatonin, and multicomponent nonpharmacologic treatments) did not find a significant effect on reducing the incidence and duration of ICU delirium (p > 0.05).

CONCLUSIONS

The current evidence suggests that non-pharmacological sleep interventions are not effective in preventing delirium in ICU patients. However, limited by the number and quality of included studies, future well-designed multicenter randomized controlled trials are still needed to validate the results of this study.

A nonuniform demagnetizing field model for both static and dynamic responses of anisotropic magnetoresistive thin film sensors

In this paper, an anisotropic magnetoresistive (AMR) thin film sensor which can be used for magnetic scale has been prepared, and its output voltage is about 4.7-4.9 mV V-1. On the basis of the Stoner-Wohlfarth model and with considering the non-uniformity of the demagnetizing field along the width direction of the strips, both the static and dynamic responses of the AMR sensors have been calculated. The results have shown that the calculated results are in agreement with the experimental data. The magnetization rotation in the magnetic sensor strongly depends on the nonuniform demagnetizing field along the width direction. The magnetization at the center is easily rotated into the field direction, and the magnetization at the edge is difficult to be rotated. The smaller the width of the magnetoresistive strip is, the larger both the demagnetizing field at the edge and the saturation field of the magnetic sensor are. The results are helpful for understanding the magnetization rotation of magnetic sensors and developing the magnetic sensors with high performance.

Chemical inhomogeneity-induced profuse nanotwinning and phase transformation in AuCu nanowires

Nanosized metals usually exhibit ultrahigh strength but suffer from low homogeneous plasticity. The origin of a strength-ductility trade-off has been well studied for pure metals, but not for random solid solution (RSS) alloys. How RSS alloys accommodate plasticity and whether they can achieve synergy between high strength and superplasticity has remained unresolved. Here, we show that face-centered cubic (FCC) RSS AuCu alloy nanowires (NWs) exhibit superplasticity of ~260% and ultrahigh strength of ~6 GPa, overcoming the trade-off between strength and ductility. These excellent properties originate from profuse hexagonal close-packed (HCP) phase generation (2H and 4H phases), recurrence of reversible FCC-HCP phase transition, and zigzag-like nanotwin generation, which has rarely been reported before. Such a mechanism stems from the inherent chemical inhomogeneity, which leads to widely distributed and overlapping energy barriers for the concurrent activation of multiple plasticity mechanisms. This naturally implies a similar deformation behavior for other highly concentrated solid-solution alloys with multiple principal elements, such as high/medium-entropy alloys. Our findings shed light on the effect of chemical inhomogeneity on the plastic deformation mechanism of solid-solution alloys.

Erratum: Upper limit of the transition temperature of superconducting materials

[This corrects the article DOI: 10.1016/j.patter.2022.100609.].

Geriatric Services Hub - A Collaborative Frailty Management Model between The Hospital and Community Providers

BACKGROUND

Frailty is an important geriatric syndrome especially with ageing populations. Frailty can be managed or even reversed with community-based interventions delivered by a multi-disciplinary team. Innovation is required to find community frailty models that can deliver cost-effective and feasible care to each local context.

OBJECTIVES

We share pilot data from our Geriatric Service Hub (GSH) which is a novel frailty care model in Singapore that identifies and manages frailty in the community, supported by a hospital-based multi-disciplinary team.

METHODS

We describe in detail our GSH model and its implementation. We performed a retrospective data analysis on patient characteristics, uptake, prevalence of frailty and sarcopenia and referral rates for multi-component interventions.

RESULTS

A total of 152 persons attended between January 2020 to May 2021. Majority (59.9%) were female and mean age was 81.0 ± 7.1 years old. One-fifth (21.1%) of persons live alone. Mean Charlson Co-morbidity Index was 5.2 ± 1.8. Based on the clinical frailty risk scale (CFS), 31.6% were vulnerable, 51.3% were mildly frail and 12.5% were moderately frail. Based on SARC-F screening, 45.3% were identified to be sarcopenic whilst 56.9% had a high concern about falling using the Falls-Efficacy Scale-International. BMD scans were done for 41.4% of participants, of which 58.7% were started on osteoporosis treatment. In terms of referrals to allied health professionals, 87.5% were referred for physiotherapy, 71.1% for occupational therapy and 50.7% to dieticians.

CONCLUSION

The GSH programme demonstrates a new local model of partnering with community service providers to bring comprehensive population level frailty screening and interventions to pre-frail and frail older adults. Our study found high rates of frailty, sarcopenia and fear of falling in community-dwelling older adults who were not presently known to geriatric care services.

