Setting up regional diagnostic reference levels for pediatric interventional cardiology in Latin America and the Caribbean countries: preliminary results and identified challenges

The goal of the present study was to propose a set of preliminary regional diagnostic reference levels (DRLs) for pediatric interventional cardiology (IC) procedures in Latin America and the Caribbean countries, classified by age and weight groups. The study was conducted in the framework of the Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean program coordinated by the World Health Organization and the Pan American Health Organization in cooperation with the International Atomic Energy Agency. The first step of the program was focused on pediatric IC. Dose data from diagnostic and therapeutic procedures were collected between December 2020 and December 2021. Regional DRLs were set as the third quartile of patient dose data (kerma area product) collected in 18 hospitals from 10 countries in an initial sample of 968 procedures. DRLs were set for four age bands and five weight ranges. The values obtained for the four age bands (<1 yr, 1 to <5 yr, 5 to <10 yr and 10 to <16 yr) were 2.9, 6.1, 8.8 and 14.4 Gy cm²for diagnostic procedures, and 4.0, 5.0, 10.0 and 38.1 Gy cm²for therapeutic procedures, respectively. The values obtained for the five weight bands (<5 kg, 5 to <15 kg, 15 to <30 kg, 30 to <50 kg and 50 to <80 kg) were 3.0, 4.5, 8.1, 9.2 and 26.8 Gy cm²for diagnostic procedures and 3.7, 4,3, 7.3, 16.1 and 53.4 Gy cm²for therapeutic procedures, respectively. While initial data were collected manually as patient dose management systems (DMSs) were not available in most of the hospitals involved in the program, a centralized automatic DMS for the collection and management of patient dose indicators has now been introduced and is envisaged to increase the sample size. The possibility of alerting on high dose values and introducing corrective actions will help in optimization.

Scintillation light detection in the 6-m drift-length ProtoDUNE Dual Phase liquid argon TPC

DUNE is a dual-site experiment for long-baseline neutrino oscillation studies, neutrino astrophysics and nucleon decay searches. ProtoDUNE Dual Phase (DP) is a 6  ×  6  ×  6 m 3 liquid argon time-projection-chamber (LArTPC) that recorded cosmic-muon data at the CERN Neutrino Platform in 2019-2020 as a prototype of the DUNE Far Detector. Charged particles propagating through the LArTPC produce ionization and scintillation light. The scintillation light signal in these detectors can provide the trigger for non-beam events. In addition, it adds precise timing capabilities and improves the calorimetry measurements. In ProtoDUNE-DP, scintillation and electroluminescence light produced by cosmic muons in the LArTPC is collected by photomultiplier tubes placed up to 7 m away from the ionizing track. In this paper, the ProtoDUNE-DP photon detection system performance is evaluated with a particular focus on the different wavelength shifters, such as PEN and TPB, and the use of Xe-doped LAr, considering its future use in giant LArTPCs. The scintillation light production and propagation processes are analyzed and a comparison of simulation to data is performed, improving understanding of the liquid argon properties.

The contribution of intermolecular spin interactions to the London dispersion forces between chiral molecules

Dispersion interactions are one of the components of van der Waals (vdW) forces that play a key role in the understanding of intermolecular interactions in many physical, chemical, and biological processes. The theory of dispersion forces was developed by London in the early years of quantum mechanics. However, it was only in the 1960s that it was recognized that for molecules lacking an inversion center, such as chiral and helical molecules, there are chirality-sensitive corrections to the dispersion forces proportional to the rotatory power known from the theory of circular dichroism and with the same distance scaling law R^-6 as the London energy. The discovery of the chirality-induced spin selectivity effect in recent years has led to an additional twist in the study of chiral molecular systems, showing a close relation between spin and molecular geometry. Motivated by it, we propose in this investigation to describe the mutual induction of charge and spin-density fluctuations in a pair A-B of chiral molecules by a simple physical model. The model assumes that the same fluctuating electric fields responsible for vdW forces can induce a magnetic response via a Rashba-like term so that a spin-orbit field acting on molecule B is generated by the electric field arising from charge density fluctuations in molecule A (and vice versa). Within a second-order perturbative approach, these contributions manifest as an effective intermolecular exchange interaction. Although expected to be weaker than the standard London forces, these interactions display the same R^-6 distance scaling.

AB0775 Efficacy, safety and survival of Secukinumab in spondyloarthritis

Background

Secukinumab (SCK) is a fully human monoclonal antibody that selectively inhibits IL-17A indicated for both axial and peripheral spondyloarthritis (SpA) and psoriatic arthritis (PsA). In this paper we present our experience with SCK since its approval, in a tertiary hospital.

Objectives

To describe the efficacy, survival and safety of SCK treatment in real clinical practice in patients with SpA and PsA.

Methods

We performed a descriptive, retrospective analysis of patients diagnosed with SpA according to ASAS criteria and PsA according to CASPAR criteria. For this purpose, data were collected from the medical records of 75 patients treated with SCK in the rheumatology service.

To evaluate efficacy in the Spa group, analytical variables (C-reactive protein (CRP)), the Ankylosing Spondylitis Disease Activity Score (ASDAS) scale and the patient’s visual analog scale (VAS) were analyzed. In the PA group, VAS and CRP were assessed at baseline and at 12 months. Survival was evaluated with respect to the causes of drug discontinuation and its association with individual baseline characteristics, such as metabolic syndrome. Safety was evaluated by analyzing intercurrent infections or neoplasms requiring discontinuation.

Results

Seventy-five patients with spondyloarthritis included in treatment with SCK were analyzed, 40 had Spa and 34 had PAs. The mean age at diagnosis was 45.1 years (SD 11.3) and the median time from diagnosis to onset of SCK was 4.5 years (IQR 1-10) (Table 1).

