Effects of exercise programs on cardiorespiratory fitness and arterial stiffness on postmenopausal women: A systematic review study

BACKGROUND

Arterial stiffness is an important marker of cardiovascular disease, with a considerable increase in menopause. The impact of exercise, as a preventive measure, on controlling the progression of cardiovascular disease and arterial dysfunction in middle age remains under investigation.

OBJECTIVE

This systematic review aims to present the results of studies that examined the effects of different exercise programs (isolated, aerobic, and resistance or combined) on arterial stiffness and cardiorespiratory fitness in postmenopausal women.

METHODS

Based on PRISMA guidelines, B-On, BioMed, EBSCOhost, MEDLINE, ScienceOpen, PubMed, Science Direct, Scopus, Web of Science, Cochrane library and LILACS databases were searched using specific keywords.

RESULTS

A final total of 13 manuscripts were included in the qualitative synthesis, involving 700 participants. Four studies used only cardiorespiratory exercise, three only resistance, taekwondo class or flexibility exercise, and six combined exercise programs. Most interventions ranged from 3 to 5 days per week. Carotid-femoral pulse wave velocity showed improvements between 0.22 m/s and 1.56 m/s. In addition, one study showed an improvement of 4.4 ml/kg/min in maximal oxygen consumption. In 7 studies, participation in exercise programs improved arterial stiffness.

CONCLUSIONS

Combined exercise (aerobic and resistance exercise) and aerobic exercise alone (swimming) improve cardiorespiratory fitness and arterial stiffness in postmenopausal women, particularly pulse wave velocity. The combined exercise program is the most effective, promoting improvements of up to -2.6 m/s in pulse wave velocity in this climacteric phase.

Observational Study About the Impact of Simulation Training of Non-Technical Skills on Teamwork: Towards a Paradigm Shift in Undergraduate Medical Training

INTRODUCTION

Recently, simulation as an educational method has gained increasing importance in Medicine. However, medical education has favored the acquisition of individual knowledge and skills, while overlooking the development of teamwork skills. Since most errors in clinical practice are due to human factors, i.e., non-technical skills, the aim of this study was to assess the impact that training in a simulation environment has on teamwork in an undergraduate setting.

MATERIAL AND METHODS

This study took place in a simulation center, with a study population of 23 participants, fifth year undergraduate students, randomly divided into teams of four elements. Twenty simulated scenarios of teamwork in the initial assessment and resuscitation of critically ill trauma patients were recorded. Video recordings were made at three distinct learning moments (before training, end of the semester, and six months after the last training), and a blinded evaluation was performed by two independent observers, who applied the Trauma Team Performance Observation Tool (TPOT). Additionally, the Team STEPPS Teamwork Attitudes Questionnaire (T-TAQ) was applied to the study population before and after the training to assess any change in individual attitudes towards non-technical skills. A 5% (or 0.05) significance level was considered for statistical analysis.

RESULTS

With a moderate level of inter-observer agreement (Kappa = 0.52, p = 0.002), there was a statistically significant improvement in the team's overall approach, evidenced by the TPOT scores (median of 4.23, 4.35 and 4.50, in the three time-points assessed, respectively, p = 0.003). In the T-TAQ, there was an improvement in non-technical skills, that was statistically significant for "Mutual Support" (median from 2.50 to 3.00, p = 0.010).

CONCLUSION

In this study, incorporating non-technical skills education and training in undergraduate medical education was associated with sustained improvement in team performance in the approach to the simulated trauma patient. Consideration should be given to introducing non-technical skills training and teamwork in the emergency setting during undergraduate training.

Non-technical skills and teamwork in trauma: from the emergency department to the operating room

Management of a trauma patient is a challenging process. Swift and accurate clinical assessment is required and time-sensitive decisions and life-saving procedures must be performed in an unstable patient. This requires a coordinated response by both the emergency room (ER) and operating room (OR) teams. However, a team of experts does not necessarily make an expert team. Root cause analysis of adverse events in surgery has shown that failures in coordination, planning, task management and particularly communication are the main causes for medical errors. While most research is focused on the ER trauma team, the trauma OR team also deserves attention. In fact, OR team dynamics may resemble more the ER team than the elective OR team. ER and OR trauma teams assemble on short notice, and their members, who are from different specialties and backgrounds, may not train regularly together or even know each other beforehand. And yet, they have to perform high-risk procedures and make high stake decisions, in a time-sensitive manner. The airline industry has long recognized the role of team training and non-technical skills (NTS) in reducing hazards. The implementation of the so called crew resource management or crisis resource management (CRM) has significantly made airline travel safer and the transposition to the medical context, with specific training in non-technical skills, has also brought great benefits. In fact, it is clear that adoption of non-technical skills (NTS) in healthcare has led to an increase in patient safety. In this narrative review we recapitulate some of the key non-technical skills and their relevance in trauma, with a focus on both the emergency department (ER) and the operating room (OR) teams, as well as on the transition of care from one to the other. Also, we explore the use of debriefing the team, as well as the roles of NTS training in both undergraduate and postgraduate settings. We review some of the existing trauma training courses and their roles in developing NTS. Finally, we briefly address the challenges posed by the development of trauma hybrid operating rooms.

Relapsing COVID-19 in a Patient With Non-Hodgkin Lymphoma on Chemotherapy

Hematologic malignancies and chemotherapy are risk factors for COVID-19 progression and mortality. Immunocompromised hosts, particularly those with severe B-cell depletion, can shed viable viruses for extended periods, which can lead to persistent infection. We present the case of a 73-year-old male with diffuse large B-cell lymphoma (stage IV-B) under curative immunochemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). After the first episode of mild COVID-19, he developed two severe relapses following the third and fourth cycles of R-CHOP. Lung CT scans performed in both episodes showed new-onset ground-glass infiltrates and fibrosis of previously affected pulmonary segments. In light of similar semiquantitative SARS-CoV-2 viral loads between episodes, without further risk exposure or microbiological findings, persistent COVID-19 with severe clinical relapses was assumed and successfully treated with polyclonal immunoglobulin and remdesivir. Whole-genome sequencing was performed in all samples, confirming the same specimen, which belonged to the B.1.177 lineage. This case stands out for the unusually long viral persistence and the various relapses of severe COVID-19 related to the worsening immune status with each immunochemotherapy cycle.

Viral genetic clustering and transmission dynamics of the 2022 mpox outbreak in Portugal

Pathogen genome sequencing during epidemics enhances our ability to identify and understand suspected clusters and investigate their relationships. Here, we combine genomic and epidemiological data of the 2022 mpox outbreak to better understand early viral spread, diversification and transmission dynamics. By sequencing 52% of the confirmed cases in Portugal, we identified the mpox virus sublineages with the highest impact on case numbers and fitted them into a global context, finding evidence that several international sublineages probably emerged or spread early in Portugal. We estimated a 62% infection reporting rate and that 1.3% of the population of men who have sex with men in Portugal were infected. We infer the critical role played by sexual networks and superspreader gatherings, such as sauna attendance, in the dissemination of mpox virus. Overall, our findings highlight genomic epidemiology as a tool for the real-time monitoring and control of mpox epidemics, and can guide future vaccine policy in a highly susceptible population.

