Atrioventricular nodal ablation with pacemaker implant is associated with improved safety outcomes compared to pulmonary vein isolation of atrial fibrillation with heart failure

Background

Pulmonary vein isolation (PVI) and atrioventricular nodal ablation (AVNA) with pacemaker implant have both been advocated for patients with atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF). Direct comparisons between the two are limited.

Purpose

We sought to compare outcomes and complications following PVI versus AVNA with implant of a cardiac implantable electronic device (CIED) among patients with AF and HFrEF.

Methods

We queried the National Inpatient Sample from 2011 to 2019, using relevant ICD-9 and -10 diagnostic and procedural codes for AF, HFrEF, ablation, and CIED implant to identify our study cohort. Exclusion criteria included presence of a pre-existing CIED, ventricular arrhythmias, non-AF supraventricular arrhythmias, and surgical AF ablation. Baseline characteristics included age, sex, race, and comorbidities related to AF and cardiovascular disease. Severity of comorbidities was assessed via Deyo-Charlson Comorbidity Index (Deyo-CCI). Outcomes investigated include all-cause mortality, major adverse cardiovascular events (MACE), extra-cardiac procedural complications, length of stay, and total hospital charges. Outcomes associations were analyzed using multivariate logistic regression adjusted for baseline characteristics that were significantly different (P<0.05) between cohorts expressed as adjusted odds ratios (aOR) and 95% confidence intervals (CI). SPSS v28.0 (IBM, Armonk, NY) was used to carry out all calculations.

Results

We identified 3,565 encounters for PVI and 1,355 for AVNA with CIED implant among hospitalized patients with AF and HFrEF. Patients who underwent AVNA were more often older (73.8 vs 66.2 years), with more severe comorbidities (mean Deyo-CCI score 2.9 vs 2.6) and were more likely to have an emergent procedure performed (81.3% vs 69.7%; p<0.001 for all). However, the AVNA cohort had less mortality (0.5% vs 1.2%, p=0.03), MACE (6.1% vs 7.8%, p=0.04), and total complications (12.7% vs 16.3%, p=0.002), but longer hospital stay (8.0 vs 6.5 days) and higher total charges ($201,100 vs $159,382; p<0.001 for both). After adjusting for confounders, AVNA remained independently associated with decreased odds of mortality (aOR: 0.370; 95% CI [0.159–0.862], p=0.02), MACE (aOR: 0.552; 95% CI [0.420–0.726], p<0.001), and total complications (aOR: 0.708; 95% CI [0.589–0.852], p<0.001).

Conclusion

Despite older age with more severe comorbidities and less elective procedures, hospitalized patients with AF and HFrEF who underwent AVNA with CIED implant had improved safety outcomes compared to PVI. Further studies comparing the intermediate and long-term outcomes and efficacy between therapies are needed to better delineate which would best serve this population.

Funding Acknowledgement

Type of funding sources: None.

Assessing outcomes following catheter ablation of ventricular tachycardia in patients with durable left ventricular assist devices

Background

Management of ventricular tachycardia (VT) after implant of a durable left ventricular assist device (LVAD) is challenging, without consensus on optimal therapy. Multiple small studies have examined catheter ablation of VT in these patients with low reported incidence of complications.

Purpose

We sought to evaluate periprocedural outcomes following VT ablation among LVAD recipients.

Methods

We queried the National Inpatient Sample from 2011 to 2019 to conduct our study. Baseline characteristics include age, sex, race, and comorbidities related to cardiovascular disease. Comorbidity severity was assessed using the Deyo-Charlson Comorbidity Index (Deyo-CCI). Patients with any supraventricular arrhythmias were excluded. Outcomes investigated include heart transplant procedure, all-cause mortality, major adverse cardiovascular events (MACE), and periprocedural complications. Multivariate regression was used to analyze outcomes associations adjusted for baseline characteristics that were significantly different (P<0.05) between cohorts expressed as adjusted odds ratios (aOR) and 95% confidence intervals (CI). SPSS v28.0 (IBM, Armonk, NY) was used to carry out all calculations.