Effect of Annealing Time on the Cyclic Characteristics of Ceramic Oxide Thin Film Thermocouples

Oxide thin film thermocouples (TFTCs) are widely used in high-temperature environment measurements and have the advantages of good stability and high thermoelectric voltage. However, different annealing processes affect the performance of TFTCs. This paper studied the impact of different annealing times on the cyclic characteristics of ceramic oxide thin film thermocouples. ITO/In₂O₃ TFTCs were prepared on alumina ceramics by a screen printing method, and the samples were annealed at different times. The microstructure of the ITO film was studied by scanning electron microscopy (SEM), X-ray diffraction (XRD), and X-ray photoelectron spectroscopy (XPS). The results show that when the annealing temperature is fixed, the stability of the thermocouple is worst when it is annealed for 2 h. Extending the annealing time can improve the properties of the film, increase the density, slow down oxidation, and enhance the thermal stability of the thermocouple. The thermal cycle test results show that the sample can reach five temperature rise and fall cycles, more than 50 h, and can meet the needs of stable measurement in high temperature and harsh environments.

Upper limit of the transition temperature of superconducting materials

Why are the transition temperatures (T c) of superconducting materials so different? The answer to this question is not only of great significance in revealing the mechanism of high-T c superconductivity but also can be used as a guide for the design of new superconductors. However, so far, it is still challenging to identify the governing factors affecting the T c. In this work, with the aid of machine learning and first-principles calculations, we found a close relevance between the upper limit of the T c and the energy-level distribution of valence electrons. It implies that some additional inter-orbital electron-electron interaction should be considered in the interpretation of high-T c superconductivity.

The mitral to aortic/pulmonary velocity-time integral ratio is a simple, feasible and accurate discriminator for echocardiographic evaluation of severe isolated mitral regurgitation

Background

Echocardiographic quantification of mitral regurgitation (MR) remains challenging, requiring dedicated image acquisition, and is limited by potential error from geometric assumptions of annular dimensions. Volume is a product of area and flow and assuming proportional mitral/aortic areas, an increased mitral-inflow volume compared to LV/RV-outflow semi-quantitatively represents greater MR regurgitant volume. Therefore, we investigated the feasibility and diagnostic performance of the mitral-aortic velocity-time integral (VTI) ratio in isolated MR. We also investigated the use of the mitral-pulmonary VTI ratio as an alternative in clinical situations where the LV outflow tract (LVOT) VTI could not be used.

Methods

We reviewed 166 consecutive patients (54 (33% severe MR by multi-parameter integrated expert opinion)). Pulsed-Doppler VTI at the mitral leaflet tips and the left ventricular outflow and continuous-wave Doppler of the right ventricular outflow tract were measured individually and independently by blinded readers (expert and trainee status) to derive the ratio. Receiver operator characteristic area under the curve (AUC) comparison was calculated and compared with effective regurgitant orifice area (EROA &gt;40 mm), regurgitant volume (RVol &gt;6 0mL), vena contracta (VC &gt;0.7 cm), E-velocity &gt;1.2 cm, systolic flow reversal (SFR), left atrial and ventricular dilatation.

Results

Increasing ratio was associated with severe MR (AUC 0.94) with optimal threshold defined at 1.3. This provided significant discrimination for severe MR (AUC 0.81) compared to EROA (0.68), VC (0.52), LV dilatation (0.69), LA dilatation (0.70), SFR (0.73), E-velocity (0.68) all p&lt;0.05, with sensitivity 82% and specificity 94%. The mitral-pulmonary VTI ratio demonstrated similar discrimination (AUC 0.92) with optimal threshold defined at 1.14. Excellent inter-observer reproducibility (intra-class correlation 0.97) was seen between trainee and expert readers. There was no difference in AUC comparison by MR mechanism or patient rhythm.

Conclusions

The mitral-aortic or mitral-pulmonary VTI ratio is a simple, geometric-free parameter feasibly reproducible from routine echocardiographic datasets and is an excellent discriminative tool for severe MR. Readers should consider integration of this parameter in routine reporting.

Funding Acknowledgement

Type of funding sources: None.

