Effect of polyphenols from Ascophyllum nodosum seaweeds on the rheology and digestion of corn starch gels and gluten-free bread features

The main objective of this work is to study the effect of polyphenols, from the brown seaweed Ascophyllum nodosum, on the structure and digestion behaviour of gels at two corn starch concentrations (1.95 and 5.00% w/w) as well as the structure, color and texture features of crumbs from gluten-free breads. Adsorption isotherms of polyphenols on native and gelled starches were carried out and modelled by means of Langmuir and Henry models, respectively. The formation and characteristics of tested gels were rheologically monitored by means of heating ramp, time sweep at high temperature, cooling ramp and frequency sweep at 25 °C. Elastic modulus values decreased with the presence of polyphenols. Additionally, the polyphenols significantly decreased the digestion rate, measured by both chemical and rheological procedures, and the final concentration of digested starch. Finally, the presence of polyphenols in breads increased the hardness and chewiness values and decreased the cohesiveness and resilience values as well as the crumb hardening during storage.

Antioxidant and Antidiabetic Properties of Phlorotannins from Ascophyllum nodosum Seaweed Extracts

Seaweeds have gained considerable attention in recent years due to their potential health benefits and high contents of bioactive compounds. This review focuses on the exploration of seaweed's health-promoting properties, with particular emphasis on phlorotannins, a class of bioactive compounds known for their antioxidant and antidiabetic properties. Various novel and ecofriendly extraction methods, including solid-liquid extraction, ultrasound-assisted extraction, and microwave-assisted extraction are examined for their effectiveness in isolating phlorotannins. The chemical structure and isolation of phlorotannins are discussed, along with methods for their characterization, such as spectrophotometry, nuclear magnetic resonance, Fourier transform infrared spectroscopy, and chromatography. Special attention is given to the antioxidant activity of phlorotannins. The inhibitory capacities of polyphenols, specifically phlorotannins from Ascophyllum nodosum against digestive enzymes, such as α-amylase and α-glucosidase, are explored. The results suggest that polyphenols from Ascophyllum nodosum seaweed hold significant potential as enzyme inhibitors, although the inhibitory activity may vary depending on the extraction conditions and the specific enzyme involved. In conclusion, seaweed exhibits great potential as a functional food ingredient for promoting health and preventing chronic diseases. Overall, this review aims to condense a comprehensive collection of high-yield, low-cost, and ecofriendly extraction methods for obtaining phlorotannins with remarkable antioxidant and antidiabetic capacities.

Advanced Proteomic and Bioinformatic Tools for Predictive Analysis of Allergens in Novel Foods

In recent years, novel food is becoming an emerging trend increasingly more demanding in developed countries. Food proteins from vegetables (pulses, legumes, cereals), fungi, bacteria and insects are being researched to introduce them in meat alternatives, beverages, baked products and others. One of the most complex challenges for introducing novel foods on the market is to ensure food safety. New alimentary scenarios drive the detection of novel allergens that need to be identified and quantified with the aim of appropriate labelling. Allergenic reactions are mostly caused by proteins of great abundance in foods, most frequently of small molecular mass, glycosylated, water-soluble and with high stability to proteolysis. The most relevant plant and animal food allergens, such as lipid transfer proteins, profilins, seed storage proteins, lactoglobulins, caseins, tropomyosins and parvalbumins from fruits, vegetables, nuts, milk, eggs, shellfish and fish, have been investigated. New methods for massive screening in search of potential allergens must be developed, particularly concerning protein databases and other online tools. Moreover, several bioinformatic tools based on sequence alignment, motif identification or 3-D structure predictions should be implemented as well. Finally, targeted proteomics will become a powerful technology for the quantification of these hazardous proteins. The ultimate objective is to build an effective and resilient surveillance network with this cutting-edge technology.

Influence of Oxidation and Dialysis of Phlorotannins on Bioactivity and Composition of Ultrasound-Assisted Extracts from Ascophyllum nodosum

The isolation and chemical characterization of phlorotannins has gained special attention in recent years due to their specific health-promoting benefits. Flow-cell ultrasound-assisted extraction (90 W/cm2 of sonication power, 2 min of retention time and 20 g solvent/g algae of liquid-solid ratio) was carried out by using double-distilled water (WE) and acetone:water mixture (AWE) as extraction solvents. The AWE showed a higher total polyphenols content (TPC), carbohydrates (CHOs) and antioxidant activities than WE. However, when the WE was purified by using Amberlite XAD16 column, the purified WE (PWE) showed similar a TPC, decreased CHOs and increased antioxidant activity compared to WE. The oxidation of the PWE extract was evaluated under natural, forced and severe oxidation condition for 120 h. Only severe oxidation conditions were able to significantly reduce TPC and antioxidant activities. PWE was dialyzed (20, 10, 3.5 and 2 kDa). The main bioactive fraction of phlorotannins was obtained from 10 to 20 kDa. CHOs were distributed in fractions below 20 kDa. MALDI-TOF analysis was performed for PWE, PD20 and PD2 extracts to analyze the degree of polymerization of phlorotannins, which ranged from 4 to 17 phloroglucinol units/molecule. Fragmentation patterns allowed the proximate identification of several phlorotannins in Ascophyllum nodosum extracts.

A new cardiopulmonary exercise testing score for predicting heart failure events

Background

Cardiopulmonary exercise test (CPET) provides several variables (V) that are strong predictors of events in patients (pts) with heart failure (HF).

Purpose

Our aim was to develop and evaluate the predictive power (PP) of a CPET-based score, comparing to that of the Heart Failure Survival Score – HFSS.