Table 1.

Baseline characteristics

SpAAPsTotalAge at diagnosis45.1 (SD11.8)44.9 (SD10.9)45.1 (SD11.3)Age at begging of SCK53.5 (SD 9.3)52.2 (SD 10)52.9 (9.6DE)Hypertension10 (25.0%)10 (29.4%)20 (27.0%)Dyslipidaemia17 (42.5%)17 (51.5%)34 (46.6%)Diabetes mellitus5 (12.5%)6 (17.6%)11 (14.9%)Body Mass Index27.9 (SD4.4)30.5 (SD8.4)29.2 (SD6.7)Tobacco14 (35.0%)10 (29.4%)24 (32.4%)Cardiovascular disease5 (12.5%)2 (5.9%)7 (9.5%)Previous sDMARD-Methotrexate13 (32.5%)24 (70.6%)37 (50%)-Leflunomide1.7% (15%)12 (35.3%)18 (24.2%)Initial corticosteroids7 (18.4%)15 (44.1%)22 (30.6%)

Fifty-seven patients (76%) were on treatment with anti-TNF prior to SCK initiation. The mean number of anti-TNF prior to SCK was 1.8 (SD 1.2). Twenty-six patients (35.1%) received were on treatment with SCK at a dose of 150 mg and 48 (64.9%) with 300 mg every 4 wk. The mean CRP before starting SCK was 8.46 mg/L (SD 18.38) and VAS 4.83 (SD 2.99).

Statistically significant improvement was observed in both pathologies in VAS (-2.1 SD 3.1) (p 0.003). Despite the improvement in CRP, in both groups of -3.7 mg/L (SD 15) was not statistically significant. Regarding ASDAS, in the Spa group, 2 patients (5.3%) showed great improvement (>3.1), 9 patients (23.7%) clinical improvement (>1.1), 17 patients (42.5%) improvement (<1.1), 6 patients (15%) showed no improvement and 4 patients (10.5%) worsening.

The overall drug survival to date is 19.41 months (SD 13.76), 20.6 months (SD 14.8) in the Spa group and 18 (SD 12.6) in the AP group (Figure 1).

Figure 1.

Secukinumab survival in both groups

17 patients (23%) discontinued treatment, with a median duration of 12 months (SD 4.66). 12 (70.6%) due to ineffectiveness, 1 (5.9%) by their own decision, 3 (17.6%) due to persistent mechanical pain and 1 (5.9%) due to neoplasia (gastric adenocarcinoma). The clinical variables of metabolic syndrome were evaluated (Table 1) none of these characteristics had a statistically significant association as a cause of drug discontinuation. No patient presented infections that required discontinuation of the drug. No association was detected between drug discontinuation or the development of metabolic syndrome.

Conclusion

In our cohort, SCK showed a statistically significant improvement in the VAS scale in both groups. A 23.7% of patients with Spa showed clinical improvement according to ASDAS values, 5.3% showed great improvement and 42.5% showed mild improvement. The overall drug survival to date is 19.41 months (SD 13.76) slightly longer in the SpA group than in APs. SCK seems to be a safe drug as none of our patients presented infections during its use.

Disclosure of Interests

None declared

AB0854 Descriptive and retrospective study of different types of spondyloarthritis and referral and diagnosis times

Background

Spondyloarthritis (SpA) is a group of inflammatory arthropathies of unknown aetiology that share several clinical, pathophysiological, serological and radiological features. In many cases the initial symptoms are insidious, leading to a delay in diagnosis and initiation of treatment. The time between the onset of symptoms and treatment is of vital importance for the prognosis of the disease.

Objectives

To describe the clinical characteristics of the SpA cohort, to analyse the number of months from symptom onset to referral to the rheumatology department and diagnosis of SpA, as well as differences according to the referring department.

Methods

Retrospective descriptive study of patients with a diagnosis of PsA according to the ASAS criteria and CASPAR criteria for the psoriatic arthritis subgroup (PsA), in a single hospital centre.

We collected demographic variables separated by subgroups of peripheral and axial SpA and PsA, age at diagnosis, time from symptom onset to referral to the rheumatology department and to diagnosis, as well as differences according to the department making the referral.

Results

Seventy-five patients with SpA were analysed, 40 had peripheral and axial SpA and 35 (46.66%) PsA. Thirty-six patients (49.3%) were female (Table 1). Patients with peripheral and axial SpA had a higher mean age at diagnosis than patients with PsA. 45.1 years (SD 11.3) was the mean age at diagnosis. 73.6% of patients were referred from primary care (PC), 9.4% from traumatology, 9.4% from rehabilitation (RH), 3.8% from dermatology and 3.8% from the emergency department. The median time from first symptom to referral to rheumatology was 31.4 (SD 57.2), 7.1 (SD 38.5), 21.7 (SD 51.4) months in peripheral and axial SpA, PsA and total respectively (Table 2). The service with the longest time between symptom onset and referral to rheumatology is PC and rehabilitation for all groups. The median time from first symptom to diagnosis was 43.1 (SD 55.1), 34.4 (SD 65.8) and 39.2 (SD 59.7) months for peripheral and axial SpA, PsA and total respectively (Table 2). The time from referral to rheumatology to diagnosis of peripheral and axial SpA was 12.2 (SD 19.4), PsA 17 (SD 39.3) and total 14.3(SD 29.5) months.

Table 1.

Demographic characteristics and time in months according to type of SpA.