Results

We identified 56 patients who underwent ablation among 2,202 LVAD recipients hospitalized for VT. Patients who underwent ablation were more likely to have ischemic cardiomyopathy (33.9% vs. 22.2%, p=0.03) or an automated implantable cardioverter-defibrillator (55.4% vs 34.3%, p=0.001). There were otherwise no significant differences between cohorts (mean Deyo-CCI score of 2.3 for both, p=0.48). Between those who did and did not undergo ablation, there were no significant differences in heart transplant (5.4 vs 5.0%, p=0.9), mortality (7.1% vs 7.0%, p=0.96), total strokes (3.6% vs 5.0%, p=0.48), myocardial infarction (3.6% vs 4.6%, p=0.71), overall MACE (8.9% vs 10.2%, p=0.26) or total complications (35.7% vs 41.9%, p=0.35). There were no incidents of pump thrombosis in the ablation group, but 92 events (4.3%) were found in the medical therapy group. Multivariate analysis affirmed no significant association between ablation and mortality (aOR 1.277, CI [0.450–3.629]), MACE (aOR 1.125, CI [0.436–2.902]), or total complications (aOR 0.932, CI [0.528–1.645]).

Conclusion

Overall complications following VT ablation among LVAD patients were higher than previously reported but no statistically significant differences were found compared to conservative management. While ablation appears safe to perform, particularly among those with structural heart disease and ischemic cardiomyopathy, longer duration studies are needed to determine the efficacy of this procedure.

Funding Acknowledgement

Type of funding sources: None.

Sex and gender disparities in patients with advanced gastroesophageal adenocarcinoma: data from the AGAMENON-SEOM registry

Background

Recommendations for research articles include the use of the term sex when reporting biological factors and gender for identities or psychosocial or cultural factors. There is an increasing awareness of incorporating the effect of sex and gender on cancer outcomes. Thus, these types of analyses for advanced gastroesophageal adenocarcinoma are relevant.

Patients and methods

Patients with advanced gastroesophageal adenocarcinoma from the Spanish AGAMENON-SEOM registry treated with first-line combination chemotherapy were selected. Epidemiology, characteristics of the disease, treatment selection, and results were examined according to sex.

Results

This analysis included 3274 advanced gastroesophageal adenocarcinoma patients treated with combination chemotherapy between 2008 and 2021: 2313 (70.7%) men and 961 (29.3%) women. Tumors in females were more frequently HER2-negative (67.8% versus 60.8%; P < 0.0001), grade 3 (45.4% versus 36.8%; P < 0.001), diffuse (43.3% versus 26.5%; P < 0.0001), and signet ring cell histology (40.5 versus 23.9%; P < 0.0001). Peritoneal spread was more common in women (58.6% versus 38.9%; P < 0.0001), while liver burden was lower (58.9% versus 71.1%; P < 0.0001). There were no significant differences in treatment recommendation. Treatment doses, density, and duration were comparable between sexes. Women experienced more diarrhea (46% versus 37%; P < 0.0001), neutropenia (51% versus 43%; P < 0.0001), and anemia (62% versus 57%; P < 0.0001). After a median 59.6-month follow-up [95% confidence interval (CI) 54.5-70.8], there were no statistically significant differences between the sexes in progression-free survival [6.21 months (95% CI 5.8-6.5 months) versus 6.08 months (95% CI 5.8-6.3 months); log-rank test, χ² = 0.1, 1 df, P = 0.8] or in overall survival [10.6 months (95% CI 9.8-11.1 months) versus 10.9 months (95% CI 10.4-11.4 months); log-rank test: χ² = 0.6, 1 df, P = 0.5].

Conclusion

This sex analysis of patients with advanced gastroesophageal adenocarcinoma from the AGAMENON-SEOM registry receiving first-line polychemotherapy found no differences in survival. Although women had worse prognostic histopathology, metastatic disease pattern, and greater toxicity, treatment allocation and compliance were equivalent.