USP36 Facilitates the Progression of Hepatocellular Carcinoma by Upregulating Myc

Objective: Our study will explore the function and regulatory mechanism of USP36 in hepatocellular carcinoma (HCC). Methods: USP36-overexpressed and USP36-knockdown cells were established. The USP36 and Myc level were checked by Western blotting and the cell viability was checked by the MTT method. The apoptotic rate was checked by flow cytometry, while the migration was detected by the Transwell assay. A xenograft model was constructed in nude mice to explore the function of USP36 in HCC. USP36-overexpressed and USP-knockdown cells were constructed by transfecting pcDNA3.1-USP36 and siRNA-USP36 (si-USP36), respectively. Myc-overexpressed cells were constructed by transfecting pcDNA3.1-Myc. Results: Significantly declined cell viability, increased apoptotic rate, elevated number of migrated cells, downregulated Myc, and repressed tumor growth were observed in USP36-knockdown HepG2 and HUH7 cells, while opposite results were observed in USP36-overexpressed HepG2 and HUH7 cells. The expression level of Myc was positively regulated by USP36. However, the USP36 level was not regulated by Myc. Lastly, the declined cell viability, increased apoptotic rate, and elevated number of migrated cells in USP36-knockdown HepG2 cells were dramatically abrogated by the overexpression of Myc. Conclusion: USP36 facilitated the progression of hepatocellular carcinoma by upregulating Myc.

Annual prevalence estimation of lymphatic malformation with a cutaneous component: observational study of a national representative sample of physicians

Background

Lymphatic malformations (LMs) represent a potentially life-threatening, rare disease of the lymphatic system characterized by development of abnormal vessels, outpouchings, or cysts filled with lymphatic fluid. There are three morphologic types of LMs based on the size of the individual cysts: macrocystic (typically > 2 cm), microcystic (generally < 2 cm), and mixed (includes aspects of both). Macrocystic LMs typically exist beneath the skin and often can involve vascular components and/or organs. Microcystic LMs often have a cutaneous component and clinically present with lymphorrhea, bleeding, pain, itching, malodor, and functional deficits. There are no treatments approved by the US Food and Drug Administration (FDA) for either macrocystic or microcystic lymphatic malformations. The totality of the epidemiologic literature for LM is limited to the incidence of the disease among various birth cohorts. This is the first nationally representative study to estimate the national managed prevalence for patients with microcystic LM or combined LM with a cutaneous component annually across physician specialties likely to manage this condition. We conducted a retrospective observational survey of a nationally representative sample of patient-care physicians in the United States most likely to manage lymphatic malformations with a cutaneous component (LMC). Once recruited, target physicians participated via an electronic questionnaire. We weighted study physician self-estimates of the number of LMC patients treated in the past 12 months to reflect the specialists’ corresponding proportion in the national universe. All patient information was anonymous; no personally identifiable information was collected.

Results

Of the 420 physicians who visited the study website, 316 agreed to be screened and to participate (75.2% participation rate). Our survey results indicated the estimated number of unique annually managed LMC patients by target specialists is 79,920 (CI 66,600–93,250). This number corresponds to managed prevalence of 24.1 LMC patients per 100,000 population (CI 19.6/100,000–28.4/100,000).

Conclusions

The study indicates that while rare, LMC affects a substantial number of people in the US (79,920) who are being managed by one or more specialists. By better understanding the prevalence of people living with LMC who require treatment, efforts to both increase disease awareness and to identify underserved populations in need of potential new treatments can be better focused.

Tracking the sliding of grain boundaries at the atomic scale

Grain boundaries (GBs) play an important role in the mechanical behavior of polycrystalline materials. Despite decades of investigation, the atomic-scale dynamic processes of GB deformation remain elusive, particularly for the GBs in polycrystals, which are commonly of the asymmetric and general type. We conducted an in situ atomic-resolution study to reveal how sliding-dominant deformation is accomplished at general tilt GBs in platinum bicrystals. We observed either direct atomic-scale sliding along the GB or sliding with atom transfer across the boundary plane. The latter sliding process was mediated by movements of disconnections that enabled the transport of GB atoms, leading to a previously unrecognized mode of coupled GB sliding and atomic plane transfer. These results enable an atomic-scale understanding of how general GBs slide in polycrystalline materials.

Impact of oral abrocitinib on signs, symptoms and quality of life among adolescents with moderate-to-severe atopic dermatitis: an analysis of patient-reported outcomes

Background

A significant improvement in clinical signs was demonstrated with abrocitinib relative to placebo in adolescents with moderate‐to‐severe atopic dermatitis (AD) in three phase 3, randomized, double‐blinded, placebo‐controlled studies (JADE TEEN [ClinicalTrials.gov, NCT03796676], JADE MONO‐1 [NCT03349060] and JADE MONO‐2 [NCT03575871]).

Objectives

To evaluate the impact of abrocitinib on patient‐reported signs/symptoms, including sleep loss and quality of life among adolescents with moderate‐to‐severe AD.

