Delivering adapted physical activity by videoconference to patients with fatigue under immune checkpoint inhibitors: Lessons learned from the PACTIMe-FEAS feasibility study

INTRODUCTION

Fatigue is one of the most frequent symptoms in anti-cancer immune therapy. Physical activity has been proven effective in reducing fatigue, but unmet needs remain regarding the provision and access to adapted programmes, which efficiently addresses the main barriers to PA.

METHODS

The PACTIMe-FEAS study primarily aimed at primarily to evaluate the feasibility and the acceptability of a videoconference-based 6-month programme promoting physical activity, and secondarily to assess its potential post-immediate and short-term effectiveness in reducing fatigue in cancer patients under immune therapy. Numeric self-reported questionnaires (Visual Analogue Scale-fatigue, Multidimensional Fatigue Inventory, International Physical Activity Questionnaire, Échelle de Motivation envers l'Activité Physique en contexte de Santé, Medical Outcomes Study 36-Item Short Form Health Survey, Hospital Anxiety and Depression Scale and Insomnia Severity Index) were completed by participants through an online secure platform at three time points: just before (T1), and after (T2) the programme, and 3 months later (T3).

RESULTS

Sixteen participants (50% male, 50% female, mean age 54 years, 69% melanoma, 31% overweight), with moderate-to-severe fatigue, entered the internet-delivered intervention; 14 completed it, with an average completion rate of physical activity supervised sessions of 75%. Satisfaction was high, confirming a demand for group format, personalised approach, professional guidance and home-based device, to support the practice of regular physical activity. A decrease in fatigue was observed at the end of the programme.

DISCUSSION

The recruitment process did prove to be challenging, with a relatively small eligible population, and will need to be reconsidered to envision a larger scale trial. But here and now, this feasibility study provides the first promising foundations to develop further research on the effectiveness of an original remote programme.

Information needs on nutrition in link to cancer prevention among cancer patients, high-risk individuals and general population - A national cross-sectional study

BACKGROUND & AIMS

Nutrition is one of the fundamentals of cancer prevention. Knowing what are the patients' needs and beliefs in terms of "nutrition and cancer" information helps tailor future nutritional interventions. The aim of this study was to evaluate specific information needs about "nutrition in relation to cancer prevention", including primary and tertiary prevention, among cancer patients, cancer-free individuals, and genetic high cancer risk individuals.

METHODS

This online survey was shared within two large National cancer social networks and proposed to all attendees and carers of a comprehensive cancer center.

RESULTS

2887 individuals answered the survey (of whom 33% were cancer patients, 13% high-risk individuals and 55% participants of the general population). More than 80% of participants were women, had at least a high school degree. Median body mass index was 23.2 kg/m². Eleven percent (n = 321) were following a diet, mostly low carbohydrate and weight-loss diets. Around 70% of all categories felt they lacked information on nutrition and cancer interplays. Only 12% of cancer patients (n = 108) considered they had received enough information on nutrition during their care pathway. A majority of participants agreed that food can modify cancer risk (93%, n = 2526) and 66% (n = 1781) considered that nutrition should be personalized according to the risk of cancer. Only twenty-nine percent (n = 792) believed that eating 5 fruits and vegetables a day was enough to avoid cancer, but 64% (n = 1720) thought that dietary supplements could help obtain a better health. All proposed nutrition topics were considered important by the participants.

CONCLUSIONS

Although cancer patients and cancer-free respondents, whether at high risk of cancer or not, share a common broad interest on the interplay between nutrition and cancer and seek after more information on this topic, some false beliefs are observed. Healthcare providers could successfully propose more evidence-based information to these populations.

An epidemiologic retrospective study of maxillofacial traumatology in the elderly

INTRODUCTION

The elderly population, which is more active than before, is increasingly suffering from trauma (loss of reflexes and systemic pathologic conditions). Surgical management may be more controversial due to the potential consequences of general anesthesia and the sometimes negligible consequences of functional management. The main objective of this study was to analyze the causes and location of facial fractures in subjects older than 65 years. The secondary objective was to evaluate the management of these fractures (surgical or functional) according to comorbidities.

MATERIAL & METHODS

In this retrospective study (over a five-year period), we analyzed the causes and management of facial fractures in patients aged over 65 years, and the medical history of each patient was investigated.