Worldwide snapshot of trauma team structure and training: an international survey

INTRODUCTION

Trauma teams (TTs) are a key tool in trauma care, as they bring a multidisciplinary approach to the trauma patient, improving outcomes. Excellent teamwork (TW) requires not only individual skills but also training at non-technical skills (NTS). Although there is evidence supporting TTs, there is little information regarding how they are organized and trained. With this study, we intend to assess the reality of TTs all over the world, focusing on how they are organized and trained.

MATERIALS AND METHODS

We composed a 42-question sheet on Google Forms, in four different languages (English, Polish, Portuguese, and Spanish). The questions regarded the respondents' background, and their respective hospitals' trauma patient management, TT features and its training, NTS and TW. The survey was shared on social media, through the International Assessment Group of Online Surgical & Trauma Education community, and the European Society of Trauma and Emergency Surgery. Statistical analysis was performed on Statistical Package for the Social Sciences (SPSS®) version 27.

RESULTS

We obtained 296 answers from 52 different countries, with 6 having at least 10 answers (Brazil, Portugal, Poland, Spain, Italy, and USA). While the majority of the respondents (97%) agreed that TTs can improve outcomes, only 61% have a TT in their hospital, with 69% of these being dedicated TTs. General surgery (76%), trauma surgery (68%), and anesthesia (66%) were the three most common specialties in the teams. Teams performed briefings and debriefings with a frequency of, at least, "often" in only 49% and 38%, respectively. Only 50% and 33% of the respondents stated that their hospital provided trauma management courses focusing on individual technical skills, and TT training courses, respectively. The Advanced Trauma Life Support (85%), the Definitive Surgical and Anesthetic Trauma Care (38%), and the European Trauma Course (31%) were the three trauma management courses of choice. Regarding TT training courses, the European Trauma Course (52%) and local/in-house (42%) courses were the most common ones. Most participants (93%) stated that NTS were highly important in trauma care. However, only 60% of the respondents had postgraduate training on NTS and TW, and only 24% had this type of training on an undergraduate level.

CONCLUSION

The number of TTs worldwide does not match their relevance in trauma care. Institutions are not providing enough trauma courses, particularly TT training courses and NTS teaching. Implementing TT should include promotion of team courses, as well as team briefings and debriefings.

Antibiotic Resistance of Enterococcus Species in Ornamental Animal Feed

Enterococcus is a bacterial genus that is strongly associated with nosocomial infections and has a high capacity to transfer and acquire resistance genes. In this study, the main objective was to evaluate the presence of Enterococcus species in ornamental animal feed and characterize their antimicrobial resistance and virulence factors. Antimicrobial susceptibility was determined using 14 antimicrobial agents by the disk diffusion method, complemented by genotypic analysis to identify Enterococcus species and the presence of 14 antimicrobial resistance and 10 virulence genes. From 57 samples of ornamental animal feed, 103 Enterococcus isolates were recovered from 15 bird, 9 fish and 4 reptile feed samples. Enterococcus isolates were highly resistance to rifampicin (78%) and erythromycin (48%), and 48% of isolates were classified as multidrug-resistant. Enterococcus faecalis (36.7%) and E. faecium (31.7%) were the species most frequently identified. Most isolates carried the resistance genes ermB (57%) and tetL (52%) and the virulence genes, cylL (52%) and esp (40%). Enterococcus gallinarum was the species with the highest number of multidrug-resistant isolates (50%) and virulence genes (80%). These results highlight the high levels of antibiotic-resistant Enterococcus spp. present in ornamental animal feed and the growing interaction of these animals with humans as a public health concern.

Stafne's bone defect: a systematic review

BACKGROUND

This systematic review integrated the available data published in the literature on Stafne's bone defect (SBD), considering the clinical, imaging and histopathological results.

MATERIAL AND METHODS

An electronic search was undertaken in six databases. Eligibility criteria were: articles in English, Spanish, and Portuguese describing case reports or case series of SBD, reported up to September/2021. Risk of bias was assessed using the Joanna Briggs Institute tool.

RESULTS

A total of 98 articles were retrieved, involving 465 individuals with SBD and were included for quantitative analysis. Mean age was 52.78 years (range: 11-89 years), with male predilection (n=374/80.85%). Radiographs were the most frequent imagiological exams (n=298/64.09%), followed by computed tomography (n=98/21.08%). SBD was more prevalent in the posterior mandible (n=361/93.77%) as a hypodense radiolucent lesion (n=250/77.40%). Mean size was 1.58 cm (range: 0.3-.8.0 cm). Two-hundred-and-two lesions (97.37%) were unilocular and 126 (91.97%) were classified as well-defined. Clinical symptoms were reported in 73 cases, while 68 cases (93.15%) were asymptomatic. Only 34 cases (12.32%) were submitted to histopathological examination. Mean follow-up time was 26.42 ±25.39 months.

CONCLUSIONS

SBD is more frequent in male patients in the fifth and sixth decade of life. Classic SBD is radiographically characterized as a single, unilocular and well-defined lesion in the posterior region of the jaw with a radiolucent/hypodense appearance.

Prunus lusitanica L. Fruits: A Promising Underexploited Source of Nutrients with Potential Economic Value

In recent times, less-known fruit species have increasingly attracted worldwide attention and their health benefits are at the forefront. The fruits of plants from the genus Prunus are good sources of nutrients due to their economic, agronomic, and healthy values. However, Prunus lusitanica L., commonly known as Portuguese laurel cherry is considered an endangered species. Thus, the present work aimed to monitor the nutritional components of P. lusitanica fruits grown in three locations in northern Portugal for four consecutive years (2016-2019), using AOAC (Association of Official Analytical Chemists), spectrophotometric, and chromatographic analysis. The results evidenced the abundance of phytonutrients in P. lusitanica, such as proteins, fat, carbohydrates, soluble sugars, dietary fibre, amino acids, and minerals. It was also highlighted that the variation of nutritional components was relatively linked to the year factor, being especially relevant in the frame of the current changing climate, among others. These findings suggest that P. lusitanica L. deserves to be conserved and planted because of its food and nutraceutical applications. However, more detailed information on this rare plant species, such as phytophysiology, phytochemistry, bioactivity, pharmacology, etc., is certainly required for the design and development of appropriate uses and valorization alternatives for this species.

Augmented Reality-Assisted Ultrasound Breast Biopsy

Breast cancer is the most prevalent cancer in the world and the fifth-leading cause of cancer-related death. Treatment is effective in the early stages. Thus, a need to screen considerable portions of the population is crucial. When the screening procedure uncovers a suspect lesion, a biopsy is performed to assess its potential for malignancy. This procedure is usually performed using real-time Ultrasound (US) imaging. This work proposes a visualization system for US breast biopsy. It consists of an application running on AR glasses that interact with a computer application. The AR glasses track the position of QR codes mounted on an US probe and a biopsy needle. US images are shown in the user's field of view with enhanced lesion visualization and needle trajectory. To validate the system, latency of the transmission of US images was evaluated. Usability assessment compared our proposed prototype with a traditional approach with different users. It showed that needle alignment was more precise, with 92.67 ± 2.32° in our prototype versus 89.99 ± 37.49° in a traditional system. The users also reached the lesion more accurately. Overall, the proposed solution presents promising results, and the use of AR glasses as a tracking and visualization device exhibited good performance.