Methods

JADE TEEN, JADE MONO‐1 and JADE MONO‐2 were conducted in the Asia‐Pacific region, Europe and North America and included patients aged 12–17 years with moderate‐to‐severe AD and inadequate response to ≥ 4 consecutive weeks of topical medication or treatment with systemic therapy for AD. Patients were randomly assigned (1 : 1 : 1, JADE TEEN; 2 : 2 : 1, JADE MONO‐1/‐2) to receive once‐daily oral abrocitinib (200 or 100 mg) or placebo for 12 weeks in combination with topical therapy (JADE TEEN) or as monotherapy (JADE MONO‐1/‐2). Data from adolescent patients in JADE MONO‐1/‐2 were pooled for these analyses.

Results

At week 12, more adolescents treated with abrocitinib (200 or 100 mg) vs. placebo achieved a ≥ 4‐point improvement from baseline in the Patient‐Oriented Eczema Measure in JADE TEEN (83.9% and 77.0% vs. 60.2%) and JADE MONO‐1/‐2 (83.0% and 69.4% vs. 43.5%) and a ≥ 6‐point improvement from baseline in the Children’s Dermatology Life Quality Index in JADE TEEN (73.8% and 67.5% vs. 56.5%) and JADE MONO‐1/‐2 (70.0% and 57.1% vs. 19.0%). Significant improvements in SCORing Atopic Dermatitis Visual Analog Scale for sleep loss scores were demonstrated with abrocitinib vs. placebo at weeks 2‐12 in JADE TEEN and JADE MONO‐1/‐2.

Conclusions

Patient‐reported signs/symptoms, including reduction of sleep loss and quality of life, were substantially improved with abrocitinib monotherapy or combination therapy relative to placebo in adolescents with moderate‐to‐severe AD.

Enhanced negative magnetoresistance near the charge neutral point in Cr doped topological insulator

Negative magnetoresistance (MR) is not only of great fundamental interest for condensed matter physics and materials science, but also important for practical applications, especially magnetic data storage and sensors. However, the microscopic origin of negative MR is still elusive and the nature of the negative MR in magnetic topological insulators has still not been completely elucidated. Here, we report magnetotransport studies on Cr doped (Bi1-x Sb x )2Te3 topological insulator thin films grown by magnetron sputtering. At the temperature of 2 K, a giant negative MR reaching 61% is observed at H = 2 T. We show that the negative MR is closely related to the position of the Fermi level, and it reaches the maximum when the Fermi level is gated near the charge neutral point. We attribute these results to the Coulomb potential due to the random composition fluctuations in Cr doped (Bi1-x Sb x )2Te3. Our results provide a deeper insight into the mechanism of negative MR, and are helpful to realize the quantum anomalous Hall effect in the sputtered Cr-(Bi1-x Sb x )2Te3 thin-film systems by tuning the Fermi level and reducing disorder effects.

MicroRNA-488 regulates diabetic nephropathy via TGF-β1 pathway

OBJECTIVE

The aim of this study was to clarify the biological roles of microRNA-488 and transforming growth factor β1 (TGF-β1) pathway in the occurrence and progression of diabetic nephropathy (DN).

MATERIALS AND METHODS

Quantitative Real Time-Polymerase Chain Reaction (qRT-PCR) was used to detect the expressions of microRNA-488, fibrinogen factors coII, coIIV, and fibronectin (FN) in Human mesangial cells (HMCs) with high-glucose or low-glucose treatment. After transfection of microRNA-488 mimics or inhibitor, expression levels of coII, coIIV, and FN in HMCs were determined by qRT-PCR and Western blot. Their expressions in HMC cells treated with different doses of TGF-β1 at different time points were also detected. Finally, we evaluated the potential influence of microRNA-488 on TGF-β1-induced fibrosis of HMC cells by qRT-PCR.

RESULTS

Compared with low-glucose treatment, the expression of microRNA-488 markedly increased in HMCs treated with high-glucose, as well as coII, coIIV, and FN. Overexpression of microRNA-488 remarkably upregulated mRNA and protein levels of coII, coIIV, and FN, whereas microRNA-488 knockdown downregulated their levels. Expression levels of microRNA-488, coII, coIIV, and FN gradually upregulated with the increase of TGF-β1 dose and treatment duration.

CONCLUSIONS

MicroRNA-488 regulates the development of diabetic nephropathy-induced fibrosis by TGF-β1 pathway.

0143 Vigilance Declines Following Sleep Deprivation are Associated with Two Previously Identified Dynamic Connectivity States

Introduction

Dynamic functional connectivity (DFC) analysis of resting-state fMRI data has been successfully used to track fluctuations in arousal in the human brain. Changes in DFC have also been reported with acute sleep deprivation. Here, we demonstrate that dynamic connectivity states (DCS) previously related to arousal are reproducible, and are associated with individual differences in sustained attention declines after one night of total sleep deprivation.