RESULTS

One hundred and nineteen patients with 198 facial fractures were included. The main cause of fractures was a fall (50%). The zygomatic region (39.9%) and mandible (27.8%) were the sites of the most frequent fractures. Comorbidities were found in 84.9% of patients, the majority of which were cardiovascular diseases (82.3%). 75.8% of fractures were treated surgically and 4.8% of patients had complications.

DISCUSSION

This work is a help to understanding the causes and consequences of facial trauma in the elderly population. The management of these facial fractures requires a multidisciplinary assessment, taking into account the patient's medical history and evaluating the risks and benefits of a surgical procedure with general anesthesia.

Intraoperative cone beam assessment after reduction of zygomatic fractures helps in taking a decision on associated orbital floor fractures

INTRODUCTION

Orbital floor fracture (OFF) are frequently associated with zygomatic fractures (ZF). The reduction of the ZF may modify the features of the associated OFF. Intraoperative cone beam CT (CBCT) has shown diagnostic performance of OFF. The aim of our study was to evaluate how intraoperative CBCT control made after the reduction of ZF may help to take a decision on the associated OFF.

MATERIAL AND METHOD

Patients with a unilateral displaced ZF associated with an OFF were consecutively included during a 3-year period. Intraoperative CBCT, systematically performed after reduction of the ZF, allowed to decide if the OFF needed reconstruction. The preoperative estimation made on MDCT and the intraoperative decision regarding the OFF were compared.

RESULTS

Fifty-nine consecutive patients could be included in the study. Nineteen OFF were presumed to be surgical indications on the preoperative MDCT but only 16 indications were confirmed on the intraoperative CBCT, meaning that 3 OFF behaved favorably during the ZF reduction. Forty orbital floor fractures were presumed to be non-surgical on the preoperative MDCT but 6 of them worsened during ZF reduction and became surgical indications. Overall, the intraoperative CBCT control had an impact on 9 (15.3%) of the OFF.

CONCLUSION

Our study showed that OFF after ZF reduction may evolve favorably or, on the contrary, get worse in 15% of the cases. Surgical indication on an OFF can therefore be confirmed intraoperatively. This allows to avoid under-treatment in the patients where the OFF worsens after ZF reduction and over-treatment in the patient where the OFF reduces after ZF.

OP0273 CHARACTERISTICS OF PATIENTS WITH DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS IN FRANCE

Background

Recently, EULAR has proposed a definition of difficult-to-treat rheumatoid arthritis (D2TRA). However, descriptive data on D2TRA are scarce and only one Japanese publication details the D2TRA encountered in routine practice, no similar work has been done in Europe so far.

Objectives

To describe D2TRA patients encountered in France according to two definitions and evaluate their therapeutic responses to different targeted therapies.

Methods

We reviewed all patients with RA treated in day hospital at Cochin University Hospital between 2020 and 2021. We divided our population into two groups of patients, a D2TRA group and a non-D2TRA group. This division was made on the same population according to two different definitions of D2TRA, resulting in four patient groups. The first definition is the one proposed by EULAR (EULAR D2TRA) defining D2TRAs as RAs with failure of ≥2 b/tsDMARDs (with different mechanisms of action) after failing csDMARD therapy. The second defined as D2TRA patients who have failed at least two targeted therapies, without prejudging the mechanism of action (non-EULAR D2TRA). We analyzed clinical characteristics and evaluated their response to different targeted therapies. Disease activity was assessed using the DAS for 28 joints (DAS28) at the latest visit.

Results

In total, we included 320 patients, we identified 76 EULAR D2TRA patients (mean age 59 years, 87% female) with 244 of corresponding non-DTRA patients (mean age 60 years, 85% female) and 120 non-EULAR D2TRA patients (mean age 58.7 years, 87% female) with 200 of corresponding non-DTRA (mean age 61 years, 85% female). Compared to non-D2TRA patients, there were significantly more D2TRA patients from low socioeconomic backgrounds in both D2TRA groups. In the EULAR-D2TRA group, compared to the non-D2TRA, there were significantly more patients with diabetes (14% vs 6%, p=0.024). D2TRA patients in both groups had significantly more rheumatoid factor (RF), interstitial lung disease (ILD) and a higher DAS28 than non-D2TRA patients. No difference was noted regarding ACPA and erosions. We observed a lower proportion of remission in both D2TRA groups than in non-D2TRA group (21% in EULAR-D2TRA vs 34% in non-D2TRA, p=0.034 and 23% in non-EULAR D2TRA vs 36% in non-D2TRA, p=0.024). There were significantly fewer patients on Methotrexate in the non-EULAR D2TRA group compared to the non-D2TRA group (53% vs 64%, p=0.046). In the non-EULAR D2TRA group, there were significantly more patients in remission on Rituximab than on TNF inhibitors (41% vs 5%, p=0.0032). We did not observe a significant difference in achieving remission in patients on JAK inhibitors or IL-6 inhibitors in the two groups of D2TRA.