Methods

Retrospective evaluation of adult pts with HF submitted to CPET in a tertiary center. Pts were followed up for at least 1 year for the primary endpoint of cardiac death and urgent heart transplantation/ ventricular assist device implantation (MTV). The PP of several CPET V's was assessed using ROC curve analysis, which was used to define optimal threshold values for each V. A multiple regression analysis was performed to identify independent prognostic predictors and to determine the regression coefficient (β) for the Vs included in the model, each expressed dichotomously using the threshold value. According to β, a weight was assigned to each V and summed to calculate the composite score. ROC curves were compared using the Hanley and McNeil test.

Results

CPET was performed in 487 HF pts, with a mean age of 56±13 years, 79% were male. 46% of pts were of ischemic etiology, with a mean LVEF of 30±8%, a mean HFSS of 8.6±1.1 and a mean BNP value of 509±668pg/ml. The mortality rate during a mean follow-up of 21 months, was 19% (93pts) with 23 pts (5%) undergoing HT. The primary endpoint was reached by 55 (11%) pts. The variables with higher predictive power were OUES (AUC 0.796), ventilatory power (AUC 0.790), the partial pressure of end-tidal CO2 at the anaerobic threshold (PETCO2L – AUC of 0.787), the pVO2 (AUC 0.767) and heart rhythm (HR) during the test (AUC – 0.640). LVEF also presented a high predictive power with AUC of 0.755. The multivariate analysis revealed that pVO2, PETCO2L, AF, and LVEF were independent prognostic predictors. According to the β of these Vs, the equation was calculated as follows: (pVO2 × 2.194) + (PETCO2L × 1.545) + (LVEF × 1.134) + (HR × 1.055; 0 if AF, 1 if sinus rhythm). The score presented a high PP with an AUC of 0.866. A cut-off of 120 had an 83.6% sensitivity and a 75% specificity for MTV, and pts with a score value of <120 had a markedly lower rate of MTV (log-rank p<0.001). When compared to HFSS, our score presented a higher PP (0.866 vs 0.774, p=0.011).

Conclusion

A multivariable score based on readily available CPET Vs provides a simple, integrated and powerful method to predict HF events.

Funding Acknowledgement

Type of funding sources: None.

Unraveling the impact of viscosity and starch type on the in vitro starch digestibility of different gels

Starch is one of the most important carbohydrates that is present in many foods. Gelatinization is an important property of starch, associated with physical changes that promote an increase in viscosity. The objective of this research was to understand how the viscosity of starch gels affects their hydrolysis and whether that effect was dependent on the type of starch. Different gels (corn, wheat, and rice) with variable or constant viscosity were analyzed using diverse methodologies to determine the changes in the pasting behavior. A rapid force analyzer, a vibration viscometer and a rheometer were used to differentiate the gels based on the starch source and concentration. At a fixed starch concentration, corn gel displayed the highest viscosity, slowing the enzymatic starch hydrolysis. The higher viscosity of those gels prepared with a fixed starch concentration significantly enhanced the slowly digestible starch (SDS) and reduced the kinetic constant (k). Nevertheless, gels with constant viscosity (550 mPa s) showed comparable hydrolysis kinetics, obtaining similar SDS, total hydrolyzed starch and k. The correlation matrix confirmed the relationship between k and gel viscosity (r = -0.82), gelatinization rate (α-slope) (r = -0.87), breakdown (r = -0.84) and elastic modulus (G' 37 °C) (r = -0.73). Therefore, these parameters could be used as predictors of the hydrolysis performance of starch gels as well as in reverse engineering for the design of healthy foods.

Negative symptoms - a real unmet need

Introduction

Schizophrenia is frequently a chronic and disabling disorder, characterized by heterogeneous positive and negative symptoms. Negative symptoms are a major health concern and a core component of schizophrenia that account for a large part of the long-term disability and poor functional outcomes in patients with the disorder. Adequate treatment would mean important progress and Distinguishing primary from secondary negative symptoms may inform about treatment options.

Objectives

Objective: to provide information that may be useful for clinicians treating patients with negative symptoms of schizophrenia.

Methods

We searched Pubmed and Cochrane Library database for english language articles.

Results

Negative symptoms are a core component of schizophrenia that account for a large part of the long-term disability and poor functional outcomes. Negative symptoms are common in schizophrenia; up to 60% of patients may have prominent clinically relevant negative symptoms that require treatment. Negative symptoms can occur at any point in the course of illness, although they are reported as the most common first symptom of schizophrenia. Negative symptoms can be primary symptoms, which are intrinsic to the underlying pathophysiology of schizophrenia, or secondary symptoms that are related to psychiatric or medical comorbidities, adverse effects of treatment, or environmental factors. Negative symptoms clearly constitute an unmet medical need in schizophrenia, and new and effective treatments are urgently needed.

Conclusions

Clinically relevant negative symptoms of schizophrenia need to be recognized, assessed, and as well managed as possible in order to achieve improved outcomes for patients. More studies are needed to establish the better approach to negative symptoms.

Disclosure

No significant relationships.

OCD symptom dimensions and treatment: a new dimension?

Introduction

Background: Obsessive-compulsive disorder (OCD) is a condition that includes distressing obsessions and repetitive compulsions. Usually presents with a wide range of symptons normally grouped into different clusters or dimensions. clinical impression and some empirical data suggest that certain groups of symptoms or clusters are more responsive to treatment than others, thus it can help clinicians to better guide initial treatment choices and management of individual patients

Objectives

Objetictive: to describe the symptom dimensions in a clinical database that includes patients accompannied in an obssessive conpulsive disorder consultation in a tertiary hospital in Portugal and to point out some differences in treatment outcomes.

Methods

We searched Pubmed and Cochrane Library database for english language articles.

Results

To date it appears that pharmacotherapy and CBT are an effective treatment for the various OCD dimensions, although not all dimensions have been adequately studied or respond well to treatment. Knowing a specific symptom profile may have implications in treatment components that clinicians should be aware of.