Peripheral and axial SpAPsATotalAge at diagnosis45.1 (SD11.8)44.9 (SD10.9)45.1 (SD11.3)Female20 (51.3%)16 (47.1%)36 (49.3%)Hypertension10 (25.0%)10 (29.4%)20 (27.0%)Dyslipidaemia17 (42.5%)17 (51.5%)34 (46.6%)Diabetes mellitus5 (12.5%)6 (17.6%)11 (14.9%)Body Mass Index27.9 (SD4.4)30.5 (SD8.4)29.2 (SD6.7)Cardiovascular disease5 (12.5%)2 (5.9%)7 (9.5%)Cerebrovascular disease2 (5.0%)2 (5.9%)4 (5.4%)Depression1 (2.5%)1 (2.9%)2 (2.7%)Renal insufficiency1 (2.5%)1 (3.0%)2 (2.7%)Liver failure3 (7.5%)5 (14.7%)8 (10.8%)Time in months from 1st symptom to referral31.4 (SD57.2)7.1 (SD38.5)21.7 (SD51.4)  1Primary care30.9(SD10.9)7.01(SD34.1)21.07(SD35.2)  1Traumatology5 (SD1.25)5 (SD2.82)5 (SD1.48)  Rehabilitation36 (SD29.14)1927.5 (SD24.75)  7Dermatology13 (SD1.41)13 (SD1.41)  3Emergency service111Time from referral to diagnosis12.2 (SD19.4)17.0 (SD39.3)14.3 (SD29.5)Time from 1st symptom to diagnosis43.1 (SD55.1)34.4 (SD65.8)39.2 (SD59.7)

Conclusion

In our cohort, patients are referred to rheumatology mainly from PC, which in turn is the service with the longest delay, especially in the peripheral and axial SpA group. Patients with PsA take less time to be referred than patients with peripheral and axial SpA. Once referred to rheumatology, peripheral and axial SpA patients take less time to be diagnosed than those in the PsA group.

Disclosure of Interests

None declared

A nanographene disk rotating a single molecule gear on a Cu(111) surface

On Cu(111) surface and in interaction with a single hexa-tert-butylphenylbenzene molecule-gear, the rotation of a graphene nanodisk was studied using the large-scale atomic/molecular massively parallel simulator molecular dynamics simulator. To ensure a transmission of rotation to the molecule-gear, the graphene nanodisk is functionalized on its circumference bytert-butylphenyl chemical groups. The rotational motion can be categorized underdriving, driving and overdriving regimes calculating the locking coefficient of this mechanical machinery as a function of external torque applied to the nanodisk. The rotational friction with the surface of both the phononic and electronic contributions is investigated. For small size graphene nanodisks, the phononic friction is the main contribution. Electronic friction dominates for the larger disks putting constrains on the experimental way of achieving the transfer of rotation from a graphene nanodisk to a single molecule-gear.

Emotion production of facial expressions: A comparison of deaf and hearing children

The production of facial expressions is an important skill that allows children to share and adapt emotions during social interactions. While deaf children are reported to show delays in their social and emotion understanding, the way in which they produce facial expressions of emotions has been relatively unexplored. The present study investigated the production of facial expressions of emotions by young congenitally deaf children. Six facial expressions of emotions produced by 5 congenitally deaf children and 5 hearing children (control group) were filmed across three tasks: 1) voluntarily posed expression of emotion 2) responding to social stories 3) intentionally mimicking expressions of emotion. The recorded videos were analysed using a software based of the Facial Action Coding System (FACS), and then judged by adult raters using two different scales: according to the emotion elicited (i.e. accuracy) and the intensity of the emotion produced. The results of both measurement scales showed that all children (deaf and hearing) were able to produce socially recognisable prototypical configuration of facial expressions. However, the deaf children were rated by adults as expressing their emotions with greater intensity compared to the hearing children. The results suggest deaf children may show more exaggerated facial expressions of emotion, possibly to avoid any ambiguity in communication.

POS1355 THE REMITTING SERONEGATIVE SYMMETRICAL SYNOVITIS WITH PITTING EDEMA SYNDROME (RS3PE): REVIEW OF TEN YEARS AT A REFERENCE HOSPITAL

Background:

The Remitting Seronegative Symmetrical Synovitis with Pitting Edema Syndrome (RS3PE) is a rare rheumatological disease, considered a benign process.

Objectives:

This study aims to describe its clinical features and serological markers, and also to analyze its possible association with neoplasms.

Methods:

An observational retrospective study was performed to assess demographic and clinical characteristics of patients diagnosed from RS3PE at a reference hospital amongst the Rheumatology and Internal Medicine departments, from 2010 to 2021.

Results:

Twenty-seven patients were included, with a mean age of 82.74 y.o. (IC95% 80.45-85.04; range 66 to 93), and a 51.85% proportion of males. Only 22.22% were from rural areas.

All patients presented bilateral hand edema although some associated feet edema (40.74%) or morning stiffness (70.37%). Blood tests demonstrated anemia in 44.44% of patients. Inflammatory markers were elevated, such as C-Reactive Protein (29.23 mg/L, IC95% 18.17-40.29), erythrocyte-sedimentation rate (33.74 mm/hour, IC95% 24.22-43.26) and fibrinogen (531.6 mg/dL, IC95% 482.91-580.30). Only a few patients presented any autoimmune serological marker such as antinuclear antibodies (18.18%) or rheumatoid factor (8.70%).

X-ray screening was realized to 22 patients. 14 showed of osteoarthritis radiologic presentation, 4 had radiological findings of chondrocalcinosis and one of them presented both. Only one patient had bone erosion.

Malignancy screening was performed at diagnosis in only 29.63% of patients (all negative). During follow-up only two tumors were detected (mean accumulated follow-up: 40.37 months, IC95% 26.70-54.04; range 1 to 122) and there were adenocarcinoma primary neoplasms.

