Boosting Supercapacitor Efficiency with Amorphous Biomass-Derived C@TiO2 Composites

Carbon materials are readily available and are essential in energy storage. One of the routes used to enhance their surface area and activity is the decoration of carbons with semiconductors, such as amorphous TiO2, for application in energy storage devices. This work reports the preparation of amorphous TiO2 nanopowders, which were obtained through the anodization of titanium in ethaline media. The obtained amorphous TiO2 was used to obtain TiO2-decorated carbon (obtained through the carbonization of glycogen precursor from mussel cooking wastewater, under N2 atmosphere) composites through three different methods: electrochemical in-situ attachment of TiO2 nanopowders to the carbon matrix using ultrasounds and sonication in ethaline. Commercial TiO2 was used as the comparison material. Morphology, composition, and structure analysis were performed, followed by the electrochemical analysis in ethaline electrolyte. The in-situ attachment of amorphous TiO2 to the carbon matrix shows the most promising electrochemical performance of 956 F g-1 at 1 A g-1 for the three-electrode cell setup, with 100%  and 98% capacitance retention after 1000 and 10000 cycles. On a two-electrode symmetric solid-state electrolyte cell, the gravimetric capacitance is 1251 F g-1, at 1 A g-1, with 90% and 78% capacitance retention after 1000 and 10000 cycles, respectively.

Electrochemical immunosensor for point-of-care detection of soybean Gly m TI allergen in foods

Soybean is a legume with high technological functionality, commonly used by the food industry as an ingredient in different products. However, soybean is an allergenic food whose undeclared presence in processed foods may represent a public health risk. In this work, it was developed an efficient electrochemical immunosensor, targeting the soybean trypsin inhibitor (Gly m TI) allergen using commercial anti-Gly m TI IgG, aiming at detecting/quantifying minute amounts of soybean in different food formulations. For this purpose, model mixtures of different foods (sausages, cooked-hams, biscuits) were prepared to contain known amounts of soybean protein isolate (100,000-0.1 mg kg-1) and submitted to specific thermal treatments (autoclaving, oven-cooking, baking). The electrochemical immunosensor allowed quantifying down to 0.1 mg kg-1 of soybean in the three food matrices, raw and processed (0.0012 mg of Gly m TI/kg of matrix). Accordingly, the immunosensor is suitable for detecting traces of soybean in raw, processed, and complex foods, thus protecting 99 % of soybean-allergic patients.

Flexible tape-drive target system for secondary high-intensity laser-driven sources

We present the development of a flexible tape-drive target system to generate and control secondary high-intensity laser-plasma sources. Its adjustable design permits the generation of relativistic MeV particles and x rays at high-intensity (i.e., ≥1 × 1018 W cm-2) laser facilities, at high repetition rates (>1 Hz). The compact and robust structure shows good mechanical stability and a high target placement accuracy (<4 μm RMS). Its compact and flexible design allows for mounting in both the horizontal and vertical planes, which makes it practical for use in cluttered laser-plasma experimental setups. The design permits ∼170° of access on the laser-driver side and 120° of diagnostic access at the rear. A range of adapted apertures have been designed and tested to be easily implemented to the targetry system. The design and performance testing of the tape-drive system in the context of two experiments performed at the COMET laser facility at the Lawrence Livermore National Laboratory and at the Advanced Lasers and Extreme Photonics (ALEPH) facility at Colorado State University are discussed. Experimental data showing that the designed prototype is also able to both generate and focus high-intensity laser-driven protons at high repetition rates are also presented.

Leveraging a multivariate approach towards enhanced development of direct compression extended release tablets

Extended release formulations play a crucial role in the pharmaceutical industry by maintaining steady plasma levels, reducing side effects, and improving therapeutic efficiency and compliance. One commonly used method to develop extended release formulations is direct compression, which offers several advantages, such as simplicity, time savings, and cost-effectiveness. However, successful direct compression-based extended release formulations require careful assessment and an understanding of the excipients' attributes. The scope of this work is the characterization of the compaction behavior of some matrix-forming agents and diluents for the development of extended release tablets. Fifteen excipients commonly used in extended release formulations were evaluated for physical, compaction and tablet properties. Powder properties (e.g., particle size, flow properties, bulk density) were evaluated and linked to the tablet's mechanical properties in a fully integrated approach, and data were analyzed by constructing a principal component analysis (PCA). Significant variability was observed among the various excipients. The present work successfully demonstrates the applicability of PCA as an effective tool for comparative analysis, pattern and clustering recognition and correlations between excipients and their properties, facilitating the development and manufacturing of direct compressible extended release formulations.

Plasmonic genosensor for detecting hazelnut Cor a 14-encoding gene for food allergen monitoring

A plasmonic nanostructure was constructed as a biorecognition element coupled to an optical sensing platform in sandwich format, targeting the hazelnut Cor a 14 allergen-encoding gene. The analytical performance of the genosensor presented a linear dynamic range between 100 amol L-1 and 1 nmol L-1, a limit of detection (LOD) < 19.9 amol L-1, and a sensitivity of 13.4 ± 0.6 m°. The genosensor was successfully hybridized with hazelnut PCR products, tested with model foods, and further validated by real-time PCR. It reached a LOD <0.001% (10 mg kg-1) of hazelnut in wheat material (corresponding to 1.6 mg kg-1 of protein) and a sensitivity of -17.2 ± 0.5 m° for a linear range of 0.001%-1%. Herein, a new genosensing approach is proposed as a highly sensitive and specific alternative tool with potential application in monitoring hazelnut as an allergenic food, protecting the health of sensitized/allergic individuals.

Renewable Carbon Materials as Electrodes for High-Performance Supercapacitors: From Marine Biowaste to High Specific Surface Area Porous Biocarbons

Waste, in particular, biowaste, can be a valuable source of novel carbon materials. Renewable carbon materials, such as biomass-derived carbons, have gained significant attention recently as potential electrode materials for various electrochemical devices, including batteries and supercapacitors. The importance of renewable carbon materials as electrodes can be attributed to their sustainability, low cost, high purity, high surface area, and tailored properties. Fish waste recovered from the fish processing industry can be used for energy applications and prioritizing the circular economy principles. Herein, a method is proposed to prepare a high surface area biocarbon from glycogen extracted from mussel cooking wastewater. The biocarbon materials were characterized using a Brunauer-Emmett-Teller surface area analyzer to determine the specific surface area and pore size and by scanning electron microscopy coupled with energy-dispersive X-ray analysis, Raman analysis, attenuated total reflectance Fourier transform infrared spectroscopy, X-ray diffraction, X-ray photoelectron spectroscopy, and transmission electron microscopy. The electrochemical characterization was performed using a three-electrode system, utilizing a choline chloride-based deep eutectic solvent (DES) as an eco-friendly and sustainable electrolyte. Optimal time and temperature allowed the preparation of glycogen-based carbon materials, with a specific surface area of 1526 m² g^-1, a pore volume of 0.38 cm³ g^-1, and an associated specific capacitance of 657 F g^-1 at a current density of 1 A g^-1, at 30 °C. The optimal material was scaled up to a two-electrode supercapacitor using a DES-based solid-state electrolyte (SSE@DES). This prototype delivered a maximum capacitance of 703 F g^-1 at a 1 A g^-1 of current density, showing 75% capacitance retention over 1000 cycles, delivering the highest energy density of 0.335 W h kg^-1 and power density of 1341 W kg^-1. Marine waste can be a sustainable source for producing nanoporous carbon materials to be incorporated as electrode materials in energy storage devices.

Discussing the possibility of fertility treatment being unsuccessful as part of routine care offered at clinics: patients' experiences, willingness, and preferences

STUDY QUESTION

Are patients willing to discuss the possibility of treatment being unsuccessful as part of routine care offered at clinics, and what are the factors associated with this willingness?

SUMMARY ANSWER

Nine in every 10 patients are willing to discuss this possibility as part of routine care, with willingness being associated with higher perceived benefits, lower barriers, and stronger positive attitudes towards it.

WHAT IS KNOWN ALREADY

Fifty-eight percent of patients who complete up to three cycles of IVF/ICSI in the UK do not achieve a live birth. Offering psychosocial care for unsuccessful fertility treatment (PCUFT), defined as assistance and guidance on the implications of treatment being unsuccessful, could reduce the psychosocial distress patients experience when it happens, and promote positive adjustment to this loss. Research shows 56% of patients are willing to plan for an unsuccessful cycle, but little is known about their willingness and preferences towards discussing the possibility of definitive unsuccessful treatment.

STUDY DESIGN, SIZE, DURATION

The study was of cross-sectional design, comprising a theoretically driven and patient-centred bilingual (English, Portuguese) mixed-methods online survey. The survey was disseminated via social media (April 2021-January 2022). Eligibility criteria included being aged 18 or older, waiting to or undergoing an IVF/ICSI cycle, or having completed a cycle within the previous 6 months without achieving a pregnancy. Out of 651 people accessing the survey, 451 (69.3%) consented to participate. From these, 100 did not complete 50% of the survey questions, nine did not report on the primary outcome variable (willingness), and 342 completed the survey (completion rate 75.8%, 338 women).

