Navigating the Mental Lexicon: Network Structures, Lexical Search and Lexical Retrieval

This paper examines the implications of the association patterns in our understanding of the mental lexicon. By applying the principles of graph theory to word association data, we intend to explore which measures tap better into lexical knowledge. To that end, we had different groups of English as Foreign language learners complete a lexical fluency task. Based on these empirical data, a study was undertaken on the corresponding lexical availability graph (LAG). It is observed that the aggregation (mentioned through human coding) of all lexical tokens on a given topic allows the emergence of some lexical-semantic patterns. The most important one is the existence of some key terms, featuring both high centrality in the sense of network theory and high availability in the LAG, which define a hub of related terms. These communities of words, each one organized around an anchor term, or most central word, are nicely apprehended by a well-known network metric called modularity. Interestingly enough, each module seems to describe a conceptual class, showing that the collective lexicon, at least as approximated by LA Graphs, is organised and traversed by semantic mechanisms or associations via hyponymy or hiperonymy, for instance. Another empirical observation is that these conceptual hubs can be appended, resulting in high diameters compared to same-sized random graphs; even so it seems that the small-world hypothesis holds in LA Graphs, as in other social and natural networks.

Fluctuation Relations to Calculate Protein Redox Potentials from Molecular Dynamics Simulations

The tunable design of protein redox potentials promises to open a range of applications in biotechnology and catalysis. Here, we introduce a method to calculate redox potential changes by combining fluctuation relations with molecular dynamics simulations. It involves the simulation of reduced and oxidized states, followed by the instantaneous conversion between them. Energy differences introduced by the perturbations are obtained using the Kubo-Onsager approach. Using a detailed fluctuation relation coupled with Bayesian inference, these are postprocessed into estimates for the redox potentials in an efficient manner. This new method, denoted MD + CB, is tested on a de novo four-helix bundle heme protein (the m4D2 "maquette") and five designed mutants, including some mutants characterized experimentally in this work. The MD + CB approach is found to perform reliably, giving redox potential shifts with reasonably good correlation (0.85) to the experimental values for the mutants. The MD + CB approach also compares well with redox potential shift predictions using a continuum electrostatic method. The estimation method employed within the MD + CB approach is straightforwardly transferable to standard equilibrium MD simulations and holds promise for redox protein engineering and design applications.

A comparative study of cyclic fatigue of 6 endodontic systems. An in vitro study

Background

Mechanical preparation and the formation of space for adequate obturation are included in root canal shaping, but the complex root canal anatomy may be affect it. Manufacturers have created different alloys like M-Wire, Blue-Wire, Gold-Wire or R-phase. Objective: This investigation was performed to verify the null hypothesis that there were not significant differences between size 25 instruments ESP Files Thermoflex, Protaper Ultimate, Protaper Next, Blueshaper, One Curve and 2Shape about cyclic fatigue and length of broken fragments.

Material and Methods

180 new size 25 files of the systems investigated were selected (n=30). Files were used with Endo Mate DT endo motor with speed and torque recommended by manufacturers, holding the instruments with clamping mechanism, with passive adjustment, glycerine and without pressure in a stainless-steel block. The time was calculated in seconds until fracture. Number of fatigue cycles was determined as (Resistance (s) x Speed)/60. Separated fragment lengths were calculated with digital Vernier caliper. Statistical analysis was carried out with the SPSS 18 programme at a 95% confidence level, using Levene´s Test to compare variances, Welch’s Test to compare means, and Games-Howell´s Test to reveal differences between groups.

Results

Levene’s Test determined no equal variances (P<0.05). Welch’s Test and ANOVA (P<0.05) showed significant differences in cyclic fatigue and separated fragment lengths. Games-Howell’s and Bonferroni´s Test established significant differences in multiple comparisons (P<0.05).

Conclusions

ESP Files Thermoflex was superior in cyclic fatigue. About separated fragment lengths, ESP Files Thermoflex, Protaper Ultimate and Blueshaper obtained longer lengths.

Key words:Cyclic fatigue, continuous movement, separated fragment lengths, rotary systems.

POS1225 PREDICTORS OF WEAK ANTIBODY RESPONSE POST-COVID-19 mRNA VACCINATION IN SLE

Background

Throughout the COVID-19 pandemic, the BNT162b2 (manufactured by Pfizer—BioNTech) and mRNA-1273 (manufactured by Moderna Inc) vaccines have demonstrated an acceptable safety profile and a high degree of effectiveness in preventing severe COVID-19 outcomes in healthy individuals. However, it remains to be determined if similar benefits can be replicated in immunocompromised patients, who were largely excluded from Phase III clinical trials. Preliminary data on vaccine immunogenicity among lupus patients reveal blunted humoral responses, particularly in those using prednisone and/or mycophenolate (1-2).

Objectives

This study sought to measure the antibody responses following SARS-CoV-2 vaccination in patients with SLE and to identify clinical and laboratory parameters associated with low antibody responses.

Methods

We prospectively enrolled SLE patients from the Beth Israel Deaconess Medical Center Systemic Lupus Erythematosus Cohort (BIDLC). The patients received two doses of either BNT162b2 or mRNA-1273 and were tested for the SARS-CoV-2 IgG spike antibody at least 4 weeks after the second vaccine dose. Patients with evidence of prior COVID-19 infection were excluded. The primary goal of this study was to measure the prevalence of a weak IgG spike antibody response and identify predictive clinical-laboratory factors. We first measured the antibody responses in a healthy control group and defined a low antibody titer as values that fell below the 25% percentile of this reference group (<6). We then used simple logistic regression to assess for associations between different predictive variables and our predefined dichotomous outcome: <6 vs ≥6 IgG spike antibody titer. To account for potential cofounders, a multiple logistic regression model was performed. Risk ratios were calculated with the Log Binomial regression. Significance level was set at p <0.05.