All but one patient received low-dose corticosteroids, with a good and rapid response in all cases. Three patients received treatment with methotrexate (2) or leflunomide (1).

Conclusion:

RS3PE must be contemplated in elderly patients presenting with bilateral hand pitting edema and articular symptoms. No specific biomarkers have been described, but inflammatory reaction is often found in the absence of rheumatoid arthritis biomarkers. Rapid response to corticosteroids is prevalent. Only two neoplasms were detected during follow-up.

References:

[1]Paira S, Graf C, Roverano S, Rossini J. Remitting seronegative symmetrical synovitis with pitting oedema: a study of 12 cases. Clin Rheumatol. 2002 May;21(2):146-9. doi: 10.1007/pl00011218. PMID: 12086166.

[2]Cobeta García JC, Martínez Burgui J. RS3PE syndrome or benign edematous polysynovitis in the elderly. Study of 8 cases. Rev Clin Esp. 1999 Dec;199(12):785-9. Spanish. PMID: 10687410.

[3]Moreno Obregón F, Del Castillo Madrigal M, Díaz Narváez F, Pérez Delgado FJ. RS3PE syndrome with positive rheumatoid factor. Reumatol Clin. 2019 Nov-Dec;15(6):e168-e169. English, Spanish. doi: 10.1016/j.reuma.2017.11.009. Epub 2017 Dec 15. PMID: 29254743

Disclosure of Interests:

None declared

Prospects for beyond the Standard Model physics searches at the Deep Underground Neutrino Experiment: DUNE Collaboration

The Deep Underground Neutrino Experiment (DUNE) will be a powerful tool for a variety of physics topics. The high-intensity proton beams provide a large neutrino flux, sampled by a near detector system consisting of a combination of capable precision detectors, and by the massive far detector system located deep underground. This configuration sets up DUNE as a machine for discovery, as it enables opportunities not only to perform precision neutrino measurements that may uncover deviations from the present three-flavor mixing paradigm, but also to discover new particles and unveil new interactions and symmetries beyond those predicted in the Standard Model (SM). Of the many potential beyond the Standard Model (BSM) topics DUNE will probe, this paper presents a selection of studies quantifying DUNE's sensitivities to sterile neutrino mixing, heavy neutral leptons, non-standard interactions, CPT symmetry violation, Lorentz invariance violation, neutrino trident production, dark matter from both beam induced and cosmogenic sources, baryon number violation, and other new physics topics that complement those at high-energy colliders and significantly extend the present reach.

Oral delivery of Hyperimmune bovine serum antibodies against CS6-expressing enterotoxigenic Escherichia coli as a prophylactic against diarrhea

BACKGROUND

. Oral administration of bovine antibodies active against enterotoxigenic Escherichia coli (ETEC) have demonstrated safety and efficacy against diarrhea in human challenge trials. The efficacy of bovine serum immunoglobulins (BSIgG) against recombinant colonization factor CS6 or whole cell ETEC strain B7A was assessed against challenge with the CS6-expressing B7A.

METHODS

. This was a randomized, double-blind, placebo-controlled trial in which healthy adults received oral hyperimmune BSIgG anti-CS6, anti-B7A whole cell killed or non-hyperimmune BSIgG (placebo) in a 1:1:1 ratio then challenged with ETEC B7A. Two days pre-challenge, volunteers began a thrice daily, seven day course of immunoprophylaxis. On day 3, subjects received 1 × 10¹⁰ CFUs of B7A. Subjects were observed for safety and the primary endpoint of moderate-severe diarrhea (MSD).

RESULTS

. A total of 59 volunteers received product and underwent ETEC challenge. The BSIgG products were well-tolerated across all subjects. Upon challenge, 14/20 (70%) placebo recipients developed MSD, compared to 12/19 (63%; p = .74) receiving anti-CS6 BSIgG and 7/20 (35%; p = .06) receiving anti-B7A BSIgG. Immune responses to the ETEC infection were modest across all groups.

CONCLUSIONS

. Bovine-derived serum antibodies appear safe and well tolerated. Antibodies derived from cattle immunized with whole cell B7A provided 50% protection against MSD following B7A challenge; however, no protection was observed in subjects receiving serum antibodies targeting CS6. The lack of observed efficacy in this group may be due to low CS6 surface expression on B7A, the high dose challenge inoculum and/or the use of serum derived antibodies versus colostrum-derived antibodies.

1028 Sleep and Enteric Disease: Sleep Now for Less Diarrhea Later

Introduction

The bi-directional relationship between sleep and immune function is well-established. Sufficient sleep supports immune health and can increase vaccine efficacy. Conversely, sickness can disturb sleep quality, which can delay recovery and waking functioning. However, the bidirectional relationship between sleep and infectious diarrhea, the leading infectious disease threat to deployed military populations, has not been studied. We assessed the bi-directional relationship between sleep and enteric disease utilizing data from a recently-completed controlled human infection model (CHIM) with enterotoxigenic Escherichia coli (ETEC).

Methods

During a CHIM to assess the efficacy of an immunoprophylactic targeting ETEC (NCT03040687), we measured sleep via actigraphy over an 8-day inpatient period. Participants ingested prophylaxis 3 times/day during days -2 and -1 and ingested ETEC on day 0. The primary outcome was moderate-severe diarrhea following the ETEC challenge. We hypothesized better sleep pre-challenge would reduce risk of disease after the challenge (assessed using linear regression). We also hypothesized total sleep time (TST) and sleep efficiency (SE) after the challenge would be lower/poorer than baseline (assessed using paired t-test).