PARTICIPANTS/MATERIALS, SETTING, METHODS

The survey was informed by the Health Belief Model (HBM) and Theory of Planned Behaviour (TPB). Quantitative questions covered sociodemographic characteristics and treatment history. Quantitative and qualitative questions gathered data on past experiences, willingness, and preferences (with whom, what, how and when) to receive PCUFT, as well as theory-informed factors hypothesized to be associated with patients' willingness to receive it. Descriptive and inferential statistics were used on quantitative data about PCUFT experiences, willingness, and preferences, and thematic analysis was applied to textual data. Two logistic regressions were used to investigate the factors associated with patients' willingness.

MAIN RESULTS AND THE ROLE OF CHANCE

Participants were, on average, 36 years old and most resided in Portugal (59.9%) and the UK (38.0%). The majority (97.1%) were in a relationship for around 10 years, and 86.3% were childless. Participants were undergoing treatment for, on average, 2 years [SD = 2.11, range: 0-12 years], with most (71.8%) having completed at least one IVF/ICSI cycle in the past, almost all (93.5%) without success. Around one-third (34.9%) reported having received PCUFT. Thematic analysis showed participants received it mainly from their consultant. The main topic discussed was patients' low prognosis, with the emphasis being put on achieving a positive outcome. Almost all participants (93.3%) would like to receive PCUFT. Reported preferences indicated that 78.6% wanted to receive it from a psychologist/psychiatrist/counsellor, mostly in case of a bad prognosis (79.4%), emotional distress (73.5%), or difficulties in accepting the possibility of treatment being unsuccessful (71.2%). The preferred time to receive PCUFT was before initiating the first cycle (73.3%), while the preferred format was in an individual (mean = 6.37, SD = 1.17; in 1-7 scale) or couple (mean = 6.34, SD = 1.24; in 1-7 scale) session. Thematic analysis showed participants would like PCUFT to provide an overview of treatment and all possible outcomes tailored to each patient's circumstances and to encompass psychosocial support, mainly focused on coping strategies to process loss and sustain hope towards the future. Willingness to receive PCUFT was associated with higher perceived benefit of building psychosocial resources and coping strategies (odds ratios (ORs) 3.40, 95% CI 1.23-9.38), lower perceived barrier of triggering negative emotions (OR 0.49, 95% CI 0.24-0.98), and stronger positive attitudes about PCUFT being beneficial and useful (OR 3.32, 95% CI 2.12-5.20).

LIMITATIONS, REASONS FOR CAUTION

Self-selected sample, mainly composed of female patients who had not yet achieved their parenthood goals. The small number of participants unwilling to receive PCUFT reduced statistical power. The primary outcome variable was intentions, and research shows a moderate association between intentions and actual behaviour.

WIDER IMPLICATIONS OF THE FINDINGS

Fertility clinics should provide patients with early opportunities to discuss the possibility of their treatment being unsuccessful as part of routine care. PCUFT should focus on minimizing suffering associated with grief and loss by reassuring patients they can cope with any treatment outcome, promoting coping resources, and signposting to additional support.

STUDY FUNDING/COMPETING INTEREST(S)

M.S.-L. holds a doctoral fellowship from the Portuguese Foundation for Science and Technology, I.P. [Fundação para a Ciência e a Tecnologia] (FCT; SFRH/BD/144429/2019). R.C. holds a post-doctoral fellowship supported by the European Social Fund (ESF) and FCT (SFRH/BPD/117597/2016). The EPIUnit, ITR and CIPsi (PSI/01662) are also financed by FCT through the Portuguese State Budget, in the scope of the projects UIDB/04750/2020, LA/P/0064/2020 and UIDB/PSI/01662/2020, respectively. Dr Gameiro reports consultancy fees from TMRW Life Sciences and Ferring Pharmaceuticals A/S, speaker fees from Access Fertility, SONA-Pharm LLC, Meridiano Congress International and Gedeon Richter, grants from Merck Serono Ltd, an affiliate of Merck KgaA, Darmstadt, Germany.

TRIAL REGISTRATION NUMBER

N/A.

RNA- and ATAC-sequencing Reveals a Unique CD83+ Microglial Population Focally Depleted in Parkinson's Disease

All brain areas affected in Parkinson's disease (PD) show an abundance of microglia with an activated morphology together with increased expression of pro-inflammatory cytokines, suggesting that neuroinflammation may contribute to the neurodegenerative process in this common and incurable disorder. We applied a single nucleus RNA- and ATAC-sequencing approach using the 10x Genomics Chromium platform to postmortem PD samples to investigate microglial heterogeneity in PD. We created a multiomic dataset using substantia nigra (SN) tissues from 19 PD donors and 14 non-PD controls (NPCs), as well as three other brain regions from the PD donors which are differentially affected in this disease: the ventral tegmental area (VTA), substantia inominata (SI), and hypothalamus (HypoTs). We identified thirteen microglial subpopulations within these tissues as well as a perivascular macrophage and a monocyte population, of which we characterized the transcriptional and chromatin repertoires. Using this data, we investigated whether these microglial subpopulations have any association with PD and whether they have regional specificity. We uncovered several changes in microglial subpopulations in PD, which appear to parallel the magnitude of neurodegeneration across these four selected brain regions. Specifically, we identified that inflammatory microglia in PD are more prevalent in the SN and differentially express PD-associated markers. Our analysis revealed the depletion of a CD83 and HIF1A- expressing microglial subpopulation, specifically in the SN in PD, that has a unique chromatin signature compared to other microglial subpopulations. Interestingly, this microglial subpopulation has regional specificity to the brainstem in non-disease tissues. Furthermore, it is highly enriched for transcripts of proteins involved in antigen presentation and heat-shock proteins, and its depletion in the PD SN may have implications for neuronal vulnerability in disease.

Chitins from Seafood Waste as Sustainable Porous Carbon Precursors for the Development of Eco-Friendly Supercapacitors

Carbon materials derived from marine waste have been drawing attention for supercapacitor applications. In this work, chitins from squid and prawn marine wastes were used as carbon precursors for further application as electrodes for energy storage devices. Chitins were obtained through a deproteinization method based on enzymatic hydrolysis as an alternative to chemical hydrolysis as commonly presented in the literature. The obtained porous carbons were characterized using a BET surface area analyzer to determine the specific surface area and pore size, as well as scanning electron microscopy (SEM) with energy dispersive X-ray analysis (EDX), transmission electron microscopy (TEM), Raman spectroscopy, attenuated total reflectance Fourier transform infrared (ATR-FTIR) spectroscopy, X-ray diffraction (XRD), and X-ray photoelectron spectroscopy (XPS), to characterize their morphology, composition, and structure. The electrochemical characterization was performed using a glassy carbon (GC) electrode modified with marine waste-based porous carbons as the working electrode through cyclic voltammetry and galvanostatic charge/discharge using ethaline, a choline chloride-based deep eutectic solvent (DES), as an eco-friendly and sustainable electrolyte. Squid and prawn chitin-based carbons presented a surface area of 149.3 m² g^-1 and 85.0 m² g^-1, pore volume of 0.053 cm³ g^-1 and 0.029 cm³ g^-1, and an associated specific capacitance of 20 and 15 F g^-1 at 1 A g^-1, respectively. Preliminary studies were performed to understand the effect of -OH groups on the chitin-based carbon surface with DES as an electrolyte, as well as the effect of aqueous electrolytes (1 mol L^-1 sulphuric acid (H₂SO₄) and 1 mol L^-1 potassium hydroxide (KOH)) on the capacitance and retention of the half-cell set up. It is provided, for the first time, the use of chitin-based carbon materials obtained through a one-step carbonization process combined with an eco-friendly DES electrolyte for potential application in energy storage devices.

Comparative bench study evaluation of a modified snorkeling mask used during COVID-19 pandemic and standard interfaces for non-invasive ventilation

PURPOSE

The aim of this bench study is to compare the standard NIV and nCPAP devices (Helmet, H; Full face mask, FFM) with a modified full face snorkeling mask used during COVID-19 pandemic.

METHODS

A mannequin was connected to an active lung simulator. The inspiratory and expiratory variations in airways pressure observed with a high simulated effort, were determined relative to the preset CPAP level. NIV was applied in Pressure Support Mode at two simulated respiratory rates and two cycling-off flow thresholds. During the bench study, we measured the variables defining patient-ventilator interaction and performance.

RESULTS

During nCPAP, the tested interfaces did not show significant differences in terms of ∆Pawi and ∆Pawe. During NIV, the snorkeling mask demonstrated a better patient-ventilator interaction compared to FFM, as shown by significantly shorter Pressurization Time and Expiratory Trigger Delay (p < 0.01), but no significant differences were found in terms of Inspiratory Trigger Delay and Time of Synchrony between the interfaces tested. At RR 20sim, the snorkeling mask presented the lower ΔPtrigger (p < 0.01), moreover during all the conditions tested the snorkeling mask showed the longer Pressure Time Product at 200, 300, and 500 ms compared to FFM (p < 0.01). A major limitation of snorkeling mask is that during NIV with this interface it is possible to reach maximum 18 cmH₂O of peak inspiratory pressure.

CONCLUSIONS

The modified snorkeling mask can be used as an acceptable alternative to other interfaces for both nCPAP and NIV in emergencies.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

Exclusive breastfeeding during the COVID-19 pandemic in 17 WHO European Region countries

Background

Maternal experience of labour and delivery is multidimensional and is influenced by a variety of factors.