Pulmonary Actinomycosis: A Diagnostic Challenge

Pulmonary actinomycosis is an uncommon and challenging infectious disease with non-specific symptoms and imaging findings. The authors report a case of a 68-year-old man with diabetes and a history of past smoking who presented with anorexia and weight loss with no significant findings on physical examination. A parenchymal consolidation in the anterior segment of the right upper lobe was detected after a chest computed tomography (CT). Bacterial colonies of Actinomyces species were identified in the histology of transbronchial biopsy. Imaging reassessment after six weeks of treatment with oral amoxicillin showed progression with a high metabolism 10.5 standardized uptake value (SUV) documented on the f-fluorodeoxyglucose positron emission tomography/CT. Concern about the possibility of lung cancer was raised and ruled out by a negative transthoracic needle biopsy. The diagnosis of pulmonary actinomycosis with pyogenic superinfection was presumed. The patient was successfully treated with intravenous amoxicillin and clavulanate for two weeks, followed by six months of oral treatment.

The influence of simultaneous pancreas-kidney transplantation on the evolution of diabetic foot lesions and peripheral arterial disease

PURPOSE

Simultaneous pancreas-kidney transplantation (SPKT) remains the best treatment option in patients with type 1 diabetes and chronic kidney failure. There are only a few studies addressing the potential ischemic deterioration of peripheral arterial disease (PAD) due to blood diverting from the iliac artery to the kidney graft. We aimed to evaluate diabetic foot lesions and PAD evolution in SPKT recipients and investigate if they are more frequent in ipsilateral lower limb of kidney graft.

METHODS

We developed a retrospective cohort, including patients submitted to SPKT in our tertiary center, between 2000 and 2017. Diabetic foot lesions and PAD frequencies were compared in the period before and after transplantation.

RESULTS

Two hundred and eleven patients were included, 50.2% (n = 106) female, with a median age at transplantation of 35 years (IQR 9). After a median follow-up period of 10 years (IQR 7), patient, kidney, and pancreatic graft survival were 90.5% (n = 191), 83.4% (n = 176), and 74.9% (n = 158), respectively. Before transplant, 2.8% (n = 6) had PAD and 5.3% (n = 11) had history of foot lesions. In post-transplant period, 17.1% (n = 36) patients presented PAD and 25.6% (n = 54) developed diabetic foot ulcers, 47.6% (n = 35) of which in the ipsilateral and 53.3% (n = 40) in the contralateral lower limb of the kidney graft (p = 0.48). Nine patients (4.3%) underwent major lower limb amputation, 3 (30%) ipsilateral and 7 (70%) contralateral to the kidney graft (p = 0.29).

CONCLUSIONS

Diabetic foot lesions were not more frequent in the ipsilateral lower limb of the kidney graft, therefore downgrading the 'steal syndrome' role in these patients.

The influence of overweight and obesity in the oral health of a sample of portuguese adults

Background

Overweight and obesity may lead to different problems in various body systems and in the oral cavity. Dental caries and periodontal disease have been related with overweight. The aim of this study was to assess how overweight and obesity have impact on the lifestyle, oral habits and oral pathologies.

Methods

We conducted an observational cross-sectional study where we applied a questionnaire to 140 individuals from Lisbon and Viseu, Portugal., which 70 had a normal Body Mass Index (BMI) (control group) and 70 had an excessive BMI. We also made an oral observation in each individual to record the permanent teeth decayed, missing and filled index (DMFT), the Community Periodontal Index and the oral hygiene status.

Results

From the final sample, 30% of the subjects with overweight brushed their teeth once a day or less, while the majority (62.9%) of the control group brushed twice a day. In the oral examination, 70% had calculus, while in the control group only 22.5% presented calcified plaque. The DMFT was higher among the obesity group in comparison with the control group. Regarding periodontal disease, the participants with overweight need more dental intervention (81.4%) in contrast with the control group (14%).

Conclusions

Most overweight and obese individuals present precarious oral hygiene habits, higher prevalence of dental caries, and worse periods of periodontal health. They are not aware of the repercussions of the association between their cariogenic diet, oral health and overweight.

Key messages

• Oral health behaviors are related with other health conditions, namely obesity and this is a fundamental public health issue.

• Primary preventive strategies should be established having in consideration the oral health status of adults in treatment for obesity and in weight control programs.

Feasibility, Acceptability, and Preliminary Impact of Full-Body Interaction on Computerized Cognitive Training Based on Instrumental Activities of Daily Living: A Pilot Randomized Controlled Trial with Chronic Psychiatric Inpatients

Objective: To conduct a pilot randomized control trial to assess the feasibility and acceptability of full-body interaction cognitive training (FBI-CT) inspired by instrumental activities of daily living in chronic psychiatric inpatients and to explore its preliminary impact on cognitive and noncognitive outcomes. Materials and Methods: Twenty psychiatric inpatients met the inclusion criteria and were randomly allocated to the FBI-CT group (n = 10) or the tablet-based CT group (T-CT) (n = 10). Neuropsychological assessments were performed at baseline, postintervention, and 3-month follow-up. Results: Both groups presented high completion rates at postintervention and follow-up. Participants reported high satisfaction following the interventions, with the FBI-CT group exhibiting slightly higher satisfaction. A within-group analysis showed significant improvements in the FBI-CT group for processing speed and sustained attention for short periods (P = 0.012), verbal memory (P = 0.008), semantic fluency (P = 0.027), depressive symptoms (P = 0.008), and quality of life (P = 0.008) at postintervention. At 3-month follow-up, this group maintained verbal memory improvements (P = 0.047) and depressive symptoms amelioration (P = 0.026). The T-CT group revealed significant improvements in sustained attention for long periods (P = 0.020), verbal memory (P = 0.014), and executive functions (P = 0.047) postintervention. A between-group analysis demonstrated that the FBI-CT group exhibited greater improvements in depressive symptoms (P = 0.042). Conclusions: Overall, we found support for the feasibility and acceptability of both training approaches. Our findings show promise regarding the preliminary impact of the FBI-CT intervention, but due to study limitations such as the small sample size, we cannot conclude that FBI-CT is a more effective approach than T-CT for enhancing cognitive and noncognitive outcomes of chronic psychiatric inpatients. Clinical trials (number: NCT05100849).

Chronic obstructive pulmonary disease exacerbations' management in Portuguese hospitals - EvaluateCOPDpt, a multicentre, observational, prospective study

INTRODUCTION AND OBJECTIVES

In order to improve the quality of chronic obstructive pulmonary disease (COPD) patients' care, better knowledge of clinical practice and the factors associated with patient outcomes are needed. This study aimed to evaluate the relation between clinical practice and the outcomes of patients admitted for COPD exacerbations in Portuguese hospitals.