Table 1.

Clinical data of patients with D2TRA

NON D2T RA n=200NON-EULAR D2T RA n=120p-valueNON D2T RA n=244EULAR D2T RA n=76p-valueLow socioeconomic level69 (35)61 (51)0.00591 (37)39 (51)0.032TJC (0-28), mean (SD)3.4 (4.6)4.9 (5.8)0.01673.5 (4.5)5.6 (6.5)0.001SJC (0-28), mean (SD)2.4 (3.1)3.5 (4.3)0.00672.6 (3.3)3.5 (4.3)0.0503CRP in mg/dl, mean (SD)6 (9.5)7 .5 (12.1)0.21286.1 (9.9)7.9 (12.3)0.2060DAS28CRP, mean (SD)3.2 (1.2)3.6 (1.4)0.00443.2 (1.3)3.6 (1.4)0.0052Remission71 (36)28 (23)0.02483 (34)16 (21)0.034RF positive, n (%)156 (78)105 (88)0.037193 (79)68 (89)0.043Anti-CCP positive, n (%)152 (76)101 (84)0.099188 (77)66 (87)0.075Erosion, n (%)114 (57)69 (58)1138 (56)46 (60)0.596Interstitial Lung Disease, n (%)16 (8)19 (16)0.04117 (7)18 (24)<0.001Corticosteroids, n (%)84 (42)64 (53)0.064101 (41)46 (61)0.004 Dose (mg), mean ± SD6 (4.9)5.5 (3.4)0.4166 (4.6)5.3 (3.6)0.374Methotrexate, n (%)128 (64)63 (53)0.046149 (61)42 (55)0.422 Dose (mg), mean ± SD17.3 (4.25)17.5 (5.3)0.78617.2 (4.5)18.1 (5.1)0.291

Conclusion

The complexity of managing RA patients can be explained by socio-economic status and the presence of comorbidities such as diabetes and ILD. Our work suggests that D2TRA patients have less Methotrexate and better response to Rituximab. These data need to be confirmed in prospective studies to allow personalized management of D2TRA.

Disclosure of Interests

None declared

[A comparative study of recreational screen time in neurodevelopmental disorders]

INTRODUCTION

Digital screen time has been largely studied in children populations, but few have focused on children with neurodevelopmental disorders. Our main objective was to study the characteristics of use of recreational screens (television (TV) and video games), in children with neurodevelopmental disorders.

SUBJECTS AND METHODS

We conducted a case-control study in which children with neurodevelopmental disorders under the age of 6 were compared with controls of the same age range. We analysed TV and video game exposure through a designed questionnaire for parents that included daily time exposure, sociodemographic characteristics, home media environment, sociocultural habits, attitudes and beliefs about TV.

RESULTS

Sixty-one individuals with developmental and 153 controls were enrolled. Children with developmental problems spend more time watching TV than controls (124,4 ± 83,4 vs 71,5 ± 47,4 min / day p <0,001), while video game time was similar in both groups (37,6 ± 39, 6 vs 31,7 ± 32,6 min / day p = 0,138). Children with neurodevelopmental disorders began earlier to watch TV than controls. There were no relevant differences between groups in demographics, Sociocultural, environmental and attitudinal and belief variables.

CONCLUSIONS

Children with neurodevelopmental disorders start watching TV at an earlier age and consume more screen time than healthy children. Our findings indicate that Children with neurodevelopmental disorders are more vulnerable to screen abuse, and stress the importance to offer anticipatory guidance to their parents.

Speed-up and slow-down of a quantum particle

We study non-relativistic propagation of Gaussian wave packets in one-dimensional Eckart potential, a barrier, or a well. In the picture used, the transmitted wave packet results from interference between the copies of the freely propagating state with different spatial shifts (delays), \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$x'$$\end{document}x′, induced by the scattering potential. The Uncertainty Principle precludes relating the particle’s final position to the delay experienced in the potential, except in the classical limit. Beyond this limit, even defining an effective range of the delay is shown to be an impracticable task, owing to the oscillatory nature of the corresponding amplitude distribution. Our examples include the classically allowed case, semiclassical tunnelling, delays induced in the presence of a virtual state, and scattering by a low barrier. The properties of the amplitude distribution of the delays, and its pole representation are studied in detail.