Conclusions

More research will be needed to determine the best tailor treatments to each patient’s profile and Modifications to treatment may be needed. Clinical implications and directions for future research are discussed.

Disclosure

No significant relationships.

In vitro inhibition of starch digestive enzymes by ultrasound-assisted extracted polyphenols from Ascophyllum nodosum seaweeds

Seaweeds are gaining importance due to their antidiabetic characteristics. This study investigated the inhibitory effects of aqueous Ascophyllum nodosum extracts, obtained by ultrasound-assisted extraction with different sonication powers (70-90 W/cm2 ) and subjected to resin purification, against α-amylase and α-glucosidase enzymes. Different inhibition methodologies were carried out, preincubating the extract either with the enzyme or the substrate. Chemical characterization, in terms of proximate analysis, antioxidant capacity (2,2-diphenyl-1-picryl-hydrazyl-hydrate [DPPH] and FRAP), and polyphenols characteristics (reversed-phase high-performance liquid chromatography [RP-HPLC] and 1 H-NMR) were carried out to explain inhibitory activities of extracts. Sonication power did not influence the proximal composition nor antiradical activity of extracts, but increasing sonication power increased inhibition capacity (>15%) against both starch digestive enzymes. The extract purification largely improved the inhibition efficiency decreasing the IC50 of α-amylase and α-glucosidase by 3.0 and 6.1 times, respectively. Seaweed extracts showed greater inhibition effect when they were preincubated with the enzyme instead of the substrate. RP-HPLC together with 1 H-NMR spectra allowed relating the presence of uronic acids-polyphenols complexes and quinones in the extracts with the different inhibitory capacities of samples. PRACTICAL APPLICATION: The study confirms that ultrasound-assisted extracts from Ascophyllum nodosum can be used to inhibit digestive enzymes. This opens the alternative to be used in foods for modulating glycemic index.

Interactions between Ascophyllum nodosum Seaweeds Polyphenols and Native and Gelled Corn Starches

The effect of several blending procedures between Ascophyllum nodosum seaweed flour (AF) and corn starch (CS) on the interactions between polyphenols and starch was studied in this paper. These methods comprised the blending of AF with native starch (NT) with previously gelled starch gel (GL) and promoting the gelling of corn starch in the presence of AF (CGL). Different AF-CS (g/g) ratios (from 1:0.5 to 1:25) were studied. The liquid phase was chemically characterized by polyphenols (TPC) and carbohydrates content. The antioxidant activity of the liquid phase after achieving the solid-liquid equilibrium was determined by DPPH, ABTS, and FRAP methods. The solid phase was characterized by FT-IR and SEM techniques. The Halsey model successfully fitted the equilibrium TPC in liquid and polyphenols adsorbed/retained by the solid phase of tested systems. NT samples showed lower polyphenols sorption than gelled samples. The differences found between samples obtained with GL and CGL methods suggested different interactions between polyphenols and starch. Specifically, physisorption is predominant in the case of the GL method, and molecular trapping of polyphenols in the starch gel structure is relevant for the CGL method. Results allowed us to determine the enhancement of the retention of polyphenols to achieve starchy foods with high bioactivity.

Rheological Properties of Corn Starch Gels With the Addition of Hydroxypropyl Methylcellulose of Different Viscosities

The objective of this study is to determine the effect of the addition of hydroxypropyl methylcellulose (HPMC) (from 0.5 to 2.0% w/w, starch basis) with three different viscosities (40–60, 80–120, and 2,600–5,600 mPa⋅s) to corn starch (30% w/w, total basis) gels. Average viscosimetric molecular weights (M_v) of tested HPMC were determined (from 27.2 × 10³ to 82.7 × 10³ g/mol). Water retention capacity of HPMC varied linearly with M_v. The formation and curation of gels were monitored by rheology employing consecutive steps such as heating ramp (25–90°C), time sweep (90°C), cooling ramp (90–25°C), time sweep (25°C), and frequency sweep. Additionally, creep-recovery tests were performed. HPMC above 1.5% w/w delayed the range of gelatinization temperature of starch up to 2°C. Viscoelasticity and stiffness of corn starch gels with HPMC depend on both the amount of polymer added and M_v of the HPMC. Finally, to achieve corn gels with mimetic viscoelastic properties to wheat gel (with constant total solids), HPMC with relatively low viscosity (low M_v) is necessary to be added at certain content.

Estimation of viscosity and hydrolysis kinetics of corn starch gels based on microstructural features using a simplified model

Viscosity is an important rheological property, which may have impact on the glycemic response of starchy foods. However, the relationship between starch gels viscosity on its hydrolysis has not been elucidated. The aim of this work was to assess the effect of gels viscosity on the microstructure, and the kinetics of enzymatic hydrolysis of starch. Corn starch gels were prepared from starch:water ratios varying from 1:4 to 1:16. A structural model was proposed that correlated (R-square = 0.98) the porous structure (cavity sizes, thickness walls) of gels and its viscosity. Kinetics constants of hydrolysis decreased with increasing starch content and consequently with gel viscosity. Relationships of viscosity with the microstructural features of gels suggested that enzyme diffusion into the gel was hindered, with the subsequent impact on the hydrolysis kinetics. Therefore, starch digestibility could be governed by starch gels viscosity, which also affected their microstructure.

Impact of drying on the sodium alginate obtained after polyphenols ultrasound-assisted extraction from Ascophyllum nodosum seaweeds

Ultrasound-assisted extraction (UAE) of polyphenols from the brown seaweeds Ascophyllum nodosum leaves a solid phase where alginates can be extracted. This study characterizes alginates extracted after the UAE process, with and without an intermediate drying stage at different temperatures (50 and 90 °C) producing sequentially two bioactive compounds from a unique raw material. FT-IR and 1H NMR analyses showed the high purity of alginates with features in the range of commercial alginates. Drying at high temperature decreased average block length and viscosity average molecular weight (Mv) of alginate from 428 to 133 kg/mol. Steady-shear curves (shear-thinning behaviour) and viscoelasticity (liquid like character) features depended clearly on Mv. Solutions of alginates with high Mv were more viscous and the elastic character was more relevant. Cox-Merz rule was only accomplished within the semi-dilute regimes of alginate concentration. Tested process conditions allow the production of alginates with different properties.