MATERIALS AND METHODS

Observational, multicentre, prospective study with a 60-days follow-up period, in 11 hospitals, including patients aged ≥ 30 years, admitted to hospital for at least 24 hours due to an acute exacerbation of COPD. Demographic and clinical data were collected, including sex, age, smoking habits, hospitalisations, pulmonary function, comorbidities, COPD symptoms, and treatment. Sixty days after discharge, COPD exacerbations management, outcome measures, and readmission data were evaluated through a structured phone follow-up interview.

RESULTS

196 patients were included (85.7% male, mean age 71.2 years), the majority admitted through the emergency service. Ex-smokers and current smokers accounted for 51% and 36%, respectively. On admission, 72.4% were on LAMA, 54.6% on LABA, and 45.5% were on LABA/LAMA. Inhaled corticosteroids (ICS) were used in 37.3% and systemic steroids (SCS) in 10.3%. 35.7 % had had at least one exacerbation, with hospitalisation, in the previous year. There was no spirometry data for 23.2%. On hospitalisation, 98.5% of patients were treated with oxygen and 38.3% with non-invasive ventilation. Additionally, 93.4% used SCS and 60.2% ICS. Antibiotics were administered to 85.2%. 95.4% of patients were discharged; 9 died, 5 of whom had a COPD-related death. The median length of stay was 12 days for discharged patients and 33 days for patients who died. At discharge, 79.1% were prescribed with LAMA, 63.6% SCS, 61.5% LABA and 55.6% LAMA+LABA. 26,2% were prescribed with ICS+LABA+LAMA. At follow-up, 44.4% had a scheduled medical appointment within the 60 days after being discharged, and 28.3% were later readmitted due to exacerbation, of whom 52.8% were hospitalised.

CONCLUSIONS

The severity of COPD, particularly in exacerbations, is directly related to impaired lung function and quality of life, mortality, and significant health system costs. Knowledge about COPD exacerbations' management in acute hospital admissions in Portugal may help stimulate a national discussion and review of existing data to engage clinicians, policymakers, managers, and patients, raising awareness and promoting action on COPD.

Introducing Mediterranean Lupins in Lamb Diets: Effects on Carcass Composition, Meat Quality, and Intramuscular Fatty Acid Profile

The objective of this preliminary study was to evaluate the effects of partial replacement of soybean meal by lupins on lambs’ diets, on the carcass traits, meat characteristics, and meat fatty acid profile. Two trials were conducted: In trial 1, the soybean meal (control; C) was partially replaced by Lupinus albus or Lupinus luteus (50 g/kg; LA5 and LL5, respectively); in trial 2, lambs were fed four diets with graded levels of Lupinus luteus (0, 100, 150 and 200 g/kg; C, LL10, LL15, LL20, respectively). At the end of the feeding trials, animals were slaughtered to evaluate carcass characteristics and meat composition, including fatty acids. Carcass composition in tissues was not affected (p > 0.05) by diet in both trials. Additionally, no significant (p < 0.05) differences were observed in meat quality attributes between diets in trials 1 and 2. Overall, the Longissimus muscle’s fatty acid content was not affected by diet (p > 0.05) in both trials. Carcass and meat quality was overall comparable between lambs fed with soybean meal and lupins, indicating the latter as a potential alternative protein source. However, the lack of significant differences could also be attributed to the small sample size.

Pharmacological Targeting of Senescence with ABT-263 in Experimental Heart Failure with Preserved Ejection Fraction

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Fundação Ciência e Tecnlogia

HFpEF is the most common form of heart disease in the elderly and is associated with high morbidity and mortality. Our understanding of HFpEF pathophysiology is limited and development of efficient therapies that alter the clinical course of the disease has proved greatly challenging. Although aging is a risk factor of HFpEF1, the involvement of aging hallmarks such as cell senescent and immunosenescence is unclear. Recently, a link between endothelial senescence and HFpEF development was demonstrated in mice with accelerated aging [1], endorsing anti-aging pharmacologic as potential new therapeutic alternatives for HFpEF. In fact, the senolytic (drugs that selectively promote apoptosis of senescent cells) ABT-263 has already proven efficacy in the context of cardiovascular diseases. Further studies are needed to clarify the relevance of aging and of anti-aging therapies in the context of HFpEF.

Using ZSF1 obese rats (ZSF1-Ob) as model of HFpEF we showed from 18 weeks signs of immunosenescence compared to ZSF1-Ln, namely an increased frequency of circulating myeloid cells and decreased frequency of T and B cells. Concomitantly, expression of pro-inflammatory factors (IL-6, IL-1, TGF-β, TNF-α) was upregulated in peripheral blood mononuclear cells (PBMCs) of ZSF1-Ob which also displayed characteristic features of cell senescence (p21 expression, lysosomal endogenous Beta-galactosidase (SA-B-Gal) senescence-associated secretory phenotype (SASP) and up-regulation of BCL-XL. Importantly, no signs of cellular senescence (SA-B-gal, pH2AX and senescence associated pathways) were found in the main hematopoietic organs (spleen and bone marrow). Alongside, these systemic alterations, an upsurge of cellular senescence was observed in myocardium of ZSF1-Ob rats, particularly in endothelial and hematopoietic cells. Serum of ZSF1-Ob rat was able to induce activation and cellular senescence of cardiac microvascular endothelial cells, indicating that systemic circulating factors may be the upstream mechanism of cellular senescence and dysfunction in HFpEF. Analysis of HFpEF patients and a control cohort adjusted to main co-morbidities further demonstrated accumulation of senescent monocytes in HFpEF patients. In these patients, the senescence marker SA-B-Gal correlated with plasmatic brain natriuretic peptide (BNP) levels and pulmonary artery systolic pressure. Targeting aging hallmarks through the treatment of ZSF1-Ob rat with ABT-263 resulted in a reduction in circulating senescent cells, decreased systemic and local inflammation, re-established immune proportions, restore the levels of circulating BNP and attenuated myocardial remodeling, particularly endothelial dysfunction and fibrosis.

Collectively these findings support that premature cellular senescence contributes to the establishment of a deleterious pro-inflammatory environment in HFpEF and that senolytic agents hold promise for the treatment of this syndrome.

Intercellular transfer of miR-200c-3p impairs the angiogenic capacity of cardiac endothelial cells

As mediators of intercellular communication, extracellular vesicles containing molecular cargo such as microRNAs, are secreted by cells and taken up by recipient cells to influence their cellular phenotype and function. Here, we report that cardiac stress-induced differential microRNA content, with miR-200c-3p being one of the most enriched, in cardiomyocyte-derived extracellular vesicles mediates functional crosstalk with endothelial cells. Silencing of miR-200c-3p in mice subjected to chronic increased cardiac pressure overload resulted in attenuated hypertrophy, smaller fibrotic areas, higher capillary density and preserved cardiac ejection fraction. Interestingly, we were able to maximal rescue microvascular and cardiac function with very low doses of antagomir, which specifically silences miR-200c-3p expression in the non-myocyte cells. Our results reveal vesicle transfer of miR-200c-3p from cardiomyocytes to cardiac endothelial cells, underlining the importance of cardiac intercellular communication in the pathophysiology of heart failure.