Aim

to report maternal childbirth experience as described by the women themselves during the COVID-19 pandemic in Sweden using a WHO Standards-based tool adapted for an online survey (Quality of maternal and newborn care-QMNC).

Methods

Women ≥ 18 years of age who gave birth from March 1, 2020 to June 30, 2021 were asked to give voluntary consent to participate in an online survey. The survey included 40 questions on four key domains: provision of care, experience of care, availability of human and physical resources and organisational changes due to COVID-19.

Results

5003 women were included in the analysis. Among those who underwent labour (n = 4528), 46.7% perceived a reduction in QMNC due to the COVID-19 pandemic, 50.7% were not allowed a companion of choice, 62.5% reported that health workers were not always using protective personal equipment and 36.5% rated the number of health workers as “insufficient”. Fundal pressure was applied in 22.2% of instrumental vaginal births and 36.8% received inadequate breastfeeding support. In addition, 18.4% of women did not feel treated with dignity and 6.9% reported some form of abuse. In general, findings were significantly worse among women who did not undergo labour (n = 475).

Conclusions

Swedish mothers’ satisfaction of care provided during childbirth was strongly influenced by many variables. Actions to promote high-quality, evidence-based, patient-centered respectful care for all mothers and newborns are urgently needed.

Health-related quality of life among five-year-old extremely preterm children with motor disorders

Background

Motor disorders resulting from extremely preterm birth (EPT; &lt;28 weeks’ gestation) can limit daily activities, schooling and social relationships. Cerebral palsy (CP) affects about 10% of children and non-CP movement difficulties (MD) are highly prevalent, although they tend to be under-diagnosed, especially in children without other developmental difficulties. We investigated the association between motor disorders and health-related quality of life (HRQoL) among five-year-old children born EPT.

Methods

We included children at age five from a population-based EPT birth cohort born in 2011-2012 in 11 European countries (N = 1,021). Children without CP were classified using the Movement Assessment Battery for Children - 2nd edition as having significant MD (≤5th percentile of standardised norms) or being at risk of MD (6th-15th percentile). Parents reported on CP diagnoses and HRQoL using the Pediatric Quality of Life InventoryTM. We used linear regression to compare HRQoL scores by motor status adjusting for social characteristics.

Results

Children born EPT with CP, significant MD and at risk of MD had lower adjusted HRQoL total scores [95% confidence intervals] than those without MD: -26.1 [-31.0; -21.2], -9.1 [-12.0; -6.1] and -5.0 [-7.7; -2.3]. Decreases were greater for physical scores: -35.3 [-42.7; -27.9], -11.9 [-16.1; -7.8] and -5.4 [-9.1; -1.6] than psychosocial scores: -20.6 [-25.2; -16.0], -7.4 [-10.3; -4.5] and -4.9 [-7.6; -2.1]. These differences persisted after exclusion of children with other developmental difficulties.

Conclusions

Motor disorders among 5-year-old children born EPT were associated with lower HRQoL, even among children with less severe motor difficulties and without other developmental difficulties.

Key messages

Individual and country-level variables associated with the medicalization of birth

Introduction

According to the World Health Organization, the medicalisation of birth tends “to undermine the woman's own capability to give birth and negatively impacts her childbirth experience”. The COVID-19 pandemic has disrupted maternity care, with potential increase in the medicalisation of birth and in occurrences of disrespectful maternity care. We aim to investigate potential associations between individual and country-level factors and medicalisation of birth in 15 European countries during the COVID-19 pandemic.

Methods

We collected data through an online, anonymous survey for women who gave birth in 2020-2021. We ran multivariable, multi-level logistic regression models estimating associations between indicators of medicalisation (caesarean section (CS), instrumental vaginal birth (IVB), episiotomy, fundal pressure) and proxy variables related to care culture and contextual factors at the individual and country-level.

Results

Among 27173 women, 24.4% had a CS, and 8.8% an IVB. Among women with IVB, 41.9% reported receiving fundal pressure. Among women with spontaneous vaginal births, 22.3% had an episiotomy. Less respectful care, as perceived by the women, was associated with higher levels of medicalisation. For example, women who reported having CS, IVB and episiotomy reported not feeling treated with dignity more frequently than women who didn't have those interventions (respectively: OR: 1.37; OR: 1.61; OR: 1.51; all: p < 0.001). Country-level variables contributed to explaining some of the variance between countries.

Conclusions

We recommend a greater emphasis in health policies on the promotion of respectful and patient-centered care approaches to birth to enhance women's experiences of care, and the development of a European-level indicator to monitor the medicalisation of reproductive care.

Speakers/Panellists

Emanuelle Pessa Valente

WHO Collaborating Centre, Institute for Maternal and Child Health IRCCS, Trieste, Italy

Quality of facility-based maternal and newborn care around the time of childbirth during the COVID-19 pandemic

Background

Multi-country studies assessing the quality of maternal and newborn care (QMNC) during the COVID19 pandemic, as defined by WHO Standards, are lacking.

Methods

Women who gave birth in 12 countries of the WHO European Region from March 1, 2020 - March 15, 2021 answered an online questionnaire, including 40 WHO Standard-based Quality Measures.

Results

21,027 mothers were included in the analysis. Among those who experienced labour (N = 18,063), 41.8% (26.1%- 63.5%) experienced difficulties in accessing antenatal care, 62% (12.6%-99.0%) were not allowed a companion of choice, 31.1% (16.5%-56.9%) received inadequate breastfeeding support, 34.4% (5.2%-64.8%) reported that health workers were not always using protective personal equipment, and 31.8% (17.8%-53.1%) rated the health workers’ number as “insufficient”. Episiotomy was performed in 20.1% (6.1%-66.0%) of spontaneous vaginal births and fundal pressure applied in 41.2% (11.5% -100%) of instrumental vaginal births. In addition, 23.9% women felt they were not treated with dignity (12.8%-59.8%), 12.5% (7.0%-23.4%) suffered abuse, and 2.4% (0.1%-26.2%) made informal payments. Most findings were significantly worse among women with prelabour caesarean birth (N = 2,964). Multivariate analyses confirmed significant differences among countries, with Croatia, Romania, Serbia showing significantly lower QMNC Indexes and Luxemburg showing a significantly higher QMNC Index than the total sample. Younger women and those with operative births also reported significantly lower QMNC Indexes.

Conclusions

Mothers reports revealed large inequities in QMNC across countries of the WHO European Region. Quality improvement initiatives to reduce these inequities and promote evidence-based, patient-centred respectful care for all mothers and newborns during the COVID-19 pandemic and beyond are urgently needed.

Funding: The study was financially supported by the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.

Mechanical circulatory support devices in left main occlusion: a multicenter study from 2008 to 2020

Introduction

Evidence of benefit in the use of mechanical circulatory support devices (MCS) in patients with acute myocardial infarction (AMI) is scarce. We aimed to evaluate the clinicalcharacteristics, prognosis and factors associated with the use of MCS in patients with AMI due to left main (LM) occlusion.

Methods

We performed a retrospective multicenter study of 128 consecutive patients with AMI with ≤12h of presentation with LM occlusion submitted to immediate reperfusion between January 1, 2008, until December 31, 2020 in three terciary hospitals of Portugal. Among this cohort, we divided patients into two groups according to the use of MCS devices.

Results

Regarding the baseline characteristics no statistically significant differences were found, except for the presence of cerebrovascular disease (2.9% in group with vs 16.9% in group without MCS, p=0.007) and peripheral artery disease (8.8% in group with vs 22% in group without MCS, p=0.037). We observed that the use of MCS devices was statistically different between the three centers (47.8%, 42%, 8.7%, p&lt;0.001). No differences were found at presentation for ST-segment elevation vs non-ST segment elevation AMI (p=NS). The presence of cardiogenic shock (72.4% vs 45.8%, p=0.002), cardiac arrest (27.5% vs 23.7%, p=0.034) and more severe thrombolysis in myocardial infarction (TIMI) flow at presentation (55.1% vs 35.6%, p=0.015) were more frequent in group with MCS. The rate of 1-year cumulative mortality was high in both groups (31/59=52.5% in the group without vs 47/69=68.1%, p=NS). Also, no statistically significant differences were found in terms of survival, but we observed a trend to higher mortality in those who received MCS as Kaplan-Meier survival curves show (log rank=0.062). Finally, in multivariable analysis, older age [odds ratio (OR), 0.935; 95% CI, 0.87–0.99], the presence of diabetes (OR, 0.223; 95% CI, 0.056–0.88), peripheral artery disease (OR, 0.070; 95% CI, 0.009–0.566) and extra-hospitalar cardiac arrest (OR, 0.06; 95% CI, 0.007–0.543) were characteristics associated with lower odds of receiving MCS. Contrarily, male sex (OR, 5; 95% CI, 1–20.4) and the presence of cardiogenic shock (OR, 5.7; 95% CI, 1.42–23) were factors associated with higher use of MCS.

Conclusion

The use of MCS does not seem to modify prognosis in patients admitted withAMI due to left main occlusion. Only cardiogenic shock and male gender were predictors of MCS use.

Funding Acknowledgement

Type of funding sources: None.

