Promoting advanced medical services in the framework of 3PM-a proof-of-concept by the "Centro" Region of Portugal

Multidisciplinary team from three universities based in the "Centro" Region of Portugal developed diverse approaches as parts of a project dedicated to enhancing and expanding Predictive, Preventive, and Personalized Medicine (3PM) in the Region. In a sense, outcomes acted as a proof-of-concept, in that they demonstrated the feasibility, but also the relevance of the approaches. The accomplishments comprise defining a new regional strategy for implementing 3PM within the Region, training of human resources in genomic sequencing, and generating good practices handbooks dedicated to diagnostic testing via next-generation sequencing, to legal and ethical concerns, and to knowledge transfer and entrepreneurship, aimed at increasing literacy on 3PM approaches. Further approaches also included support for entrepreneurship development and start-ups, and diverse and relevant initiatives aimed at increasing literacy relevant to 3PM. Efforts to enhance literacy encompassed citizens across the board, from patients and high school students to health professionals and health students. This focus on empowerment through literacy involved a variety of initiatives, including the creation of an illustrated book on genomics and the production of two theater plays centered on genetics. Additionally, authors stressed that genomic tools are relevant, but they are not the only resources 3PM is based on. Thus, they defend that other initiatives intended to enable citizens to take 3PM should include multi-omics and, having in mind the socio-economic burden of chronic diseases, suboptimal health status approaches in the 3PM framework should also be considered, in order to anticipate medical intervention in the subclinical phase.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-024-00353-9.

The salivary peptide histatin-1 enhances bone repair in vivo

The salivary peptide histatin-1 was recently described as a novel osteogenic factor that stimulates cell adhesion, migration, and differentiation in bone-lineage cells. Since these cell responses collectively contribute to bone regeneration, we hypothesized that histatin-1 harbors the capacity to enhance bone tissue repair at the preclinical level. By using a model of monocortical bone defect, we explored the effects of histatin-1 in tibial mineralization and organic matrix formation in vivo. To this end, different amounts of histatin-1 were embedded in one-mm3 collagen sponges and then applied to tibial monocortical defects in C57bl/6 mice. After seven days, mice were euthanized, and samples were processed for subsequent analysis. Micro-computed tomography screening showed that histatin-1 increased intraosseous mineralization, and this phenomenon was accompanied by augmented collagen matrix deposition and closure of cortical defect edges, as determined by Hematoxylin-Eosin and Masson's Trichrome staining. Moreover, immunohistochemical analyses showed that histatin-1 increased the expression of the osteogenic marker alkaline phosphatase, which was accompanied by augmented blood vessel formation. Collectively, our findings show that histatin-1 itself promotes bone regeneration in an orthotopic model, proposing this molecule as a therapeutic candidate for use in bone regenerative medicine.

Global survival trends for brain tumors, by histology: analysis of individual records for 556,237 adults diagnosed in 59 countries during 2000-2014 (CONCORD-3)

BACKGROUND

Survival is a key metric of the effectiveness of a health system in managing cancer. We set out to provide a comprehensive examination of worldwide variation and trends in survival from brain tumors in adults, by histology.

METHODS

We analyzed individual data for adults (15-99 years) diagnosed with a brain tumor (ICD-O-3 topography code C71) during 2000-2014, regardless of tumor behavior. Data underwent a 3-phase quality control as part of CONCORD-3. We estimated net survival for 11 histology groups, using the unbiased nonparametric Pohar Perme estimator.

RESULTS

The study included 556,237 adults. In 2010-2014, the global range in age-standardized 5-year net survival for the most common sub-types was broad: in the range 20%-38% for diffuse and anaplastic astrocytoma, from 4% to 17% for glioblastoma, and between 32% and 69% for oligodendroglioma. For patients with glioblastoma, the largest gains in survival occurred between 2000-2004 and 2005-2009. These improvements were more noticeable among adults diagnosed aged 40-70 years than among younger adults.

CONCLUSIONS

To the best of our knowledge, this study provides the largest account to date of global trends in population-based survival for brain tumors by histology in adults. We have highlighted remarkable gains in 5-year survival from glioblastoma since 2005, providing large-scale empirical evidence on the uptake of chemoradiation at population level. Worldwide, survival improvements have been extensive, but some countries still lag behind. Our findings may help clinicians involved in national and international tumor pathway boards to promote initiatives aimed at more extensive implementation of clinical guidelines.

Disentangling the complexities of modelling when high social capital contributes to indicating good health

The association between social capital and health is under continuous research. Based both on theoretical frameworks and previous empirical studies, the magnitude and sign of this association are ambiguous. Our main goal is to empirically investigate under which conditions is social capital relevant to obtain good or very good self-rated health, while acknowledging that different paths can lead to this outcome. The data used in this study come from the European Social Survey 2018 (47,423 observations for 29 European countries) and fuzzy-set qualitative comparative analysis was adopted. Our results show that neither the presence of social capital (as measured in this study - 'Generalised trust' and/or 'Informal social connections'), nor its absence, is a necessary condition for good or very good self-rated health. While not being necessary, there are contexts where social capital is relevant for health and, whenever it is present, it positively contributes to good or very good self-rated health. However, our results further suggest that social capital alone is not sufficient to be healthy. The relevance of social capital is contingent on the presence, or absence, of other conditions. What works for some individuals does not work for others. And for any given individual, rarely there is only one way to be healthy. Additionally, our findings suggest that the impact of belonging to a minority ethnic group on health might be stronger than what has been hitherto recognised.

Modeling the continua in the outcomes of biotic interactions

The outcome of many ecological interactions lies somewhere along a continuum between pure positive and pure negative effects. Although the popularity of this idea has notoriously risen in the last decades, with the occurrence of continua in interaction outcomes invoked for a wide variety of interactions, the absence of a precise theoretical treatment has led to considerable inaccuracy and ambiguity in its treatment. We develop here a consumer-resource model to explore the occurrence of continua. This model is based on the assumption that the distribution of individual interaction events includes both negative and positive immediate outcomes, with variable frequencies, for at least one of the interacting species. Our study shows that continua in interaction outcomes happen just by varying the sign and impact of individual events. The exact shape of the continua depends on the proportion of positive versus negative events and the relative magnitude of per-capita interaction strengths. Our model shows that continua in interaction outcomes are a key property of most pairwise interactions and are originated from the variable roles played by the interacting partners. It constitutes a step forward in the paradigm change from discrete categorization of ecological interactions to a new perspective over a continuous space.