Results

Among 59 participants (aged 34.4±8.1yrs, 64% female), longer TST the night preceding ETEC challenge was associated with lower total diarrhea volume (B=-3.13,p=.001). SE was slightly but significantly poorer after the challenge (78 vs. 76%; t(55)=2.2,p=.03), but there was no significant change in TST, potentially due to low TST pre-challenge (316 vs. 329 minutes; p=0.12).

Conclusion

These results - in aggregation with previous work on sleep and vaccines - suggest military sleep regulations should be put in place to increase sleep prior to traveling to an area of responsibility with high risk for enteric disease. These minor behavioral changes could provide lasting benefits to readiness of military servicemembers.

Support

This work was supported by Joint Warfighter Medical Research Program (JWMRP) and the Military Operational Medicine Research Program (MOMRP). The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the US Army or of the US Department of Defense. This abstract has been approved for public release with unlimited distribution.

Green function, quasi-classical Langevin and Kubo-Greenwood methods in quantum thermal transport

With the advances in fabrication of materials with feature sizes at the order of nanometers, it has been possible to alter their thermal transport properties dramatically. Miniaturization of device size increases the power density in general, hence faster electronics require better thermal transport, whereas better thermoelectric applications require the opposite. Such diverse needs bring new challenges for material design. Shrinkage of length scales has also changed the experimental and theoretical methods to study thermal transport. Unsurprisingly, novel approaches have emerged to control phonon flow. Besides, ever increasing computational power is another driving force for developing new computational methods. In this review, we discuss three methods developed for computing vibrational thermal transport properties of nano-structured systems, namely Green function, quasi-classical Langevin, and Kubo-Green methods. The Green function methods are explained using both nonequilibrium expressions and the Landauer-type formula. The partitioning scheme, decimation techniques and surface Green functions are reviewed, and a simple model for reservoir Green functions is shown. The expressions for the Kubo-Greenwood method are derived, and Lanczos tridiagonalization, continued fraction and Chebyshev polynomial expansion methods are discussed. Additionally, the quasi-classical Langevin approach, which is useful for incorporating phonon-phonon and other scatterings is summarized.

Multiple Submucosal Out-Fracture of the Inferior Turbinates: Evaluation of the Results by Acoustic Rhinometry

A multiple submucosal out-fracture of the inferior turbinates was made in 21 patients with nasal obstruction due to hypertrophy of the inferior turbinates. Before surgery, an endoscopic evaluation and an acoustic rhinometry was performed in all the cases. The operation was done under general anesthesia and bilaterally in all the patients. Three months after surgery, a postoperative acoustic rhinometry was done and an increase of the minimal cross-section area was achieved in all the cases. Acoustic rhinometry performed in 100 normal cases was used as a control group.

Paediatric interventional cardiology in Costa Rica: diagnostic reference levels and estimation of population dose

The goal of the present study was to propose a set of national diagnostic reference levels (DRLs) in Costa Rica for paediatric interventional cardiology (IC) procedures classified by age and weight and to estimate the collective dose of the paediatric population from these intervention practices. The data collection period was May 2016 to May 2017. The third quartile of patient dose data distributions for kerma-area product (KAP) values was set as the national DRLs. A sample of 154 paediatric IC procedures (collected in the national paediatric hospital with a single x-ray system) was used and divided into four age ranges and five weight ranges. The national DRLs obtained for KAPs by age range were 1.79 Gy cm² (<1 year) to 23.0 Gy cm² (10-15 years). The national DRLs obtained for KAPs by weight range were 1.0 Gy cm² (<10 kg) to 49.6 Gy cm² (50-79 kg). The contribution to the collective dose of the population of Costa Rica amounted to 0.78 person Sv.

Impact of Preemptive Fibrinogen Concentrate on Transfusion Requirements in Liver Transplantation: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial

We hypothesized that preemptive fibrinogen administration to obtain an initial plasma level of 2.9 g/L would reduce transfusion requirements in liver transplantation. A randomized, multicenter, hemoglobin-stratified, double-blind, fibrinogen-versus-saline-controlled trial was conducted. The primary end point was the percentage of patients requiring red blood cells. We evaluated 51 patients allocated to fibrinogen and 48 allocated to saline; the primary end point was assessed using data for 92 patients because the electronic record forms were offline for three patients in the fibrinogen group and four in the saline group. We injected a median of 3.54 g fibrinogen preemptively in the fibrinogen group. Nine patients in the saline group (20.9%) required fibrinogen at graft reperfusion (compared with one patient [2.1%] in the fibrinogen group; p = 0.005). Blood was transfused to 52.9% (95% confidence interval [CI] 42.5-63.3%) in the fibrinogen group and 42.74% (95% CI 28.3-57.2%) in the saline group (p = 0.217). Relative risk for blood transfusion was 0.80 (95% CI 0.57-1.13). Thrombotic events occurred in one patient (2.1%) and five patients (11.4%) in the fibrinogen and saline groups, respectively. Seven patients (14.6%) in the fibrinogen group and nine (20.3%) in the saline group required reoperation. Preemptive administration of fibrinogen concentrate did not influence transfusion requirements.