O-090 Patients’ willingness and preferences about being counselled for the possibility of fertility treatment being unsuccessful

Study question

What are the factors associated with patients’ willingness to be counselled about the possibility of treatment being unsuccessful and their preferences towards it?

Summary answer

Nine in ten patients are willing to be counselled, with willingness being associated with stronger positive attitudes towards counselling, higher perceived benefit and lower barriers

What is known already

Around 57% of patients in the UK end all cycles of IVF/ICSI without having a live birth. Counselling patients on this outcome could reduce the psychosocial distress they experience when it actually happens and facilitate adjustment. Patients perceive they do not have opportunity to discuss the end of treatment with staff. Staff express concerns about such counselling ‘crushing patients’ optimism’ and compromising their engagement with treatment. Research shows 56% of patients are willing to plan in advance for an unsuccessful cycle, but little is known about their willingness and preferences to be counselled about the possibility of treatment being unsuccessful.

Study design, size, duration

Cross-sectional, mixed-methods. Bilingual (Portuguese/English), online survey, disseminated via social media (April-December 2021). Eligibility criteria include being aged 18 or older, waiting to/undergoing an IVF/ICSI cycle, or completing one within the last six months without achieving pregnancy. Out of 651 people accessing the survey, 451 consented to participate. From these, 100 did not complete 50% of survey questions, nine did not report on willingness to be counselled, and 342 completed the survey (75.8%, 338 women).

Participants/materials, setting, methods

Theoretically informed survey. Quantitative questions covered sociodemographic, fertility history and treatment, willingness (yes, no), preferences (by whom, when, why, how), and perceptions (Theory of Planned Behaviour predictors: attitudes, perceived norms, perceived behavioural control; Health belief Model predictors: perceived susceptibility, severity, benefits, barriers) towards being counselled about the possibility of treatment being unsuccessful. Qualitative questions gathered textual data on past experiences of counselling (by whom, topics addressed). Descriptive, logistic regressions, and thematic analysis were used.

Main results and the role of chance

Participants were on average 36 years old, most resident in Portugal (59.9%) and the UK (37.7%). The majority (97.1%) were in a relationship for 10 years, and 86.3% were childless. Participants were undergoing treatment for on average two years [SD=2.11, 0-12 years]. Most (71.8%) completed at least one cycle in the past, with 93.5% not having achieved a positive outcome. Almost all (93.3%) would like to be counselled for possible unsuccessful treatment. Reported preferences indicated that 78.3% wanted to be counselled by a counsellor/psychologist/psychiatrist; 73.3% before initiating the first cycle; mostly in case of a bad prognosis (79.4%), emotional distress (73.5%) or difficulties in accepting the possibility treatment being unsuccessful (71.2%); and mainly in an individual (M=6.37, SD=1.17; in 1-7 scale) or couple (M=6.34, SD=1.24; in 1-7 scale) session. Willingness was associated with stronger positive attitudes towards counselling (OR[95% CI]; 3.11[2.02-4.78]), higher perceived benefits of discussing psychosocial resources and strategies to cope with the loss (12.83[1.72-95.67]), and lower concerns about counselling triggering negative emotions (0.15[0.03-0.74]). Around one-third (34.9%) reported having been counselled, with thematic analysis showing patients were mostly counselled by their consultant and the main topic addressed was low prognosis, with emphasis being put on a future positive outcome.

Limitations, reasons for caution

Self-selected sample, mostly composed of female patients who had not yet achieved their parenthood goals. Small number of unwilling participants reduced statistical power. The main outcome variable was intentions and research shows intentions are only moderately associated with actual behaviour.

Wider implications of the findings

To meet patients’ preferences, fertility clinics should provide more opportunities for patients to discuss the possibility of their treatment being unsuccessful, both before and during treatment. Such counselling should reassure patients they can cope with any treatment outcome and signpost them to coping resources and support sources.

Trial registration number

Not applicable

Molecularly imprinted polymer as a synthetic antibody for the biorecognition of hazelnut Cor a 14-allergen

Artificial receptors that mimic their natural biological counterparts have several advantages, such as lower production costs and increased shelf-life stability/versatility, while overcoming the ethical issues related to raising antibodies in animals. In this work, the proposed tailor-made molecularly imprinted polymer (MIP)-allergen receptors aimed at substituting or even transcending the performance of biological antibodies. For this purpose, a MIP was proposed as an artificial antibody for the recognition of hazelnut Cor a 14-allergen. The target protein was grafted onto the conducting polypyrrole receptor film using gold screen-printed electrodes (Au-SPE). The electrochemical assessment presented a linear response for the dynamic range of 100 fg mL^-1-1 μg mL^-1 and a LOD of 24.5 fg mL^-1, as determined by square wave voltammetry from the calibration curves prepared with standards diluted in phosphate buffer. Surface plasmon resonance (SPR) was used as a secondary transducer to evaluate the performance of the Cor a 14-MIP sensor, enabling a linear dynamic range of 100 fg mL^-1- 0.1 μg mL^-1 and a LOD of 18.1 fg mL^-1. The selectivity of the tailored-made Cor a 14-MIP was tested against potentially cross-reactive plant/animal species based on the rebinding affinity (Freundlich isotherm-K_F) of homologues/similar proteins, being further compared with custom-made polyclonal anti-Cor a 14 IgG immunosensor. Results evidenced that the MIP mimics the biorecognition of biological antibodies, presenting higher selectivity (only minor cross-reactivity towards walnut and Brazil nut 2S albumins) than the Cor a 14/anti-Cor a 14 IgG immunosensor. The application of electrochemical Cor a 14-MIP sensor to model mixtures of hazelnut in pasta enabled quantifying hazelnut down to 1 mg kg^-1 (corresponding to 0.16 mg kg^-1 of hazelnut protein in the matrix). To the best of our knowledge, Cor a 14-MIP is the first sensor based on an artificial/synthetic biorecognition platform for the specific detection of hazelnut allergens, while presenting high-performance parameters with demonstrated application in food safety management.

Characterization of Carbon Nanomaterials Dispersions: Can Metal Decoration of MWCNTs Improve Their Physicochemical Properties?

A suitable dispersion of carbon materials (e.g., carbon nanotubes (CNTs)) in an appropriate dispersant media, is a prerequisite for many technological applications (e.g., additive purposes, functionalization, mechanical reinforced materials for electrolytes and electrodes for energy storage applications, etc.). Deep eutectic solvents (DES) have been considered as a promising "green" alternative, providing a versatile replacement to volatile organic solvents due to their unique physical-chemical properties, being recognized as low-volatility fluids with great dispersant ability. The present work aims to contribute to appraise the effect of the presence of MWCNTs and Ag-functionalized MWCNTs on the physicochemical properties (viscosity, density, conductivity, surface tension and refractive index) of glyceline (choline chloride and glycerol, 1:2), a Type III DES. To benefit from possible synergetic effects, AgMWCNTs were prepared through pulse reverse electrodeposition of Ag nanoparticles into MWCNTs. Pristine MWCNTs were used as reference material and water as reference dispersant media for comparison purposes. The effect of temperature (20 to 60 °C) and concentration on the physicochemical properties of the carbon dispersions (0.2-1.0 mg cm^-3) were assessed. In all assessed physicochemical properties, AgMWCNTs outperformed pristine MWCNTs dispersions. A paradoxical effect was found in the viscosity trend in glyceline media, in which a marked decrease in the viscosity was found for the MWCNTs and AgMWCNTs materials at lower temperatures. All physicochemical parameters were statistically analyzed using a two-way analysis of variance (ANOVA), at a 5% level of significance.

Sustainable Preparation of Nanoporous Carbons via Dry Ball Milling: Electrochemical Studies Using Nanocarbon Composite Electrodes and a Deep Eutectic Solvent as Electrolyte

The urgent need to reduce the consumption of fossil fuels drives the demand for renewable energy and has been attracting the interest of the scientific community to develop materials with improved energy storage properties. We propose a sustainable route to produce nanoporous carbon materials with a high-surface area from commercial graphite using a dry ball-milling procedure through a systematic study of the effects of dry ball-milling conditions on the properties of the modified carbons. The microstructure and morphology of the dry ball-milled graphite/carbon composites are characterized by BET (Brunauer-Emmett-Teller) analysis, SEM (scanning electron microscopy), ATR-FTIR (attenuated total reflectance-Fourier transform infrared spectroscopy) and Raman spectroscopy. As both the electrode and electrolyte play a significant role in any electrochemical energy storage device, the gravimetric capacitance was measured for ball-milled material/glassy carbon (GC) composite electrodes in contact with a deep eutectic solvent (DES) containing choline chloride and ethylene glycol as hydrogen bond donor (HBD) in a 1:2 molar ratio. Electrochemical stability was tracked by measuring charge/discharge curves. Carbons with different specific surface areas were tested and the relationship between the calculated capacitance and the surface treatment method was established. A five-fold increase in gravimetric capacitance, 25.27 F·g-1 (G40) against 5.45 F·g-1, was found for commercial graphene in contact with DES. Optimal milling time to achieve a higher surface area was also established.