Methods

32 participants underwent two counterbalanced resting-state fMRI scans: during rested wakefulness (RW) and following total sleep deprivation (SD). They also completed the Psychomotor Vigilance Test (PVT), a sustained attention task that is highly sensitive to the effects of sleep loss. SD vulnerability was computed as the decrease in response speed (∆RS) and increase in lapses (∆lapse) in SD compared with RW.

Dynamic functional connectivity analysis was conducted on rs-fMRI data. Connectivity matrices were clustered to obtain 5 prototypical DCS. We calculated the proportion of time participants spent in each of these DCS, as well as how often participants transitioned between DCSs. Relationships between SD vulnerability and connectivity metrics were then correlated.

Results

We recovered two DCS that were highly similar (ρ = .89-.91) to arousal-related DCS observed in previous work (high arousal state (HAS); low arousal state (LAS)).

After sleep deprivation, the proportion of time spent in the LAS increased significantly (t29=3.16, p=.0039), while there was no significant change in HAS (t29=-1.43, p=.16). We observed significantly more state transitions in RW compared with SD. Change in LAS and HAS across sleep conditions correlated significantly with SD vulnerability (ΔLASxΔRS: r=-0.64, p&lt;.0001; ΔLASxΔlapse: r=0.43, p=.018; ΔHASxΔRS; r=0.43, p=.019; ΔHASxΔlapse; r=-0.39, p=.033). Finally, Δ%transitions was correlated with ΔRS but not Δlapse.

Conclusion

This study adds to the evidence that two specific reproducible DCS are robust markers of arousal and attention, and may be useful indicators of SD vulnerability.

Support

This work was supported by the National Medical Research Council, Singapore (STaR/0015/2013), and the National Research Foundation Science of Learning (NRF2016-SOL002-001).

0519 Mindfulness Based Therapy for Insomnia Improves Objective Markers of Sleep in the Elderly: Preliminary Data from the Mindfulness Sleep Therapy (MIST) Study

Introduction

Mindfulness-based treatment for insomnia (MBTI) is a viable intervention for improving poor sleep. We report preliminary data from an ongoing pre-registered, randomized controlled trial which investigates the effect of MBTI on elderly adults.

Methods

Participants above 50 years old with PSQI ≥ 5 were recruited and randomised into either MBTI or an active control group (Sleep hygiene education and exercise program, SHEEP) in sequential cohorts with about 20 participants per cohort (10 per group). Before and after the intervention, 1 night of portable polysomnography (PSG) and 1 week of actigraphy (ACT) and sleep diary (DIARY) data were collected. We report the ACT and DIARY results of the first 3 cohorts (n = 46, male = 23, mean age = 62.3, std = 6.3) and PSG data of the first 2 cohorts (n = 29, male = 12, mean age = 62.5, std = 5.7). Time in bed (TIB), total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE) were analysed with mixed-model repeated-measures ANOVA.

Results

We observed increases in TIBDIARY (F1,44 = 5.151, p &lt; .05) and SEDIARY (F1,44 = 22.633, p &lt; .0001), and significant reductions in SOLDIARY (F1,44 = 7.031, p &lt; .05) and WASODIARY (F1,39 = 7.411, p &lt; .05). In the actigraphy data, we found a significant interaction in SOLACT (F1,39 = 4.273, p &lt; .05) with an increase in SHEEP SOLACT (t18= 2.36, p &lt; .05). Significant reductions were also observed in WASOACT (F1,44 = 16.459, p &lt; .0001) Finally, we observed a reduction in SOLPSG (F1,26 = 5.037, p &lt;. 05). All other tests were non-significant.

Conclusion

Preliminary results suggest that both interventions lead to improvements in sleep with more pronounced effects in subjective sleep reports. Objective sleep data suggest that improvements in sleep is a result of improved sleep quality and not simply extending sleep opportunity. These preliminary data shows that MBTI may be a promising intervention for elderly individuals with sleep difficulties.

Support

This study was supported by an award from the 7th grant call of the Singapore Millennium Foundation Research Grant Programme

0824 Improving Subjective Sleep Quality Measures Through Mindfulness Training in the Elderly: Preliminary Data from the Mindfulness Sleep Therapy (MIST) Study

Introduction

Poor sleep is a modifiable risk factor for multiple chronic disorders. Mindfulness-based therapies potentially improve sleep by enhancing awareness and acceptance of internal and external experiences, thus reducing pre-sleep hyper-arousal. In this pre-registered, randomized controlled trial, we tested the effect of mindfulness-based treatment for insomnia (MBTI) on subjective sleep quality measures (Pittsburgh Sleep Quality Questionnaire, PSQI) in the elderly.