Results

A total of 71 patients were included in the study. At the time of vaccination, patients were on various immune modulator and suppressive medications, including: Hydroxychloroquine 87%, Prednisone 38%, Mycophenolate 38%, Azathioprine 18% and Belimumab 7%. The proportion of patients who received BNT162b2 and mRNA-1273 were 58% and 42%, respectively. Overall, 63% of patients had a high IgG spike antibody titer (≥ 6) and 37% of patients had a low IgG spike antibody titer (<6). Univariate logistic regression demonstrated that a SLEDAI ≥6 (OR: 4.55, p = 0.02), the use of azathioprine (OR: 3.55, p = 0.04) and receiving the BNT162b2 vaccine vs. mRNA-1273 (OR: 3.80, P = 0.01) were independent predictors of antibody titers <6. After controlling for age, sex, race, time to spike testing and use of immunosuppressive drugs, the association between a high SLEDAI score or receiving the BNT162b2 vaccine and a weak antibody response remained significant (Figure 1). Using the Log Binomial regression, the BNT162b2 and the high SLEDAI group were found to have 2.1- and 2.4-times, respectively, higher likelihood of developing weak antibody responses.

Figure 1.

Logistic regression plot

Conclusion

In patients with SLE, Azathioprine use independently predicts reduced antibody titers. More importantly, we demonstrated that a pre-vaccine high disease activity score or receiving BNT162b2 (Pfizer—BioNTech) increases the risk of impaired immune response to the COVID-19 vaccine.

References

[1]Ammitzbøll, C., et al (2021). Impaired antibody response to the BNT162b2 messenger RNA coronavirus disease 2019 vaccine in patients with systemic lupus erythematosus and rheumatoid arthritis. ACR open rheumatology, 3(9), 622-628.

[2]Izmirly, P. M., et al (2021). Evaluation of Immune Response and Disease Status in SLE Patients Following SARS-CoV-2 Vaccination. Arthritis & Rheumatology

Disclosure of Interests

Christine Parsons: None declared, Jose Rubio: None declared, Afroditi Boulougoura: None declared, Vasileios Kyttaris Grant/research support from: Dr. Kyttaris is a grant recipient of Exagen Diagnostics, Employee of: Dr. Kyttaris serves on the advisory board of Aurinia Pharmaceuticals

Eudragit® L100/chitosan composite thin bilayer films for intravaginal pH-responsive release of Tenofovir

The high rate of HIV new infections and AIDS-related deaths each year make prevention tools still necessary today. Different dosage forms - including films - for vaginal administration of antiretroviral drugs have been developed for this purpose. Six batches of Tenofovir-loaded films were formulated based on Eudragit® L100 (EL100) and chitosan, containing triethyl citrate and glycerol. In all the cases films structured in two layers - the upper layer mainly attributed to EL100 and the lower layer to chitosan - were revealed by SEM. A higher content in EL100 and plasticizers improves the mechanical properties and control over drug release in the vaginal medium without affecting mucoadhesion. The EL100-based layer acts as a structuring agent that controls Tenofovir release for days in the vaginal medium while it occurs in a few hours in the presence of seminal fluid. Bilayer films with the highest tested content of EL100 and plasticizers would be the most suitable as vaginal microbicides as they are easier to administer due to their excellent mechanical properties and they offer more comfortable posology and enhanced protection against HIV during intercourse due to their pH-responsive release of Tenofovir.

Long-term outcomes among a cohort of 4296 implantable cardioverter-defibrillator patients: insights from the UMBRELLA study

Background

Large observational real-world studies describing modern implantable cardioverter-defibrillator (ICD) populations with long-term follow-up are lacking.

Purpose

To assess the incidence of arrhythmias in a cohort of contemporary patients undergoing ICD implant from 2005 and 2017 and to analyze the arrhythmic risk and mortality according to their clinical profiles.

Methods

UMBRELLA (NTC01561144) is a prospective, multicentre, nationwide study of ICD patients followed by remote monitoring. All device information was automatically stored through the remote monitoring system and a blinded review of all the stored arrhythmic episodes was performed. The study outcomes were first appropriate ICD therapy and all-cause death.

Results

The study population consisted of 4296 patients (61.9±12.9 years, ischaemic cardiomyopathy (ICM): n=2150, dilated cardiomyopathy (DCM): n=1166, valvular heart disease (VHD): n=119, hypertrophic cardiomyopathy (HCM): n=294, arrhythmogenic right ventricular cardiomyopathy (ARVC): n=71, Brugada syndrome (BS): n=143, long QT syndrome (LQTS): n=43, and adult congenital heart disease (ACHD): n=60)). Primary prevention (PP) was the main indication (n=2758).