Real-time, in situ measurement of H2O generated during in situ combustion tests using 1f-normalized wavelength modulation spectroscopy with second harmonic detection

The development and deployment of a real-time, in situ, non-invasive sensor to monitor the concentration of H ₂ O during in situ combustion (ISC) experiments with a heavy-crude oil is described. A real-time sensor to monitor the gas-phase products from ISC can support the study of the kinetics of the complex chemical reactive system in ISC. The mole fraction of H ₂ O was measured using tunable diode laser (TDL) absorption spectroscopy coupled with 1f-normalized wavelength modulation spectroscopy (WMS) and 2f detection. The WMS 2f/1f strategy was used to enhance sensitivity with effective noise rejection, particularly suitable when characterizing the water vapor evolved from oil-water emulsions. H ₂ O was measured at 3934.10c m ^-1 from the fundamental band v ₃. That transition was selected using the HITRAN database to increase the line strength and minimize interference from neighbor compounds. Measurements of H ₂ O concentration were conducted at ambient temperature and pressure using a reference cell (H ₂ O=2% at 98.6 kPa) to validate the sensor architecture under controlled laboratory environments. The TDL sensor was also successfully validated during real ISC experiments involving heavy-crude oil. Validation and combustion experiments showed the potential of the TDL-based sensor for non-invasive, real-time, in situ measurements of gas-phase species in conditions similar to those of laboratory-scale experimental ISC tests.

Synergistic enhancement of the phytostabilization of a semiarid mine tailing by a combination of organic amendment and native microorganisms (Funneliformis mosseae and Bacillus cereus)

The goal of this work was to evaluate the effects of fermented sugar beet residue and inoculation with a native arbuscular mycorrhizal (AM) fungus, Funneliformis mosseae (Nicol. and Gerd.) Gerd. and Trappe, or a native bacterium, Bacillus cereus Frankland & Frankland, alone or in combination, on the establishment of Lygeum spartum L. seedlings grown in a mine tailing under semiarid conditions. We conducted a field study to analyse root and shoot dry biomass, shoot nutrient contents, mycorrhization, plant nitrate reductase (NR) and acid phosphomonoesterase activities, soil enzyme activities and aggregate stability. Ten months after field transplanting, it was found that the three experimental factors had interacted synergistically with regard to shoot and root biomass, with increases of about 410% and 370%, respectively relative to plants in the untreated soil. The treatment combining all three factors increased the root content of all heavy metals, and the levels of nitrogen (N), phosphorus, potassium and NR activity in shoot tissues, whereas it decreased root acid phosphomonoesterase activity. Soil dehydrogenase, protease and β-glucosidase activities, total N content and aggregate stability were increased by the combined treatment. In conclusion, the combination of the organic amendment, the native AM fungus and the native bacterium can be regarded as a suitable tool for phytostabilization with L. spartum due to its ability to enhance the tolerance of plants to heavy metals, improve the plant nutritional status and increase the soil microbial function related to the C cycling.

Role of the hypothalamus in ghrelin effects on reproduction: sperm function and sexual behavior in male mice

In brief

Ghrelin signals to the hypothalamus inhibit reproduction during times of food scarcity. In this study, we demonstrate that ghrelin impairs sperm quality in male mice.

Abstract

Ghrelin (GHRL) is an orexigenic peptide that has been investigated as one of the signals responsible for the reproductive performance of mammals under fluctuating metabolic conditions. Central GHRL administration impairs spermatogenesis in mice by regulating the hypothalamic-pituitary-gonadal axis function. In the present study, the hypothalamus role as a mediator of GHRL effects on sperm fertilizing capacity and male sexual behavior was evaluated. After 42 days of hypothalamic GHRL infusion or artificial cerebrospinal fluid, in vitro and in vivo sperm fertilizing capacity, testicular α-tubulin, speriolin gene expression and spermatic α-tubulin protein were evaluated. Hypothalamic expression of genes Kiss1, Gpr54 and Gnrh was also studied. The second group of animals was infused with one time only GHRL or artificial cerebrospinal fluid into the hypothalamus to evaluate the effects on sexual behavior. Results demonstrated that chronic GHRL administration to male mice significantly increased the percentages of pre-implantation embryo loss and the number of post-implantation embryo loss. In relation to the gene expression, our results show a relative decrease of Kiss1, Gpr54 and Spatc1. Although no significant differences were observed in the quantitative expression of α-tubulin protein, qualitative changes in its expression pattern were observed. In addition, a dual effect on sexual behavior was observed: 40% of the treated animals showed a significant reduction in the number of mounts and intromissions, while a 60% showed a significant decrease in ejaculation latency vs control animals. In conclusion, our results provide evidence that central GHRL administration possibly induces failure in embryo development and/or implantation in the females mated with treated males, possibly because of a negative effect in the α-tubulin pattern.

Comparison of functional-oil blend and anticoccidial antibiotics effects on performance and microbiota of broiler chickens challenged by coccidiosis

This study aimed to compare the effects of different levels of cashew nutshell liquid (CNSL) and castor oil (CNSL-castor oil) with growth-promoting antibiotics associated with anticoccidials in broiler chickens challenged with coccidiosis. In this work, 2520 one-day-old male broiler chicks (Cobb) were randomly assigned to 84 pens, containing 30 birds each. The experimental design was completely randomized, with seven treatments: enramycin (8 ppm), virginiamycin (16.5 ppm), and tylosin (55 ppm); different doses of CNSL-castor oil (0.5, 0.75, and 1.00 kg/t); and a control diet (without additives). All treatments received semduramicin + nicarbazin (500 g/t; Aviax® Plus) from 0 to 28 d and monensin sodium (100 ppm; Elanco) from 29 to 35 days of age, when the feed was without antibiotics. The challenge was introduced at 14 days of age by inoculating broiler chickens with sporulated Eimeria tenella, Eimeria acervulina, and Eimeria maxima oocysts via oral gavage. In addition to performance parameters, intestinal contents were collected at 28 and 42 days of age for microbiota analysis by sequencing the 16s rRNA in V3 and V4 regions using the Illumina MiSeq platform. Taxonomy was assigned using the SILVA database (v. 138) with QIIME2 software (v. 2020.11). After one week of challenge, the broilers that received tylosin had a higher body weight gain (BWG) than those in the control group (p < 0.05), while the other treatments presented intermediate values. At 28 d, the BWG was lower for the control, CNSL-Castor oil 0.5 kg/t, enramycin, and virginiamycin treatments than that in the tylosin treatment. The inclusion of CNSL-Castor oil at concentrations of 0.75 and 1 kg/t acted as an intermediate treatment (p < 0.05). For alpha diversity, using the Shannon index, it was possible to observe the effect of age, with substantial diversity at 42 d. The Firmicutes phylum had the highest abundance, with values between 84.33% and 95.16% at 42 d. Tylosin showed better performance indices than other treatments. CNSL-castor oil treatments with concentrations of 0.75 and 1 kg/t showed similar results to those of enramycin and virginiamycin. Furthermore, CNSL-castor oil acted as a modulator of intestinal microbiota, reducing the abundance of pathogenic bacteria.