Off-pump versus on-pump coronary artery bypass grafting: a propensity score-matching analysis of safety and long-term results

Background

The role and the indications for using off-pump coronary artery bypass surgery (OPCAB), instead of the traditional on-pump (ONCAB), is still to be addressed.

Aim

To describe our centre experience and to compare 15-years survival and early safety outcomes between OPCAB and ONCAB.

Methods

Single-centre retrospective cohort including 9-years of isolated first CABG (2005–2013). Multi-vessel disease with at least 2 surgical grafts patients were considered and the first 50 surgeries of each surgeon with each technique were excluded to account for the learning curve effect. Emergent surgeries and on-pump beating heart procedures were also excluded. A propensity-score matching (PSM) analysis was performed to balance groups and both survival and early outcomes comparison was done within the matched cohort using Kaplan-Meier or Cox stratified and paired tests, respectively. The median follow-up was 9 years, maximum 15 years.

Results

From 3012 multi-vessel patients with at least 2 surgical grafts, 2503 were included at the main analysis: 1487 ONCAB and 1016 OPCAB. ONCAB patients presented more frequently 3-vessels disease and left ventricular dysfunction, but received similar number of grafts than OPCAB, who in turn, received more frequently multiple arterial grafts. The surgical completeness of revascularization (CR) was similar, but hybrid procedures were more frequent in OPCAB raising CR rate in this group. After PSM (646 pairs), both groups were similar regarding pre and peri-operative characteristics. The long-term survival was similar (HR stratified by pair: 1.02 (0.81–1.30), but OPCAB evidenced benefits at early term results including bleeding, postoperative atrial fibrillation and stroke incidence.

Conclusion

At our centre, OPCAB performed by experienced surgeons provides rates of complete revascularization and long-term survival similar to ONCAB. In-hospital results favoured OPCAB.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Universidade do Porto/FMUP; Social European Fund; FCT-Fundação para a Ciência e a Tecnologia

Predictive ability of cardiopulmonary exercise test parameters in heart failure patients with cardiac resynchronization therapy

Introduction

There is evidence suggesting that a peak oxygen uptake (pVO2) cut-off of 10ml/kg/min provides a more precise risk stratification in Cardiac Resynchronization Therapy (CRT) patients. Our aim was to compare the prognostic power of several cardiopulmonary exercise testing (CPET) parameters in patients with CRT and assess the discriminative ability of the guideline-recommended pVO2 cut-off values.

Methods

Prospective evaluation of consecutive heart failure (HF) patients with left ventricular ejection fraction ≤40%. The primary endpoint was a composite of cardiac death and urgent heart transplantation (HT) in the first 24 follow-up months and was analyzed by several CPET parameters for the highest area under thecurve (AUC) in the CRT group. A survival analysis was performed to evaluate the risk stratification provided by several different cut-offs.

Results

A total of 450 HF patients, of which 114 had a CRT device. These patients had a higher baseline risk profile, but there was no difference regarding the primary outcome (13.2% vs 11.6%, p=0.660). End-tidal carbon dioxide pressure at the anaerobic threshold (PETCO2AT) had the highest AUC value, which was significantly higher than that of pVO2 in the CRT group (0.951 vs 0.778, p=0.046). The currently recommended pVO2 cut-off provided accurate risk stratification in this setting (p<0.001),and the suggested cut-off value of 10 ml/min/kg did not improve risk discrimination in device patients (p=0.772).

Conclusion

PETCO2AT outperforms pVO2's prognostic power for adverse events in CRT patients. The current guideline-recommended pVO2 cut-off can precisely risk-stratify this population.

Funding Acknowledgement

Type of funding sources: None.

Looking beyond electroconvulsive therapy: A case report

Introduction

Electroconvulsive therapy (ECT) is considered a gold-standart treatment of severe and treatment-resistant depression. Lack of response to ECT often causes distress in psychiatrists regarding the next therapeutic decisions.

Objectives

To present a case report of a patient with psychotic depression with partial response to ECT.

Methods

Clinical interviews and review of literature using the Pubmed platform.

Results

The authors present a case of a 60 year-old woman admitted for severe depressive episode with psychotic symptoms. Due to lack of response to multiple antidepressive and antipsychotic treatments, 15 sessions of ECT were performed with improvement of behavioral and psychotic symptoms. However, endogenous depressive symptoms with functional impairment persisted. It was then initiated Bupropion 300mg/day resulting in vast improvements on drive, energy and activity levels with restored functionality. Previously to ECT, Bupropion was not considered a valid option due to the psychomotor restlessness that was present. This case exposes the limitations of ECT and the therapeutic conundrums that arise when there is partial response. The symptoms expressed in the patient after ECT course correlate with deficits in noradrenergic and dopaminergic pathways that are involved in endogenous depression. The use of Bupropion, with its effect on noradrenaline and dopamine receptors, may offer a therapeutic lifeline in these cases.

Conclusions

ECT still stands as a gold-standart for severe depressive disorder, especially when several psychopharmacological therapies have failed. In cases of partial response to ECT, the neurobiological correlates of clinical presentation can guide the therapeutic management towards improved outcomes.

Disclosure

No significant relationships.

Sensory experience in obsessive compulsive disorder - sensiocd: Do they think or feel differently?