During a mean follow-up of 46.6±27.3 months, 16,067 episodes of sustained ventricular arrhythmia (SVA) occurred in 1344 patients. Appropriate ICD therapy was delivered to 85.7% (n=13,767) episodes of SVA in 1173 patients (27.3% of population). A higher risk of first appropriate ICD therapy was observed in VHD (HR: 1.94, 95% CI: 1.43–2.62), ARVC (HR: 1.84, 95% CI: 1.28–2.66), ICM (HR: 1.51, 95% CI: 1.29–1.78), and DCM (HR: 1.28, 95% CI: 1.07–1.53) whereas patients with HCM (HR: 0.72, 95% CI: 0.54–0.96) and BS (HR: 0.25, 95% CI: 0.14–0.45) were at significantly lower risk (Figure 1A). In multivariate analysis (Table 1), age, gender, atrial fibrillation (AF), secondary prevention, LVEF ≤35%, and QRS width emerged as clinical predictors of appropriate ICD therapy, whereas CRT-D correlated with lower risk. An independently higher risk was found in DCM, VHD, and ARVC, and a lower risk in BS patients.

At follow-up, 590 deaths (13.4% of population) were reported. Patients with ICM (HR 3.90, 95% CI: 2.58–5.90), DCM (HR 3.33, CI 95%: 2.18–5.10), and VHD (HR 3.97, CI 95%: 2.25–6.99) had worse prognoses and it was significantly better in BS patients (HR 0.11, 95% CI: 0.01–0.67, p=0.017) (Figure 1B). In multivariate analysis, age, gender, AF, renal failure, diabetes and reduced LVEF, emerged as independent predictors of all-cause death (Table 1).

Conclusions

Irrespective of the aetiology, contemporary ICD patients with an arrhythmic substrate derived from left ventricular systolic dysfunction had a similar risk of ICD life-saving interventions and death.

Funding Acknowledgement

Type of funding sources: None. Table 1Figure 1

Removal of flocculated TiO2 nanoparticles by settling or dissolved air flotation

Engineered nanoparticles of TiO₂ (TiO₂-NPs) are used in the industry for a great number of applications. After their usage, the particles end up in aquatic environments, contaminating supply waters and watercourses. Bench-scale studies report removal of TiO₂-NPs (450 nm, the mean volumetric diameter) by flocculation followed by settling or by dissolved air flotation (4 bar saturation pressure and 30% recycling ratio). Floc formation was conducted after heterocoagulation with iron hydroxide (30-40 mg L^-1Fe³⁺⁾ and gelatinized corn starch (10-20 mgL^-1) as flocculant, at pH 7. Particle size distribution and zeta potential, removal efficiencies as a function of time and microphotography of flocs were analyzed. Mechanisms involve ferric hydroxide precipitation, heterocoagulation with the nanoparticles and flocculation of the loaded carrier precipitates with gelatinized starch. Best results showed removals between 95-100% of TiO₂-NPs, either by settling or flotation after 5 min. Clear treated waters with low turbidity < 3 nephelometric turbidity units (NTU) and TiO₂-NPs concentrations <1 mg L^-1 were obtained. A practical advantage in DAF was the higher solids content (1.9% w/w) of the sludge, when compared to settling (0.7% w/w). This would facilitate the sludge dewatering and disposal, but DAF has the disadvantage of the poor efficiency at high concentration of the nanoparticles of titanium oxide (>100 mg L^-1). Conversely, the removal by settling of the flocs increased at high dosages. It is believed that both processes are sustainable in terms of reagents and the removal efficiencies of TiO₂ nanoparticles from water.

Association of NFκβ, TNFα, IL-6, IL-1β, and LPL Polymorphisms with Type 2 Diabetes Mellitus and Biochemical Parameters in a Mexican Population

Chronic low-grade inflammation is strongly related to the etiology of diabetes mellitus type 2 (T2DM), and the expression of inflammatory cytokines may be modulated by polymorphisms located in the regulatory regions of the NFκβ, IL-1β, IL-6, TNFα, and LPL genes. We considered it particularly important to investigate the relationship of gene polymorphisms involved in chronic inflammation with the risk of T2DM or uncontrolled biochemical parameters.

METHODS

We included 199 individuals with a T2DM diagnosis and 213 individuals without a T2DM diagnosis. Restriction fragment length polymorphism (RFLP) analyses were used to assess polymorphisms.

RESULTS

We found a risk association between T2DM and uncontrolled biochemical parameters in a Mexican population for the genotypes del/del of NFκβ, -174 and -572 of IL-6, C/C of IL-1β, -308 and -238 of TNFα, and T/T of LPL. In subjects without diabetes (controls), we found an association between the G/C genotype of the -572 polymorphism and the G/C and C/C genotypes of the -597 polymorphism of IL-6 with the risk of glucose levels > 131 mg/dL. Genotype C/C of polymorphism -174 of the IL-6 gene was associated with high triglyceride levels, and levels > 5.8% of HbA1c were associated with the G/A genotype of TNFα -308.

CONCLUSION

Here, we describe for the first time the relationship of T2DM risk and uncontrolled biochemical parameters with polymorphisms in the NFκβ, IL-6, TNFα, IL-1β, and LPL genes in a Mexican population. We also showed that for the population included in this study, there is an additive effect of the polymorphisms of the studied genes that considerably increases the risk of developing T2DM.We also showed that there are interactions between genes related to chronic inflammation that affect the risk of T2DM.

