Post-traumatic retinal siderosis, a case report

A thirty-year-old patient attended a few hours after an ocular trauma while hammering, receiving trauma with a metal splinter at the left eye. Due to an unfavorable clinical picture, surgical management was decided, which was initially rejected by the patient. He returned six months later with a profound decrease in left eye visual acuity, reaching counting finger at one meter despite optical correction. The anterior segment shows a lower scarring leukoma, associated with Tyndall (++), retrokeratic pigment, lower posterior synechiae and a total cataract. Cataract surgery with intraocular lens implantation and a posterior vitrectomy with intraocular foreign body extraction were indicated. At postoperative control it was shown that post-traumatic ocular siderosis did not significantly affect his central vision, which remains until now.

The Rac inhibitor HV-107 as a potential therapeutic for metastatic breast cancer

BACKGROUND

The significant challenge in treating triple-negative breast cancer (TNBC) lies in its high rate of distant metastasis. To address this, inhibiting metastasis formation in TNBC is vital. Rac is a key player in cancer metastasis. Previously, we developed Ehop-016, a Rac inhibitor that successfully reduced tumor growth and metastasis in mice. In this study, we assessed the effectiveness of HV-107, a derivative of Ehop-016, in inhibiting TNBC metastasis at lower doses.

METHODS

Rho GTPases activity assays were performed with the use of GST-PAK beads and Rac, Rho, and Cdc42 GLISA. Cell viability was assessed through trypan blue exclusion and MTT assays. Cell cycle analysis was conducted using flow cytometry. To evaluate invading capabilities, transwell assays and invadopodia formation assays were performed. Metastasis formation studies were conducted using a breast cancer xenograft mouse model.

RESULTS

HV-107 inhibited Rac activity by 50% in MDA-MB-231 and MDA-MB-468 cells at concentrations of 250-2000 nM, leading to a 90% decrease in invasion and invadopodia activity. Concentrations of 500 nM and above caused dose-dependent reductions in cell viability, resulting in up to 20% cell death after 72 h. Concentrations exceeding 1000 nM upregulated PAK1, PAK2, FAK, Pyk2, Cdc42, and Rho signallings, while Pyk2 was downregulated at 100-500 nM. Through in vitro experiments, optimal concentrations of HV-107 ranging from 250 to 500 nM were identified, effectively inhibiting Rac activity and invasion while minimizing off-target effects. In a breast cancer xenograft model, administration of 5 mg/kg HV-107 (administered intraperitoneally, 5 days a week) reduced Rac activity by 20% in tumors and decreased metastasis by 50% in the lungs and liver. No observed toxicity was noted at the tested doses.

CONCLUSION

The findings indicate that HV-107 exhibits promising potential as a therapeutic medication utilizing Rac inhibition mechanisms to address metastasis formation in TNBC.

Short-term decreased post transplant lymphoproliferative disorder risk after kidney transplantation using two novel regimens

BACKGROUND

Belatacept is employed alongside calcineurin inhibitor (CNI) therapy to prevent graft rejection in kidney transplant patients who are Epstein-Barr virus (EBV) seropositive. Preliminary data suggested that rates of post-transplant lymphoproliferative disorder (PTLD) were higher in individuals treated with belatacept compared to CNI therapy alone.

METHODS

The records of 354 adults who underwent kidney only transplantation from January 2015 through September 2021 at one medical center were evaluated. Patients underwent treatment with either low-doses of mycophenolate, tacrolimus and sirolimus (B⁰, n = 235) or low-doses of mycophenolate, tacrolimus and belatacept (B¹, n = 119). All recipients underwent induction with antithymocyte globulin and a rapid glucocorticosteroid taper. Relevant donor and recipient information were analyzed and endpoints of PTLD were assessed.

RESULTS

There were no cases of PTLD in either cohort within the study period. Recipients in the belatacept cohort experienced lower estimated glomerular filtration rates at 12 months (B⁰: 67.48 vs. B¹: 59.10, p = 0.0014). Graft failure at 12 (B⁰: 1.28% vs. B¹: 0.84%, p = 1.0) and 24 months (B⁰:2.55% vs. B¹: 0.84%, p = 0.431) were similar. There was no difference in rejection rates at 12 (B⁰: 1.27% vs. B¹: 2.52%, p = 0.408) or 24 months (B⁰: 2.12% vs. B¹: 2.52%, p = 1.000). Both groups had similar rates of malignancy, mortality and CMV/BK viremia.

CONCLUSION

Non-belatacept (MMF, tacrolimus and sirolimus) and belatacept-based (MMF, tacrolimus and belatacept) regimens do not appear to pose any increased risk of early onset PTLD. Both cohorts benefited from low rates of rejection, malignancy, mortality and graft failure. Recipients will continue to be monitored as PTLD can manifest as a long-term complication.

Central retinal artery occlusion as an ophthalmic complication after snakebite

Snakebite causes 421.000-1.200.000 poisonings per year due to and hematotoxicity, neurotoxicity y vasculotoxicity. Ophthalmological manifestations secondary to snake bites are rare. If the snake belongs to the Viperidae family, the most frequent ophthalmologic manifestations are macular infarction, chronic open-angle glaucoma, and retinal or vitreous hemorrhage. Central retinal artery occlusion is an extremely rare ocular complication. We report the case of a 30-year-old patient, who consulted due to poor vision in her left eye weeks after suffering a snake bite (Bothrops atrox) in her left lower limb. The diagnosis was a central retinal artery occlusion in the left eye with abnormal findings in the ophthalmological physical examination and in complementary retinal and neuro-ophthalmological tests.