•

Sex and gender are determinants of health inequalities and may affect treatments, tolerability, and therapeutic outcomes.

•

According to sex, subtle biological and clinical differences exist in advanced gastroesophageal adenocarcinoma.

•

Women with advanced gastroesophageal adenocarcinoma experience greater toxicity with therapeutic results comparable with men.

•

Stratification and analysis by sex in studies of gastroesophageal adenocarcinoma should be considered.

Antipsychotics as environmental pollutants: An underrated threat?

The heterogeneous class of what we nowadays call antipsychotics was born almost 70 years ago with the serendipitous discovery of chlorpromazine. Their utilization is constantly growing because they are used to treat a diverse group of diseases and patients across all age groups: schizophrenia, bipolar disease, depression, autism, attention deficit hyperactivity disorder, behavioural and psychological symptoms in dementia, among others. They possess a complex pharmacological profile, acting on multiple receptors: dopaminergic, serotoninergic, histaminergic, adrenergic, and cholinergic, leading scientists to call them "agents with rich pharmacology" or "dirty drugs". Serotonin, dopamine, acetylcholine, noradrenaline, histamine and their respective receptors are evolutionary ancient compounds, and as such, are found in many different living beings in the environment. Antipsychotics do not disappear once excreted by patient's urine or faeces and are transported to wastewater treatment plants. But as these plant's technology is not designed to eliminate drugs and their metabolites, a variable proportion of the administered dose ends up in the environment, where they have been found in almost every matrix: municipal wastewater, hospital sewage, rivers, lakes, sea and even drinking water. We believe that reported concentrations found in the environment might be high enough to exert significant effect to aquatic wildlife. Besides, recent studies suggest antipsychotics, among others, are very likely bioaccumulating through the web food. Crucially, psychotropics may provoke behavioural changes affecting populations' dynamics at lower concentrations. We believe that so far, antipsychotics have not received the attention they deserve with regards to drug pollution, and that their role as environmental pollutants has been underrated.

Social support, coping strategies and sociodemographic factors in women with breast cancer

INTRODUCTION

The aim of this study was to analyze the associations between perceived social support and sociodemographic variables on coping strategies.

METHODS

A prospective, cross-sectional, multicenter study was conducted in 404 women with resected, non-metastatic breast cancer. Participants completed questionnaires: perceived social support (MSPSS), coping strategies (Mini-MAC), and psychological distress (BSI-18).

RESULTS

Sociodemographic factors as age, education, and partnership status were associated with coping strategies. As for maladaptive strategies, hopelessness was more frequent in older people and lower educational level; fatalism in older and single people, and cognitive avoidance was associated with lower educational level. Suppor t from family, friends, and partners was associated with a greater fighting spirit. In contrast, high psychological distress (anxiety and depression) was associated with greater use of maladaptive strategies.

CONCLUSION

Young people, a high level of education, having a partner, low psychological distress, and seeking social support were associated with the use of adaptive cancer coping strategies.

Lower predicted probabilities of attained Lifés Simple 7 factors in the presence of sleep problems

Background

Given that sleep disturbances seem to be increasing in Brazil, this may have serious implications on Cardiovascular Health and mortality.

Objective

To examine the predicted probabilities of attained Lifés Simple 7 factors (LS7) in the presence of sleep problems among Brazilian adults.

Methods

We used data from the 2013 Brazilian National Health Survey (PNS), a nationally representative cross-sectional household survey of adults in Brazil. Cardiovascular Health was assessed by the sum of Lifés Simple 7 factors (LS7), which includes four behaviors (smoking, physical activity, body mass index and diet) and three biological factors (hypercholesterolemia, hypertension and diabetes). We analyzed self-reported data from 36,480 Brazilian adults aged 18 and over, including the sleep problems. We estimated predicted probabilities after multivariate Poisson regression.