Pathological characteristics, survival, and risk of breast cancer associated with estrogen and xenobiotic metabolism polymorphisms in Mexican women with breast cancer

Prolonged exposure to estrogens is the main factor associated with the risk and prognosis of breast cancer (BC). The genes involved in the biotransformation of estrogens and xenobiotics have allelic variants with modified enzymatic activities. We investigated the association of nine polymorphisms of some genes from the classical estrogen pathway with the risk of breast cancer and their role in the clinicopathological characteristics of poor clinical prognosis in a sample of Mexican women with BC.

METHODS

We included 150 controls and 150 cases matched by age. To analyze the selected polymorphisms, TaqMan assays and high-resolution melting (HRM) analysis were used.

RESULTS

The polymorphisms of the genes ERα, CYP1A1, CYP1B1, COMT, MGMT, and XRCC1 were positively associated with the BC risk. We found negative associations between CYP1B1^G/G genotype and tumor size, and status of lymph node, estrogen receptor, triple negative, and survival.

CONCLUSIONS

The polymorphisms included in this study are associated not only with the risk of BC, but also with some clinicopathological characteristics for poor prognosis of patients with breast cancer, highlighting the important role of CYP1B1 Leu432Val polymorphism.

Calcium and magnesium ion removal from water feeding a steam generator by chemical precipitation and flotation with micro and nanobubbles

This work summarises the results of calcium and magnesium ion removal from raw water feeding an industrial steam generation system. The cations were precipitated with sodium phosphate before separation of the solids by dissolved air flotation, with micro and nanobubbles. Studies were done at bench scale and validated at pilot scale (raw water feed = 1 m³h^-1; air-to-solids ratio = 0.046 mg of air mg^-1 of solids; residence time = 11 min). Results indicated that chemical precipitation followed by flotation significantly improved the quality of the boiler water. Best results were obtained after precipitating the cations with 50 mg L^-1 of sodium phosphate at pH 11.5 and flotation with a saturation pressure (P _sat) of 4 bar, a recycling ratio of 30% and a sodium oleate concentration of 20 mg L^-1 as an hydrophobizing reagent. The latter assisted the adhesion of the nanobubbles (100-500 nm) generated at 4 bar with a numeric concentration of about 2.5 × 10⁸NBs mL^-1. At pilot scale, the total hardness in the solution decreased by 80%; the residual calcium and phosphate ion concentrations were 12 and 2 mg L^-1 respectively. This cell was designed including lamellae and perforate plate to improve the superficial loading capacity (up to 9 m h^-1). The results were explained by chemical and interfacial phenomena and it is believed that this technique has great potential in water softening processes.

Application of the 2019 European League Against Rheumatism/American College of Rheumatology systemic lupus erythematosus classification criteria in clinical practice: a single center experience

Originally developed as research tools, different classification criteria sets for systemic lupus erythematosus (SLE) are also used to diagnose SLE in routine clinical care. The recently developed European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) 2019 criteria set is noted to perform better than previous SLE classification criteria. This study applied the new criteria schema to a tertiary center SLE cohort, ascertained its performance, and identified the clinical characteristics of patients who did not fulfill these criteria. From the 217 patients who were included, 11 (5%) did not meet the new criteria, mainly because of the antinuclear antibody entry criterion, resulting in a diagnostic sensitivity of 94%. Within this group, we found that constitutional and renal manifestations were unusual. Additionally, specific SLE antibodies as well as hypocomplementemia were less likely to be present. We did not observe a statistically significant difference in outcomes between the two groups of patients (fulfilling vs. unfulfilling the new criteria). We conclude that the EULAR/ACR criteria may misclassify a small subset of SLE patients with milder disease. It is important to be cognizant of key clinical and serologic features of these patients and treat them accordingly to prevent further irreversible damage.

Bulk nanobubbles in the mineral and environmental areas: Updating research and applications

In the last decade, the research with bulk nanobubbles (ultrafine bubbles with a diameter <1 μm, according to ISO 20480-1:2017) has been rapidly increasing in the academic and industrial environments. Nowadays, there are many applications reported in the literature, with several patents, procedures, and techniques on nanobubbles generation and an evergrowing research and many applications. Yet, most of those publications reporting bulk nanobubbles generation devices, do not bring information on measurements of size distribution or bubbles concentration (if nanobubbles). Further, there is a problem of scale and many of these products are small bench discontinuous rigs difficult to scale up, which might serve small scale purposes, but are not able for treating high flow-rate wastewaters or minerals pulps at industrial scale. These nanometric bubbles present interesting and peculiar properties such as high surface area per volume unit, high stability and longevity, surface charge in water and the ability to aggregate hydrophobic particles. These findings demonstrate their high potential for applications in many technological areas, which occur not only as isolated bubbles but also jointly with micro (~ 1-100 μm diameter) and/or macrobubbles (~100 μm - 2 mm diameter). This paper reviews the evolution of basic research on nanobubbles, the challenges concerning generation and stability and their applications in the mineral (flotation) and environmental areas (treatment of water and wastewaters or remediation of contaminated environments). Herein, because the importance in engineering, as a whole, most of the studies are based on the nanobubbles generated by depressurisation/hydrodynamic cavitation of the air-saturated water in flow constrictors (venturi, needle valves). In the mineral area, they appear to be responsible for increasing the recovery and flotation kinetics of fine (<74 μm) and ultrafine (<13 μm) particles at lower frother and collector dosages. In the environmental area, nanobubbles have been reported to enhance the removal of a variety of pollutants (emulsified oil, colloidal solids, organic/inorganic precipitates, ions) by flotation associated with bigger bubbles. More, the application of isolated nanobubbles on the removal of residual pollutants, such as amine and oil (both as flocs) were reported. Also, the use of ozone and oxygen nanobubbles has been studied for the remediation/decontamination of soil and aquatic ecosystems and for the oxidation of emerging pollutants in water and wastewater treatment. The future of nanobubbles in flotation separation research is highly promising; operating costs of the different forms of nanobubbles generation and bench studies should be validated through pilot and real scale with the continuous injection of these bubbles.