Introduction

Obsessive-compulsive disorder (OCD) is associated to a wide range of symptomatic expression and treatment response variability [1]. Sensory perception has been identified as an emerging factor in this process [2]. Sensory vulnerability and atypical sensory experience were identified as risk factors for the development of OCD [3] and a sensory subtype of the disease was proposed in which there is a positive correlation with early onset sensory symptoms, male gender and family background [4]. Adding to the atypical sensory profile, obsessions are frequently experienced as partially perceptual.

Objectives

Our main goals are to characterize the sensory perception in OCD patients; assess the prevalence and intensity of the sensory properties of the obsessive thoughts and explore the how sensory perception, obsessive thoughts and obsessive dimensions/clusters are interrelated.

Methods

Patients with OCD diagnosis, aged 18 to 65 years and no comorbid mental disorder (except depression) will be recruited. The study battery will include participant form with demographical and clinical features, assessment of depressive and anxiety symptoms (HAM-A and HAM-D) evaluation of clinical outcome measures and obsessive dimensions/clusters (Yale-Brown Obsessive-Compulsive Scale (Y-BOQS) and Obsessive Beliefs Questionnaire-44 (OBQ-44)), assessment of sensory perception and sensory properties of obsessive thoughts (Sensory Perception Quotient (SPQ 21) and Sensory Properties of Obsessive Thoughts Questionnaire (SPOQ)).

Results

The results will help us understand the interaction between perceptual and cognitive processes in OCD.

Conclusions

Better definition of OCD psychopathology and the establishment of a sensory subtype may indicate the need of specific therapeutic indications or a different escalation of treatment measures.

Disclosure

No significant relationships.

Early dual antiplatelet therapy versus acetylsalicylic acid monotherapy after CABG: propensity score analysis addressing survival and safety outcomes

Background

There is currently conflicting evidence regarding the security profile and outcomes of dual antiplatelet therapy (DAPT) in patients following coronary artery bypass grafting (CABG).

Aim

We aim to compare the effect of early DAPT in short and long-term survival versus acetylsalicylic acid in a monotherapy regimen (ASA). Therapy's safety was evaluated through immediate or early postoperative outcomes, with particular emphasis on the haemorrhagic.

Methods

Single-centre retrospective cohort study on consecutive patients undergoing 1st isolated CABG surgery in 2010. Median follow-up time was 9 years. Pre-, peri- and postoperative data was collected through clinical files and digital databases. The DAPT and ASA groups were defined considering the administration of clopidogrel plus acetylsalicylic acid and only acetylsalicylic acid, respectively, within a 24h window after CABG. T-tests and Pearson's chi-squared tests were used for group comparison. Survival analysis was performed using Kaplan-Meier curves, Log-Rank test and multivariable Cox regression. Propensity scores (PS) were estimated using a multivariable logistic regression model and included in multivariable regressions as a covariate along with DAPT. Early mortality was defined if occurred before discharge or within the 30 days following the surgery; bleeding was assessed through red blood cells' (RBC) transfusion, re-exploration of thorax and drainage.

Results

We included 351 patients, 81% were male, and DAPT was performed in 251 patients (72%). DAPT patients were younger (63±10 vs. 66±10 years, p=0.007) but both groups were similar regarding the cardiovascular modifiable risk factors. Kaplan-Meier curves showed similar cumulative survival between groups (75% in DAPT vs. 67% in ASA group, at 9 years of follow-up, Log-rank p=0.103), as well as the PS adjusted analysis (HR DAPT: 0.93, 95% CI: 0.57–1.51). Regarding safety outcomes, we found no differences in early mortality (two cases in the DAPT group and one in the ASA group). Total median cell-saver transfusion (300mL vs. 250mL, p=0.318) and the re-exploration of thorax due to bleeding (1.6% vs. 4% p=0.231) showed no statistical significance either. On the other hand, post-operative total median chest tube drainage was higher in the ASA group (1220mL in DAPT vs. 1300mL in ASA, p=0.043). There was also a lower frequency of DAPT patients requiring 3 or more peri and postoperative RBC transfusions (8.5% vs. 13.3% p<0.001 and 4.8% vs. 13%, p=0.009, respectively) and a shorter in-hospital stay following CABG (median of 7 days for DAPT and 8 days for ASA, P<0.001). Redo-CABG was performed in 3 patients (2 DAPT vs. 1 ASA) during follow-up.

Conclusion

Compared with ASA, DAPT showed a non-significant impact on long-term survival but demonstrated to be a safe option within the assessed bleeding outcomes. Further studies are needed to provide recommendations on the therapeutical strategy following CABG.

Funding Acknowledgement

Type of funding source: Public grant(s) – EU funding. Main funding source(s): Universidade do Porto/FMUP, FSE-Fundo Social Europeu, NORTE 2020-Programa Operacional Regional do Norte, Programas Doutorais. Project NetDIAMOND, supported by ESIF under Lisbon Portugal Regional Operational Programme and National Funds through FCT

Optimizing diagnosis of obstructive coronary artery disease by CT angiography: RCT's final results and 12-months follow-up

Aim

In patients (pts) with suspected coronary artery disease (CAD), computed tomographic angiography (CTA) may improve pt selection for invasive coronary angiography (ICA) as alternative to functional testing. However. the role of CTA in symptomatic pts after abnormal functional test (FT) is incompletely defined.