Heat rectification with a minimal model of two harmonic oscillators

We study heat rectification in a minimalistic model composed of two unequal atoms subjected to linear forces and in contact with effective Langevin baths induced by Doppler lasers. Analytic expressions of the heat currents in the steady state are spelled out. Asymmetric heat transport is found in this linear system if both the bath temperatures and the temperature-dependent bath-system couplings are exchanged. The model can be realized with two ions in either common or individual traps. This physical setting allows for a natural temperature dependence of the coupling to the baths. We also explore the parameter space of the model to optimize asymmetric heat current and find conditions for maximal rectification. High rectification corresponds to a good match of the power spectra of the ions for forward temperature bias and mismatch for reverse bias, which may be understood by the behavior of dissipative normal modes.

Nurse navigators' telemonitoring for cancer patients with COVID-19: a French case study

Purpose

The Gustave Roussy Cancer Institute implemented a patient-reported outcome platform (CAPRI-COVID) for cancer patients with coronavirus disease 2019 (COVID-19) to quarantine patients at home while ensuring monitoring of COVID-related symptoms and securing the care pathway. In this study, we described the CAPRI-COVID intervention, evaluated its use, and presented results of the tracking indicators with a focus on the nurse navigators’ (NNs) activities and the experience of patients.

Methods

Data of 130 cancer patients with COVID-19 diagnosed from March 23 to June 5, 2020, were collected. Six COVID-related symptoms were monitored daily, either by the patient via the CAPRI mobile application (CAPRI App) or by NNs via telemonitoring. In the cases of worsening or new-onset symptoms, an automated alert was sent to the platform, and NNs could immediately consult an emergency physician for future course of action.

Results

All 130 patients (median age: 59 years; 59.2% female) were monitored during the study period. There were no deaths or admissions to the intensive care unit attributable to COVID-19; 7.8% of patients were hospitalized (excluding scheduled hospitalization), and 17.1% were admitted to the emergency department at least once during the monitoring period. NNs carried out 1412 regular monitoring calls (average of 10.9 calls per patient), while 55% of the patients downloaded the CAPRI App.

Conclusions

Most patients monitored with CAPRI-COVID were quarantined during the first wave of the pandemic. In addition to the CAPRI App, which helped limit phone calls, NNs played an essential role in patient management.

Klein paradox for bosons, wave packets and negative tunnelling times

We analyse a little known aspect of the Klein paradox. A Klein–Gordon boson appears to be able to cross a supercritical rectangular barrier without being reflected, while spending there a negative amount of time. The transmission mechanism is demonstrably acausal, yet an attempt to construct the corresponding causal solution of the Klein–Gordon equation fails. We relate the causal solution to a divergent multiple-reflections series, and show that the problem is remedied for a smooth barrier, where pair production at the energy equal to a half of the barrier’s height is enhanced yet remains finite.

Intervention par visioconférence et dynamique groupale

Recourir à la visioconférence pour proposer des séances d’éducation, de soutien ou de psychothérapie en groupe est une des solutions pour faciliter l’accès aux soins de support. Très peu de données sont disponibles sur les spécificités interactionnelles que pourrait impliquer ce dispositif encore récent. L’article a pour objectif de rendre compte de la démarche de recherche exploratoire visant à construire une grille d’observation pour étudier cette question relationnelle à partir d’un dispositif d’ateliers thématiques collectifs mené en oncologie.

Diagnostic performance of mobile cone beam computed tomography versus conventional multi-detector computed tomography in orbital floor fractures: a study on human specimens

The aim of this study was to evaluate the diagnostic accuracy of mobile cone beam computed tomography (MCBCT) versus multi-detector computed tomography (MDCT) in orbital floor fractures. Twenty-four fresh cadaver heads were used, and one orbital floor was fractured for each head by transconjunctival approach. MDCT and MCBCT were performed on each of the heads. The images obtained were then analysed independently by eight evaluators. The radiological characteristics of the orbital floor fractures were visualized with good interpretation agreement between the two images. The location of the fracture and enophthalmos were identified in a comparable manner with strong agreement (κ=0.93 and κ=0.85, respectively). Measurements of fatty hernias and bone defects showed a strong correlation between the two imaging modalities (Pearson coefficient between 0.64 and 0.71 and between 0.67 and 0.71, respectively). The fracture limits and the presence of bone fragments, an intrasinus fatty hernia, and a fracture of the associated medial orbital wall were visualized in both examinations with good agreement (κ=0.68, κ=0.51, κ=0.57, and κ=0.46, respectively). The soft tissue study showed superiority for MDCT, with a κ<0.0009. MCBCT showed good diagnostic performance in the study of orbital floor fracture characteristics.