Science and Technology Parks: Opening the Pandora’s Box of Regional Development

For the last decades, Science and Technology Parks (STPs) have been emerging to help in the development of regions; as a consequence, there has been an improvement in RIS (Regional Innovation System) performance. This research aims to assess the contribution of STPs to the performance improvement of RIS in Portugal. A quantitative methodology is used, based on a framework, which is supported by four latent variables: (1) Policy Instrument (PI); (2) Regional Innovation Inputs (INNI); (3) Regional Innovation Outputs (INNO), and (4) Regional Idiosyncrasies (REG). The data was collected from Regional Innovation Scoreboard reports available for the seven Portuguese regions: North, Center, Lisbon, Alentejo, Algarve, and Autonomous Regions of Azores and Madeira between 2007 and 2018. The working sample is composed of 392 observations. Our findings show a clear innovation delimitation in Portugal. The North, Center, and Lisbon areas are the areas that have strong innovation. The rest of the country has moderate innovation, including the autonomous regions. Nonetheless, an improvement in innovation was registered between 2016 and 2019 in all regions except Alentejo and Algarve. This aligns with the Policy Instrument’s positive influence on the Regional Innovation inputs, which positively influences the Regional Innovation Outputs. The outcome allowed practical suggestions for regional stakeholders. This research is original for its methodological approach, never applied to the Portuguese context.

Effects of Dietary Incorporation of Grape Stalks Untreated and Fungi-Treated in Growing Rabbits: A Preliminary Study

Simple Summary

The use of winery by-products as an animal feed ingredient in rabbit production can enhance the sustainability of this livestock sector by reducing feeding costs and simultaneously diminishing environmental problems related to the management of those by-products. White-rot fungi have been studied for the delignification of lignocellulosic materials due to their potential to decrease the content of lignin. In fact, white-rot fungi also improve the nutritional value due to the deposition of bioactive compounds, acting as a possible biological treatment to enhance the nutritive value of grape stalks. The objective of this work was to evaluate the incorporation of untreated grape stalks and fungi-treated grape stalks in rabbits’ diets.

Abstract

This study aimed to evaluate the effect of the incorporation of untreated grape stalks (U_GS) and fungi-treated grape stalks (Lentinula edodes, T_GS) in rabbits’ diets. The control group was fed with a control diet without grape stalks (C), two experimental groups were fed on diets with 5% and 10% incorporation of U_GS (5U_GS and 10U_GS), and two with 5% and 10% incorporation of T_GS (5T_GS and 10T_GS). Rabbits fed with T_GS diets showed higher daily weight gain (p = 0.034), feed conversion rate (p = 0.002), carcass weight (p = 0.038), and reference carcass weight (p = 0.03) when compared to the control diet. Moreover, animals fed with T_GS diets showed an increase in the caecum (p = 0.015) and small intestine (p = 0.021) lengths and in the total volatile fatty acid content (p = 0.005) compared to animals fed U_GS diets. Blood triglyceride levels were lower in animals fed with T_GS diets compared to U_GS (p = 0.005) and C (p ≤ 0.001) diets (12% and 19% lower, respectively), and a trend to lower cholesterol levels was observed (p = 0.071). Meat from rabbits fed with T_GS diets had higher levels of linoleic acid, γ-linolenic, ∑ω-6, ∑PUFA, and ∑PUFA/∑SFA ratio compared to rabbits fed with the C diet. Results indicated that grape stalks (U_GS and T_GS) could be effectively used as an alternative raw material in rabbits’ diets without compromising animal performance.

Hydrostatic pressure mimicking diurnal spinal movements maintains anabolic turnover in bovine nucleus pulposus cells in vitro

Treatment strategies for progressive intervertebral-disc degeneration often alleviate pain and other symptoms. With the goal of developing strategies to promote the regeneration of the nucleus pulposus (NP), the present study tried to identify the biological effects of hydrostatic (HP) and osmotic pressures on NP cells. The study hypothesis was that a repetitive regimen of cyclic HP followed by constant HP in high-osmolality medium would increase anabolic molecules in NP cells. Bovine NP cells/clusters were enclosed within semi-permeable membrane pouches and incubated under a regimen of cyclic HP for 2 d followed by constant HP for 1 d, repeated 6 times over 18 d. NP cells showed a significantly increased expression of anabolic genes over time: aggrecan, chondroitin sulfate N-acetylgalactosaminyltransferase 1, hyaluronan synthase 2, collagen type 2 (p < 0.05). In addition, the expression of catabolic or degenerative genes (matrix metalloproteinase 13, collagen type 1) and cellular characteristic genes (proliferating cell nucleic antigen, E-cadherin) was suppressed. The amount of sulfated glycosaminoglycan increased significantly at day 18 compared to day 3 (p < 0.01). Immunostaining revealed deposition of extracellular-matrix molecules and localization of other specific molecules corresponding to their genetic expression. An improved understanding of how cells respond to physicochemical stresses will help to better treat the degenerating disc using either cell- or gene-based therapies as well as other potential matrix-enhancing therapies. Efforts to apply these tissue-engineering and regenerative-medicine strategies will need to consider these important physicochemical stresses that may have a major impact on the survivability of such treatments.

The impact of experiences of violence on the physical and mental health of a portuguese sample

Introduction

Violent Experiences result in economic and social costs for society, impacting on emotions in families, on health (both physical and mental), and overall quality of life, causing potential damages. Thus, it becomes relevant to do research on this impact, aiming at raising awareness and promoting prevention.

Objectives

The purpose of the study is to estimate the impact of experiences of violence on both physical and mental health taking into account variables such as age, gender, and marital status.

Methods

This is a cross-sectional study sampling 1407 Portuguese speaking adults, with an age average of 42 years old (DP=17.28). The measures used were: The SF-36 questionnaire to assess quality of life, physical and mental health, and the Experiences of Violence Questionnaire.

Results

The sample was divided into two groups (victims and non-victims). The group of participants that were not subjected to violence presents more positive results. In relation to the comparison between genders, it was verified that males present more positive results having into account all dimensions SF-36 when compared to women. Also, older participants (53 years old or more) presents lower results of general health.

Conclusions

Violence and health, increasingly related due to the impact it has on the subjects’ physical and mental health and quality of life.

Disclosure

No significant relationships.

Improving Intraoperative Communication in Trauma: The Educational Effect of the Joint DSTC™-DATC™ Courses

BACKGROUND

Operative management of severe trauma requires excellent communication among team members. The surgeon and anesthesiologist need to interact efficiently, exchanging vital information. The Definitive Surgical Trauma Care (DSTC) and Definitive Anesthesia Trauma Care (DATC) courses provide an excellent opportunity for teamwork training. Our goal was to study the impact of the joint DSTC-DATC courses in candidates' self-reported assessment in communication skills and techniques in a simulated intraoperative trauma scenario.

METHODS

Study population consists of 93 candidates (67 surgeons and 26 anesthesiologists) participating in four consecutive joint DSTC-DATC courses in May and June 2019 in Brazil (3) and in Portugal (1). Median age was 30 years; 53 (60%) of subjects were male (46 senior residents and 47 specialists). All participants attended joint lectures, case discussions and surgical skills session, emphasizing intraoperative communication. Post-course survey on several aspects of perioperative communication (responses on a Likert scale) was conducted with participants being asked which aspects of intraoperative communication they valued the most.