A Comparative Study of Cyclic Fatigue of 10 Different Types of Endodontic Instruments: an in Vitro Study

Objective

This study was designed to test the null hypothesis that there were no significant differences between size 25 files F360, F6 SkyTaper, Hyflex EDM, iRace, Neoniti, One Shape Protaper Next, Reciproc, Revo-S and Wave One Gold in terms of resistance to cyclic fatigue and length of broken fragments.

Material and methods

300 new size 25 files of the systems studied were selected (n=30). The instruments were mechanized with a X-Smart Plus endo motor at the speed and torque recommended by the manufacturer, holding the instruments steady with a clamping mechanism, with passive adjustment and without pressure in a stainless-steel block. The time was calculated in seconds until fracture. The number of fatigue cycles was calculated as (Resistance (s) x Speed)/60. The separated fragment lengths were measured with a digital Vernier calliper. A statistical analysis was performed with the SPSS 18 programme at a 95% confidence level, using the Levene´s Test to compare variances, the Welch’s Test to compare means, and the Games-Howell´s Test to reveal differences between groups.

Results

The Levene’s Test showed no equal variances (P<0.05). The Welch’s Test (P<0.05) showed significant differences in cyclic fatigue and separated fragment lengths. The Games-Howell test (P<0.05) exhibited significant differences in multiple comparisons, (P<0.05).

Conclusions

The systems with CM-Wire (Hyflex EDM and Neoniti) were superior in resistance to the other systems for cyclic fatigue. For separated fragment lengths, F360 (conventional NiTi) and Reciproc (M-Wire) were better significantly better in terms of resistance.

Revisiting Coiled Flocculator Performance for Particle Aggregation

  This work summarizes recent studies evaluating the torsion and curvature parameters in flocculation efficiency using a hydraulic plug flow flocculator known as a Flocs Generator Reactor (FGR). Colloidal Fe(OH)3 and coal particles were used as suspension models and a cationic polyacrylamide was used for the flocculation. The effectiveness of the aggregation process (in the distinct curvature and torsion parameters, and hydrodynamic conditions) was evaluated by the settling rate of the Fe(OH)3 flocs, and flocs size by photographic analysis. As a result of curvature, a secondary flow is induced and the profiles of the flow quantities differ from those for a straight pipe. Results showed that the differences in the flocculator design influences the Fe(OH)3 flocs size and settling rates, reaching values of about 13 and 4 m/h, for the coiled and straight pipes respectively. Coal flocs generation was also shown to be dependent on the flocculator design and shear rate. Results showed that turbulent kinetic energy increases because of curvature when the torsion parameter is kept constant (pitch close to zero), enhancing the flocs formation.

Effects of Thermal Protection in Patients Undergoing Body Contouring Procedures: A Controlled Clinical Trial

BACKGROUND

Hypothermia is common in many plastic surgery procedures, but few measures to prevent its occurrence are taken.

OBJECTIVES

This study evaluated the effect of hypothermia in patients undergoing plastic surgery procedures and the effect of utilizing simple and inexpensive measures to prevent patient hypothermia during surgery.

METHODS

A randomized controlled clinical trial was performed among 3 groups of patients who underwent body contouring surgery for longer than 3.5 hours. In group 1, no protective measures were taken to prevent hypothermia; in group 2, maneuvers were applied intraoperatively for the duration of the entire surgical procedure; and in group 3, measures were taken preoperatively and intraoperatively. The results were quantified and analyzed through a bivariate analysis, including degree of hypothermia, anesthesia recovery time, time spent in the recovery area, intensity of pain, cold perception, response to opioids, and nausea.

RESULTS

There were 122 patients included in the study: 43 in group 1, 39 in group 2, and 40 in group 3. All patients in group 1 had a higher degree of hypothermia, longer recovery time from anesthesia, longer overall recovery time, increased pain, increased feeling of cold, and more nausea. These patients also required a greater amount of opioids compared with the patients in groups 2 and 3. Many of the results were statistically significant.

CONCLUSIONS

The adoption of simple and inexpensive measures before and during plastic surgery can prevent patient hypothermia during the procedures, leading to a shorter anesthesia recovery time and avoiding the undesirable effects associated with hypothermia. In addition, these measures may have significant economic savings.

LEVEL OF EVIDENCE 2

Comparison of Shaping Ability of 10 Rotary and Reciprocating Systems: an In Vitro Study with AutoCad

Objective

The aim of this study was to compare the cutting are, root canal anatomy preservation and non-instrumented areas of F360®, F6-SkyTaper®, Hyflex-EDM®, iRACE®, Neoniti®, O.Shape®, P.Next®, Reciproc®, Revo-S® and Wave-One-Gold® size 25 files.