Results

Mean CVH scores was higher among those who did not report sleep disturbances [4.2 (95% CI: 4.1; 4.2)], than those with sleep disturbances [3.8 (95% CI: 3.7; 3.8)]. Predicted probabilities of attained LS7 and CVH score was lower in the presence of sleep complaints, with a dose response for blood pressure, glucose, smoking and CVH score in both unadjusted and adjusted analyses, for age, sex, schooling, depression and night work shift.

Conclusions

Brazilian adults with sleep disturbances are less likely to achieve LS7 and consequently ideal cardiovascular health. Given that sleep disturbances seem to be increasingly more common in Brazil, recent gains in CVH mortality may be affected.

Key messages

Sleep disturbances may potentially affect metabolic outcomes and modifiable lifestyles behaviors as decreased physical activity and smoking. Sleep disturbances is novel risk factor for metabolic diseases.

Experimental study of speckle patterns generated by low-coherence semiconductor laser light

Speckle is a wave interference phenomenon that has been studied in various fields, including optics, hydrodynamics, and acoustics. Speckle patterns contain spectral information of the interfering waves and of the scattering medium that generates the pattern. Here, we study experimentally the speckle patterns generated by the light emitted by two types of semiconductor lasers: conventional laser diodes, where we induce low-coherence emission by optical feedback or by pump current modulation, and coupled nanolasers. In both cases, we analyze the intensity statistics of the respective speckle patterns to inspect the degree of coherence of the light. We show that the speckle analysis provides a non-spectral way to assess the coherence of semiconductor laser light.

0682 Evaluation Of An Incentive-based Intervention To Improve 90-day Adherence In Pap-naive Patients

Introduction

Although PAP therapy is the gold standard treatment for obstructive sleep apnea, adherence to treatment is suboptimal. Without sustained therapy adherence, patients are at risk of serious negative health outcomes. The objective of this study was to test whether a digitally delivered monetary and social reward program helped patients new to PAP therapy. Financial incentive schemes are effective in helping patients adhere to difficult medication or therapy plans. Additionally, there is an abundance of evidence that social support is a critical component to long-term health behavior change.

Methods

This prospective, randomized, single site pilot is evaluating the effectiveness of an app-based intervention in helping patients adhere to PAP therapy. The financial incentive design leverages loss aversion, and the social incentive design leverages the strength of close ties and variable reinforcement. The primary endpoint is mean PAP usage at 3 months. Secondary endpoints include Medicare compliance, change in functional status, and baseline scores of perceived disease severity, claustrophobia, coping skills, and health literacy as moderators of the intervention’s effectiveness. Study recruitment is ongoing, with an expected sample size of 150 subjects.

Results

Of the 132 subjects enrolled, 56% are male, 61% are Caucasian, and 65% are married. The mean age is 49.6 ± 12.0 years and mean BMI is 32.4 ± 8.4 kg/m2. Additional demographics such as income level, education level, and number of children along with the primary and secondary endpoints will be presented. A subgroup analysis of the primary endpoint will be generated for subjects identified as strugglers within the first 3 days of usage.

Conclusion

The results of this study will provide insight into methods such as financial and social incentives delivered via a smartphone on initial compliance with PAP therapy, as well as provide more information on the behavioral change associated with beginning PAP therapy.

Support

ResMed

P3370Prevalence of right ventricular dysfunction according to different parameters: basal and one year after transcatheter aortic valve implantation

Background

Right ventricle (RV) is not often specifically studied in patients with severe aortic stenosis (AS). It's difficult to find the correct tool to assess RV function with echocardiographic parameters, and the percentage of patients with dysfunction may vary depending on the parameter that we use.

The aim of the study was to evaluate the prevalence of RV dysfunction basal and one year after transcatheter aortic valve implantation (TAVI), according to different parameters.

Methods

Consecutive patients with severe AS undergoing TAVI from January 2016 to July 2017 were included. RV anatomical and functional parameters were analyzed according to ESC and ASE guidelines. RV dysfunction was assessed using tricuspid annular plane systolic excursion (TAPSE) <17 mm, fractional area change <35%, systolic movement of the RV lateral wall by tissue Doppler imaging (RV-S'TDI) <9.5 cm/s, global longitudinal (RV-GLS) and free wall strain (RV-FWS) using as cutting point [20]. Pre procedure echo, immediate post procedure and 1 year echo were analyzed. Statistical analysis was performed using SSPS version 22.