Surgical reconstruction of the foramen tympanicum: What is known and how we do it

Defects affecting the anterior wall of the tympanal bone can result from trauma, infection, neoplasm or previous local surgery. An anatomic variation, namely the persistence of the foramen tympanicum, can also be encountered. When symptomatic, surgical reconstruction may be indicated. The aim of this study was to identify the surgical treatments of symptomatic foramen tympanicum found in the literature and detail our innovative reconstruction technique. A bibliographic research was conducted in PubMed database in March 2020, without time limitation. Papers dealing with surgical management of a foramen tympanicum were included. Data collected were the publication date, the number of patients, their age and gender, the symptoms and the surgical treatment performed. We report, in addition, the case of a symptomatic persistent foramen tympanicum in a 30-year-old man with a follow-up of 18-months. A total of 17 studies (n=23 patients) were included for analysis. The main reconstruction techniques were, in equal proportion, cartilage graft (30%) and insertion of a titanium mesh (30%). We carried out an iliac crest bone graft using a preauricular approach on a patient suffering from chronic tinnitus and fullness in the left ear resulting from a persistent foramen tympanicum, confirmed by clinical and radiological examinations. It allowed the complete resolution of symptoms and no complication such as temporomandibular ankylosis occurred. Based on the review of the literature, we believe this technique has the advantage of providing durable reconstruction thanks to osseointegration.

Asymmetric heat transport in ion crystals

We numerically demonstrate heat rectification for linear chains of ions in trap lattices with graded trapping frequencies, in contact with thermal baths implemented by optical molasses. To calculate the local temperatures and heat currents we find the stationary state by solving a system of algebraic equations. This approach is much faster than the usual method that integrates the dynamical equations of the system and averages over noise realizations.

[Towards excellence in hospital management. A description of strategical management model]

BACKGROUND AND OBJECTIVE

Health services are evolving from the traditional view of paternalistic medicine towards a more informed and participatory patient-provider relationship. This situation includes the empowerment and participation of patients and their families in health management, including their joint responsibility in the development of health services. The objective of this article is to describe the experience in a large teaching hospital in Spain on the application of a model that focuses on a three-fold approach to healthcare management that includes the experience of the patient.

MATERIAL AND METHODS

This approach is identified by the initials EMC2 transforming the E of excellence into 3main areas of improvement: methodology, clinical knowledge and client, or patient, experience. the model has been implemented in different areas: childbirth, asthma care, outpatient clinics, and operating theatre.

RESULTS

In the case of childbirth, there was a reduction in caesarean sections, episiotomies, induction of delivery, mean hospital stay, and number of deliveries with instrumentation. The Net Promoter Score went from 82 to 86. There was also an improvement in the areas of patient experience, hospital procedures, and clinical knowledge. Qualitative improvement results were obtained in other areas such as, asthma management, outpatient visits, and the operating room.

CONCLUSIONS

This model can be applied to different areas. It promotes patient-focused practice, as well as system sustainability, efficiency, effectiveness, and level of satisfaction with the health care process.

Reactive chemical vapor deposition of heteroepitaxial Ti1−xAlxN films

A novel methodology combining CVD experiments, nanoscale characterisation and reaction–diffusion modelling demonstrates Ti_1−xAl_xN epitaxial growth on single crystalline AlN films.

Bilateral methachronous testicular germ cell tumor and testicular microlithiasis in a child: Genetic analysis and insights. A case report

OBJECTIVES

To report our experience with a case of a child with bilateral testicular micro-lithiasis (TML) who developed bilateral metachronous testicular germ cell tumor (TGCT) and determine the most appropriate follow-up and care management in children with testicular micro calcifications in regards to the theoretical risk of testicular cancer.

CASE REPORT

A 12 year-old boy was diagnosed with TGCT and TML. Ten years after complete remission, he presented with a recurrence on the contralateral testis. Genetic screening was performed on both resected and the patient's karyotype was analyzed.

RESULTS

Blood karyotype was normal. Aberrations were found in the tumor karyotype. CGH array showed alterations in chromosome arm 12p.