Identification of VEGFR2 as the Histatin-1 receptor in endothelial cells

Histatin-1 is a salivary peptide with antimicrobial and wound healing promoting activities, which was previously shown to stimulate angiogenesis in vitro and in vivo via inducing endothelial cell migration. The mechanisms underlying the proangiogenic effects of Histatin-1 remain poorly understood and specifically, the endothelial receptor for this peptide, is unknown. Based on the similarities between Histatin-1-dependent responses and those induced by the prototypical angiogenic receptor, vascular endothelial growth factor receptor 2 (VEGFR2), we hypothesized that VEGFR2 is the Histatin-1 receptor in endothelial cells. First, we observed that VEGFR2 is necessary for Histatin-1-induced endothelial cell migration, as shown by both pharmacological inhibition studies and siRNA-mediated ablation of VEGFR2. Moreover, Histatin-1 co-immunoprecipitated and co-localized with VEGFR2, associating spatial proximity between these proteins with receptor activation. Indeed, pulldown assays with pure, tagged and non-tagged proteins showed that Histatin-1 and VEGFR2 directly interact in vitro. Optical tweezers experiments permitted estimating kinetic parameters and rupture forces, indicating that the Histatin-1-VEGFR2 interaction is transient, but specific and direct. Sequence alignment and molecular modeling identified residues Phe26, Tyr30 and Tyr34 within the C-terminal domain of Histatin-1 as relevant for VEGFR2 binding and activation. This was corroborated by mutation and molecular dynamics analyses, as well as in direct binding assays. Importantly, these residues were required for Histatin-1 to induce endothelial cell migration and angiogenesis in vitro. Taken together, our findings reveal that VEGFR2 is the endothelial cell receptor of Histatin-1 and provide insights to the mechanism by which this peptide promotes endothelial cell migration and angiogenesis.

A concept of a broadband inverted geometry spectrometer for the Second Target Station at the Spallation Neutron Source

BWAVES is an acronym for Broadband Wide-Angle VElocity Selector spectrometer, indicating that a novel WAVES (Wide-Angle VElocity Selector) device will be used to select the velocity/wavelength of the detected neutrons after they are scattered by the sample. We describe a conceptual design of BWAVES, a time-of-flight broadband inverted-geometry neutron spectrometer for the Second Target Station at the Spallation Neutron Source operated by Oak Ridge National Laboratory. Being the first inverted geometry spectrometer where the energy of the detected neutrons can be chosen by a WAVES device mechanically, irrespective of the limitations imposed by the crystal analyzers or filters, BWAVES will feature a uniquely broad, continuous dynamic range of measurable energy transfers, spanning 4.5 decades. This will enable measurements of both vibrational and relaxational excitations within the same, continuous scattering spectra. Novel approaches that are necessary for the implementation of a WAVES device at the BWAVES spectrometer will result in a spectrometer with the design and characteristics much different from those displayed by the neutron spectrometers in existence today.

Elevated functional versatility of the soil microbial community associated with the invader Carpobrotus edulis across a broad geographical scale

Exotic invasive plants may shape their own rhizosphere microbial community during global invasions. Nevertheless, the impacts of such plant invasions on the functional capacities of soil microbial communities remain poorly explored. We used an approach at a broad geographical scale to estimate the composition and abundance of the fungal functional groups, as well as the bacterial metabolic functions, associated with the rhizospheres of Carpobrotus edulis (L.) L. Bolus and the predominant native plants in coastal ecosystems located in different geographical regions. We used the ASV method to infer the potential functions of the soil microbial community with the PICRUSt2 and FUNGuild tools. The predictive functional profiling of the bacterial communities differed between the rhizospheres of the invasive and native plants, regardless of the biogeographic location of the invaded soil. Some predicted pathways related to the biosynthesis of nucleotides such as ppGpp and pppGpp, lipids, carbohydrates and secondary metabolites and the degradation of organic matter were enriched in the C. edulis rhizosphere. Moreover, the invasive microbiota was characterised by a greater richness and diversity of catabolic enzymes involved in nutrients cycling and higher relative abundances of saprotrophs and pathotrophs. Invasion by C. edulis promoted a shift in the potential functional versatility of the soil microbial communities, which can cope with nutrient limitations and biotic stress, and can favour the establishment of the invasive plant, but also alter the functioning and stability of the invaded ecosystems.

CHARACTERIZING COVID-19-RELATED RETINAL VASCULAR OCCLUSIONS: A Case Series and Review of the Literature

PURPOSE

To describe clinical and ophthalmologic features and outcomes of patients with coronavirus disease-19 with retinal vascular occlusions.

METHODS

Retrospective multicenter case series and PubMed review of cases reported from March 2020 to September 2021. Outcome measures are as follows: type of occlusion, treatments, best-corrected visual acuity, and central macular thickness on optical coherence tomography.

RESULTS

Thirty-nine patients were identified. Fifteen patients with a median age of 39 (30-67) years were included in the multicenter study. Vascular occlusions included central retinal vein occlusion (12 eyes), branch retinal vein occlusion (4 eyes), and central retinal artery occlusion (2 eyes). Three cases were bilateral. Baseline best-corrected visual acuity was 20/45 (no light perception-20/20). Baseline central macular thickness was 348.64 (±83) μm. Nine eyes received anti-vascular endothelial growth factor agents, dexamethasone intravitreal implant, or both. Final best-corrected visual acuity was 20/25 (no light perception-20/20), and central macular thickness was 273.7 ± 68 μm (follow-up of 19.6 ± 6 weeks). Among the 24 cases from the literature review, retinal vein occlusion was the predominant lesion. Clinical characteristics and outcomes were similar to those found in our series.

CONCLUSION

Coronavirus disease-19-associated retinal vascular occlusions tend to occur in individuals younger than 60 years. Retinal vein occlusion is the most frequent occlusive event, and outcomes are favorable in most cases.

P–269 Effect of well-of-the-well culture as in vitro maturation system for human oocytes

Study question

Can the Well-of-the-Well system (WOW), applied on denuded oocytes, improve germinal vesicle breakdown (GVBD) and maturation rate?