Results

The final study population consisted of 78 patients (115 patients were included, 37 were excluded due to suboptimal acoustic window for RV anatomical and functional evaluation), mean age 83.73±6.31 year-old, 38.2% females. We analyzed the percentages of RV dysfunction according to the different parameters evaluated before and in the control one year after. They are shown in Figure 1.

Prevalence of RV dysfunction

Conclusions

The presence of RV dysfunction in patients with severe AS is higher than expected Our data suggest that RV function improve one year after TAVI, in terms of a reduction in the number of patients with dysfunction. The assessment of RV function is difficult, and there is no agreement on what tools are more accurate and useful. RV strain seems to be the most sensible parameter to assess RV function in patients with AS undergoing TAVI. Impact of these measurements in patients management needs further evaluation.

Incidence of sleep problems and their mediating role on depression and anxious preoccupation in patients with resected, non-advanced cancer: data from NEOcoping study

BACKGROUND

Our study analyzes the incidence of sleep problems and their mediating role on depression and anxious preoccupation in patients with resected, non-advanced cancer.

METHODS

A multi-institutional, prospective, observational study was conducted with 750 participants of 14 hospitals in Spain. Participants' socio-demographic and clinical characteristics were collected using a standardized self-report form and using EORTC QoL-QLQ-C30, BSI, Mini-MAC questionnaires.

RESULTS

In women, sleep problems, depression and anxious preoccupation were observed in 65, 41 and 21%, respectively. In men, sleep problems, depression and anxious preoccupation were reported in 51, 29 and 61%, respectively. More sleep problems, depression and anxious preoccupation were found among women than males. Depression was a significant predictor of anxious preoccupation. In males, sleep problems partially mediated this association. This was not confirmed in women.

CONCLUSION

Our findings point toward the importance of developing interventions that decrease depression and sleep problems in cancer.

Risk of malnutrition and emotional distress as factors affecting health-related quality of life in patients with resected cancer

INTRODUCTION

This study analyzes the prevalence of malnutrition, depression, anxiety, and somatization and which factor has the biggest effect on quality of life (QoL) in individuals with resected cancer.

METHODS

A prospective study was conducted among 747 participants. Participants completed the EORTC-QLQ30, MST, and BSI-18 questionnaires.

RESULTS

Prevalence for risk of malnutrition, depression, anxiety, and somatization were 36.4%, 35.5%, 35.2%, and 48.8%, respectively. Hierarchical multiple regression analyses revealed that malnutrition risk, somatization, depression, and anxiety accounted for 50.8% of the variance in functional scale, 45.3% in symptom scale, and 52.2% in global health. Malnutrition, somatization, depression, and anxiety displayed high explanatory power on all health-related QoL (HRQoL) scales.

CONCLUSION

The risk of malnutrition and psychological symptoms is strongly associated with HRQoL in cancer patients; thus, medical oncologists should develop effective interventions that contribute to lowering the risk of malnutrition and psychological distress, thereby improving subjects' HRQoL before initiating adjuvant chemotherapy.

Cyclotron production and radiochemical separation of 55Co and 58mCo from 54Fe, 58Ni and 57Fe targets