Molecular design driving tetraporphyrin self-assembly on graphite: a joint STM, electrochemical and computational study

Tuning the intermolecular interactions among suitably designed molecules forming highly ordered self-assembled monolayers is a viable approach to control their organization at the supramolecular level. Such a tuning is particularly important when applied to sophisticated molecules combining functional units which possess specific electronic properties, such as electron/energy transfer, in order to develop multifunctional systems. Here we have synthesized two tetraferrocene-porphyrin derivatives that by design can selectively self-assemble at the graphite/liquid interface into either face-on or edge-on monolayer-thick architectures. The former supramolecular arrangement consists of two-dimensional planar networks based on hydrogen bonding among adjacent molecules whereas the latter relies on columnar assembly generated through intermolecular van der Waals interactions. Scanning Tunneling Microscopy (STM) at the solid-liquid interface has been corroborated by cyclic voltammetry measurements and assessed by theoretical calculations to gain multiscale insight into the arrangement of the molecule with respect to the basal plane of the surface. The STM analysis allowed the visualization of these assemblies with a sub-nanometer resolution, and cyclic voltammetry measurements provided direct evidence of the interactions of porphyrin and ferrocene with the graphite surface and offered also insight into the dynamics within the face-on and edge-on assemblies. The experimental findings were supported by theoretical calculations to shed light on the electronic and other physical properties of both assemblies. The capability to engineer the functional nanopatterns through self-assembly of porphyrins containing ferrocene units is a key step toward the bottom-up construction of multifunctional molecular nanostructures and nanodevices.

Assessment, validation and deployment strategy of a two-barcode protocol for facile genotyping of duckweed species

Lemnaceae, commonly called duckweeds, comprise a diverse group of floating aquatic plants that have previously been classified into 37 species based on morphological and physiological criteria. In addition to their unique evolutionary position among angiosperms and their applications in biomonitoring, the potential of duckweeds as a novel sustainable crop for fuel and feed has recently increased interest in the study of their biodiversity and systematics. However, due to their small size and abbreviated structure, accurate typing of duckweeds based on morphology can be challenging. In the past decade, attempts to employ molecular barcoding techniques for species assignment have produced promising results; however, they have yet to be codified into a simple and quantitative protocol. A study that compiles and compares the barcode sequences within all known species of this family would help to establish the fidelity and limits of this DNA-based approach. In this work, we compared the level of conservation between over 100 strains of duckweed for two intergenic barcode sequences derived from the plastid genome. By using over 300 sequences publicly available in the NCBI database, we determined the utility of each of these two barcodes for duckweed species identification. Through sequencing of these barcodes from additional accessions, 30 of the 37 known species of duckweed could be identified with varying levels of confidence using this approach. From our analyses using this reference dataset, we also confirmed two instances where mis-assignment of species has likely occurred. Potential strategies for further improving the scope of this technology are discussed.

Vibrational heating in single-molecule switches: an energy-dependent density-of-states approach

In recent experiments, it has been shown that the switching rate of single-molecule switches can show a rather complicated dependence on the applied bias voltage. Here, we discuss a minimal model which describes the switching process in terms of inelastic scattering processes of the tunneling electron by specific molecular vibrations. One important point is the introduction of an energy-dependent electronic density of states around the Fermi energy. The influence of different model parameters on the switching rate is studied and we show that the inclusion of a variable density of states allows us to understand the non-monotonic behavior of the switching rate observed in some experiments.

Assessing red deer antler density with a hydrostatic method versus a new parametric volume-modelling technique using 3D-CAD

Two methods of volume measurement were compared, to develop a simple and reliable method for estimating the whole-antler density. We used 10 cast antlers, previously dried and weighed, from 10 different red deer (Cervus elaphus hispanicus) individuals. The volumes were determined by the traditional Archimedes method versus a new parametric volume-modelling technique using a ‘computer-aided design-three dimensions’ (3D-CAD), which is now being used in the biomedical industry in applications such as medical-implant design, tissue engineering and in developing a better understanding of anatomical functionality and morphological analysis. The process paths to follow in the generation of CAD models from cast antlers were described. The whole-antler density was estimated from the weight and volume measurement and a paired-sample comparison procedure was performed to assess differences between volumes as well as densities. Cast-antler weight ranged from 219.93 to 1857.9 g, and the volume estimated by the hydrostatic method was 732.45 ± 474.06 cm3 and by the CAD-3D method it was 730.65 ± 492.59 cm3. The DM density of the antler by the hydrostatic method (Density A) was 1.112 ± 0.120 g/cm3, ranging from 0.915 to 1.345 g/cm3 (Shapiro–Wilks, P = 0.449), and by the 3D-CAD method (Density B) it was 1.112 ± 0.158 g/cm3, ranging from 0.939 to 1.326 g/cm3 (Shapiro–Wilks, P = 0.751). There were no differences in the volume (t = 0.95, P = 0.37) or density (t = 0.54, P = 0.60) between the two methods and the correlation coefficient between Density A and Density B was 0.968. Both methods had similar reliability, although the computing process with the 3D-CAD system calculated antler volume faster than did the traditional hydrostatic weighing. 3D-CAD also avoided cast damage and the methodological problems with larger or smaller antlers or with floatability due to low density, which occur when using the hydrostatic method.

Policies and management of overabundant deer (native or exotic) in protected areas

A workshop was convened in Chile in August 2010 as part of the 7th International Deer Biology Congress (IDBC). Its aim was to explore global differences in the policies and management of overabundant deer in protected areas. The main goal of the workshop was to provide South American researchers and managers with a snapshot of some of the approaches to management of deer overabundance used in a diverse array of case studies from North America, Europe, Australia and New Zealand. Various case studies were presented to illustrate the different methodological approaches in implementing deer control measures. Some general recommendations were formulated.