Methods and results

This randomized clinical trial conducted in single academic tertiary center selected 218 symptomatic pts with mild to moderately abnormal FT referred to ICA to receive either the originally intended ICA (n=103) or CTA (n=115). CTA interpretation and subsequent care decisions were made by the clinical team. Pts with high risk features on FT, previous acute coronary syndrome, previously documented CAD, chronic kidney disease (GFR<60ml/min/1.73m2) or persistent atrial fibrillation were excluded. The primary endpoint was the percentage of ICA with no significant obstructive CAD (no stenosis ≥50%) in each group. Diagnostic (DY) and revascularization (RY) yields of ICA in either group were also assessed. Pts were followed up for at least 1 year for the primary safety endpoint of all cause death/ nonfatal myocardial infarction/ stroke. Unplanned revascularization

(UP) and symptomatic status (SS) were also evaluated. Pts averaged 68±9 years of age, 60% were male, 29% were diabetic. Nuclear perfusion stress test was used in 33.9% in CTA group and 31.1% in control group (p=0.655). Mean post (functional) test probability of obstructive CAD was 34%. Overall prevalence of obstructive CAD was 32.1%. In the CTA group, ICA was cancelled by referring physicians in 83 of the pts (72.2%) after receiving CTA results. For those undergoing ICA, non-obstructive

CAD was found in 5 pts (15.6%) in the CTA-guided arm and 60 (58.3%) in the usual care arm (p<0.001 Mean cumulative radiation exposure related to diagnostic work up was similar in both groups (6±14 vs 5±14mSv, p=0.152). Both DY (84.4% vs 41.7, p<0.001) and RY (71.9% vs 38.8%, p=0.001) yields were significantly higher for CTA-guided ICA as compared to standard FT-guided ICA. The rate of the primary safety endpoint was similar between both groups (1.9% vs 0%, p=0.244), as well as the rates of UP (0.9% vs 0.9%, p=1.000) and SS (persistent angina: 29.6% vs 24.8%, p=0.425).

Conclusions

In pts with suspected CAD and mild to moderately abnormal ischemia test, a diagnostic strategy including CTA as gatekeeper is safe, effective and significantly improves diagnostic and revascularization yields of ICA.

Funding Acknowledgement

Type of funding source: None

Prognostic value of the cardiorespiratory optimal point during submaximal exercise testing

Background

Peak oxygen consumption (pVO2) is a key parameter in assessing the prognosis of heart failure with reduced ejection fraction (HFrEF) patients (pts). However, it is a less reliable parameter when the cardiopulmonary exercise test (CPET) is not maximal. It is crucial to identify the submaximal exercise variables with the best prognostic power (PP), in order to improve the management of pts that cannot attain a maximal CPET.

Purpose

The aim of this study was to evaluate and compare the PP of several exercise parameters in submaximal CPET for risk stratification in pts with HFrEF.

Methods

Prospective evaluation of adult pts with HFrEF submitted to CPET in a tertiary center. A submaximal CPET was defined by a respiratory exchange ratio (RER) ≤1.10. Pts were followed up for at least 1 year for the primary endpoint of cardiac death and urgent heart transplantation/ ventricular assist device implantation. Several CPET parameters were analyzed as potential predictors of the combined endpoint and their PP (area under the curve - AUC) was compared to that of pVO2, using the Hanley and McNeil test.

Results

CPET was performed in 487 HF pts, of which 317 (66%) performed a submaximal CPET. Pts averaged 57±12 years of age, 77% were male, 45.7% had ischemic cardiomyopathy, with a mean LVEF of 30.4±7.6%, a mean heart failure survival score of 8.6±1.1. The mean pVO2 was 17.1±5.5 ml/kg/min and the mean RER 1.01±0.08. During a mean follow-up (FU) time of 11±1 months, 18 pts (6%) met the primary endpoint. Cardiorespiratory optimal point (OP - VE/VO2) had the highest AUC value (0.915, p=0.001), followed by the partial pressure of end-tidal CO2 at the anaerobic threshold - PETCO2L (0.814, p<0.001). pVO2 presented an AUC of 0.730 (p=0.001). OP≥31 and PETCO2L ≤37mmHg had a sensitivity of 100 and 76.9% and a specificity of 71.1 and 67%, respectively, for the primary outcome. OP presented a significantly higher PP than pVO2 (p=0.048), whether PETCO2L didn't achieve any statistical significance (p=0.164). Pts with anOP≥31 presented a significantly lower survival free of HT during FU (log rank p=0.002).

Conclusion

OP had the highest PP for HF events of all parameters analyzed for a submaximal CPET. This parameter can help stratify the HF pts physiologically unable to reach a peak level of exercise.

Funding Acknowledgement

Type of funding source: None

Development of a Virtual Game with Android Operating System for the Rehabilitation of Chewing and Swallowing in the Elderly

Introduction With the aging, the orofacial structures may suffer changes related to disorganization of the stomatognathic system, with a reduction in the strength and resistance of the tongue reflecting delays in the handling of the boluses in the mouth and the elevation of the hyolaryngeal complex; it may result in changes in swallowing (presbifagia or dysphagia). Changes in swallowing may be adjuvants for the illness of the elderly with great socioeconomic impact due to the high costs that bring to the public health with prolonged hospitalizations.

Objectives Before it an app was created with a board game for android operating system with the possibility of training in the functions of chewing and swallowing in elderly using biofeedback.

Methodology A hardware was built capable of capturing, conditioning and transmitting the electrical signal of the masseter and supra-hyoid muscles, with surface electrodes, using an interface system scan with four channels for a mobile device with Android operating system via Bluetooth. The electrical signal is received by software through a biogame, which originally held the calibration of the data, being the value range of the strength of the bite ranging from zero to 255 µV. The participant will receive the information to chew and swallow through the simulation of a “virtual farm” with the displacement of a tractor irrigating the earth which will create a plantation. The chewing cycle was standardized in 10 insect chewing’s, five for each side, ending with the swallowing.

Results At the end of the game a report stating: date of the examination, consistency of the food chosen, testing time, masticatory cycles completed and incomplete, maximum and average power of bite and muscle activity of the swallowing of each side.

Conclusion The application with game developed is a promising resource for training of the masticatory muscles and the swallowing of the elderly.