Summary answer

In vitro maturation (IVM) of denuded germinal vesicle (GV) oocyte using WOW culture system increases nuclear maturation competence when compared with droplet conventional culture

What is known already

Further research remains necessary to address the mechanism of oocyte maturation in order to refine culture conditions and improve the implantation rate of in vitro matured oocytes. Several studies on bovine oocytes have shown that oocyte-secreted factors (an uncharacterized mix of growth factors secreted by the oocyte) enhance oocyte developmental competence during in vitro maturation. These oocyte-secreted factors may accumulate at the bottom of the micro-well, as suggested for the WOW culture system. Previous reports suggested that diffusible factors secreted by individual oocytes probably accumulated in a micro-well WOW dish, may provide a suitable microenvironment for their in vitro maturation.

Study design, size, duration

A total of 879 GV collected between 2017 and 2019 were included in this study. They were randomly allocated into two experimental groups: (1) single-cultured oocytes (SC) that were cultured individually in micro-droplets, and (2) group-cultured oocytes (WOW) that were cultured in a microwell culture system using the WOW dish (culture dish for time lapse incubator). The nuclear maturation was assessed after 24 hours and 48 hours of IVM

Participants/materials, setting, methods

GV oocytes were obtained from 609 patients undergoing controlled ovarian stimulation cycles. Oocytes from the experimental group (1) were placed individually in conventional 25μl micro-droplets in a 35 mm dish. Oocytes from the experimental group (2) were placed in 80 μl droplet individually in each of 9 microwells of WOW dish. All GV oocytes were matured in a single step embryo culture medium, supplemented with human menopausal gonadotropin and synthetic serum substitute.

Main results and the role of chance

Mature oocyte (MII) was considered when we observed rupture of the GV and the presence of a first polar body in the perivitelline space during the first 24 or 48 hours of culture under inverted optical microscope. GVBD noted significant differences (p-valor = 0.000) between the study groups after culturing of 24 hours [GVBD: SC group; 70% (318/455) vs. WOW group; 83% (352/424)] and 48 hours [GVBD: SC group; 77% (319/416) vs. WOW group; 94% (398/424)]. The maturation rates (MR) showed significant differences (p-valor = 0.000) between the study groups after culturing of 24 hours [MR: SC group; 51% (233/455) vs. WOW group; 80% (338/424)] and 48 hours [MR: SC group; 71% (295/416) vs. WOW group; 91% (387/424)].

Limitations, reasons for caution

There is no data on cleavage and blastocyst rates.

There are no previous reports comparing the maturation rates in denuded human oocytes single-cultured in individually droplet or group-cultured in WOW dish.

Wider implications of the findings: Our results must be taken into account in order to improve the culture conditions for the optimization of the in vitro maturation technique in human oocytes from stimulated cycles.

We now provide evidence that group-cultured oocytes in WOW dish increase GVBD and maturation rates.

Trial registration number

Not applicable

The impact of obesity on left ventricular hypertrophy and diastolic dysfunction in children and adolescents

Childhood obesity continues to escalate worldwide and may affect left ventricular (LV) geometry and function. The aim of this study was to investigate the impact of obesity on prevalence of left ventricular hypertrophy (LVH) and diastolic dysfunction in children. In this analysis of prospectively collected cross-sectional data of children between 5 and 16 years of age from randomly selected schools in Peru, parameters of LV geometry and function were compared according to presence or absence of obesity (body mass index z-score > 2). LVH was based on left ventricular mass index (LVMI) adjusted for age and sex and defined by a z-score of > 2. LV diastolic function was assessed using mitral inflow early-to-late diastolic flow (E/A) ratio, peak early diastolic tissue velocities of the lateral mitral annulus (E′), early diastolic transmitral flow velocity to tissue Doppler mitral annular early diastolic velocity (E/E′) ratio, and left atrial volume index (LAVI). Among 1023 children, 681 children (mean age 12.2 ± 3.1 years, 341 male (50.1%)) were available for the present analysis, of which 150 (22.0%) were obese. LVH was found in 21 (14.0%) obese and in 19 (3.6%) non-obese children (p_adjusted < 0.001). LVMI was greater in obese than that in non-obese children (36.1 ± 8.6 versus 28.7 ± 6.9 g/m^2.7, p < 0.001). The mean mitral E/E′ ratio and LAVI were significantly higher in obese than those in non-obese individuals (E/E′: 5.2 ± 1.1 versus 4.9 ± 0.8, p_adjusted = 0.043; LAVI 11.0 ± 3.2 versus 9.6 ± 2.9, p_adjusted = 0.001), whereas E′ and E/A ratio were comparable. Childhood obesity was associated with left ventricular hypertrophy and determinants of diastolic dysfunction.

ClinicalTrials.gov Identifier: NCT02353663.

Biomarkers Predictive of Extubation and Survival of COVID-19 Patients

Purpose

Many patients with COVID-19 who develop acute respiratory distress syndrome (ARDS) require prolonged periods of mechanical ventilation. Mechanical ventilation may amplify ventilator-associated complications and extend resource utilization. A better understanding of prognostic indicators could help in the planning and distribution of resources, particularly in resource-limited areas. We analyzed laboratory studies of intubated COVID-19 patients with the goal of identifying biomarkers that may predict extubation success and survival to discharge.

Methods

A retrospective chart review was performed on all COVID-19 patients requiring mechanical ventilation between January 3, 2020, and January 7, 2020, in a single academic tertiary care center in Northeastern New York State. The electronic medical record was used to collect 14 laboratory variables at three time points: admission, intubation, and extubation (including terminal extubation) for all intubated intensive care unit (ICU) patients treated for COVID-19. Mean laboratory values were analyzed with the Mann-Whitney U test. Categorical variables were analyzed with the two-sample Wilcoxon rank-sum test.

Results

Seventy-two patients met the inclusion criteria. Forty-three patients were male. The mean age was 61 years. The overall mortality was 50%. On admission, intubated patients who survived had significantly higher platelet counts (p=0.024), and absolute lymphocyte counts (ALC; p=0.047). Notably, ferritin (p=0.018) and aspartate transaminase (AST; p=0.0045) levels were lower in survivors.

At the time of intubation, survivors again had a higher platelet count (p=0.024) and ALC (p=0.037) levels. They had a lower D-dimer (p=0.0014), ferritin (p=0.0015), lactate dehydrogenase (LDH; p=0.0145), and AST (p=0.018) compared to intubated patients who died.

At extubation, survivors had higher platelet count (p=0.0002), ALC (p=0.0013), and neutrophil/lymphocyte ratio (NLR; p=0.0024). Survivors had lower d-dimer (p=0.035), ferritin (p=0.0012), CRP (p=0.045), LDH (p=0.002), AST (p<0.001), and ALK (p=0.0048).