MRI Detection of Otherwise Occult Malignancies in Women Recently Diagnosed with Breast Cancer

Objective. Breast Magnetic Resonance Imaging (MRI) is recommended as a screening test for women at high risk for breast cancer but its role as a diagnostic tool for women recently diagnosed with breast cancer is not universally accepted. We report outcomes in a center that routinely uses breast MRI to evaluate extent of disease in patients recently diagnosed with breast cancer.Material and Methods. Between 1/1/2003 and 4/30/2007, 592 patients with recently diagnosed breast cancer underwent bilateral breast MRI to assess extent of disease. All had undergone mammography prior to breast MRI. Twenty-two were excluded because they were either lost to follow up (n=7) or had a mastectomy or lumpectomy (n=15) where correlation of pathology to the study lesion was not possible or incomplete. 570 patients comprised the analysis set. Patient age, index tumor characteristics (histologic subtype, grade, ER/PR status, HER2 status and presence of angiolymphatic invasion), axillary lymph node status, and pathologic stage were recorded in addition to mammographic breast density. All MR exams were coded following the American College of Radiology Breast Imaging-Reporting and Data System (BI-RADS) breast MRI lexicon. Biopsy rates, positive predictive values of biopsy, and overall yield of detecting an occult cancer in the ipsilateral or contralateral breast were calculated and compared using Chi-square test across patient age, mammographic breast density, index tumor type, receptor status and presence or absence of lymph node metastases.Results. The distribution of tumor histologies was typical of that seen in the U.S. during the study period, with 61% having invasive ductal index cancers, 21% pure ductal carcinoma in situ, 19% invasive lobular or other invasive cancers and 67% being node negative at time of diagnosis. Additional biopsy was recommended for 152/570 (27%) patients found to have one or more suspicious lesions on MRI distinct from the index cancer, based upon mammographic, sonographic, or clinical exam measurements. Of the 152 women who underwent biopsy, 67 women had additional cancers diagnosed, for a positive predictive value of 44% (67/152). Overall, 12% (67/570) of women had otherwise occult cancers diagnosed by MRI alone: 8% of women had additional sites or greater extent of ipsilateral disease and 4% of women had unsuspected contralateral cancer detected by MRI alone. No significant differences were found in the probability of detecting an occult cancer based on patient age, breast density, index tumor characteristics, or lymph node status.Conclusion. The 12% added cancer yield of MRI in detecting additional ipsilateral or contralateral malignancies in a clinical population of women recently diagnosed with breast cancer is significantly higher than the added cancer yield of MRI screening among women at high risk for breast cancer. The positive predictive value of MRI in this clinical setting is also high, with 44% of women who undergo additional tissue sampling being diagnosed with otherwise occult cancer. The probability of finding additional malignancy does not vary significantly with patient age, breast density, or index cancer characteristics.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4017.

Two-year prospective study of major depressive disorder in HIV-infected men

OBJECTIVE

The risks and factors contributing to major depressive episodes in HIV infection remain unclear. This 2-year prospective study compared cumulative rates and predictors of a major depressive episode in HIV-infected (HIV+) men (N=297) and uninfected (HIV-) risk-group controls (N=90).

METHODS

By design participants at entry were without current major depression, substance dependence or major anxiety disorder. Standardized neuromedical, neuropsychological, neuroimaging, life events, and psychiatric assessments (Structured Clinical Interview for DSM III-R) were conducted semi-annually for those with AIDS, and annually for all others.

RESULTS

Lifetime prevalence of major depression or other psychiatric disorder did not differ at baseline between HIV+ men and controls. On a two-year follow-up those with symptomatic HIV disease were significantly more likely to experience a major depressive episode than were asymptomatic HIV+ individuals and HIV-controls (p<0.05). Episodes were as likely to be first onset as recurrent depression. After baseline disease stage and medical variables associated with HIV infection were controlled, a lifetime history of major depression, or of lifetime psychiatric comorbidity (two or more psychiatric disorders), predicted subsequent major depressive episode (p<0.05). Neither HIV disease progression during follow-up, nor the baseline presence of neurocognitive impairment, clinical brain imaging abnormality, or marked life adversity predicted a later major depressive episode.

LIMITATIONS

Research cohort of men examined before era of widespread use of advanced anti-HIV therapies.

CONCLUSIONS

Symptomatic HIV disease, but not HIV infection itself, increases intermediate-term risk of major depression. Prior psychiatric history most strongly predicted future vulnerability.

Dopamine levels modulate the updating of tastant values

To survive, animals must constantly update the internal value of stimuli they encounter; a process referred to as incentive learning. Although there have been many studies investigating whether dopamine is necessary for reward, or for the association between stimuli and actions with rewards, less is known about the role of dopamine in the updating of the internal value of stimuli per se. We used a single-bottle forced-choice task to investigate the role of dopamine in learning the value of tastants. We show that dopamine transporter knock-out mice (DAT-KO), which have constitutively elevated dopamine levels, develop a more positive bias towards a hedonically positive tastant (sucrose 400 mM) than their wild-type littermates. Furthermore, when compared to wild-type littermates, DAT-KO mice develop a less negative bias towards a hedonically negative tastant (quinine HCl 10 mM). Importantly, these effects develop with training, because at the onset of training DAT-KO and wild-type mice display similar biases towards sucrose and quinine. These data suggest that dopamine levels can modulate the updating of tastant values, a finding with implications for understanding sensory-specific motivation and reward seeking.

Regionalization of epididymal duct and epithelium in rats and mice by automatic computer-aided morphometric analysis

AIM

To establish a rat and mouse epididymal map based on the use of the Epiquatre automatic software for histologic image analysis.

METHODS

Epididymides from five adult rats and five adult mice were fixed in alcoholic Bouin's fixative and embedded in paraffin. Serial longitudinal sections through the medial aspect of the organ were cut at 10 microm and stained with hematoxylin and eosin. As determined from major connective tissue septa, nine subdivisions of the rat epididymis and seven for the mouse were determined, consisting of five sub-regions in the caput (rat and mouse), one (mouse) or three (rat) in the corpus and one in the cauda (rat and mouse). Using the Epiquatre software, several tubular, luminal and epithelial morphometric parameters were evaluated.