Self-driving laboratory for accelerated discovery of thin-film materials

Discovering and optimizing commercially viable materials for clean energy applications typically takes more than a decade. Self-driving laboratories that iteratively design, execute, and learn from materials science experiments in a fully autonomous loop present an opportunity to accelerate this research process. We report here a modular robotic platform driven by a model-based optimization algorithm capable of autonomously optimizing the optical and electronic properties of thin-film materials by modifying the film composition and processing conditions. We demonstrate the power of this platform by using it to maximize the hole mobility of organic hole transport materials commonly used in perovskite solar cells and consumer electronics. This demonstration highlights the possibilities of using autonomous laboratories to discover organic and inorganic materials relevant to materials sciences and clean energy technologies.

P715 When "wait and see" is the best option: a case report of a spontaneous coronary artery dissection

Introduction

Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome and is now being identified more frequently, in part because of increased awareness.

Case report

We present the case of a 63-year-old female, without cardiovascular risk factors or relevant past medical history. She complained of atypical chest pain in the last year. The patient was admitted due to acute chest pain at rest, hemodynamically stable, with unremarkable physical examination, including absence of heart failure signs. The EKG revealed a dynamic ST depression in leads V4-V6. The peak of high sensitivity troponin I was 13744pg/mL (ULN< 15.6) and CK 874U/l (ULN <168). The echocardiogram showed preserved left ventricular ejection fraction and hypokinesia of mid-apical segments of anterior wall. Considering the diagnosis of NSTEMI the patient underwent coronary angiography that revealed luminal narrowing of 70% in left main artery, 70% in proximal anterior descending artery (LAD) and 99% in first obtuse marginal. Given the absence of cardiovascular risk factors, the smooth angiographic appearance of coronary lesions and absence of calcium, we suspected of spontaneous dissection or vasculitis. Considering the absence of angina revascularization was delayed. A first coronary angio-CT confirmed the luminal narrowing and suggested a spontaneous dissection. Two weeks later the coronariography and the angio-CT were repeated with a significant improvement, showing only intermediate stenosis of proximal LAD. The additional imaging study revealed a 45mm ascending aortic dilation and a left primitive carotid stenosis without other vascular territory alterations, excluding fibromuscular dysplasia. The auto-immune study was unremarkable. With all these results it was assumed the diagnosis of a spontaneous coronary artery dissection and the patient was discharged asymptomatic under single antiplatelet therapy and Rivaroxaban. Three months later a new coronary angio-CT showed no significant coronary artery stenosis and the patient was asymptomatic.

Discussion and conclusion

The recognition of spontaneous coronary artery dissection is essential to the correct management of these cases because, unlike acute coronary syndrome due to atherosclerotic disease, the results of revascularization in these patients are suboptimal and conservative management is probably the best option.

Abstract P715 Figure. angio-CT

Autologous Adipose Tissue-Derived Mesenchymal Stem Cells Introduced by Biliary Stents or Local Immersion in Porcine Bile Duct Anastomoses

Biliary complications (strictures and leaks) represent major limitations in living donor liver transplantation. Mesenchymal stem cells (MSCs) are a promising modality to prevent biliary complications because of immunosuppressive and angiogenic properties. Our goal was to evaluate the safety of adipose-derived MSC delivery to biliary anastomoses in a porcine model. Secondary objectives were defining the optimal method of delivery (intraluminal versus extraluminal) and to investigate MSC engraftment, angiogenesis, and fibrosis. Pigs were divided into 3 groups. Animals underwent adipose collection, MSC isolation, and expansion. Two weeks later, animals underwent bile duct transection, reanastomosis, and stent insertion. Group 1 received plastic stents wrapped in unseeded Vicryl mesh. Group 2 received stents wrapped in MSC-seeded mesh. Group 3 received unwrapped stents with the anastomosis immersed in an MSC suspension. Animals were killed 1 month after stent insertion when cholangiograms and biliary tissue were obtained. Serum was collected for liver biochemistries. Tissue was used for hematoxylin-eosin and trichrome staining and immunohistochemistry for MSC markers (CD44 and CD34) and for a marker of neoangiogenesis (CD31). There were no intraoperative complications. One pig died on postoperative day 3 due to acute cholangitis. All others recovered without complications. Cholangiography demonstrated no biliary leaks and minimal luminal narrowing. Surviving animals exhibited no symptoms, abnormal liver biochemistries, or clinically significant biliary stricturing. Group 3 showed significantly greater CD44 and CD34 staining, indicating MSC engraftment. Fibrosis was reduced at the anastomotic site in group 3 based on trichrome stain. CD31 staining of group 3 was more pronounced, supporting enhanced neoangiogenesis. In conclusion, adipose-derived MSCs were safely applied to biliary anastomoses. MSCs were locally engrafted within the bile duct and may have beneficial effects in terms of fibrosis and angiogenesis.

Determination of thermal transitions of gluten-free chestnut flour doughs enriched with brown seaweed powders and antioxidant properties of baked cookies

A protocol for determining the characteristic temperatures of thermomechanical transitions on gluten-free flour doughs is proposed. This protocol is based on the mathematical analysis of experimental curve of storage modulus (G′) vs temperature obtained by means of Dynamic Mechanical Thermal Analysis (DMTA) technique. Doughs at constant consistency of chestnut flour with different levels (3, 6 and 9% flour basis, f.b.) of brown seaweed (Bifurcaria bifurcata, Fucus vesiculosus and Ascophyllum nodosum) powders addition, 2% f.b. of guar gum and 1.8% f.b. of salt with different water absorption were used to test the proposed protocol. The ranges of temperatures corresponding to starch gelatinization (59–97 °C), amylopectin crystallites melting (82–101 °C), reversible dissociation of lipid-amylose complexes (107–128 °C) and amylose melting (133–171 °C) showed a strong dependence with water absorption of samples. Doughs with the same water absorption submitted to starch gelatinization during mixing were also analysed to corroborate the protocol suitability. Total polyphenols content and radical scavenging activity of extracts from chestnut flour-seaweed powder blends and seaweed-enriched chestnut cookies baked at 180 °C were determined. Extraction assisted with ultrasounds was carried out employing acetone-water (70:30 v/v) solution as solvent during 4 min with a liquid/solid ratio of 30 w/w. Seaweed powder addition had a positive effect on antioxidant properties of doughs before baking. However, the seaweed powder addition effect on baked products (cookies) is not clear due to antioxidant activity is overlapped by Maillard's products generated during baking.