Conclusions

Biomarkers associated with increased risk of mortality include platelet count, ALC, lymphocyte percentage, NLR, D-dimer, ferritin, C-reactive protein (CRP), AST, alanine transaminase (ALT), and alkaline phosphatase (ALK). This study provides additional evidence that these biomarkers have prognostic value in patients with severe COVID-19. The goal is to find objective surrogate markers of disease improvement or success of extubation. When considered within the larger body of data, it is our hope that a mortality risk calculator can be generated for intubated COVID-19 patients.

Novel Bloch wave excitation platform based on few-layer photonic crystal deposited on D-shaped optical fiber

With the goal of ultimate control over the light propagation, photonic crystals currently represent the primary building blocks for novel nanophotonic devices. Bloch surface waves (BSWs) in periodic dielectric multilayer structures with a surface defect is a well-known phenomenon, which implies new opportunities for controlling the light propagation and has many applications in the physical and biological science. However, most of the reported structures based on BSWs require depositing a large number of alternating layers or exploiting a large refractive index (RI) contrast between the materials constituting the multilayer structure, thereby increasing the complexity and costs of manufacturing. The combination of fiber-optic-based platforms with nanotechnology is opening the opportunity for the development of high-performance photonic devices that enhance the light-matter interaction in a strong way compared to other optical platforms. Here, we report a BSW-supporting platform that uses geometrically modified commercial optical fibers such as D-shaped optical fibers, where a few-layer structure is deposited on its flat surface using metal oxides with a moderate difference in RI. In this novel fiber optic platform, BSWs are excited through the evanescent field of the core-guided fundamental mode, which indicates that the structure proposed here can be used as a sensing probe, along with other intrinsic properties of fiber optic sensors, as lightness, multiplexing capacity and easiness of integration in an optical network. As a demonstration, fiber optic BSW excitation is shown to be suitable for measuring RI variations. The designed structure is easy to manufacture and could be adapted to a wide range of applications in the fields of telecommunications, environment, health, and material characterization.

Model of End-Stage Liver Disease (MELD) Score as a Predictor of In-Hospital Mortality in Patients with COVID-19: A Novel Approach to a Classic Scoring System

Background Limited data is available for reliable and accurate predictors of in-hospital mortality in patients diagnosed with COVID-19. Methods This scientific study is a retrospective cohort study of patients without a known history of liver diseases who were hospitalized with COVID-19 viral infection. Patients were stratified into low score groups (Model of End-Stage Liver Disease [MELD] score <10) and high score groups (MELD ≥10). Clinical outcomes were evaluated, including in-hospital mortality, hospital length of stay, and intensive care unit length of stay (ICU LOS).  Results Our cohort of 186 COVID-19 positive patients included 88 (47%) women with a mean age of 60 years in the low score group and mean age of 73 years in the high score group. Patients in the high score group were older in age (p<0.0001) and more likely to have history of diabetes mellitus (p=0.0020), stage 3 chronic kidney disease (CKD) (p=0.0013), hypertension (p<0.0001), stroke/transient ischemic attack (TIA) (p=0.0163), asthma (p=0.0356), dementia (p<0.0001), and chronic heart failure (p=0.0055). The in-hospital mortality or discharge to hospice rate was significantly higher in the high-score group as opposed to the low-score group (p=0.0014). Conversely, there was no significant difference among both groups in the hospital length of stay (LOS) and ICU LOS (p=0.6929 and p=0.7689, respectively). Conclusion Patients hospitalized with COVID-19 infection and found to have a MELD score greater than or equal to 10 were found to have a higher mortality as compared to their counterparts. Conversely a low MELD score is a very strong indicator of a more favorable prognosis, indicating hospital survival. We propose using the MELD score as an adjunct for risk stratifying patients diagnosed with COVID-19 without prior history of liver dysfunction.

SARS-CoV-2 3D database: understanding the coronavirus proteome and evaluating possible drug targets

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a rapidly growing infectious disease, widely spread with high mortality rates. Since the release of the SARS-CoV-2 genome sequence in March 2020, there has been an international focus on developing target-based drug discovery, which also requires knowledge of the 3D structure of the proteome. Where there are no experimentally solved structures, our group has created 3D models with coverage of 97.5% and characterized them using state-of-the-art computational approaches. Models of protomers and oligomers, together with predictions of substrate and allosteric binding sites, protein-ligand docking, SARS-CoV-2 protein interactions with human proteins, impacts of mutations, and mapped solved experimental structures are freely available for download. These are implemented in SARS CoV-2 3D, a comprehensive and user-friendly database, available at https://sars3d.com/. This provides essential information for drug discovery, both to evaluate targets and design new potential therapeutics.

Histatin-1 is a novel osteogenic factor that promotes bone cell adhesion, migration, and differentiation

Histatin-1 is a salivary antimicrobial peptide involved in the maintenance of enamel and oral mucosal homeostasis. Moreover, Histatin-1 has been shown to promote re-epithelialization in soft tissues, by stimulating cell adhesion and migration in oral and dermal keratinocytes, gingival and skin fibroblasts, endothelial cells and corneal epithelial cells. The broad-spectrum activity of Histatin-1 suggests that it behaves as a universal wound healing promoter, although this is far from being clear yet. Here, we report that Histatin-1 is a novel osteogenic factor that promotes bone cell adhesion, migration, and differentiation. Specifically, Histatin-1 promoted cell adhesion, spreading, and migration of SAOS-2 cells and MC3T3-E1 preosteoblasts in vitro, when placed on a fibronectin matrix. Besides, Histatin-1 induced the expression of osteogenic genes, including osteocalcin, osteopontin, and Runx2, and increased both activity and protein levels of alkaline phosphatase. Furthermore, Histatin-1 promoted mineralization in vitro, as it augmented the formation of calcium deposits in both SAOS-2 and MC3T3-E1 cells. Mechanistically, although Histatin-1 failed to activate ERK1/2, FAK, and Akt, which are signaling proteins associated with osteogenic differentiation or cell migration, it triggered nuclear relocalization of β-catenin. Strikingly, the effects of Histatin-1 were recapitulated in cells that are nonosteogenically committed, since it promoted surface adhesion, migration, and the acquisition of osteogenic markers in primary mesenchymal cells derived from the apical papilla and dental pulp. Collectively, these observations indicate that Histatin-1 is a novel osteogenic factor that promotes bone cell differentiation, surface adhesion and migration, as crucial events required for bone tissue regeneration.

Cardiac Troponin-I and COVID-19: A Prognostic Tool for In-Hospital Mortality

BACKGROUND

The number of fatalities due to coronavirus disease 2019 (COVID-19) is escalating with more than 800,000 deaths globally. The scientific community remains in urgent need of prognostic tools to determine the probability of survival in patients with COVID-19 and to determine the need for hospitalization.