DISCUSSION

TML is frequently associated with testicular malignancy in adults: in 16.9% of cases the normal contralateral testicle develops TML in TGCT. Recent works of literature find no relationship between TML and cancer in general, but in patients with additional risks, the relationship becomes stronger. Some authors suggest that environmental components and genetics are determinant factors. This is highly suspected in our reported case. It would seem that TML is not a precancerous lesion per se, but rather a marker of an at-risk situation. Long term evolution is uncertain and regular self-palpation that starts before puberty is the only way to ensure proper screening and monitoring.

CONCLUSION

TML have been suspected to be a sign of testicular dysgenesis syndrome, which yields a risk of developing TGCT in case of noxious associations. In patients with a history of TGCT contralateral TML is alarming and aggressive surgical management should be discussed. Therapeutic education of these patients on self-palpation is the best way to ensure proper follow-up.

Self-organization of charged particles in circular geometry

The basic principles of self-organization of one-component charged particles, confined in disk and circular parabolic potentials, are proposed. A system of equations is derived, which allows us to determine equilibrium configurations for an arbitrary, but finite, number of charged particles that are distributed over several rings. Our approach reduces significantly the computational effort in minimizing the energy of equilibrium configurations and demonstrates a remarkable agreement with the values provided by molecular dynamics calculations. With the increase of particle number n>180 we find a steady formation of a centered hexagonal lattice that smoothly transforms to valence circular rings in the ground-state configurations for both potentials.

[Secondary megaureter: A rare complication of Deflux® endoscopic management of vesicoureteral reflux in children]

Endoscopic management is the gold standard for symptomatic low-grade vesicoureteral reflux (VUR) in children. Deflux^® (hyaluronic acid/dextranomer) injection is highly effective and has very few complications. We report on two cases of secondary megaureter after Deflux^® injections. In the first case, a boy presented with Grade 4 VUR. He received a bilateral Deflux^® injection with a total of three syringes. The postoperative ultrasound was normal. However, a check-up ultrasound 3 years later showed a significant ureteropyelocalyceal dilatation, with stasis and decreased renal function on scintigraphy, the reason why antireflux surgery (Cohen procedure) was performed. In the second case, a girl diagnosed with bilateral VUR at birth received bilateral injections with one syringe on each side at the age of 12 months. One month later, the ultrasound showed a dilation of the distal ureters (diameter of the right ureter, up to 10mm; left ureter, up to 6.7mm). The child underwent surgery 8 months later (Cohen procedure) because of iterative pyelonephritis and persistent ureter dilatation. Only one previous case has been described in the literature. In our experience, this complication has occurred only twice in 452 injections (4‰). In conclusion, endoscopic treatment with hyaluronic acid/dextranomer injection is a minimally invasive procedure that improves the situation in cases of VUR. It has few complications. Other than failure, there is a low risk of secondary expansion requiring, in our opinion, ultrasound verification over the long term.

NMR signal enhancement of >50 000 times in fast dissolution dynamic nuclear polarization

A novel mixed biradical polarizing agent (BDPAesterTEMPO) showing one of the largest NMR signal enhancements to be observed so far in fast dissolution Dynamic Nuclear Polarization (dDNP).

Paramagnetic spherical nanoparticles by the self-assembly of persistent trityl radicals

The self-association of a water-soluble persistent trityl radical gives rise to paramagnetic nanoparticles: a new class of non-metallic high spin systems.

Self-assembled trityl radical capsules – implications for dynamic nuclear polarization

The OX63 radical forms supramolecular capsules hosting tetraalkylammonium cations. Extensive self-association is also observed under standard dynamic nuclear polarization conditions.

A low-cost, sustainable, second generation system for surveillance of people living with HIV in Spain: 10-year trends in behavioural and clinical indicators, 2002 to 2011

A second-generation surveillance system of people infected with human immunodeficiency virus (HIV) has been implemented in Spain. Behavioural and clinical data were collected between 2002 and 2011 through an annual one-day, cross-sectional survey in public hospitals, including all in- and outpatients receiving HIVrelated care on the survey day. Mean age increased over time (from 38.7 years in 2002 to 43.8 years in 2011) and 68.4% of the 7,205 subjects were male. The proportion of migrants increased from 6.1% to 15.9%, while people who inject or used to inject drugs (PWID and Ex-PWID) decreased and men who have sex with men (MSM) and heterosexuals increased. Unprotected intercourse at last sex increased among MSM and PWID/Ex-PWID. Patients receiving antiretroviral treatment increased significantly from 76.0% to 88.2% as did those with CD4 T-cell counts ≥350 (from 48.2% to 66.9%) and viral copies <200 (from 47.0% to 85.2%). HIV-infected people with hepatitis C virus RNA decreased from 36.0% in 2004 to 29.9% in 2011, while those with HBsAg remained stable at around 4.4%. Implementation of a low-cost, sustainable system for second-generation surveillance in people living with HIV is feasible. In Spain, the information obtained has helped to define and refine public health policy and document treatment effectiveness.