Materials and Methods

300 teeth with a single straight root and a circular or elliptical root canal were divided into 10 groups (1-F360®, 2- F6-SkyTaper®, 3-Hyflex-EDM®, 4-iRACE®, 5-Neoniti®, 6-O.Shape®, 7-P.Next®, 8-Reciproc®, 9-Revo-S® and 10-Wave-One-Gold®) cut into 3 cross sections using an ultrafine cutting disc. They were photographed under a stereo microscope and preinstrumentation analyses were made before rebuilding the teeth with# 10 K- File and epoxy glue. A glide path was created with #10 and #15 K files and each group was instrumented using rotary or reciprocating systems. Cutting areas, root canal anatomy preservation and non-instrumented areas were analyzed using the AutoCAD 2015 Levene's test, the Welch´s test, and the Games-Howell´s test. The Pearson’s chi-squared test was used for statistical analysis.

Results

Levene's test showed no equality of variances (P<0.05), therefore Welch´s and Games-Howell's tests were applied to cutting areas, showing significant differences in all thirds and overall (P<0.05). No differences in root canal anatomy preservation were observed (P>0.05). In non-instrumented areas, significant differences were found (P<0.05) in middle third being better in Reciproc®, Neoniti® and WaveOneGold®, and in apical thirds being higher P.Next®, Reciproc®, HyflexEDM®, Neoniti® and WaveOneGold®.

Conclusions

In cutting area, P.Next® and Reciproc® were superior in coronal third, Neoniti® and Hyflex EDM® medially and apically and Neoniti® and Reciproc® overall. Regarding the root canal anatomy preservation, all systems were similar. For non-instrumented areas, all systems achieved similar results coronally, but Reciproc®, Neoniti® and Wave One Gold® were superior in middle third and P.Next®, Reciproc®, Hyflex EDM®, Neoniti® and Wave One Gold® were superior in apically.

Separation of emulsified crude oil in saline water by flotation with micro- and nanobubbles generated by a multiphase pump

The flocculation-column flotation with hydraulic loading (HL, >10 m h^-1) was studied for the treatment of oil-in-water emulsions containing 70-400 mg L^-1 (turbidity = 70-226 NTU) of oil and salinity (30 and 100 g L^-1). A polyacrylamide (Dismulgan, 20 mg L^-1) flocculated the oil droplets, using two floc generator reactors, with rapid and slow mixing stages (head loss = 0.9 to 3.5 bar). Flotation was conducted in two cells (1.5 and 2.5 m) with microbubbles (MBs, 5-80 μm) and nanobubbles (NBs, 50-300 nm diameter, concentration of 10⁸ NBs mL^-1). Bubbles were formed using a centrifugal multiphase pump, with optimized parameters and a needle valve. The results showed higher efficiency with the taller column reducing the residual oil content to 4 mg L^-1 and turbidity to 7 NTU. At high HL (27.5 m h^-1), the residual oil concentrations were below the standard emission (29 mg L^-1), reaching 18 mg L^-1. The best results were obtained with high concentration of NBs (apart from the bigger bubbles). Mechanisms involved appear to be attachment and entrapment of the NBs onto and inside the flocs. Thus, the aggregates were readily captured, by bigger bubbles (mostly MBs) aiding shear withstanding. Advantages are the small footprint of the cells, low residence time and high processing rate.

The Effect of Price on Surgeons' Choice of Implants: A Randomized Controlled Survey

PURPOSE

Surgical costs are under scrutiny and surgeons are being held increasingly responsible for cost containment. In some instances, implants are the largest component of total procedure cost, yet previous studies reveal that surgeons' knowledge of implant prices is poor. Our study aims to (1) understand drivers behind implant selection and (2) assess whether educating surgeons about implant costs affects implant selection.

METHODS

We surveyed 226 orthopedic surgeons across 6 continents. The survey presented 8 clinical cases of upper extremity fractures with history, radiographs, and implant options. Surgeons were randomized to receive either a version with each implant's average selling price ("price-aware" group), or a version without prices ("price-naïve" group). Surgeons selected a surgical implant and ranked factors affecting implant choice. Descriptive statistics and univariate, multivariable, and subgroup analyses were performed.

RESULTS

For cases offering implants within the same class (eg, volar locking plates), price-awareness reduced implant cost by 9% to 11%. When offered different models of distal radius volar locking plates, 25% of price-naïve surgeons selected the most expensive plate compared with only 7% of price-aware surgeons. For cases offering different classes of implants (eg, plate vs external fixator), there was no difference in implant choice between price-aware and price-naïve surgeons. Familiarity with the implant was the most common reason for choosing an implant in both groups (35% vs 46%). Price-aware surgeons were more likely to rank cost as a factor (29% vs 21%).

CONCLUSIONS

Price awareness significantly influences surgeons' choice of a specific model within the same implant class. Merely including prices with a list of implants leads surgeons to select less expensive implants. This implies that an untapped opportunity exists to reduce surgical expenditures simply by enhancing surgeons' cost awareness.

TYPE OF STUDY/LEVEL OF EVIDENCE

Economic/Decision Analyses I.