METHODS

This is a retrospective cohort study of patients with a diagnosis of COVID-19 admitted to a tertiary center between March 2020 and July 2020. Patients age 18 years and older were stratified into two groups based on their troponin-I level in the first 24 h of admission (groups: elevated vs. normal). The aim of the study is to explore the utility of cardiac troponin-I level for early prognostication of patients with COVID-19.

RESULTS

This cohort of 257 patients included 122/257 (47%) women with a mean age of 63 ± 17 years. Patients with an elevated troponin-I level were more likely to be older (77 ± 13 vs. 58 ± 16 years, P < 0.0001), have a history of hypertension (P < 0.0001), diabetes mellitus (P = 0.0019), atrial fibrillation or flutter (P = 0.0009), coronary artery disease (P < 0.0001), and chronic heart failure (P = 0.0011). Patients with an elevated troponin-I level in the first 24 h of admission were more likely to have higher in-hospital mortality (52% vs. 10%, P < 0.0001). Troponin-I level in the first 24 h of admission had a negative predictive value of 89.7% and a positive predictive value of 51.9% for all-cause in-hospital mortality.

CONCLUSIONS

Troponin-I elevation is commonly seen in patients with COVID-19 and is significantly associated with fatal outcomes. However, a normal troponin-I level in the first 24 h of admission had a high negative predictive value for all-cause in-hospital mortality, thereby predicting favorable survival at the time of discharge.

The Effect of Hydroxychloroquine on In-Hospital Mortality in COVID-19

Background

Hydroxychloroquine (HCQ) is an antimalarial medication that has been tested against various viral illnesses. The available evidence regarding the role of HCQ in the coronavirus disease 2019 (COVID-19) remains controversial.

Methods

This is a comparative retrospective cohort study that aims to evaluate the efficacy and safety of HCQ in hospitalized patients with COVID-19. The primary outcome was all-cause in-hospital mortality. Secondary outcomes included ICU admission rate, mechanical ventilation, prolonged length of stay (LOS), QTc prolongation and cardiac arrest.

Results

A cohort of 175 hospitalized patients with COVID-19 were included with a median (interquartile range [IQR]) age of 66 [48-79] years. Of whom, 82 (47%) patients received HCQ. The overall mortality rate was 34.1%; 95% CI [23.7-44.6] and 16.1%; 95% CI [8.5-23.7] in the HCQ group vs. the control group, respectively (p = 0.67). A Cox regression analysis was performed adjusting for age, gender, BMI, SpO2/FiO2 ratio and CXR findings, and demonstrated that the association between HCQ use and the all-cause in-hospital mortality was not statistically significant (HR = 1.15; 95% CI [0.54-2.48]; p-value = 0.72). Patients who received HCQ were more likely to be admitted to the intensive care unit, require mechanical ventilation and have a prolonged LOS compared to those who did not receive the medication. No statistically significant difference was found in the likelihood of QTc prolongation or cardiac arrest.

Conclusions

The use of HCQ in patients hospitalized with COVID-19 confers no benefit in patient morbidity or mortality.

Abstract P144: Covid-19 And The Use Of Angiotensin-converting Enzyme Inhibitors And Receptor Blockers. Real World Experience

Background: Concerns exist that angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs) increase susceptibility to coronavirus SARS CoV-2 (the virus that causes the disease COVID-19) and the likelihood of severe COVID-19 illness.

Methods: This is a single-center retrospective cohort study of 172 patients diagnosed with 2019 Novel Coronavirus (SARS-CoV-2) between March of 2020 and May of 2020. Our study aimed to investigate the impact of ACEI and/or ARBs on the in-hospital mortality, intensive care unit (ICU) admission, hospital length of stay (LOS), and ICU LOS of patients with COVID-19.

Results: This cohort of 172 patients included 88 (51%) women with a mean age of 58±17 years. Patients who had a history of using ACEI/ARBs were older 68±14 vs. 54±17 (P<0.0001). They were more likely to be obese 28(65%) vs. 52(40%) p=0.0054, have hypertension 44(100%) vs 42(33%) p<0.0001, diabetes mellitus 18(40%) vs 13 (10%) p<0.0001, and chronic kidney disease 5(11%) vs. 1(0.8%) p= 0.0011 than patients not using ACEI/ARBs. On the other hand, the prevalence of coronary artery disease (p=0.3791), and chronic heart failure (p=0.8037) was similar between the two groups.

Outcomes: There was significantly higher in-hospital mortality in patients who used ACEI/ARBs than non-users (33% vs. 13%, p=0.0039, respectively). To evaluate the effect of ACEI/ARBs on mortality after controlling for confounding factors, multivariable logistic regression (MLR) was performed based on age (p=0.0003), obesity (p=0.3394), hypertension (p=0.4159), diabetes mellitus (p=0.0144), and chronic kidney disease (0.3189). The MLR showed no significant differences in mortality between patients who used ACEI/ARBs and non-users (p= 0.8372). Admission to ICU was more likely in patients who used ACEI/ARBs than non-users (28% vs. 13%, p=0.0384 respectively), while hospital LOS (6±9 vs. 4±6, p=0.1240 respectively), and ICU LOS (12±12 vs. 8±5, p= 0.3253 respectively) were similar between the two groups.

Conclusion: This study suggests that the use of ACEI/ARBs associated with higher mortality in patients with COVID-19. This is likely attributed to the fact that patients who use these medications are older and are more likely to have diabetes mellitus and hypertension.

The invader Carpobrotus edulis promotes a specific rhizosphere microbiome across globally distributed coastal ecosystems

The importance of plant-microbe interactions to the success of invasive plants has rarely been studied at a global scale. Carpobrotus edulis (L.) N. E. Br is an aggressive invader in many areas around the world, forming dense mats in coastal environments. In an approach at a large geographical scale, over a wide latitudinal and climatic range, we tested the ability of C. edulis to alter the local bacterial and fungal community structure and microbial activity in eight invaded coastal locations. The factors invasiveness and geographical location had a significant effect on the soil microbiota, the microbial community composition and structure from the rhizosphere of native and C. edulis plants being distinct in every location. The effect of the invader on all the chemical, physico-chemical, and microbiological properties studied depended on the invaded location. The soil bacterial and fungal community composition and structure were related to the soil available nutrients and mean annual rainfall, and those of the soil bacterial community were also linked to the soil respiration and latitude. Overall, our results reveal that the ability of the invader C. edulis to alter soil microbial community structure harboring a specific microbiome was widespread across a large invaded range - leading to concurring changes in the rhizosphere microbial functioning, such as nutrient cycling.