The 13C solid DNP mechanisms with perchlorotriphenylmethyl radicals – the role of 35,37Cl

Chlorinated trityl radicals generate ¹³C DNP frequency sweeps that indicate contributions of e → ^36,37Cl → ¹³C polarization transfer mechanism at low temperatures and that the relative contributions of the solid effect and cross effects mechanism can be controlled by the microwave irradiation power.

Study of hyperglycemia in non critically-ill patients receiving parenteral nutrition: incidence and risk factors

BACKGROUND

The objectives of our study on non-critically ill patients receiving parenteral nutrition (PN) are to assess the incidence of hyperglycemia, the risk factors associated to its development and its influence in patient's evolution.

METHODS

A multicentric prospective observational study was performed in 9 hospitals. Four multivariate studies were developed to study the temporal risk in the occurrence of hyperglycemia (endpoint), intensive care unit (ICU) admission, length of stay (LOS) and death. Demographics, nutrients, drugs and clinical variables were collected. Independent variables studied as a possible risk factors were: sex, diabetes mellitus 2, baseline glycemia, albuminemia, pancreatitis, surgery in the 7 days prior to the end point, infection, insulin/somatostatin/corticoids administration during the study, glomerular filtration rate (GFR), and difference in the amount of glucose administration between the endpoint and one day before.

RESULTS

119 patients were enrolled in the study, 25 cases of hyperglycemia were detected. In the clinical factors associated with PN hyperglycemia, significant variables were: surgery in the 7 days before the end point, GFR, glucose load in the 24 hours previous to the end point insulin administration and somatostatine/octreotide administration during the study. Hyperglycemia was significantly associated with ICU admission and increased LOS.

CONCLUSIONS

Glucose administration in non-critically ill patients receiving PN should be reassessed downwards, especially in the immediate postsurgery, renal impairment and in patients treated with somatostatin analogues. It should be taken into account that an increase in glucose dose may lead to hyperglycemia in these patients and hyperglycemia correlates with longer hospital stay and increased frequency of ICU admissions.

Long-lived states in an intrinsically disordered protein domain

Long-lived states (LLS) are relaxation-favored spin population distributions of J-coupled magnetic nuclei. LLS were measured, along with classical (1)H and (15)N relaxation rate constants, in amino acids of the N-terminal Unique domain of the c-Src kinase, which is disordered in vitro under physiological conditions. The relaxation rates of LLS can probe motions and interactions in biomolecules. LLS of the aliphatic protons of glycines, with lifetimes approximately four times longer than their spin-lattice relaxation times, are reported for the first time in an intrinsically disordered protein domain. LLS relaxation experiments were integrated with 2D spectroscopy methods, further adapting them for studies on proteins.

[Comparison of 3 combinations of 0.5% levobupivacaine and 1% mepivacaine in popliteal sciatic block in hallux valgus outpatient surgery]

BACKGROUND

To compare 3 combinations of 0.5% levobupivacaine (L) and 1% mepivacaine (M) for popliteal block for hallux valgus surgery.

METHODS

Prospective, double blind study of 120 patients undergoing unilateral hallux valgus outpatient surgery with posterior popliteal block with ultrasound-guided single injection. Patients were randomly allocated into three groups: G1: 20mL L+10mL M; G2: 10mL L+20mL M; and G3: 15mL L+15mL M. Recorded variables were: time of block, onset and reversal times for tibial and peroneal nerves block; postoperative pain until the 7(th) day by means of visual analogue scale (VAS), simple descriptive scale and the quality of nocturnal rest, complications, and patient satisfaction. ANOVA and chi2 were applied in the statistical analysis, with a P<0.05 considered significant.