Brazil: The profile of COVID-19 deaths among Nurses

 

Health-care workers (HCWs) on the frontlines have a high risk of acquiring and dying from covid-19. Nursing professionals (NP) represent over half of HCWs in Brazil, a country with high morbidity and mortality from covid-19, above all in 2021. The absenteeism and death of nursing professionals due to covid-19 have a major impact on the workforce. As part of the research by Fiocruz on working conditions among HCWs, including those considered “invisible,” we have conducted this study of death among graduated nurses. Although they represent 4 out of 5 members of nursing teams in Brazil, the technicians and assistant nurses remains largely unseen and are covered by the “invisible” HCW study. We analyzed data from Federal Council of Nurses, publicized at the website Observatorio da Enfermagem. The sociodemographic profile, professional category and timeline of nursing professional deaths were considered. The time period of the study was from March 2020 to March 2021. A total of 670 professionals of the nursing team died, 200 of these were nurses. Among nurses: 59.5% were female and 81.5% were up to 60 years old. Our study registers a concentration of deaths in the North region. Despite having fewer registered professionals, it had the highest number of deaths (29.5%), and the Southeast had the second highest percentage (26.5%). A slow decline was observed until December, when Brazil experienced a “second wave” of Covid-19. Vaccination of Nurses began in late January 2021; therefore, there was not enough time to assess the impact on morbidity and mortality. The results of a study of almost 50 professional categories are under analysis and will be published shortly.

Key messages

This study is about death by COVID-19 among nurses in Brazil.

This study is part of a large one on professional categories, essentials to supporting health care system, conducted by FIOCRUZ.

Bone scintigraphy in the diagnosis of transthyretin amyloidosis: a different performance in Portuguese hereditary variant?

Introduction

Bone scintigraphy using radioactive technetium-99m and 3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) has been increasingly used to diagnose myocardial involvement of mutated or wild-type transthyretin amyloidosis (ATTR).

However, most studies that proved a high sensitivity and specificity of the technique were not in patients with the “Portuguese variant” (Val30Met) mutation in transthyretin (TTR). Other authors had already suggested that in these patients the DPD scan could be less accurate.

Methods

Observational study of patients referred to Cardiology clinic with suspicion of ATTR cardiomyopathy. We only included patients with data from echocardiogram and DPD scan.

For statistical analyses, SPSS was used, p&lt;0.05 for statistical significance. Logistic regressions were used to test an association between DPD result and different covariates.

Results

Of 273 patients referred with suspicion of cardiac ATTR, we studied 97 patients that did an echocardiogram and a DPD scan.

Among the 75 cases with mutated TTR (Val30Met), median age was 36 (IQR 34) and 60% were males. 60 had increased ventricular wall thickness (IVWT) &gt;12 mm, but only 24 had a positive DPD (defined as a visual score &gt;2). Even though a higher wall thickness was associated with a positive DPD (p=0.004), 18 patients with a negative scan had IVWT &gt;14 mm. The DPD results was significantly associated with prior liver transplantation (LT) – p&lt;0.001; 95% CI (7.1; 503.6) – and age at first symptoms – p&lt;0.001; 95% CI (1.036; 1.113); 66.7±10.5 versus 34.8±10.2 years-old for those with and without a positive scan, respectively. Interestingly, fewer patients with a positive scan had neurologic symptoms (74% versus 96%, p=0.009), ophthalmologic, urologic or renal involvement, even though creatinine clearance was on average lower (p=0.01). We did not find a significant association between DPD result and sex, conduction disorders, NT-proBNP, troponin T or treatment with tafamidis. Patients on tafamidis had on average lower IVWT, independent of age (median of 13 versus 14 mm; p=0.020). 4 patients with negative DPD did an endomyocardial biopsy, that was positive for amyloid in 3 cases.

In comparison, in the 22 cases with wild-type TTR, there were significantly more males (86%) and patients were older (median age was 81 (IQR 9)). All patients had IVWT (that was significantly higher than in mutated ATTR) and DPD scan was negative in only 2 patients (that had a visual score of 1). Systolic dysfunction was significantly more frequent (59% versus 8%). The occurrence of death or hospitalization for heart failure was significantly higher.

Conclusions

DPD-scintigraphy seems more sensitive in patients with late onset mutated ATTR or with wild-type ATTR. It is less accurate in early onset patients with Val30Met mutation and particularly if they underwent LT. In those patients, further investigation is needed before excluding myocardial involvement.

Funding Acknowledgement

Type of funding sources: None.

Impact of cardiac rehabilitation on inflammation in patients with ischaemic cardiomyopathy

Introduction

The benefits of cardiac rehabilitation (CR) in patients with ischaemic cardiomyopathy are well-known. However, inflammatory states have been associated to an increased risk of cardiovascular events.

Purpose

Evaluate the impact of CR in the serum levels of inflammatory biomarkers and identify potential predictors of that effect.

Methods

We retrospectively studied consecutive patients with ischaemic cardiomyopathy who completed a CR programme between 2011 and 2017. Patients underwent a supervised exercise training protocol, twice a week during a period of 8 to 12 weeks. Functional capacity was evaluated by metabolic equivalents assessed prior the beginning and 3 months after the programme with a symptom limited exercise treadmill test. Patients without levels of serum C-reactive protein at beginning and at the end of CR programme were excluded. Median variation of serum C-reactive protein was assessed and two groups were defined: one with levels above that and one with levels below.

Results

Of 250 patients (60.3±11.1 years, 84% male), 67% were admitted after an acute myocardial infarction. Left ventricular ejection fraction ≤40% before CR was present in 32% of individuals. Median levels of serum C-reactive protein before CR were 8.8 (3.1–21.7) mg/L and median variation after CRP was a decrease of 5.1 (0.9–17.7) mg/L (p&lt;0.001). Before CR, higher levels of serum C-reactive protein were seen in obese (15.7 [8–52.7] versus 8.8 [3.2–27.8], p=0.04) and those with higher NT-proBNP (p&lt;0.001). Patients with decrease of &gt;5.1mg/L of serum C-reactive protein had lower prevalence of hypertension (18% versus 30%, p=0.02), higher prevalence of obesity (16% versus 7%, p=0.03), lower levels of HDL cholesterol (38.3 [11.1] versus 43.2 [12.6], p&lt;0.001) and higher levels of NT-proBNP (1079 [610.3–1988] versus 488 [215–777], p&lt;0.001) at baseline. An increase of at least of 10% of functional capacity after CR was reached in 65% of patients, similar between groups. Patients with decrease of serum C-reactive protein &gt;5.1mg/L had also higher reduction of NT-proBNP after CR comparing to baseline (491.1 [142.7–948.5] versus 162.0 [30.9–295.2], p&lt;0.001).

Conclusions

Serum levels of inflammatory biomarkers decreased after CR in patients with ischaemic cardiomyopathy. Normotension, obesity, lower HDL and higher levels of natriuretic peptides are associated to a better response.

Funding Acknowledgement

Type of funding sources: None.

Orthostatic hypotension in hereditary ATTR Val30Met amyloidosis: predictors and associated clinical features

Introduction

The prevalence of orthostatic hypotension (OH) in patients with mutated transthyretin (TTR) amyloidosis (mATTR) is 40–60%. According to previous studies, OH is frequent and an early feature in patients with Val30Met mutation (the most prevalent form of mATTR).

Aim

To characterize TTR Val30Met patients with OH and to identify clinical characteristics associated with OH development.

Methods

Retrospective study of consecutive Val30Met TTR patients with suspected cardiac involvement observed at our cardiology clinic during 2019. Two groups were defined: group 1: patients without OH; group 2: patients with OH. Data was obtained by chart review. Statistically significant predictors of OH were found using logistic regression.

Results

We included a total of 248 patients (group 1 – 173; group 2 – 75). Group 1 patients were 52% male, median age 45 [interquartile range (IQR) 39–55] and median age at onset 34 (IQR 29,75–46,25) years. Left ventricle hypertrophy [LVH, defined as maximal LV wall thickness (LVT) ≥12 mm] occurred in 26,5%, with median maximal LVT 10 mm (IQR 9–12); 49,7% had conduction disturbances, 30,6% gastrointestinal (GI), 17,3% genitourinary (GU) manifestations and 5% were in Coutinho staging ≥2/3. Group 2 had 56% male, median age of 49 years at evaluation (IQR 42–65) and 35 years at onset (IQR 30–59). LVH was present in 42,9%, with median maximal LVT 11 mm (IQR 10–14); 74,7% had conduction disturbances, 56% GI and 42,7% GU manifestations and 21% were in Coutinho staging ≥2/3.

In univariate analysis, higher age (p=0,005), presence of LVH (p=0,009), conduction disturbances (p&lt;0,001), GU manifestations (p&lt;0,001) and higher Coutinho staging (p&lt;0,001) were all associated with the presence of OH, while age at onset was not (p=0,648). In multivariate analysis, only Coutinho staging [odds ratio (OR) 2.609; 95% confidence interval (95% CI) 1.344–5.065] and GU manifestations (OR 3,151; 95% CI 1,595–6,225) were found to be significant predictors of OH.

Conclusion

Our study suggests that OH is more associated with GU manifestations and Neurologic staging, than with amyloid cardiomyopathy or age, suggesting a predominant neurogenic component. The prevalence of OH in our sample of Val30Met patients was lower than previously described.

Funding Acknowledgement

Type of funding sources: None.