Raw water clarification by flotation with microbubbles and nanobubbles generated with a multiphase pump

Raw water clarification by flotation was studied by injecting air into a centrifugal multiphase pump to generate microbubbles (MBs) and nanobubbles (NBs). Measurements of gas dispersion parameters were performed and optimal conditions were obtained using a pump pressure of 4 bar. Values showed a bubble Sauter diameter of 75 μm, an air holdup of 1.2%, a bubble surface area flux of 34 s^-1 and an NB concentration of 1 × 10⁸ NBs mL^-1 (measuring 220 nm). Then, a study compared flotation with bubbles formed with the multiphase pump (F-MP) to lamellar settling at the clarification stage of a water treatment plant (WTP), in Brazil. The F-MP showed a higher separation efficiency at high hydraulic loads (9-15 m h^-1), even without the use of a polymer, reaching 2 NTU (10-25 NTU raw water feed), which was much lower than the technical goal of the WTP (5 NTU). The results and the technical aspects are discussed, and it is concluded that the employment of MBs and NBs with pumps widens new research lines and applications in modern flotation.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Interpretation of Post-operative Distal Humerus Radiographs After Internal Fixation: Prediction of Later Loss of Fixation

PURPOSE

Stable fixation of distal humerus fracture fragments is necessary for adequate healing and maintenance of reduction. The purpose of this study was to measure the reliability and accuracy of interpretation of postoperative radiographs to predict which implants will loosen or break after operative treatment of bicolumnar distal humerus fractures. We also addressed agreement among surgeons regarding which fracture fixation will loosen or break and the influence of years in independent practice, location of practice, and so forth.

METHODS

A total of 232 orthopedic residents and surgeons from around the world evaluated 24 anteroposterior and lateral radiographs of distal humerus fractures on a Web-based platform to predict which implants would loosen or break. Agreement among observers was measured using the multi-rater kappa measure.

RESULTS

The sensitivity of prediction of failure of fixation of distal humerus fracture on radiographs was 63%, specificity was 53%, positive predictive value was 36%, the negative predictive value was 78%, and accuracy was 56%. There was fair interobserver agreement (κ = 0.27) regarding predictions of failure of fixation of distal humerus fracture on radiographs. Interobserver variability did not change when assessed for the various subgroups.

CONCLUSIONS

When experienced and skilled surgeons perform fixation of type C distal humerus fracture, the immediate postoperative radiograph is not predictive of fixation failure. Reoperation based on the probability of failure might not be advisable.

TYPE OF STUDY/LEVEL OF EVIDENCE

Diagnostic III.

A Comparative Study of Shaping Ability of four Rotary Systems

PURPOSE

This study compared the cutting area, instrumentation time, root canal anatomy preservation and non-instrumented areas obtained by F360(®), Mtwo(®), RaCe(®) and Hyflex(®) files with ISO size 35.

MATERIAL AND METHODS

120 teeth with a single straight root and root canal were divided into 4 groups. Working length was calculated by using X-rays. The teeth were sectioned with a handpiece and a diamond disc, and the sections were observed with Nikon SMZ-2T stereoscopic microscope and an Intralux 4000-1 light source. The groups were adjusted with a preoperative analysis with AutoCAD. The teeth were reconstructed by a #10 K-File and epoxy glue. Each group was instrumented with one of the four file systems. The instrumentation time was calculated with a 1/100 second chronometer. The area of the thirds and root canal anatomy preservation were analyzed with AutoCAD 2013 and the non-instrumented areas with AutoCAD 2013 and SMZ-2T stereoscopic microscope. The statistical analysis was made with Levene's Test, ANOVA, Bonferroni Test and Pearson´s Chi-square.

RESULTS

Equal variances were shown by Levene's Test (P > 0.05). ANOVA (P > 0.05) showed the absence of significant differences. There were significant differences in the instrumentation time (P < 0.05). For root canal anatomy preservation and non-instrumented areas, there were no significant differences between all systems (P > 0.05).

CONCLUSIONS

The 4 different rotary systems produced similar cutting area, root canal anatomy preservation and non-instrumented areas. Regarding instrumentation time, F360(®) was the fastest system statistically.

SECOND LATIN AMERICAN INTERCOMPARISON ON INTERNAL DOSE ASSESSMENT

Internal dosimetry intercomparisons are essential for the verification of applied models and the consistency of results'. To that aim, the First Regional Intercomparison was organised in 2005, and that results led to the Second Regional Intercomparison Exercise in 2013, which was organised in the frame of the RLA 9/066 and coordinated by Autoridad Regulatoria Nuclear of Argentina. Four simulated cases covering intakes of (131)I, (137)Cs and Tritium were proposed. Ninteen centres from thirteen different countries participated in this exercise. This paper analyses the participants' results in this second exercise in order to test their skills and acquired knowledge, particularly in the application of the IDEAS Guidelines. It is important to highlight the increased number of countries that participated in this exercise compared with the first one and, furthermore, the improvement in the overall performance. The impact of the International Atomic Energy Agency (IAEA) Projects since 2003 has led to a significant enhancement of internal dosimetry capabilities that strengthen the radiation protection of workers.

The value of 11C-methionine PET in the early differentiation between tumour recurrence and radionecrosis in patients treated for a high-grade glioma and indeterminate MRI

OBJECTIVE

To evaluate the contribution of ¹¹C-Methionine PET in the early differentiation between tumour recurrence and radionecrosis in patients treated for a high grade glioma.

METHOD

The study included 30 patients with glioma (III/IV grade) treated with surgery/radiotherapy/chemotherapy (5-8 months) and with an indeterminate MRI. All patients underwent a ¹¹C-Methione PET (within 15 days of MRI) and studies were visually analysed (intensity and morphology of uptake), quantified (SUV max/SUV mean background), and coregistered to MRI (3D-Flair). Patient management was decided by the neuro-oncology committee to clinical and imaging follow-up, second-line treatment, or surgery.