Bloch waves at the surface of a single-layer coating D-shaped photonic crystal fiber

Bloch surface wave (BSW) platforms are particularly interesting for light confinement and surface sensitivity, as an alternative to the metal-based surface plasmon polaritons (SPP). However, most of the reported BSW platforms require depositing a large number of alternating dielectric layers to realize the excitation of the surface waves. In this Letter, we demonstrate an experimentally feasible D-shaped photonic crystal fiber (PCF) platform consisting of only a single dielectric layer on its flat surface, which can sustain Bloch waves at the boundary between the dielectric layer and the PCF cladding. The presence of the dielectric layer modifies the local effective refractive index, enabling a direct manipulation of the BSWs. In addition, the D-shaped structure provides direct contact with the external medium for sensing applications with an ultrahigh sensing figure of merit ($2451\;{{\rm RIU}^{ - 1}}$2451RIU^-1) and has the potential to be used over a wide range of analyte refractive indices.

Identification of 2-((2,3-dihydrobenzo[b][1,4]dioxin-6-yl)amino)-N-phenylpropanamides as a novel class of potent DprE1 inhibitors

The identification of a novel series of DprE1 inhibitors based on a 2-((2,3-dihydrobenzo[b][1,4]dioxin-6-yl)amino)-N-phenylpropanamide scaffold is described herein. SAR exploration around the HTS hit 1 led to the identification of multiple analogues with potent DprE1 inhibition and good whole-cell antimycobacterial activity.

Cannabinoid hyperemesis syndrome, a treatment discussion

Introduction

Cannabinoid hyperemesis syndrome (CHS), is characterized by recurrent episodes of severe nausea and intractable vomiting, preceded by chronic use of cannabis. A pathognomonic characteristic is compulsive bathing in hot water. The resolution of the problem occurs when cannabis use is stopped. However, patients are often reluctant to discontinue cannabis. Treatment with anti-emetic medication is ineffective. Case series suggested haloperidol as a potential treatment. Other antipsychotics as olanzapine has been used as anti-emetic treatment in chemotherapy.

Objectives

To describe three cases of patients with CHS whom showed a successful response to olanzapine, even when, haloperidol had failed.

Aims

To present an alternative treatment for CHS which can offer benefits over haloperidol.

Methods

We present three cases of patients who suffered from CHS and were admitted to emergency department. All patients were treated with olanzapine after conventional anti-hemetic treatment failure. One patient was also unsuccessfully treated with haloperidol.

Results

All three patients showed a good response to olanzapine treatment. Different presentations were effective: velotab and intramuscular. Their nausea, vomits and agitation were ameliorated. They could be discharge after maintained remission of symptoms.

Conclusions

Olanzapine should be considered as an adequate treatment for CHS. Its suitable receptorial profile, its availability in different routes of administration and its side effects profile could offer some benefits over haloperidol.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Comparison of brain microstructure after prenatal spina bifida repair by either laparotomy-assisted fetoscopic or open approach

OBJECTIVE

To compare prenatal and postnatal brain microstructure between infants that underwent fetoscopic myelomeningocele (MMC) repair and those that had open-hysterotomy repair.

METHODS

This was a longitudinal retrospective cohort study of 57 fetuses that met the Management of Myelomeningocele Study (MOMS) trial criteria and underwent prenatal MMC repair, by a fetoscopic (n = 27) or open-hysterotomy (n = 30) approach, at 21.4-25.9 weeks' gestation. Fetoscopic repair was performed under CO₂ insufflation, according to our protocol. Diffusion-weighted magnetic resonance imaging (MRI) was performed before surgery in 30 cases (14 fetoscopic and 16 open), at 6 weeks postsurgery in 48 cases (24 fetoscopic and 24 open) and within the first year after birth in 23 infants (five fetoscopic and 18 open). Apparent diffusion coefficient (ADC) values from the basal ganglia, frontal, occipital and parietal lobes, mesencephalon and genu as well as splenium of the corpus callosum were calculated. ADC values at each of the three timepoints (presurgery, 6 weeks postsurgery and postnatally) and the percentage change in the ADC values between the timepoints were compared between the fetoscopic-repair and open-repair groups. ADC values at 6 weeks after surgery in the two prenatally repaired groups were compared with those in a control group of eight healthy fetuses that underwent MRI at a similar gestational age (GA). Comparison of ADC values was performed using the Student's t-test for independent samples (or Mann-Whitney U-test if non-normally distributed) and multivariate general linear model analysis, adjusting for GA or age at MRI and mean ventricular width.

RESULTS

There were no differences in GA at surgery or GA/postnatal age at MRI between the groups. No significant differences were observed in ADC values in any of the brain areas assessed between the open-repair and fetoscopic-repair groups at 6 weeks after surgery and in the first year after birth. No differences were detected in the ADC values of the studied areas between the control and prenatally repaired groups, except for significantly increased ADC values in the genu of the corpus callosum in the open-hysterotomy and fetoscopic-repair groups. Additionally, there were no differences between the two prenatally repaired groups in the percentage change in ADC values at any of the time intervals analyzed.

CONCLUSIONS

Fetoscopic MMC repair has no detectable effect on brain microstructure when compared to babies repaired using an open-hysterotomy technique. CO₂ insufflation of the uterine cavity during fetoscopy does not seem to have any isolated deleterious effects on fetal brain microstructure. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

The Genome3D Consortium for Structural Annotations of Selected Model Organisms

Genome3D consortium is a collaborative project involving protein structure prediction and annotation resources developed by six world-leading structural bioinformatics groups, based in the United Kingdom (namely Blundell, Murzin, Gough, Sternberg, Orengo, and Jones). The main objective of Genome3D serves as a common portal to provide both predicted models and annotations of proteins in model organisms, using several resources developed by these labs such as CATH-Gene3D, DOMSERF, pDomTHREADER, PHYRE, SUPERFAMILY, FUGUE/TOCATTA, and VIVACE. These resources primarily use SCOP- and/or CATH-based protein domain assignments. Another objective of Genome3D is to compare structural classifications of protein domains in CATH and SCOP databases and to provide a consensus mapping of CATH and SCOP protein superfamilies. CATH/SCOP mapping analyses led to the identification of total of 1429 consensus superfamilies.Currently, Genome3D provides structural annotations for ten model organisms, including Homo sapiens, Arabidopsis thaliana, Mus musculus, Escherichia coli, Saccharomyces cerevisiae, Caenorhabditis elegans, Drosophila melanogaster, Plasmodium falciparum, Staphylococcus aureus, and Schizosaccharomyces pombe. Thus, Genome3D serves as a common gateway to each structure prediction/annotation resource and allows users to perform comparative assessment of the predictions. It, thus, assists researchers to broaden their perspective on structure/function predictions of their query protein of interest in selected model organisms.