[Prognosis of in hospital nonagenarians with acute kidney injury]

BACKGROUND

There has been little in the way of study of nonagenarians with acute kidney injury (AKI, defined in lines with KDIGO guidelines), but the rise in their life expectancy makes further study of this population necessary. The aim of this study is to assess mortality in nonagenarians with AKI during hospitalization.

METHODS

In this retrospective study, patients with AKI during hospitalization between 2013-2014 were included. At baseline, epidemiological variables, comorbidities and treatments were collected. Analytics and mortality were studied during hospitalisation. Univariate analysis was carried out to evaluate mortality-associated variables. A logistic regres-sion analysis was carried out to demonstrate independent predictors for mortality.

RESULTS

Two hundred and sixty-four nonagenarian patients were included. Mean age was 93±3 years, 73 (27.7?%) of whom were men. During hospitalization, 79 patients (29.9?%) died. Comorbidities related to mortality were history of heart failure (p?=?0.018), diastolic dysfunction (p?<?0.042) and higher dependence according to the modified Barthel index (p?=?0.003). The clinical variables related to mortality at hospital admission were lower systolic (p?=?0.016) and diastolic blood pressure (p?=?0.013), higher white blood cell count (p?=?0.003), greater severity of AKI (p?=?0.003) and L-?lactic (p?=?0.005). In an adjusted multivariate analysis, history of heart failure (OR?=?2.31, 95%CI: 1.07-5.00, p?=?0.036), depend-ence according to the Barthel index (OR?=?0.80, 95%CI: 0.67-0.97, p?=?0.016) and L-?lactic acid (OR?=?1.31, 95%IC: 1.06-1.61, p?=?0.005) were independent predictors of mortality.

CONCLUSION

Heart failure, dependence according to the Barthel index and L-?lactic acid at admission are independent predictors of mortality in nonagenarians hospitalized with AKI.

Electrochemical and optical biosensing platforms for the immunorecognition of hazelnut Cor a 14 allergen

Two immunosensors were advanced to target hazelnut Cor a 14 based on electrochemical and optical transduction. Both approaches were developed with two types of custom-made antibodies, namely anti-Cor a 14 IgG (rabbit) and anti-Cor a 14 IgY (hen's egg) targeting the Cor a 14 allergen. Antibody immobilisation was performed via EDC/NHS onto disposable screen-printed electrodes. The detection limit (LOD) of the electrochemical immunoassay for Cor a 14 was 5-times lower than the optical, being down to 0.05 fg mL^-1 with a dynamic range of 0.1 fg mL^-1 to 0.01 ng mL^-1. Antibody selectivity was verified against non-target 2S albumins (potential cross-reactive plant species). Anti-Cor a 14 IgY exhibited the best specificity, presenting minor cross-reactivity with peanut/walnut. Preliminary results of the application of anti-Cor a 14 IgY electrochemical immunosensor to incurred foods established a LOD of 1 mg kg^-1 of hazelnut in wheat (0.16 mg kg^-1 hazelnut protein).

Scissors and tweezers: A skin-picking disorder case report

Introduction

Skin-Picking Disorder (SPD) is psychiatric condition characterized by recurrent and excessive picking of the skin. There are several attempts to stop the behavior and it causes negative consequences such as dermatological complications and functional impairment.

Objectives

The aim of this study is to describe a case report of SPD.

Methods

Data was collected retrospectively from case notes.

Results

A 30 year-old male, married with 2 children, currently on sick leave, was admitted to the Day Hospital at Centro Hospitalar Psiquiátrico de Lisboa (CHPL) with worsen skin-picking behaviour and functional impairment. During childhood the patient would “cut my toe nails the wrong way so that I could fix them”. By adolescence the patient suffered from acne and felt the need to “solve” them and take out the pus. Over the years the skin-picking behaviour spread to other areas of the body, mainly dorsal and chest areas. Before being admitted to the Day Hospital the episodes were daily and had 2-3 hours duration, using scissors and tweezers and evolving his family, asking his wife’s help with picking. He is being treated with fluoxetine 80 mg, risperidone 2 mg and N-acetylcysteine 1200 mg and Cognitive Behavioural Therapy. He is also participating in the Day Hospital activities that include occupational therapy, movement therapy, psychoeducation. After 2 months he has a few 20 minutes episodes per week, spends more time with his children and thinks about coming back to work.

Conclusions

SPD is a severe and debilitating illness that benefits from a multidisciplinary approach.

Disclosure

No significant relationships.

Music and emotion

Introduction

Music has been said to be emotion’s language. Research confirms a link between music structure and triggered emotions.

Objectives

To assess the relationship between selected music excerpts and the emotions trigged, in order that the former will be used in future research.

Methods

An anonymous study was performed in April 2019 on 65 subjects of both sexes, aged 19- 33 (mean=21,09; SD=3,05).Subjects listened 4 excerpts of music, believed to be related either to excitement or to calmness, and answered to a questionary on emotion’s triggered by each exposure.

Results

Regarding to the music excerpts that were believed to induce excitement 80% of the subjects mentioned exciting emotions, 78% enjoyed the music while 78% didn’t knew them. For the ones that were believed to induce calmness 69% of the subjects mentioned calm emotions, 84% enjoyed the music and 62% didn’t knew the music. In an excerpt of music related to calmness, we observed association between knowing the music and the emotion trigged (p=0,027). The triggered emotion responses were independent of liking the music (P>0,05).

Conclusions

In our study, independent of liking the music, the participants reported to have perceived the expected emotions triggered by musical excerpts, showing this to be a phenomenon related to music structure. Calmness perception may be also influenced by previous knowledge of the music and related experiences. The role of individual perceptions will be looked for in following studies.

Disclosure

No significant relationships.

How are the portuguese coping with the mandatory confinement by COVID-19? Association between mental health and coping strategies

Introduction

The global COVID-19 pandemic has had an unprecedented effect on human behaviour and wellbeing. However, researchers have not yet considered how coping responses to stress related to COVID-19 could influence mental health.

Objectives

This study aims to evaluate the mental health status of Portuguese during the national lockdown; examine how study participants cope with stress during the national lockdown; and assess the association between coping and mental health status.

Methods

We cross sectionally analysed data from a convenience sample of 430 adults living in Portugal. Mental health was measured using the five-item Mental Health Inventory. Coping strategies were assessed using the Brief COPE. We examine the univariate associations between mental health status and coping responses. We performed a multiple hierarchical regression analysis controlling for sex and age, to test the predictive importance of coping responses on mental health status.

Results

Participants’ mental health was lower than the cut-off point for poor mental health (p<.001). The use of instrumental support, emotional support, self-blame, venting, denial, behavioral disengagement, and substance use were positively significantly associated with mental health, while active coping, positive reframing, acceptance, and humor were negatively significantly associated with mental health. The multiple hierarchical regression analyses showed that sex and age accounted for 6% of the variance of mental health. Coping strategies accounted for an additional and statistically significant 30% of the variance of mental health.

Conclusions

The findings provide support for the impact of the coping strategies on mental health. We encourage future research on the present topic.

Metagenomic insights into the taxonomy, function, and dysbiosis of prokaryotic communities in octocorals

BACKGROUND

In octocorals (Cnidaria Octocorallia), the functional relationship between host health and its symbiotic consortium has yet to be determined. Here, we employed comparative metagenomics to uncover the distinct functional and phylogenetic features of the microbiomes of healthy Eunicella gazella, Eunicella verrucosa, and Leptogorgia sarmentosa tissues, in contrast with the microbiomes found in seawater and sediments. We further explored how the octocoral microbiome shifts to a pathobiome state in E. gazella.

RESULTS

Multivariate analyses based on 16S rRNA genes, Clusters of Orthologous Groups of proteins (COGs), Protein families (Pfams), and secondary metabolite-biosynthetic gene clusters annotated from 20 Illumina-sequenced metagenomes each revealed separate clustering of the prokaryotic communities of healthy tissue samples of the three octocoral species from those of necrotic E. gazella tissue and surrounding environments. While the healthy octocoral microbiome was distinguished by so-far uncultivated Endozoicomonadaceae, Oceanospirillales, and Alteromonadales phylotypes in all host species, a pronounced increase of Flavobacteriaceae and Alphaproteobacteria, originating from seawater, was observed in necrotic E. gazella tissue. Increased abundances of eukaryotic-like proteins, exonucleases, restriction endonucleases, CRISPR/Cas proteins, and genes encoding for heat-shock proteins, inorganic ion transport, and iron storage distinguished the prokaryotic communities of healthy octocoral tissue regardless of the host species. An increase of arginase and nitric oxide reductase genes, observed in necrotic E. gazella tissues, suggests the existence of a mechanism for suppression of nitrite oxide production by which octocoral pathogens may overcome the host's immune system.

CONCLUSIONS

This is the first study to employ primer-less, shotgun metagenome sequencing to unveil the taxonomic, functional, and secondary metabolism features of prokaryotic communities in octocorals. Our analyses reveal that the octocoral microbiome is distinct from those of the environmental surroundings, is host genus (but not species) specific, and undergoes large, complex structural changes in the transition to the dysbiotic state. Host-symbiont recognition, abiotic-stress response, micronutrient acquisition, and an antiviral defense arsenal comprising multiple restriction endonucleases, CRISPR/Cas systems, and phage lysogenization regulators are signatures of prokaryotic communities in octocorals. We argue that these features collectively contribute to the stabilization of symbiosis in the octocoral holobiont and constitute beneficial traits that can guide future studies on coral reef conservation and microbiome therapy. Video Abstract.