RESULTS

All participants responded to the survey. Results displayed an increase in the self-assessed importance of team briefing and intraoperative communication, particularly routine periodic communication, rather than only at critical moments. Postoperative team debriefing was also valued as highly relevant. Closed-loop and direct, by-name communication were highly rated. Self-reported communication skills improved significantly during the course.

CONCLUSIONS

Joint training in the DSTC-DATC courses improved candidates' perception and skills on proficient intraoperative communication. Further studies should address both the durability of these changes and the potential impact on patient care.

Prognostic Factors After Hepatectomy for Gastric Adenocarcinoma Liver Metastases: Desmoplastic Growth Pattern as the Key to Improved Overall Survival

Purpose

Hepatectomy (Hp) is an alternative approach for the treatment of gastric carcinoma liver metastases (GCLM). However, prognostic factors that may assist patient selection are still controversial. Several pathologic features, such as the growth pattern (GP), associated with prognosis in colorectal cancer liver metastases, were never investigated in GCLM. Our principal aim was to assess if the GP has prognostic impact on GCLM.

Patients and Methods

Review of the clinical and pathological characteristics of 19 consecutive patients submitted to surgical resection of GCLM with curative intent at our department. Major potential prognostic factors considered were patients’ gender, age, timing and extent of Hp, postoperative course, as well as histopathological characteristics of primary and secondary tumors.

Results

Major morbidity occurred in four patients, mortality in one. Median and 5-year overall survival were 17 months and 26.7%, respectively. Ten patients developed recurrent disease and two patients survived more than 10 years. Factors independently associated with overall survival were the absence of major morbidity, distal location of the primary tumor, and desmoplastic GP (p<0.05).

Conclusion

The selection of patients is crucial for the improvement of survival rates of GCLM. Consequently, we demonstrate for the first time that the desmoplastic GP of GCLM is associated with improved outcomes, prompting further research on tumor–host interactions.

Advanced hepatic vasculobiliary imaging segmentation and 3D reconstruction as an aid in the surgical management of high biliary stenosis

BACKGROUND

Three-dimensional (3D) models are increasingly used to help surgeons, guiding them through the complex hepatic vasculobiliary anatomy. The biliary tract is a relatively untapped territory with only a few case reports described in medical literature. Our aim is to present an innovative 3D reconstruction methodology for biliary imaging and surgical planning, applied to a case of iatrogenic biliary stricture, with fusion of segmented CT and MRI images.

CASE PRESENTATION

A selected case of Bismuth type III iatrogenic biliary stenosis for 3D planning. CT and MR studies were acquired with dedicated protocols for segmentation. Two radiologists performed segmentation and 3D model post-processing, fusing both imaging techniques to faithfully render the anatomical structures. Measurements of anatomical landmarks were taken in both the CT/MRI and the 3D model to assure its accuracy and differences in measurement were calculated. The 3D model replicates anatomical structures and pathology with high accuracy, with only 2.2% variation between STL, CT and MRI measurements. The model was discussed with the surgical team and used in the surgical planning, improving confidence in this delicate procedure, due to the detailed prior knowledge of the patient's anatomy.

CONCLUSION

Three-dimensional reconstructions are a rapidly growing area of research with a significant impact in the personalized and precision medicine. The construction of 3D models that combine vascular and biliary anatomy, using different imaging techniques, respectively CT and MRI, will predictably contribute to a more rigorous planning of complex liver surgeries.

Big Data in metagenomics: Apache Spark vs MPI

The progress of next-generation sequencing has lead to the availability of massive data sets used by a wide range of applications in biology and medicine. This has sparked significant interest in using modern Big Data technologies to process this large amount of information in distributed memory clusters of commodity hardware. Several approaches based on solutions such as Apache Hadoop or Apache Spark, have been proposed. These solutions allow developers to focus on the problem while the need to deal with low level details, such as data distribution schemes or communication patterns among processing nodes, can be ignored. However, performance and scalability are also of high importance when dealing with increasing problems sizes, making in this way the usage of High Performance Computing (HPC) technologies such as the message passing interface (MPI) a promising alternative. Recently, MetaCacheSpark, an Apache Spark based software for detection and quantification of species composition in food samples has been proposed. This tool can be used to analyze high throughput sequencing data sets of metagenomic DNA and allows for dealing with large-scale collections of complex eukaryotic and bacterial reference genome. In this work, we propose MetaCache-MPI, a fast and memory efficient solution for computing clusters which is based on MPI instead of Apache Spark. In order to evaluate its performance a comparison is performed between the original single CPU version of MetaCache, the Spark version and the MPI version we are introducing. Results show that for 32 processes, MetaCache-MPI is 1.65× faster while consuming 48.12% of the RAM memory used by Spark for building a metagenomics database. For querying this database, also with 32 processes, the MPI version is 3.11× faster, while using 55.56% of the memory used by Spark. We conclude that the new MetaCache-MPI version is faster in both building and querying the database and uses less RAM memory, when compared with MetaCacheSpark, while keeping the accuracy of the original implementation.

Metabolically healthy obesity in a young population assisted by the Family Health Strategy in Brazil

Background

Obesity is increasing in younger populations, and is associated with a high cardiovascular (CV) risk, however, it is not clear whether metabolically healthy obesity (MHO) may have a lower CV risk or if it is just an earlier stage of the disease.

Objective

To evaluate the prevalence and CV risk factors associated with MHO in a young population assisted by a Family Health Care unit in a large urban center in Brazil.

Methods

A cross-sectional population study for CV risk assessment in adults aged 20-50 years old from a FHC unit in Rio de Janeiro. Demographic, anthropometric data and CV risk factors were recorded. All underwent office blood pressure (OBP) measurements, laboratory evaluation (lipid and glycidic profile). Obesity was defined as a BMI ≥ 30 kg/m2 and MHO are those who have less than 3 of the following criteria: hypertension, diabetes, total cholesterol ≥ 200 mg/dL, HDL&lt;40 mg/dL (men) and 50 mg/dL (women), triglycerides&gt;150 mg/dL and increased waist circumference.

Results

A total of 632 individuals were evaluated (60% female; mean age 37 ± 9 years). The prevalence of obesity was 26%, of which 73% were classified as MHO. Obeses are older, with a higher prevalence of physical inactivity (51% vs 41%, p = 0.03), hypertension (44% vs 19%, p &lt; 0.001), dyslipidemia (50% vs 36%, p = 0.002) and diabetes (7% vs 2%, p = 0.001) with higher systolic OBP. MHO compared to unhealthy ones are significantly younger and smoke less. Despite being obese, they have lower BMI (33.6 vs 35.2 kg/m2, p = 0.02) and abdominal circumference (102 vs 110 cm, p = 0.03), with lower diastolic BP.