Tunable Whispering Gallery Mode Photonic Device Based on Microstructured Optical Fiber with Internal Electrodes

We propose and experimentally demonstrate the first tunable whispering gallery mode (WGM) photonic device based on side-hole microstructured optical fiber (SH-MOF) with internal electrodes, in which the WGM quality factors do not decrease significantly during the tuning process. The resonant modes are redshifted simply by increasing the temperature. A description of the thermal tuning properties of the WGMs in SH-MOF with internal electrodes is performed by using a two-stage computational methodology, where the effects of metal filling process are considered. SH-MOF devices with internal electrodes are tested and the experimental results show excellent agreement with the theory. A linear relationship between the shift rate of the WGM modes and temperature is observed. The tunable SH-MOF microresonator with internal electrodes is anticipated to find potential applications in optical filtering, optical switching, and highly integrated tunable photonic devices.

Bloch surface wave resonance in photonic crystal fibers: towards ultra-wide range refractive index sensors

In this work, a new approach based on the use of a one-dimensional photonic crystal (1DPC) made of dielectric layers with alternating refractive indexes deposited inside a photonic crystal fiber (PCF) is proposed as a suitable platform for the excitation of Bloch surface waves (BSWs). The presence of an additional dielectric layer on the 1DPC modifies the local effective refractive index, enabling a direct manipulation of the BSWs. In particular, we investigate BSW resonance conditions in a 1DPC of alternating layers of TiO₂ and SiO₂ deposited inside a three-hole suspended-core PCF to design an ultra-wide range refractive index sensor in the near infrared. The obtained simulation results indicate that BSW sensors based on PCF could be an alternative to surface plasmon resonance (SPR) sensors, with a ultrahigh sensing figure-of-merit, which might facilitate applications in high-resolution refractive index sensing.

Reliability and validity of self-reported questionnaires to measure pain and disability in adults with neck pain and its associated disorders: part 3-a systematic review from the CADRE Collaboration

PURPOSE

To determine the reliability and validity of self-reported questionnaires to measure pain and disability in adults with grades I-IV neck pain and its associated disorders (NAD).

METHODS

We updated the systematic review of the 2000-2010 Bone and Joint Decade Task Force on Neck Pain and its Associated Disorders and systematically searched databases from 2005 to 2017. Independent reviewers screened and critically appraised studies using standardized tools. Evidence from low-risk-of-bias studies was synthesized according to best evidence synthesis principles. Validity studies were ranked according to the Sackett and Haynes classification.

RESULTS

We screened 2823 articles, and 26 were eligible for critical appraisal; 18 were low risk of bias. Preliminary evidence suggests that the Neck Disability Index (original and short versions), Whiplash Disability Questionnaire, Neck Pain Driving Index, and ProFitMap-Neck may be valid and reliable to measure disability in patients with NAD. We found preliminary evidence for the validity and reliability of pain measurements including the Body Pain Diagram, Visual Analogue Scale, the Numeric Rating Scale and the Pain-DETECT Questionnaire.

CONCLUSION

The evidence supporting the validity and reliability of instruments used to measure pain and disability is preliminary. Further validity studies are needed to confirm the clinical utility of self-reported questionnaires to assess pain and disability in patients with NAD. These slides can be retrieved under Electronic Supplementary Material.

Prenatal brain imaging for predicting need for postnatal hydrocephalus treatment in fetuses that had neural tube defect repair in utero

OBJECTIVE

To determine if brain imaging in fetuses that underwent prenatal repair of neural tube defect (NTD) can predict the need for postnatal hydrocephalus treatment (HT) in the first year postpartum.

METHODS

This was a retrospective study of fetuses diagnosed with open NTD that had in-utero myelomeningocele repair between April 2014 and April 2016. Independent variables were collected from four chronological sets of fetal images: presurgery ultrasound, presurgery magnetic resonance imaging (MRI), 6-week postsurgery MRI and predelivery ultrasound. The following independent variables were collected from all image sets unless otherwise noted: gestational age, head circumference, mean ventricular width, ventricular volume (MRI only), hindbrain herniation (HBH) score (MRI only), and level of lesion (LOL), defined as the upper bony spinal defect (presurgery ultrasound only). Based on these measurements, additional variables were defined and calculated including change in degree of HBH, ventricular width growth (mm/week) and ventricular volume growth (mL/week). The need for HT (by either ventriculoperitoneal shunt or endoscopic third ventriculostomy with choroid plexus cauterization) was determined by a pediatric neurosurgeon using clinical and radiographic criteria; a secondary analysis was performed using the MOMS trial criteria for hydrocephalus. The predictive value of each parameter was assessed by receiver-operating characteristics curve and logistic regression analyses.

RESULTS

Fifty affected fetuses were included in the study, of which 32 underwent open hysterotomy and 18 fetoscopic repair. Two neonates from the open hysterotomy group died and were excluded from the analysis. The mean gestational ages for the presurgery ultrasound, presurgery MRI, postsurgery MRI and predelivery ultrasound were 21.8 ± 2.1, 22.0 ± 1.8, 30.4 ± 1.6 and 31.0 ± 4.9 weeks, respectively. A total of 16 subjects required HT. The area under the curve (AUC) of predictive accuracy for HT showed that HBH grading on postsurgery MRI had the strongest predictive value (0.86; P < 0.01), outperforming other predictors such as postsurgery MRI ventricular volume (0.73; P = 0.03), MRI ventricular volume growth (0.79; P = 0.01), change in HBH (0.82; P = 0.01), and mean ventricular width on predelivery ultrasound (0.73; P = 0.01). Other variables, such as LOL, mean ventricular width on presurgery ultrasound, mean ventricular width on presurgery and postsurgery MRI, and ventricular growth assessment by MRI or ultrasound, had AUCs < 0.7. Optimal cut-offs of the variables with the highest AUC were evaluated to improve prediction. A combination of ventricular volume growth ≥ 2.02 mL/week and/or HBH of 3 on postsurgery MRI were the optimal cut-offs for the best prediction (odds ratio (OR), 42 (95% CI, 4-431); accuracy, 84%). Logistic regression analyses showed that persistence of severe HBH 6 weeks after surgery by MRI is one of the best predictors for HT (OR, 39 (95% CI, 4-369); accuracy, 84%). There was no significant change in the results when the MOMS trial criteria for hydrocephalus were used as the dependent variable.

CONCLUSIONS

Persistence of HBH on MRI 6 weeks after prenatal NTD repair independently predicted the need for postnatal HT better than any ultrasound- or other MRI-derived measurements of ventricular characteristics. These results should aid in prenatal counseling and add support to the hypothesis that HBH is a significant driver of hydrocephalus in myelomeningocele patients. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.