This work presents the production with a cyclotron of the positron emitter ⁵⁵Co via the ⁵⁴Fe(d,n) and ⁵⁸Ni(p,α) reactions and the Auger electron emitter ^58mCo via the ⁵⁷Fe(d,n) reaction after high current (40μA p and 60μA d) irradiation on electroplated targets. High specific activity radionuclides (up to 55.6 GBq/μmol ⁵⁵Co and 31.8GBq/μmol ^58mCo) with high radionuclidic purity (99.995% ⁵⁵Co from ⁵⁴Fe, 98.8% ⁵⁵Co from ⁵⁸Ni, and 98.7% ^58mCo from ⁵⁷Fe at end of bombardment, EoB), in high activity concentration (final separated radionuclide in < 0.6mL) and with almost quantitative overall activity separation yield (> 92%) were obtained after processing of the irradiated targets with novel radiochemical separation methods based on HCl dissolution and the resin N,N,N',N'-tetrakis-2-ethylhexyldiglycolamide (DGA, branched). One hour long irradiations using 38-65, 110-214 and 59-78mg of enriched ⁵⁴Fe (99.93%), ⁵⁸Ni (99.48%) and ⁵⁷Fe (95.06%), respectively, electroplated over a 1.0cm² surface, yielded 58² ± 66MBq ⁵⁵Co, 372 ± 14MBq ⁵⁵Co and 810 ± 186MBq ^58mCo, respectively, decay corrected to EoB. The separation methods allow for the recovery of the costly enriched target materials, which were reconstituted into metallic targets after novel electroplating methods, with an overall recycling efficiency of 93 ± 4% for iron. The produced radionuclides were used to radiolabel the angiogenesis marker antibody TRC105 conjugated to the chelator NOTA as a demonstration of their quality.

Laboratory Animal Legislation in Latin America

A review of existing legislation covering laboratory animals in Latin America is presented. The region presents a spectrum of economic development, political stability, and cultural diversity. With the exception of a few nations, there is a lack of regulations as well as minimal enforcement of existing laws pertaining to laboratory animals. Brazil, Mexico, and Uruguay stand out as the only nations in this region with specific legislation regulating laboratory animal care and use; the history and current status of regulations in these three nations is reviewed.

Abstract P5-11-13: Experience in the ABC Medical Center of Mexico City 2010-2015 using scalp-cooling system (DigniCap) for prevention of alopecia induced by chemotherapy

Background: Alopecia is one of the secondary side effect whit the most emotionally impact for patients undergoing chemotherapy (CTX) The DigniCap System is the first scalp cooling system use to minimize alopecia. Methods: The objetive of this study was to evaluate in a restrospective trial the efficacy of DigniCap preventing alopecia in consecutive patients treated in ABC Medical Center from December 2010 to January 2015. Patients recieve different chemotherapy regimens, with different modalities, neo , adyuvant and for metastases in first and second line, as in many clinical stages whit breast cancer (BC), were evaluated with the visual scale of Dean (score 0: 0-25%, 1: 25-50%, 2: 50-75%, 3: 75-100%) with photographs of the before and after treatment. Results: 120 pts with BC in stages I-V were treated with a taxane and antraciclins regimen of chemotherapy, 66 pts receive 12 treatment weekly of paclitaxe (T)l and 4 adriamicin/cyclophosphamida (AC) every 21 days, 28 pts 6-8 cycles every 21 days AC-Taxol, 22 pts (18%)suspended the treatment because of the loss of more than 50% of hair at the 2nd an 3rd chemotherapy cycle. 98 pts actually finished the treatment (72%). Of these, 82 pts (84%) no had or had a minimal loss of hair (Dean score 0-1), 16 pts (16%) had a 50% of hair loss (Dean score 3). 8pts recieve more than one regimen of chemotherapy. In the tracing any metastases or side effects were presented with the use of DigniCap. Conclusions: The use of DigniCap minimize alopecia in a 84%, including pts with more than one chemotherapy regimen, in a a safety level.

Citation Format: Hernandez RE, Gerson R, Olivares G, Rivera S, Serrano A, Villalobos A, Lazaro M. Experience in the ABC Medical Center of Mexico City 2010-2015 using scalp-cooling system (DigniCap) for prevention of alopecia induced by chemotherapy [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-11-13.