Effects of treatment of preweaning dairy calves with recombinant bovine somatotropin on immune responses and somatotropic axis

Weaning may be associated with negative energy balance and body weight loss when calves are still immunologically immature, predisposing them to infectious diseases. The aim of the present experiment was to investigate the effects of treatment of preweaning dairy calves with recombinant bovine somatotropin (rbST) on the somatotropic axis, selected immune parameters, and hematology of calves around weaning. Thirty-six Holstein female calves were randomly assigned to receive 1.5 to 1.8 mg of rbST (Posilac, Elanco Animal Health, Greenfield, IN) per kilogram of body weight or to receive injections of saline (saline solution 0.9%, Valley Vet Supply, Marysville, KS) every 7 d from 21 to 63 d of life. Calves were fed milk replacer ad libitum from birth to 38 d of age (d -11), when progressive weaning started, and calves were weaned at 49 d of age (d 0). Calves were weighed at birth and weekly from 21 to 63 d of age, when wither height also was measured. Calves were vaccinated with 0.5 mg of ovalbumin on study d -28 and -7. Blood samples were collected on d -28, -25, -21, -11, 0, 3, 7, and 14. Polymorphonuclear leukocytes were isolated and challenged ex vivo with Escherichia coli to determine phagocytosis and oxidative burst capacity. Additionally, expression of cluster of differentiation (CD)62L and CD18 by granulocyte, lymphocyte, and CD14+ monocyte were determined. Blood samples were also used to determine hematological parameters and concentrations of growth hormone, insulin-like growth factor-1, insulin, glucose, fatty acids, β-hydroxybutyrate, haptoglobin, and anti-ovalbumin IgG. Calves treated with rbST had greater concentrations of growth hormone and insulin-like growth factor-1 from d -25 to 14 than control calves, whereas insulin, fatty acid, and β-hydroxybutyrate concentrations did not differ. On d -11, glucose concentration was greater for rbST-treated calves. Treatment did not affect polymorphonuclear lymphocyte phagocytosis and oxidative burst, but intensity of expression of CD62L and CD18 by granulocytes tended to be increased by rbST treatment. Treatment did not affect the concentration of anti-ovalbumin IgG in serum. Haptoglobin concentration was reduced in rbST treated calves on d 3 and we noted a tendency for hematocrit to be lower in rbST-treated calves. Treatment did not affect body weight, wither height, and average daily gain, despite the fact that rbST-treated calves had lower daily milk replacer intake. The relatively minor improvements in immune responses resulting from rbST treatment of weaning calves may not be sufficient to reduce the incidence of infectious diseases.

Comparative pharmacology and toxicology of tramadol and tapentadol

Moderate-to-severe pain represents a heavy burden in patients' quality of life, and ultimately in the society and in healthcare costs. The aim of this review was to summarize data on tramadol and tapentadol adverse effects, toxicity, potential advantages and limitations according to the context of clinical use. We compared data on the pharmacological and toxicological profiles of tramadol and tapentadol, after an extensive literature search in the US National Library of Medicine (PubMed). Tramadol is a prodrug that acts through noradrenaline and serotonin reuptake inhibition, with a weak opioid component added by its metabolite O-desmethyltramadol. Tapentadol does not require metabolic activation and acts mainly through noradrenaline reuptake inhibition and has a strong opioid activity. Such features confer tapentadol potential advantages, namely lower serotonergic, dependence and abuse potential, more linear pharmacokinetics, greater gastrointestinal tolerability and applicability in the treatment of chronic and neuropathic pain. Although more studies are needed to provide clear guidance on the opioid of choice, tapentadol shows some advantages, as it does not require CYP450 system activation and has minimal serotonergic effects. In addition, it leads to less side effects and lower abuse liability. However, in vivo and in vitro studies have shown that tramadol and tapentadol cause similar toxicological damage. In this context, it is important to underline that the choice of opioid should be individually balanced and a tailored decision, based on previous experience and on the patient's profile, type of pain and context of treatment.

SIGNIFICANCE

This review underlines the need for a careful prescription of tramadol and tapentadol. Although both are widely prescribed synthetic opioid analgesics, their toxic effects and potential dependence are not completely understood yet. In particular, concerning tapentadol, further research is needed to better assess its toxic effects.

Starch nanocapsules containing a novel neutrophil elastase inhibitor with improved pharmaceutical performance

Psoriasis and atopic dermatitis patients show an excessive amount of elastase in peripheral blood neutrophils due to an imbalance between this proteolytic enzyme and its endogenous inhibitors, the search for new human neutrophil elastase (HNE) inhibitors are required. The HNE is an attractive therapeutic target and inhibitors with new molecular architectures have been extensively investigated. In this context a promising novel synthetic human neutrophil elastase inhibitor (ER143) was associated to a starch-based nanoparticulate system (StNC) with improved pharmaceutical performance, using a quality by design approach to support product development and optimization. The resulting formulation was characterized in terms of and in vitro release, permeation and retention studies in newborn pig skin, using Franz diffusion cells revealing the StNC have the ability to control the drug release rate and contribute to a high skin retention and/or permeation profiles. The anti-inflammatory activity accessed in vivo using the croton oil-induced ear inflammation model in mice showed that erythema and edema were attenuated in 98% following local application. These observations suggest the association of ER143 to the StNC promotes a deeper skin penetration and retention, also confirming StNC as a potential topical delivery system.