RESULTS

Statistical comparison of the quantitative parameters revealed regional differences (2-5 in the rat, 3-6 in the mouse, dependent on parameters) with caput regions 1 and 2 being largely distinguishable from the similar remaining caput and corpus, which were in turn recognizable from the cauda regions in both species.

CONCLUSION

The use of the Epiquatre software allowed us to establish regression curves for different morphometric parameters that can permit the detection of changes in their values under different pathological or experimental conditions.

Comparison of four serological tests for the diagnosis of Chagas disease in a Colombian endemic area

The performance of 4 serological tests for the diagnosis of Chagas disease was evaluated in Santander, Colombia, a region still presenting active transmission. Serum samples from 638 individuals were submitted to an enzyme immunoassay test (EIA), using total lysate of a local Trypanosoma cruzi strain and 52.5% were positive (335/638). A subset of this group (94 positive individuals and 90 seronegatives) was randomly selected for further serological confirmation. Three additional tests were used--indirect immunofluorescence (IIF) and 2 distinct enzyme-linked immunosorbent assays using total lysate of the Y strain (EIA BM) and a mixture of 2 recombinant antigens (EIA RA). Seventy-nine patients were seropositive in all tests (84.0%-79/94). The number of positive sera with the IIF, EIA RA and EIA BM was 84/94 (89.4%), 80/94 (85.1%) and 79/94 (84.0%), respectively. In 15 out of the 94 EIA seropositive patients (16.0%), 10 individuals were negative in all 3 tests (10.6%-10/94). One was negative in the EIA BM and positive in the other two tests (1.1%-1/94) and 4 patients were positive, solely, in the IIF assay (4.3%-4/94). Relative to the 90 EIA negative individuals, 89 were confirmed in all other tests (98.9%-89/90). One individual, although seronegative in the IIF, was positive in both confirmatory EIA tests (1.1%-1/90). In addition, 120 blood specimens were submitted to PCR amplification. This group consisted of 79 confirmed seropositive cases, 16 individuals with discordant serological results and 25 validated seronegative individuals. The PCR was able to detect the presence of parasite DNA in 67 out of the 79 seropositive patients (84.8%), in 8 individuals with discordant serology (50.0%) and in only one seronegative individual (4.0%). The results pointed to the necessity for performing more than one serological test, preferentially with antigens from autochthonous strains, to achieve a reliable diagnosis of Chagas disease in Colombia.

The living kidney donation process: the donor perspective

OBJECTIVE

To evaluate the living kidney donation (LKD) process using donors' opinions on the impact on social, emotional, and financial aspects affecting donor quality of life.

MATERIALS AND METHODS

From May 2000 to December 2002, we studied 22 donors of living kidneys at the Hospital Clinic, Barcelona, Spain, who completed an anonymous survey 6 months after donation.

RESULTS

Most donors (86%) had themselves informed the recipient about their wish to donate, the other 14% were asked by family members. Eighty-eight percent stated that the information provided to the donor about the evaluation process was well explained and understood whereas 12% disagreed with the statement. At the time of thin decision, 90.5% of donors understood the vital risk. For 95%, the explanations about the process corresponded with the actual experience. One hundred percent of donors stated after donation that they would again favor it. Mean hospital stay was 6 days (range, 3-9 days). Those donors with a labor contract have been out of work for an average of 57.8 days (range, 18 days to 6 months). Twenty-five percent of donors admitted financial effects as a result of donation. All but 1 felt completely recovered with the same quality of life after donation.

DISCUSSION

LKD is a good therapeutic alternative. Some aspects should be developed, such as more information about living donation and the need to considering donors as healthy persons without loss of earnings. Recognition of the benefits of living donation requires more wide participation of all citizens nationally.

Signal-averaged electrocardiography in children with anthracycline-induced cardiomyopathy

The aim of the present study was to determine if signal-averaged ECG of patients with anthracycline-induced left ventricular dysfunction could differentiate between patients with anthracycline-induced cardiotoxicity and those without. Sixteen children with anthracycline-induced cardiomyopathy, aged 6.5 to 15.5 years (anthracycline dose = 198-737 mg/m2), and 31 patients aged 5.0 to 16.7 years, who received anthracyclines without evidence of left ventricular dysfunction (anthracycline dose = 120-517 mg/m2), were studied with signal averaged ECG. The two groups were comparable in age, body surface area, and time since completion of chemotherapy. Signal averaged ECG parameters of the patients were compared with data obtained from 530 healthy children. These parameters were converted to z-scores to account for growth-related changes in signal averaged ECG recordings. Z-scores for filtered QRS duration and low amplitude terminal signal < 40 microV were significantly lower (p = 0.002 and p = 0.015, respectively), and Z-score for root mean square voltage of the last -30 ms of filtered QRS tended to be higher (p = 0.06) in patients with left ventricular dysfunction. Filtered QRS duration lower than -1.5 SD was found in 4 of 16 patients with left ventricular dysfunction and in only 1 of 31 patients without (p < 0.05) yielding a sensitivity of 25% and a specificity of 97% to detect left ventricular dysfunction. Only 1 patient had late potentials; his left ventricular function was normal. Left ventricular mass index tended to be lower in patients with left ventricular dysfunction (p = 0.07), whereas left ventricular diastolic diameter was similar in the two groups. The mechanism that accounted for the difference in signal averaged-ECG between the two groups of patients could be linked with the decrease in left ventricular mass in patients with left ventricular dysfunction. In conclusion, children with left ventricular dysfunction following anthracycline therapy have a SA ECG different from those without left ventricular dysfunction, which is mainly characterized by a lower filtered QRS duration. A prospective study is needed in order to determine if this modification of SA ECG recordings precedes alteration of left ventricular function, and, therefore, if it could help in early detection of cardiac toxicity of anthracyclines.