Functional metagenomics reveals differential chitin degradation and utilization features across free-living and host-associated marine microbiomes

BACKGROUND

Chitin ranks as the most abundant polysaccharide in the oceans yet knowledge of shifts in structure and diversity of chitin-degrading communities across marine niches is scarce. Here, we integrate cultivation-dependent and -independent approaches to shed light on the chitin processing potential within the microbiomes of marine sponges, octocorals, sediments, and seawater.

RESULTS

We found that cultivatable host-associated bacteria in the genera Aquimarina, Enterovibrio, Microbulbifer, Pseudoalteromonas, Shewanella, and Vibrio were able to degrade colloidal chitin in vitro. Congruent with enzymatic activity bioassays, genome-wide inspection of cultivated symbionts revealed that Vibrio and Aquimarina species, particularly, possess several endo- and exo-chitinase-encoding genes underlying their ability to cleave the large chitin polymer into oligomers and dimers. Conversely, Alphaproteobacteria species were found to specialize in the utilization of the chitin monomer N-acetylglucosamine more often. Phylogenetic assessments uncovered a high degree of within-genome diversification of multiple, full-length endo-chitinase genes for Aquimarina and Vibrio strains, suggestive of a versatile chitin catabolism aptitude. We then analyzed the abundance distributions of chitin metabolism-related genes across 30 Illumina-sequenced microbial metagenomes and found that the endosymbiotic consortium of Spongia officinalis is enriched in polysaccharide deacetylases, suggesting the ability of the marine sponge microbiome to convert chitin into its deacetylated-and biotechnologically versatile-form chitosan. Instead, the abundance of endo-chitinase and chitin-binding protein-encoding genes in healthy octocorals leveled up with those from the surrounding environment but was found to be depleted in necrotic octocoral tissue. Using cultivation-independent, taxonomic assignments of endo-chitinase encoding genes, we unveiled previously unsuspected richness and divergent structures of chitinolytic communities across host-associated and free-living biotopes, revealing putative roles for uncultivated Gammaproteobacteria and Chloroflexi symbionts in chitin processing within sessile marine invertebrates.

CONCLUSIONS

Our findings suggest that differential chitin degradation pathways, utilization, and turnover dictate the processing of chitin across marine micro-niches and support the hypothesis that inter-species cross-feeding could facilitate the co-existence of chitin utilizers within marine invertebrate microbiomes. We further identified chitin metabolism functions which may serve as indicators of microbiome integrity/dysbiosis in corals and reveal putative novel chitinolytic enzymes in the genus Aquimarina that may find applications in the blue biotechnology sector. Video abstract.

Predictors of survival in patients with precapillary pulmonary hypertension

Funding Acknowledgements

Type of funding sources: None.

Introduction

Although the perceived prognosis of patients with precapillary pulmonary hypertension (PH) is poor, the natural history of this condition is very heterogeneous. In this study we sought to identify predictors of poor outcomes which could help refine prognosis.

Methods

We studied consecutive patients referred to our centre from 12/2016 to 11/2018 with confirmed precapillary PH. A range of clinical, laboratory, echocardiographic and right heart catheterization (RHC) data variables were collected to assess predictors of survival. Outcome was defined as mortality from any cause.

Results

Of the 80 included patients, 51 (64%) were female and mean age was 60.5 ± 16.0 years. The majority of patients (45%) had pulmonary arterial hypertension (group 1) and 41% were chronic thromboembolic pulmonary hypertensive disease patients (group 4). During a median follow-up of 18.7 [IQR 12.3 – 26.7] months, 10 patients (12.5%) died. New York Heart Association (NYHA) functional class (HR 19.4 [95% CI 2.56 - 147.5], p = 0.004) was the strongest predictor of mortality, whereas higher haemoglobin (HR 0.70 [0.49 - 0.99], p= 0.047) and 6-minute walking distance (6MWD) expressed as percentage of predicted (HR 0.96 [0.93 - 0.99], p = 0.004) were associated with better survival overall. Echocardiographic parameters such as eccentricity index (HR 3.35 (95% CI 1.11 - 10.0), p = 0.031), short pulmonary acceleration time (HR 0.98 [95% CI 0.96 - 0.99], p = 0.008), the presence of moderate to severe tricuspid regurgitation (HR 6.46 [95% CI 1.67 - 25.0], p = 0.007) and pericardial effusion (HR 3.86 [95% CI 1.12 - 13.4], p = 0.033) were also associated with death. Traditional right ventricular function parameters such as fractional area change, tricuspid annular plane systolic excursion (TAPSE) and S velocity of the lateral annular tricuspid annulus did not predict mortality in these patients. Invasive pressures and pulmonary vascular resistance measured by RHC were also not associated with mortality. In multivariable analysis, NYHA functional class was the only independent predictor of mortality in patients with precapillary PH (HR 14.5 [95% CI 2.3 - 146.8], p = 0.006).

Conclusion

Eccentricity index, short pulmonary acceleration time, moderate to severe tricuspid regurgitation and pericardial effusion were associated with poor survival. Functional class was the strongest independent predictor of mortality in precapillary PH patients. These parameters may help stratify the risk of death in this heterogenous population.

Diabetes and pre-infarct angina. Time to rethink comorbidities in the reperfusion-injury phenomenon?

Background

Pre-infarct angina (PIA) has been shown to reduce reperfusion injury and infarct size in patients with ST-elevation myocardial infarction (STEMI) and currently represents the most efficient form of myocardial conditioning yet discovered. The role of diabetes on ischemic preconditioning remains controversial – while some pre-clinical studies suggest that diabetes blunts ischemic conditioning, clinical studies are lacking.

Methods

We retrospectively evaluated consecutive patients with STEMI admitted in our hospital from January 2008 to August 2018 who underwent primary angioplasty (PCI). PIA was defined as chest, arm or jaw pain during the preceding 48h before STEMI diagnosis. Peak creatine kinase and peak Troponin T levels were used as a surrogate of infarct size. Ischemic time (IT) was defined as the time between the onset of symptoms to the restoration of flow after either guidewire passage, thrombus aspiration or first balloon inflation.

Results

Of the 1143 included patients, 74% (n=845) were male and mean age was 62.6±13.1 years. A quarter of STEMI-patients had diabetes (25%, n=285). Almost a third of the patients (32%, n=359) had a history of angina in the preceding 48h before STEMI (PIA). The proportion of PIA was similar between diabetic and non-diabetic patients. In patients with diabetes, PIA was associated with lower creatine kinase (CK) (1144 [500–2212] vs 1715 [908–3309] U/L, p=0.0029) and Troponin T (TnT 3.30 [1.90–6.58] vs 4.88 [2.50–9.58] ng/mL, p=0.0022) despite similar IT as compared to those without PIA (328 [200–554] vs. 258 [180–530] minutes, p=0.1365). In non-diabetic patients, PIA was not significantly associated with infarct size (TnT 3.74 [2.23–7.11] vs 4.56 [2.44–7.77] ng/mL, p=0.1945; CK 1549 [910 - 2909] vs 1793 [996 - 3078] U/L, p=0.0653) even after adjustment for the increased ischemic time (240 [150–550] vs. 210 [140–405] minutes, p=0.0128) (β=−0.12, p=0.085 for CK and β=−0.11, p=0.183 for TnT). A significant interaction was observed between the existence of PIA and diabetes on peak TnT (p=0.026 for interaction) and CK (p=0.047 for interaction), which was independent of the culprit vessel and IT. During a median follow-up period of 18.0 [12.1–25.5] months, 268 (24.0%) MACE events have occurred (165 deaths, 27 strokes, 46 myocardial infarctions and 26 target vessel revascularization). PIA was associated with a significant reduction in the incidence of MACE (HR 0.66 (95% CI: 0.48–0.89)) driven by a reduction on mortality (HR 0.44 (95% CI: 0.28–0.70)). Diabetes was associated with an increased incidence of MACE (HR 1.42 (95% CI: 1.07–1.89)). No interaction was found between diabetes and PIA on their effect on MACCE events.

Conclusion

PIA is a strong predictor of favourable outcomes in the setting of STEMI. The effect of PIA on myocardial protection in patients with STEMI undergoing primary PCI seems to be modulated by the presence of diabetes.

Distribution of Peak CK and Peak TnT

Funding Acknowledgement

Type of funding source: None

Iatrogenic transthyretin cardiac amyloidosis after sequential liver transplantation

Introduction

Sequential liver transplantation (SLT) uses livers excised from patients with hereditary transthyretin-related amyloidosis during liver transplantation as grafts to other patients with severe hepatic pathologies and a reserved prognosis. We intended to investigate the development of cardiac manifestations consistent with iatrogenic transthyretin amyloidosis (iATTR).

Methods

We retrospectively analyzed the medical records of 72 consecutive patients submitted to SLT between 2007 and 2010, who received livers with V30M mutation.