Differential expression and activity of matrix metalloproteinases 2 and 9 in canine early placenta

The zonary and endotheliochorial dog placenta is the most invasive placenta of carnivores. The importance of matrix metalloproteinases (MMP) in placenta invasiveness has been determined in several mammals including species with haemochorial, epitheliochorial and endotheliochorial placentation. Regarding the latter, the expression of MMP enzymes has been studied in the cat and the mature canine placenta. The aim of this study was to analyse the expression and activity of MMP-2 and MMP-9 in the early dog placenta. Placentae from 18 to 30 days of pregnancy were collected from four bitches. Two placentae from each bitch were analysed. Placental tissue from one uterine horn was fixed in formaldehyde for immunohistochemistry, while marginal haematoma, labyrinth, non-implantative and implantative endometrium from the contralateral horn were immediately frozen in dry ice for the analysis of MMP expression (Western blot [WB]) and activity (zymography). MMP-2 and MMP-9 were evidenced in the labyrinth, maternal glands and marginal haematoma; this finding was directly correlated with levels of MMP expression by WB, and with the activity of MMP-2, mainly in the haematoma (the area of major remodelling of tissues). Thus, although MMP-9 is well expressed in the early canine placenta, it is not active. Given the important role of MMPs for invasiveness, maternal-foetal angiogenesis and the establishment of a correct foetal nutrition, the results are consistent with the findings in other species in which the MMP-2 activation precedes the MMP-9 one in early placentation.

Separation of cyclotron-produced 44Sc from a natural calcium target using a dipentyl pentylphosphonate functionalized extraction resin

Significant interest in ⁴⁴Sc as a radioactive synthon to label small molecules for positron emission tomography (PET) imaging has been recently observed. Despite the efforts of several research groups, the ideal ⁴⁴Sc production and separation method remains elusive. Herein, we propose a novel separation method to obtain ⁴⁴Sc from the proton irradiation of calcium targets based on extraction chromatography, which promises to greatly simplify current production methodologies. Using the commercially available Uranium and Tetravalent Actinides (UTEVA) extraction resin we were able to rapidly (<20min) recover >80% of the activity generated at end of bombardment (EoB) in small ~1M HCl fractions (400μL). The chemical purity of the ⁴⁴Sc eluates was evaluated through chelation with DOTA and DTPA, and by trace metal analysis using microwave induced plasma atomic emission spectrometry. The distribution coefficients (K_d) of Sc(III) and Ca(II) in UTEVA were determined in HCl medium in a range of concentrations from zero to 12.1M. The ⁴⁴Sc obtained with our method proved to be suitable for the direct labeling of small biomolecules for PET imaging, with excellent specific activities and radiochemical purity.

Long-term outcome of the Cloward procedure for single-level cervical degenerative spondylosis. Clinical and radiological assessment after a 22-year mean follow-up

PURPOSE

To evaluate the long-term outcomes of the classical Cloward procedure in single-level cervical spondylosis.

METHODS

A retrospective study of 28 patients who were affected by cervical degenerative spondylosis at C4-C7 segments and treated by the Cloward technique at a single level from 1985-1995 was conducted. The average follow-up period was 22 years (range, 17-27 years). Preoperative clinical complaints were recorded and compared to the current clinical status. Preoperative, 3-6 months postoperative and a current radiographic study were analysed by evaluating the segmental and global sagittal alignment of the cervical spine as well as the occurrence of adjacent disc degeneration.

RESULTS

The most frequently operated segment was C5-C6 (57.1 %), followed by C6-C7 (32.1 %) and C4-C5 (7.1 %). Pain relief and symptom recovery experienced 3-6 months following the surgery was maintained at the most recent follow-up in 85 % of patients. Adjacent disc degeneration was detected in a total of 17 cases (60.7 %). Overall, a group of 14 cases (50 %) had increased lordosis at C2-C7 at the most recent follow-up, with a mean gain of 1.5º Cobb. According to Odom's criteria, 17 patients (60.8 %) presented with excellent clinical outcome, 6 (21.4 %) presented with good outcome, 5 had a (17.8 %) fair outcome, and none had a poor outcome.

CONCLUSIONS

The Cloward technique provided excellent long-term clinical outcome in the treatment of single-level cervical degenerative spondylosis. There were no major alterations of the cervical sagittal balance, and the development of adjacent segment disease (ASD) was not specifically associated with the previous surgery.