Methods

Participants above 50 years old with sleep difficulties (PSQI ≥ 5) (mean (sd) age = 62.0 (6.35), 44 female) attended either an 8-week MBTI (N = 34) or sleep hygiene education and exercise program (SHEEP; N = 35). Before and after the interventions, we collected PSQI, insomnia symptoms and features measures (Pre-Sleep Arousal Scale, PSAS; Insomnia Severity Index, ISI; Dysfunctional Beliefs and Attitudes about Sleep, DBAS-30), mindfulness (Five-Facets Mindfulness Questionnaire, FFMQ), and mood and anxiety (Back Depression Inventory, BDI; State-Trait Anxiety Inventory, STAI). PSQI and PSAS (N = 26 to date) were collected at 6-month follow-up. Data were analysed with repeated-measures ANCOVA with group as a between-subject variable for the first 69 participants who completed the study.

Results

We observed significant improvement across both groups for sleep measures (PSQI: F1,67=36.442, p&lt;.01; PSAS-Cognitive: F1,67=12.664, p&lt;.01; ISI: F1,67=36.442, p&lt;.0; DBAS: F1,67=28.749, p&lt;.01) and mood (BDI: F1,67=26.393, p&lt;.01; STAI-State: F1,67=4.608, p=.04; STAI-Trait: F1,67=7.687, p&lt;.01), but not for Mindfulness (F1,67=2.256, p=.14) nor PSAS-somatic. No significant group by time interactions were found. We observed a correlation between PSQI decreases and FFMQ increases in MBTI (r=-.53, p&lt;.01), but not in SHEEP (r=-.07, p=.70) participants. ANCOVA of 6-month PSQI data revealed a significant group by time interaction (F1,24=19.525, p=.03), with reduction from baseline in MBTI (t12=4.769, p&lt;.01), but not in SHEEP group (t12=3.813, p=.08).

Conclusion

Preliminary results support MBTI as an accessible but effective behavioural intervention with potential long-term benefits for improving sleep and mood, and reducing cognitive-emotional arousal in the elderly.

Support

This study was supported by an award from the 7th grant call of the Singapore Millennium Foundation Research Grant Programme

Safety and efficacy of fixed-dose combination calcipotriol (50 μg/g) and betamethasone dipropionate (0.5 mg/g) cutaneous foam in adolescent patients (aged 12 to <17 years) with plaque psoriasis: results of a phase II, open-label trial

Background

Fixed‐dose combination of calcipotriol (50 μg/g; Cal) and betamethasone dipropionate (0.5 mg/g; BD) foam is approved for plaque psoriasis treatment in adults, with a paucity of data supporting use in adolescents.

Objectives

To evaluate safety of 4 weeks’ treatment with Cal/BD foam in adolescent patients with psoriasis, and additional safety outcomes in patients with more severe disease (HPA‐axis cohort). Primary objectives included treatment‐emergent adverse events (TEAEs) and systemic calcium levels in the overall population, and HPA‐axis function, change in calcium excretion and the calcium:creatinine ratio in the HPA‐axis cohort. Secondary objectives included exploratory efficacy endpoints [treatment success: change in Psoriasis Area and Severity Index (PASI)]. Systemic exposure to Cal/BD was also assessed.

Methods

A phase II, open‐label, study (NCT02387853) in patients (12 to <17 years) with at least mild psoriasis, to evaluate Cal/BD foam applied once daily for ≤4 weeks.

Results

In patients assigned to treatment (n = 106), 32 TEAEs occurred in 22 patients (20.8%). All but two TEAEs were mild; none led to study withdrawal or death. Changes (0–4 weeks) in albumin‐corrected serum calcium (overall population) and urinary calcium excretion (HPA‐axis cohort) were small, transient and not considered clinically relevant. In the HPA‐axis cohort, no change in urinary calcium:creatinine ratio was observed and responses to adrenocorticotropic–hormone (ACTH) challenge did not suggest disruption of the HPA‐axis. Prespecified treatment success on the body and scalp was achieved by 71.8% and 75.7% of the overall population, respectively. Mean PASI decreased by 82.0% vs. baseline at Week 4. Systemic exposure to Cal/BD was minimal.

Conclusions

Cal/BD foam was well tolerated in adolescent patients with body/scalp psoriasis. There was no evidence for dysregulation of the HPA‐axis nor calcium homoeostasis in patients with more severe disease. Exploratory efficacy data in the overall population were encouraging.

P889 3D guided CT assessment to define the right pulmonary vein on standard apical 4-chamber view

Introduction

Pulmonary vein(PV) assessment is an integral component of the transthoracic echocardiogram(TTE) examination; typically assessed in the apical four-chamber view(A4Ch). There is disagreement in current textbooks and literature regarding which specific right pulmonary vein is visualised on A4Ch; as either the right superior(RSPV) or right inferior PV(RIPV).