Results

Our sample had 79% male patients and a mean age at transplantation of 55±6 years. Median follow-up time was 80 months, were 44% of the patients died. One-year mortality rate after SLT was 7%. Clinical manifestations of iATTR occurred in 29% of individuals, on average 6 years after SLT, and amyloid was seen in 76% of those who underwent a biopsy. Left ventricular hypertrophy (LVH) was identified in 42 (58%) patients at baseline. Considering 39 patients that had an echocardiography at baseline and during follow-up, 22 (61%) presented de novo LVH or basal LVH worsening during follow-up, with a significant increase of wall thickness (11±1 to 13±3 mm; p&lt;0.001). They had similar age at presentation (55±5 vs 58±5, p=0.249) and incidence of hypertension (52% vs 64%, p=0.365) but higher incidence of chronic kidney disease (CKD; 68% vs 29%, p=0.023). Mortality during follow-up was higher in patients with de novo LVH or worsening LVH but not significantly, probably due to the sample size (23% vs 7%, p=0.221, log rank test p=0.262). Considering the global sample, significant conduction changes were rarely seen (1 patient); however, there was a trend towards an increase in PR interval and atrial fibrillation was reported in 8% of cases.

Conclusions

In our sample, probable iATTR was often seen within a decade after SLT. Further investigation of LVH needs to be made in these patients, as it can represent amyloid cardiomyopathy, but other contributing factors such as hypertension, CKD and age need to be taken into consideration. In our sample, development of a possible infiltrative pattern was relatively more common and conduction disorders were rarer than one would extrapolate from hereditary early onset ATTR V30M patients. Further studies may help us clarify if indeed these patients behave like late onset ATTR V30M. Our data suggests that these patients should probably undergo periodic cardiac imaging during follow-up.

Funding Acknowledgement

Type of funding source: None

Hereditary transthyretin amyloidosis: predictors of conduction disease

Introduction

Pacemakers are frequently needed due to a high prevalence of conduction disease in mutated ATTR amyloidosis (mATTR). We aimed to identify the variables associated with the need of pacemaker implantation in this population.

Methods

We retrospectively studied 255 patients with suspicion of heart involvement of mATTR observed at our cardiology clinic during the last year. Clinical and outcome data were retrieved by chart review. We have defined the need for pacemaker implantation as: 1) the formal guidelines indications or 2) Ventricular pacing &gt;10% in patients who had prophylactic pacemaker implantation prior to liver transplantation (LT). This way, we have defined 3 different groups: group 1: patients with no evidence of conduction disease; group 2: patients with conduction disease, but no formal indication for pacemaker implantation; and group 3: patients with formal indication for pacemaker implantation or ventricular pacing &gt;10% in patients who had prophylactic pacemaker implantation prior to hepatic transplantation.

Results

We included 255 patients (50±14 years, 53% male, 52.5% treated with tafamidis and 27% had prior LT, and 10% with atrial fibrillation), 43.3% with no evidence of conduction disease, 32.3% with conduction disease, but no formal indication for pacemaker implantation and 24.4% with formal indication for pacemaker implantation. Patients with formal indication for pacemaker implantation were older, with longer duration of neurologic manifestations, with higher concentration of both Troponin T and NT-proBNP and with higher number of organs affected. In multivariate analysis, longer duration of neurologic manifestations (OR 1.090 – 95% IC: 1.036–1.145, p-value 0.001), Left ventricular (LV) maximal wall thickness (OR 1.230 – 95% CI: 1.070–1.414, p-value 0.004), neurologic staging (OR 3.420 – 95% CI: 1.443–8.104, p-value 0.005) and higher number of organs affected (OR 1.719 – 95% CI: 1.218–2.424, p-value 0.002) all showed to be independent predictors of the need for pacemaker implantation, in contrast to LV ejection fraction and serum concentration of Troponin T and NT-proBNP. We've also found a statistical significant association between conduction disease and ophthalmic manifestations.

Conclusions

Our findings suggest that the need for pacemaker implantation in patients with mATTR is closer linked to the duration, severity and affected number of organs than to cardiac biomarkers or echocardiographic findings.

Funding Acknowledgement

Type of funding source: None

Factors associated with psychoactive substance use among truck drivers

Introduction

The World Health Organization's report shows a growing concern about drug use and road safety worlwide.

Objectives

To identify sociodemographic, health and occupational characteristics associated with use of psychoactive substances among truck drivers.

Methods

This is a cross-sectional study conducted with 354 drivers from January to June, 2016. Data collection was based on a multidimensional questionnaire that included the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-WHO) and the Self Reporting Questionnaire (SRQ-20) instruments. The hierarchical approach was adopted for odds ratio (OR) adjustment. The variables that showed statistical significance with p ≤ 0.10 in the bivariate analyzes were selected for the multiple logistic regression analysis performed in the IBM SPSS software (v.19.0).

Results

The use of psychoactive substances in the last three months was associated to low family per capita income (OR, 2.59; 95%CI, 1.23-5.47) and poor self-reported health (1.96; 1.16-3.32), self-reported insomnia (2.9; 1.73-4.87), Common Mental Disorders (3.05; 1.62-5.75) and illness-related absenteeism (1,70; 1.02-2.85). Regarding work characteristics, the use of psychoactive substances in the last three months was observed among those with less than 15 years of work (1.78; 1.07-2.94), daily work journey longer than 6h/day (2.83; 1.69-4.74) and with less than 6 hours of daily rest (1.88; 1.12-3.14).

Conclusions

The results showed worrying vulnerability factors associated with the use of psychoactive substances among truck drivers in Brazil.

Key messages

The survey of 354 truck drivers described the vulnerability and risk factors, which are exposed, as inadequate work conditions associated with the use of psychoactive substances. It showed a greater chance of at least the use of one of the substances (alcohol, cocaine, amphetamine), among truck drivers and the importance in the development of public policies for this worker.

Ordering and Nonideality of Air-Ionic Liquid Interfaces in Surface Second Harmonic Generation

The air-ionic liquid interface for a series of ionic liquids involving imidazolium cations [C_nmim] with different alkyl chain lengths (n = 2, 4, 6, 8, 10, and 12) and the same [NTf₂] imide anion has been studied by polarization-resolved second harmonic generation (SHG). An increase as a function of the alkyl chain length of the orientational parameter reveals the increasing ordering of the air-pure ionic liquid interfaces although it is not possible to disentangle the change in mean tilt angle from a change in the tilt angle probability distribution width. Besides, the study of the air-mixed ([C₁₂mim])_x([C₂mim])_1-x[NTf₂] ionic liquid interface clearly demonstrates the interfacial nonideality of the mixed ionic liquids. The long alkyl chain cation perturbs the interface as seen from the orientational parameter and displaces the short alkyl chain one for bulk mixture contents as low as 10%. At higher long alkyl chain cation bulk mixture contents, the interface behaves close to a pure long alkyl chain ionic liquid.

555 Right ventricular longitudinal strain of patients with pulmonary hypertension

Introduction

Noninvasive echocardiography evaluation of the right ventricle (RV) has been shown to have prognostic value in patients with pulmonary hypertension (PH). Recently, speckle-tracking echocardiography has emerged as a new tool in the RV assessment. In this study, we aimed to study the value of global longitudinal strain in the RV evaluation of these patients.

Methods

We collected clinical, laboratory, echocardiographic and right heart catheterization (RHC) data from consecutive patients referred to an expert tertiary care referral centre from 12/2016 to 11/2018. Global RV systolic peak longitudinal strain (RVS) and RV free wall peak longitudinal strain (RVFWS) (mean of the basal, mid- and apical-segments) were measured by speckle-tracking technique with Echo-Pac software from GE Healthcare®.

Results

Of the 97 included patients, 76% were female. The mean age was 65 ± 15 years. Most patients were in NYHA class II. Median time between TTE and RHC was 70 days [IQR 34 - 184]. Group 2 PH was the most frequent aetiology of PH (35), followed by group 1 (26), group 4 (18), group 5 (3) and group 3 (2). The echocardiographic evaluation of this population showed borderline parameters of RV dysfunction (tricuspid annular plane systolic excursion (TAPSE) 18 ± 4 mm, fractional area change (FAC) 33 ± 10% and S’ tricuspid wave 10 ± 3 cm/sec). Mean RV global strain was -15 ± 5 and RV free wall strain was -17 ± 7.

Both strain parameters significantly correlated with other echocardiographic parameters such as TAPSE, FAC, Tricuspid S wave, RV diastolic diameter, eccentricity index (EI), systolic pulmonary artery pressure (SPAP), pulmonary acceleration time and presence of RV outflow tract notching. Strain parameters were also associated with pulmonary artery pressures and pulmonary vascular resistance (PVR) measured by RHC. Strain parameters did not correlate with PECP (p &gt; 0.05).

In multivariate analysis, RV global longitudinal strain predicted invasive mean pulmonary artery pressure and PVR independently of TAPSE and FAC (β=1.38, p &lt; 0.001). RV global strain &gt; -17.1 predicted PVR &gt; 3 wood (OR 3.46, CI 1.50 - 8.02, AUC 0.72) and PMAP &gt; 20 mmHg (OR 4.92, CI 1.67 - 14.51, AUC 0.78). TAPSE &lt; 18 mm predicted PVR &gt; 3 wood (OR 7.41, CI 2.99 - 18.36, AUC 0.72).

Conclusion

RV global and free wall longitudinal strain significantly correlate with other echocardiographic parameters of RV structure and function and with invasive pulmonary artery pressures and PVR.

Abstract 555 Figure.