Beta cell nuclear musculoaponeurotic fibrosarcoma oncogene family A (MafA) is deficient in type 2 diabetes

AIMS/HYPOTHESIS

The beta cell transcriptional factor musculoaponeurotic fibrosarcoma oncogene family A (MafA) regulates genes important for beta cell function. Loss of nuclear MafA has been implicated in beta cell dysfunction in animal models of type 2 diabetes. We sought to establish if nuclear MafA is less abundant in beta cell nuclei in humans with type 2 diabetes.

METHODS

Pancreas obtained at surgery from five non-diabetic individuals and six individuals with type 2 diabetes was immunostained for insulin, glucagon and MafA.

RESULTS

Beta cell nuclear MafA was markedly decreased in type 2 diabetes (1.6 ± 1.2% vs 46.3 ± 8.3%, p < 0.001).

CONCLUSIONS/INTERPRETATION

Beta cell nuclear MafA is markedly decreased in humans with type 2 diabetes, which may contribute to impaired beta cell dysfunction.

An overview of a regional meteorology warning system

Abstract. In this work we present a regional meteorology warning system, particularly the operational weather warning system used by the Basque Meteorology Agency (Euskalmet) for Basque Country. System considers different meteorological phenomena capable of generate warnings, and is based on combined thresholds criteria depending on particular weather event and area of territory where is applied. In this work we describe the most significant aspects related with the warning event definition and the warning bulletin. Conclusions from comparison with the former system (prior to 2009) and feedback from different users are presented.

Altered synaptic transmission in the hippocampus of transgenic mice with enhanced central nervous systems expression of interleukin-6

Elevated levels of the inflammatory cytokine interleukin-6 (IL-6) occur in a number of CNS disorders. However, little is known about how this condition affects CNS neuronal function. Transgenic mice that express elevated levels of IL-6 in the CNS show cognitive changes, increased propensity for hippocampal seizures and reduced number of inhibitory interneurons, suggesting that elevated levels of IL-6 can cause neuroadaptive changes that alter hippocampal function. To identify these neuroadaptive changes, we measured the levels of protein expression using Western blot analysis and synaptic function using field potential recordings in hippocampus from IL-6 transgenic mice (IL-6 tg) and their non-transgenic (non-tg) littermates. Western blot analysis showed enhanced levels of the GFAP and STAT3 in the IL-6 tg hippocampus compared with the non-tg hippocampus, but no difference for several other proteins. Field potential recordings of synaptic transmission at the Schaffer collateral to CA1 synapse showed enhanced dendritic excitatory postsynaptic potentials and somatic population spikes in the CA1 region of hippocampal slices from IL-6 tg mice compared with slices from non-tg littermate controls. No differences were observed for several forms of short-term and long-term synaptic plasticity between hippocampal slices from IL-6 tg and non-tg mice. These results demonstrate that elevated levels of IL-6 can alter mechanisms involved in the excitability of hippocampal neurons and synapses, an effect consistent with recent evidence indicating that elevated production of IL-6 plays an important role in conditions associated with seizure activity and in other impairments observed in CNS disorders with a neuroinflammatory component.

Soft x-ray array system with variable filters for the DIII-D tokamak

Recent upgrades to the soft x-ray (SXR) array system on the DIII-D tokamak are described. The system consists of two 32-channel arrays at one toroidal location and three toroidally distributed 12-channel arrays. The 32-channel arrays have been completely rebuilt to allow the switching of SXR filters without breaking vacuum. The 12-channel arrays have had upgrades performed to detectors, view slits, and data acquisition. Absolute extreme ultraviolet (AXUV) photodiodes are used as detectors in all arrays, allowing detection of photons ranging in energy from 2 eV to 10 keV. In the fixed-filter arrays, 127 μm Be filters are used. In the variable-filter arrays, filter wheels are used to switch between five different possible pinhole/filter combinations.