Given the high reliability of cardiac CT for PV assessment, we aimed to characterize right PV anatomy on A4Ch by utilizing multi-modality comparison of echocardiography and a 3D-guided A4Ch on CT.

Methods

Retrospective analysis was performed on consecutive patients with TTE demonstrating PV flow(by colour or pulse-wave Doppler) and cardiac CT within 30days; studies not meeting image quality criteria excluded. To simulate the A4Ch on CT, multi-planar reconstruction was used to create an image plane including right PV ostia and LV apex. This image was rotated along the long-axis to achieve an A4Ch with both ventricles and atria, tricuspid and mitral valves in view without LVOT or aorta. This was attempted for right superior, inferior and middle(RMPV, if present) PV’s.

Results

50 patients were analysed: mean age 66yrs, 48% female, mean LA volume(indexed) 43.5ml/m². A4Ch was feasible in 100%(n = 50) of CT simulations using the RIPV, only 24%(n = 12) were feasible using RSPV with all excluded cases due to LVOT/aorta persistently in view. RMPV was present in 6 cases with feasible A4ch in 67%.

Conclusion

This study demonstrates that the right PV on A4Ch is highly likely to be the RIPV due to the RSPV being anatomically impossible in the significant majority of cases.

Abstract P889 Figure. CT multiplanar reconstruction of A4Ch

Identification of inorganic oxidizing salts in homemade explosives using Fourier transform infrared spectroscopy

Recently, inorganic low explosives, such as pyrotechnic composition, black powder, and ammonium nitrate, are commonly used in improvised explosive devices (IEDs) by the rioter or terrorists since these energetic materials can be obtained easily and legally from civilian markets. Identification of inorganic oxidizing salts in these homemade explosives, including nitrates, chlorates, and perchlorates, is a necessary procedure for forensic investigators to provide criminal evidences. In this article, Fourier transform infrared (FTIR) spectroscopy was used to discriminate NO₃^-, CO₃^2-, ClO₃^-, ClO₄^-, SO₄^2-, and NH₄⁺, whose characteristic absorption bands were explained by vibration modes of the covalent bonds. Then the spectral absorption features of nitrate salts with monovalent or divalent cations were discussed. Furthermore, it was studied whether nitrates or perchlorates can be unequivocally distinguished with the presence of carbonate and sulfate impurities through FTIR technique. Finally, the feasibility of this method was verified through an analytical case of homemade explosives.

Surface Energy Driven Liquid-Drop-Like Pseudoelastic Behaviors and In Situ Atomistic Mechanisms of Small-Sized Face-Centered-Cubic Metals

The elastic strain of conventional metals is usually below ∼1%. As the metals' sizes decrease to approximate a few nanometers, their elastic strains can approach ∼8%, and they usually exhibit pseudoelastic strain that can be as large as ∼35%. Previous studies suggested that the pseudoelastic behaviors of nanocrystals were attributed to distinctive mechanisms, including the release of stored elastic energies, the temperature-enhanced surface diffusion, etc. However, the atomistic mechanisms remain elusive. In this study, through large numbers of in situ atomic-scale tensile-fracture experiments, we report liquid-drop-like pseudoelastic behaviors of face-centered-cubic fractured single-crystalline nanowires with diameters varying from 0.5 to 2.2 nm. The ultralarge liquid-drop-like pseudoelastic strain ranged from 31.4% to 81.0% after the nanowire fracture was observed. The in situ atomic-scale investigations revealed that the atomistic mechanisms resulted from surface energy driven plastic deformation including surface diffusion mixed with shear plastic deformation as well as the release of true elastic energy. As the nanowires' diameters decrease below a critical value, the surface pressure can approach the ideal strength of metals. This ultralarge surface pressure drives atoms to diffuse mixed with dislocation nucleation/propagation, which ultimately leads to the fractured nanowires exhibiting liquid-drop-like pseudoelastic phenomena.

In situ atomic scale mechanisms of strain-induced twin boundary shear to high angle grain boundary in nanocrystalline Pt

Twin boundary can both strengthen and soften nanocrystalline metals and has been an important path for improving the strength and ductility of nano materials. Here, using in-lab developed double-tilt tensile stage in the transmission electron microscope, the atomic scale twin boundary shearing process was in situ observed in a twin-structured nanocrystalline Pt. It was revealed that the twin boundary shear was resulted from partial dislocation emissions on the intersected {111} planes, which accommodate as large as 47% shear strain. It is uncovered that the partial dislocations nucleated and glided on the two intersecting {111} slip planes lead to a transition of the original <110> symmetric tilt ∑3/(111) coherent twin boundary into a <110> symmetric tilt ∑9/(114) high angle grain boundary. These results provide insight of twin boundary strengthening mechanisms for accommodating plasticity strains in nanocrystalline metals.