Conclusions

MHO was more prevalent in this young population and seems to have a lower CV risk, however it is not clear whether these younger and less obese individuals are only at an earlier stage of the disease. Perhaps the CV diseases onset is postponed for a few years. Even so, these individuals should not be excluded from public health policies as a form of primary prevention.

Key messages

In this young population, MHO was more prevalent and presented a lower CV risk. The follow-up of MHO will show if they are really healthy or if they are at an early stage of the disease.

Cardiovascular risk factors and social determinants in a population study in Rio de Janeiro, Brazil

Background

The association of cardiovascular (CV) diseases and their risk factors with socioeconomic status has been well described, but its influence is often underestimated in epidemiological studies in Brazil.

Objective

To evaluate the relationship between the main CV risk factors and socioeconomic indicators in a population of adults registered in a Family Health Care (FHC) unit in a great urban center - Rio de Janeiro, Brazil.

Methods

Cross-sectional population study that included adults aged between 20 and 50 years living in the area covered by the FHC unit in Rio de Janeiro. Demographic data (gender and age), socioeconomic data (education level, profession, employment), CV risk factors (smoking, sedentary lifestyle, obesity, hypertension, diabetes, dyslipidemia) were recorded. The metabolic profile is evaluated through laboratory tests. Those who studied up to high school were considered poorly educated.

Results

604 individuals were enrolled [39% male, mean age: 38.8 ± 8,9 years] The median of schooling was 12 years. 288 individuals had high schooling, 44.5% were male. A total of 130 individuals did not study or work. Women with low education had a higher risk of smoking, obesity and hypertension with no difference regarding labor or study activities. Otherwise, men with low education had a higher risk of sedentary lifestyle and hypertension. Among men, not working or studying increased the risk of smoking and hypertension.

Conclusions

We found an inverse association between socioeconomic conditions and the prevalence of CV risk factors. Women are more affected by low schooling, while men are more affected by their working occupation. The study suggests that socioeconomic factors influence the CV risk, affecting men and women differently, pointing to the need for more comprehensive public health policies that effectively reverse this situation.

Key messages

We found an inverse association between socioeconomic conditions and the prevalence of CV risk factors. Socioeconomic factors influence cardiovascular risk differently according to gender.

Anatomical and functional results of ILM peeling vs. non-peeling in macula-off rhegmatogenous retinal detachment

PURPOSE

To compare anatomical and functional results between internal limiting membrane (ILM) peeling and non-ILM peeling in macula-off rhegmatogenous retinal detachment (RRD).

METHODS

We completed a retrospective cohort study of patients who underwent pars plana vitrectomy (PPV) due to macula-off RRD. ILM peeling (P) versus non-ILM peeling (NP) groups were compared regarding best-corrected visual acuity (BCVA), anatomical success, endotamponade, concomitant scleral band placement and BCVA gain for epiretinal membranes (ERM) resubjected to PPV. Statistical significance was considered when p < 0.05.

RESULTS

PPV was conducted in 352 patients, among which 43.5% (n = 153) were in the P group and 55.6% (n = 196) were in the NP group. Both groups had significant BCVA improvement during the study period (p < 0.001), but with no significant difference between them. Anatomical success was similar between P (84.2%) and NP (87.2%) groups. No difference was found with regard to endotamponade (p = 0.07) or concomitant scleral band placement (p = 0.43). The NP group developed subsequent ERM more frequently (p = 0.004), but BCVA gains for eyes requiring repeat PPV for ERM were not found (p = 0.14).

CONCLUSIONS

Although ERM formation and greater anatomical success are reasons to support the use of ILM peeling in RRD, we did not observe any anatomical or functional difference regarding ILM peeling or functional gain with secondary ERM peeling.

Nutrients, Antinutrients, Phenolic Composition, and Antioxidant Activity of Common Bean Cultivars and their Potential for Food Applications

Phaseolus vulgaris L. is the most commonly consumed legume in the world, given its high vegetable protein content, phenolic compounds, and antioxidant properties. It also represents one of the most sustainable, low-carbon and sources of food available at present to man. This study aims to identify the nutrients, antinutrients, phenolic composition, and antioxidant profile of 10 common bean cultivars (Arikara yellow, butter, cranberry, red kidney, navy, pinto, black, brown eyed, pink eyed, and tarrestre) from two harvest years, thereby assessing the potential of each cultivar for specific applications in the food industry. Navy and pink eyed beans showed higher potential for enrichment of foodstuffs and gluten-free products due to their higher protein and amino acid contents. Additionally, red kidney, cranberry and Arikara yellow beans had the highest content of phenolic compounds and antioxidant properties, which can act as functional ingredients in food products, thus bringing health benefits. Our study highlights the potential of using specific bean cultivars in the development of nutrient-enriched food and as functional ingredients in diets designed for disease prevention and treatment.

P1256 Salvage mitraclip implantation for postmyocardial infarction mitral regurgitation: 2 case reports

Introduction

Acute mitral regurgitation (MR) secondary to AMI is associated with a poor clinical outcome. The role of MitraClip implantation (MCI) in this population is still not well established. We report two successful cases of salvage MCI in acute ischaemic MR.

Case Report 1: A 66-year-old diabetic woman was admitted to our institution due to extensive anterior STEMI with cardiogenic shock. Urgent cardiac catheterization (CC) revealed 100% occlusion of the left anterior descending and critical stenosis of the obtuse marginal artery, with successful PCI of both vessels and implantation of an intra-aortic balloon pump. Early transthoracic echocardiogram (TTE) revealed a dilated left ventricle with severe systolic dysfunction (LVEF – 35%), apical and anterior wall akinesia and functional grade IV MR (EROA - 40mm2 and regurgitant volume - 45mL), that was later confirmed by transesophageal echocardiography (TEE). 48h after AMI, the patient developed an arrhythmic storm requiring multiple shocks and a prolonged period of mechanical ventilation. Due to an extremely slow clinical improvement, with the need for prolonged inotropic support and refractory pulmonary congestion (NYHA IV), she was submitted to MCI, resulting in post-procedural grade I MR (EROA 7mm2 and regurgitant volume 11mL) and a marked clinical and hemodynamic improvement. An ICD for secondary prevention was implanted. At the 3 month follow-up the patient presented in NYHA II functional class without congestive symptoms.

Case Report 2: An 82-year old female patient was admitted with an inferior STEMI, with CC documenting severe 3 vessel disease with a calcified occlusion of the right coronary artery, not amenable to PCI, so the patient was submitted to emergent CABG. There was a prolonged period of post-operatory mechanical ventilation with an extremely difficult weaning process, including the need for re-intubation due to acute pulmonary edema. TTE revealed LVEF of 39% with a large inferobasal aneurysm and severe eccentric MR due to tendinous cord rupture. The patient was submitted to MCI with immediate significant improvement of the MR, allowing successful extubation 36 hours after the procedure. In the end of first month of follow-up, the TTE revealed a well-positioned clip with mild-to-moderate MR (EROA – 21.5mm2 and regurgitant volume – 38mL) with the patient being completely asymptomatic.

Conclusion

Treatment of acute MR following AMI with MCI may be a safe and effective approach in critically ill patients. In our experience, it can lead to a rapid clinical recovery and resolution of cardiogenic shock.