RESULTS

There were 23 ¹¹C-Methionine PET studies visually positive. Morphology of uptake was focal in 15, diffuse in 4, and ring-shaped in 4. Three out of the focal uptake cases underwent resection (Histopathology +). Sixteen underwent second-line therapy (11 responded; 5 progressed). The 4 cases with ring-shaped uptake were followed-up, and progression was found in 2 (true-positive), and disease-free in 2 (follow-up of 6 and 7 months, respectively) (false-positive). Seven out of ¹¹C-Methionine studies PET were visually negative, and all of them were disease-free (follow-up of 3-12 months). SUV lesion/background was 2.79±1.35 in tumour recurrence, and 1.53±0.39 in radionecrosis (P<.05). Taking into account a SUV lesion/background threshold of 2.35, the sensitivity and specificity values were 90.5% and 100%, respectively.

CONCLUSION

Visual analysis, quantitative and PET/MRI coregistration of ¹¹C-Methionine PET showed their complementary role in patients with indeterminate MRI results, thus allowing early differentiation between tumour recurrence and radionecrosis, and helping in the individual therapy approach.

Fine mapping for double podding gene in chickpea

For the first time, fine mapping for sfl locus was carried out using a battery of new STMS and SNP markers. The target region was delimited to 92.6 Kb where seven annotated genes were found that could be candidate genes for the simple/double podding trait in chickpea. Four recombinant inbred populations (RIP-1, RIP-7, RIP-11, and CPR-01) were used to map the double podding gene (sfl) in chickpea. In RIP-1, the gene was initially mapped on linkage group (LG) 6 between the two sequence-tagged microsatellite site (STMS) markers TA120 and TR1. Eight new STMS markers were added onto LG6 in the target region and sfl locus was finally located between CAGM27819 and CAGM27777 markers within an interval of 2 cM. Seven out of the eight markers were mapped in RIP-7 and its reciprocal RIP-11 confirming the location of the sfl locus to a 4.8 cM interval flanked by TR44 and CAGM27705. Furthermore, using a high-density single nucleotide polymorphism (SNP) map of CPR-01, sfl was mapped to the same genomic region in a 5.1 cM interval between TR44 and the SNP scaffold1646p97220. Five pairs of near isogenic lines (NILs) and eight recombinant inbred lines (RILs) were used to refine this region in the chickpea physical map. Combining data from linkage analysis in four RIPs, marker physical positions and recombination events obtained in both pairs of NILs and selected RILs, sfl could be placed within a genomic window of 92.6 Kb. Seven annotated genes were extracted from this region. The regulator of axillary meristem-predicted gene could be a candidate gene for the simple/double podding gene. This study provides additional set of markers flanking and tightly linked to sfl locus that are useful for marker-assisted selection.

Differences in 4-hydroxyestradiol levels in leukocytes are related to CYP1A1(∗)2C, CYP1B1(∗)3 and COMT Val158Met allelic variants

Exposure to estrogen and its metabolites, including catechol estrogens (CEs) and catechol estrogen quinones (CE-Qs) is closely related to breast cancer. Polymorphisms of the genes involved in the catechol estrogens metabolism pathway (CEMP) have been shown to affect the production of CEs and CE-Qs. In this study, we measured the induction of CYP1A1, CYP1B1, COMT, and GSTP1 by 17β-estradiol (17β-E2) in leukocytes with CYP1A1(∗)2C, CYP1B1(∗)3, COMT Val158Met and GSTP1 Ile105Val polymorphisms by semi quantitative RT-PCR and compared the values to those of leukocytes with wild type alleles; we also compared the differences in formation of 4- hydroxyestradiol (4-OHE2) and DNA-adducts. The data show that in the leukocytes with mutant alleles treatment with 17β-E2 up-regulates CYP1A1 and CYP1B1 and down-regulates COMT mRNA levels, resulting in major increments in 4-OHE2 levels compared to leukocytes with wild-type alleles. Therefore, we propose induction levels of gene expression and intracellular 4-OHE2 concentrations associated with allelic variants in response to exposure of 17β-E2 as a noninvasive biomarker that can help determine the risk of developing non-hereditary breast cancer in women.

Mapping and identification of a Cicer arietinum NSP2 gene involved in nodulation pathway

For the first time the putative NSP2 gene in chickpea has been identified using pairs of NILs differing for the Rn1 / rn1 nodulation gene that was located in LG5 of chickpea genetic map. An intraspecific cross between the mutant non-nodulating genotype PM233, carrying the recessive gene rn1, and the wild-type CA2139 was used to develop two pairs of near-isogenic lines (NILs) for nodulation in chickpea. These pairs of NILs were characterized using sequence tagged microsatellite site (STMS) markers distributed across different linkage groups (LGs) of the chickpea genetic map leading to the detection of polymorphic markers located in LG5. Using this information, together with the genome annotation in Medicago truncatula, a candidate gene (NSP2) known to be involved in nodulation pathway was selected for mapping in chickpea. The full length sequence obtained in chickpea wild-type (CaNSP2) was 1,503 bp. Linkage analysis in an F3 population of 118 plants derived from the cross between the pair of NILS NIL7-2A (nod) × NIL7-2B (non-nod) revealed a co-localization between CaNSP2 and Rn1 gene. These data implicate the CaNSP2 gene as a candidate for identity to Rn1, and suggest that it could act in the nodulation signaling transduction pathway similarly to that in other legumes species.