New twinning route in face-centered cubic nanocrystalline metals

Twin nucleation in a face-centered cubic crystal is believed to be accomplished through the formation of twinning partial dislocations on consecutive atomic planes. Twinning should thus be highly unfavorable in face-centered cubic metals with high twin-fault energy barriers, such as Al, Ni, and Pt, but instead is often observed. Here, we report an in situ atomic-scale observation of twin nucleation in nanocrystalline Pt. Unlike the classical twinning route, deformation twinning initiated through the formation of two stacking faults separated by a single atomic layer, and proceeded with the emission of a partial dislocation in between these two stacking faults. Through this route, a three-layer twin was nucleated without a mandatory layer-by-layer twinning process. This route is facilitated by grain boundaries, abundant in nanocrystalline metals, that promote the nucleation of separated but closely spaced partial dislocations, thus enabling an effective bypassing of the high twin-fault energy barrier.

Anisotropic Magnetoresistance of Nano-conductive Filament in Co/HfO2/Pt Resistive Switching Memory

Conductive bridge random access memory (CBRAM) has been extensively studied as a next-generation non-volatile memory. The conductive filament (CF) shows rich physical effects such as conductance quantization and magnetic effect. But so far, the study of filaments is not very sufficient. In this work, Co/HfO2/Pt CBRAM device with magnetic CF was designed and fabricated. By electrical manipulation with a partial-RESET method, we controlled the size of ferromagnetic metal filament. The resistance-temperature characteristics of the ON-state after various partial-RESET behaviors have been studied. Using two kinds of magnetic measurement methods, we measured the anisotropic magnetoresistance (AMR) of the CF at different temperatures to reflect the magnetic structure characteristics. By rotating the direction of the magnetic field and by sweeping the magnitude, we obtained the spatial direction as well as the easy-axis of the CF. The results indicate that the easy-axis of the CF is along the direction perpendicular to the top electrode plane. The maximum magnetoresistance was found to appear when the angle between the direction of magnetic field and that of the electric current in the CF is about 30°, and this angle varies slightly with temperature, indicating that the current is tilted.

Plastic Deformation through Dislocation Saturation in Ultrasmall Pt Nanocrystals and Its in Situ Atomistic Mechanisms

The atomic-scale deformation dynamic behaviors of Pt nanocrystals with size of ∼18 nm were in situ investigated using our homemade device in a high-resolution transmission electron microscope. It was discovered that the plastic deformation of the nanosized single crystalline Pt commenced with dislocation "appreciation" first, then followed by a dislocation "saturation" phenomenon. The magnitude of strain plays a key role on dislocation behaviors. At the early to medium stage of deformation, the plastic deformation was controlled by the full dislocation activities accompanied by the formation of Lomer dislocation locks from reaction of full dislocations. When the strain increased to a significant level, stacking faults and extended dislocations as well as Lomer-Cottrell locks appeared. The Lomer-Cottrell locks can unlock through transferring into Lomer dislocation locks first, and then Lomer dislocation locks were destructed under high stresses. The very high density dislocations and the frequent dislocation reactions through Lomer dislocations and Lomer-Cottrell locks may lead to work hardening in nanosized Pt.

RCN1 suppresses ER stress-induced apoptosis via calcium homeostasis and PERK-CHOP signaling

Endoplasmic reticulum (ER) stress is caused by the disturbance of ER homeostasis and leads to the activation of the unfolded protein response (UPR), which alleviates stress at an early stage and triggers apoptosis if homeostasis fails over a prolonged timeframe. Here, we report that reticulocalbin 1 (RCN1), a member of the CREC family, is transactivated by nuclear factor kappa B (NF-κB) during ER stress and inhibits ER stress-induced apoptosis. The depletion of RCN1 increases the UPR during drug-induced ER stress by activating PRKR-like ER kinase–CCAAT/enhancer-binding protein-homologous protein (PERK–CHOP) signaling, thus inducing apoptosis. Furthermore, we found that the first two EF-hand calcium-binding motifs of RCN1 specifically interact with inositol 1,4,5-trisphosphate (IP₃) receptor type 1 (IP₃R1) on loop 3 of its ER luminal domain and inhibit ER calcium release and apoptosis. Together, these data indicate that RCN1, a target of NF-κB, suppresses ER calcium release by binding to IP₃R1 and decreases the UPR, thereby inhibiting ER stress-induced apoptosis.