P229 Primary cardiac angiosarcoma of the right atrium: a rare entity presenting with an atrial arrhythmia

Introduction

Primary cardiac tumors are rare entities and 75% are benign. Angiosarcoma is the most common malignant primary cardiac tumor.

We report the case of cardiac angiosarcoma presenting with an atrial arrhythmia.

Clinical case

A 39-year-old female patient with no past medical history presented to the emergency department with heart palpitations and atypical chest pain.

Electrocardiogram on admission showed atrial flutter with a heart rate of 153 beats per minute.

Laboratory analysis were performed showing elevated D-dimer levels (2210 ug/L).

A thoracic CT scan was performed, which ruled out pulmonary embolism, but showed multiple pulmonary nodules and a right atrial (RA) mass measuring 48 mm that could correspond to a thrombus or neoplasia.

The patient was admitted in the Cardiology ICU of our hospital and was started on beta-blocker and amiodarone with conversion to sinus rhythm. Additional exams were performed:

- Transthoracic echocardiogram (TTE) revealed an heterogenous 32,6 x 17,7 mm mass in the lateral wall of the RA with an adherent mobile mass near the tricuspid valve with 28 mm diameter (possible adherent thrombus).

- Cardiac magnetic resonance imaging confirmed a RA tumor with invasion of the atrial free wall and compression of the superior vena cava.

Due to the unclear etiology of the RA mass, ultrasound-guided intracardiac biopsy was performed. Pathological examination revealed spindle cell proliferation, consistent with the diagnosis of angiosarcoma. Immunohistochemical staining was positive for Vimentin, CD34 and CD31, with 70% Ki67 expression.

Later on, the patient developed melena with significant drop of hemoglobin levels, requiring daily red blood cell transfusions and anticoagulation had to be stopped.

The patient was transferred to the Internal Medicine ward and thoracic-abdomen-pelvis staging computed tomography (CT) scan showed a significant increase in the number of pulmonary nodules, bilateral ovarian masses, 4 hepatic nodules and ileum metastization.

During hospitalization, the patient developed right leg deep venous thrombosis and thoracic CT scan revealed bilateral pulmonary embolism.

After improvement of the clinical status, palliative chemotherapy was started and the patient was discharged, maintaining regular outpatient follow-up in the Oncology Department for 1 month.

Cardiac angiosarcoma generally presents in a late stage of the disease with metastatic involvement. When surgical treatment is not possible, despite agressive chemotherapy, the prognosis remains poor.

Abstract P229 Figure. Echocardiogram: right atrium mass

In-air production of 3D co-culture tumor spheroid hydrogels for expedited drug screening

Three-dimensional (3D) in vitro tumor spheroids are becoming popular as pre-clinical platforms for testing the performance of existing drugs or for discovery of innovative anti-cancer therapeutics. This focus is correlated with in vitro 3D tumor models ability to mimic the multicellular compact structure and spatial architecture of human solid tumors. However, these microphysiological systems generally lack the pre-existence of tumor-ECM, a critical aspect that can affect the overall therapeutic performance and the decision of advancing candidate drugs to later stages of the pipeline. Aiming to face this drawback and mimic tumors-ECM, herein we rapidly fabricated in-air hyaluronan-methacrylate (HA-MA) and gelatin-methacrylate (GelMA) photocrosslinkable 3D spheroid microgels by using superhydrophobic surfaces. These platforms were used for establishing heterotypic 3D co-culture models of prostate cancer cells (PC-3) and human osteoblasts (hOB) to mimic prostate cancer-to-bone metastasis cellular heterogeneity and the tumor-ECM microenvironment. 3D microgel microtumors morphology, size and cell number were easily controlled via digital droplet generation on polystyrene superhydrophobic surfaces and under solvent-free conditions when compared to microfluidics or electrospray. Co-culture 3D microgels formed by 2.5%HA-MA-5%GelMA and 5%HA-MA-5%GelMA ratios showed the highest calcium deposition after 14 days of culture, evidencing osteoblasts viability and the establishment of functional mineralization in the 3D hydrogel matrix. Cisplatin cytotoxicity evaluation showed that 3D microgels are more resistant to platin chemotherapeutics than single or co-culture 3D multicellular spheroid counterparts. Overall, our findings indicate that solvent-free, in-air produced 3D microgel microenvironments are cost-effective and robust tumor mimicking platforms for in vitro high-throughput screening of therapeutics targeted to prostate-to-bone metastasis microenvironments. STATEMENT OF SIGNIFICANCE: The generation of robust microphysiological systems that recapitulate the complexity of the metastatic prostate-to-bone tumor microenvironment is crucial for pre-clinical evaluation of new therapeutics that can eradicate these secondary tumors. In this study, we employed superhydrophobic (SH) surfaces to rapidly fabricate photocrosslinkable hyaluronan-methacrylate/gelatin-methacrylate 3D spheroid microgels for prostate cancer cells and human osteoblasts co-culture models that simultaneously mimic the cellular and ECM tumor components. The use of SH platforms overcomes the issues of standard in-liquid microgel production technologies by providing a robust control over 3D microgels size/morphology and cell-cell co-encapsulation numbers, while avoiding the use of oil-based microgel droplets generation. Overall, SH surfaces allowed a solvent-free, cost-effective, reproducible and adaptable fabrication of heterotypic 3D spherical microgels for high throughput drug screening.

The impact of glycemic variability on length of stay and mortality in diabetic patients admitted with community-acquired pneumonia or chronic obstructive pulmonary disease

AIM

To investigate the influence of glycemic variability (GV) on length of stay and in-hospital mortality in non-critical diabetic patients.

METHODS

A observation retrospective study was performed. Diabetic patients admitted between January and June 2016 with the diagnosis of community-acquire pneumonia (CAP) and/or acute exacerbation of chronic obstructive pulmonary disease (COPD) were enrolled and glycemic control (persistent hyperglycemia, hypoglycemia, mean glucose level (MGL) and respective standard deviation (SD) and coefficient of variation (CV)) were evaluated. Primary outcomes were length of stay and in-hospital mortality.

RESULTS

Data from 242 patients were analyzed. Fifty-eight percent of the patients were male, with a median age of 77 years (min-max, 29-98). Patients had on average 2.1 glucose readings-day and the MGL was 193.3 mg/dl (min-max, 84.3-436.6). Hypoglycemia was documented in 13.4% of the patients and 55.4% had persistent hyperglycemia. The median length of hospital stay was 10 days (min-max, 1-66) and in-hospital mortality was 7.4%. We found a significant higher in-hospital mortality in older patients, with history of cancer and with nosocomial infections. We did not find any correlation between MGL, SD, CV, hypoglycemia or persist hyperglycemia and in-hospital mortality. A longer length of stay was observed in patients with heavy alcohol consumption and nosocomial infections. The length of stay was negatively correlated with the mean glucose level (r²-0.147; p < 0.05) and positively correlated with the coefficient of variation (p 0.162; p < 0.05).

CONCLUSION

This study confirmed the negative impact of the glycemic variability in the outcomes of diabetic patients admitted with CAP or acute exacerbation of COPD.