RESULTS

Groups were homogeneous for demographic and surgical characteristics. None of the patients required intraoperative complementary analgesia or anaesthesia. Block onset was significantly longer in G1 than in G2 and G3 (39.4±14.7 versus 32.2±16.5 and 33.2±12minutes). Recovery time from sensory and motor block was significantly longer in G1 than in G2 and G3 (29.5±9.3 versus 22.2±8.2 and 24.8±7.9hours). Postoperative pain level was below VAS 30 (1-100) in the three groups; none of the patients experienced severe pain. Maximum pain level appeared at 24h postoperatively. Patient satisfaction was high and there were no complications.

CONCLUSIONS

Block onset time and anaesthetic efficacy was adequate in the three groups. The combination of 20mL levobupivacaine 0.5% with 10mL mepivacaine 1% provide a good alternative for a lasting postoperative analgesia.

Comparison of the LMA Supreme™ with the LMA Proseal™ for airway management in patients anaesthetized in prone position

BACKGROUND

The laryngeal mask airway (LMA) has been successfully used in patients in the prone position either for rescue or elective airway management. The reusable Proseal™ LMA (PLMA) and the single use Supreme™ LMA (SLMA) have been reported to be suitable for this purpose but few comparative data are available. In this study, we compared the clinical use of both devices in adult patients anaesthetized in the prone position.

METHODS

One hundred and twenty patients undergoing surgery in the prone position were randomized to receive either the PLMA or the SLMA for airway management. Patients positioned themselves in the prone position and after pre-oxygenation, anaesthesia was induced using a target-controlled i.v. infusion of propofol and remifentanil. All PLMAs and SLMAs were inserted by experienced anaesthetists using a guided and a standard technique respectively. Ease of facemask ventilation, time and number of attempts needed for insertion, quality of ventilation, airway seal pressure, fibreoptic view, and complications were compared.

RESULTS

There were no differences between groups in insertion time or first attempt success (100% vs. 98%). The PLMA required fewer manipulations (3% vs. 15%; P=0.02) to achieve effective ventilation and provided a higher seal pressure (mean [sd] 31 [4] vs. 27 [4] cm H2O; P<0.01). The fibrescopic view of the vocal cords was similar, although easier to achieve with the PLMA. The complication rate was low and similar between the groups. Blood was present on masks in 7% vs. 8% and sore throat in 3% vs. 5% of patients with the PLMA and SLMA, respectively.

CONCLUSIONS

Airway management in patients anaesthetized in the prone position was efficient with both devices, although the PLMA required fewer manipulations and achieved a higher seal pressure.

Diffusion Barriers for Copper Metallization: Predicting Phase Stability and Reactivity using Equilibrium Thermodynamics

The guidelines for designing a conductive, amorphous material, capable of thermodynamic equilibrium with copper, are defined using readily available thermodynamic information. The tradeoff between desired properties – equilibrium at the interfaces, amorphous microstructure, and electronic conductivity – are described, along with trends in relevant binary systems that result in these properties. These guidelines defined systems for experimental study, for which preliminary results are presented.

[Outpatient or short-stay videothoracoscopy-assisted thoracic sympathectomy: anesthesia in 445 cases]

OBJECTIVE

To demonstrate the safety of outpatient or short-stay bilateral videothoracoscopy-assisted thoracic sympathectomy.

PATIENTS AND METHODS

The medical records of 445 who underwent bilateral videothoracoscopy-assisted thoracic sympathectomy were reviewed; the same protocols were used to guide these outpatient or short-stay procedures in all cases. Intravenous anesthesia was provided. An orotracheal tube allowed for carrying out the sympathectomy procedure during short periods of apnea. A 2% lidocaine solution was infused through the thoracic drains, which were removed soon after surgery. Data on intraoperative respiratory variables, pain, and intra- and postoperative complications were gathered. The data for patients undergoing the procedure on an outpatient or short-stay basis were compared.

RESULTS

No significant differences in demographic or perioperative variables were found between the 2 groups. In 3.6% of the patients in the series, there was a record of a postoperative pulmonary complication: 4 therapeutic minithoracotomies; 1 subcutaneous emphysema without radiologic changes; 9 residual pneumothoraces, 2 requiring pleural drainage; 1 chylothorax; and 1 delayed hemothorax. With the exception of the late-developing hemothorax, all complications were diagnosed and treated in the immediate postoperative period. In the outpatient surgery group, unplanned admissions because of patient refusal to leave occurred in 6.5% of the cases.

CONCLUSION

The low incidence of complications, and especially the finding that complications are detected in the early recovery period, indicate that this procedure can be performed on an outpatient basis.