O-063 Impact of group embryo culture vs individual embryo culture strategies on blastocyst rate and quality

Study question

Does group embryo culture improve blastocyst formation compared to individual culture?

Summary answer

Individual culture provides an increased blastocyst formation rate.

What is known already

Embryo culture is one of the most important steps of an IVF treatment. Several studies pointed out that group embryo culture could help embryos with lower potential, through paracrine signaling, to achieve development and improve blastocyst formation rate. On the other hand, this issue continues to be controversial and other studies did not find differences in embryo development when using either method.

Study design, size, duration

A prospective randomized study was performed between January 2020 and December 2021. The data were obtained from 830 embryos that came from 103 egg donation treatments. We defined two groups: individual vs group culture. The number of embryos analyzed in the study was calculated to test a difference of 10% in the rate of blastocyst formation between the two groups.

Participants/materials, setting, methods

A total of 103 ICSI-egg donation cycles with normozoospermic males (fresh samples) were included. After fertilization assessment, zygotes were randomized into two groups; Group 1: individual culture (399 embryos), and Group 2: culture of 2-5 embryos per drop (431 embryos). The embryos were cultured in 35 µl drops of Global Total medium until day 5 when they were classified morphologically according to Gardner criteria (1998). The statistical analysis was performed using SPSS (version 20.0).

Main results and the role of chance

The rate of high-quality embryos on day 3 were similar in Group 1 compared to Group 2 (79.2% vs 81.4%, p = 0.432). However, we observed an increase in the blastocyst formation rate on day 5 (62.9% vs 56.1%, p = 0.048) and a trend for higher embryo quality (A/B blastocysts) (55.9% vs 52%, p = 0.266) in Group 1; compared to Group 2, respectively.

Our data suggest that individual culture increases blastocyst formation rate and may benefit embryo quality on day 5. Our results challenge previous reports suggesting that culture in groups can improve embryo development. As hypothesis, we argue that some of the components that the embryos release to the culture environment during their division may affect the quality of the cohort potentially compromising further development up to the blastocyst stage.

Limitations, reasons for caution

The study is focused on laboratory outcomes until the blastocyst stage. Clinical outcomes were not analyzed.

Wider implications of the findings

Finding the most appropriate embryo culture conditions is essential to improve ART results. Time-lapse systems should be adapted to the use of both individual and group culture dishes. Larger randomized studies are needed in order to reach robust conclusions on the subject.

Trial registration number

NA

Prognostic value of baseline versus 6-month follow infarct size in patients with reperfused STEMI

Background

Acute infarct size is a predictor of clinical outcomes in acute ST segment elevation myocardial infarction (STEMI) patients, although its prognostic value has differed between studies. In acute STEMI, infarct size is often overestimated due to the presence of extensive myocardial oedema, a confounder that is no longer present at a 6-month follow-up study. It was our purpose to assess whether infarct size in the acute phase or at 6-months follow-up provided superior prognostic information in STEMI patients.

Methods

STEMI patients who underwent successful primary percutaneous revascularization were included and a cardiac magnetic resonance (CMR) was performed between 5–7 days after STEMI and at 6 months to study infarct size (as a % of myocardial mass). The primary endpoint was a composite of cardiovascular mortality, hospitalization for heart failure and ventricular arrhythmia.

Results

A total of 796 patients were included (mean age 58.3±11.5 years, 82.4% male, 52.3% anterior infarction). During a mean follow-up of 59 months, 59 patients (7.4%) presented with the primary end-point (cardiovascular death n=7, hospitalization for heart failure n=52, ventricular arrhythmia n=1). ROC curve analysis (figure 1) showed a non-significant difference between baseline and 6-month infarct size for the prediction of the primary endpoint (baseline AUC 0.685 95% CI 0.610–0.760, 6-month AUC 0.713 95% CI 0.643–0.782, p=0.60). Optimal cut-off values for baseline and 6-months follow-up infarct size for prediction of outcomes, respectively 22% and 17.5%, were used for Kaplan-Meier curve analysis (figure 2).

Conclusion

Infarct size estimated during the first week after STEMI and at 6-months follow-up showed similar predictive value and with similar cut-off values. Therefore, the prognostic information provided by infarct size can be obtained during initial STEMI admission and does not require a waiting period for infarct size stabilization.

Funding Acknowledgement

Type of funding sources: None. ROC curve analysisKaplan-Meier analysis

On how trap positioning affects phlebotomine sand fly density estimations

There is a need for standardizing sand fly sampling methodology and guidance on trap positioning for quantitative sand fly studies. We investigated differences in sand fly density with 'sticky' interception and CO₂ -light attraction traps, in relation to trap distance to the ground and the presence or absence of a continuous or discontinuous (wire mesh) vertical surface adjacent to the trap. The study, conducted in a dog kennel in southeast Spain, lasted 48 days and collected 692 Phlebotomus papatasi, P. perniciosus, P. ariasi and Sergentomyia minuta specimens. There were no significant differences between species with respect to trap position. Overall, density in sticky traps was highest closest to the ground and next to the continuous vertical surface, followed sequentially by traps similarly placed adjacent to the wire mesh and those hanging from a rope across the kennel yard. In contrast, density in CO₂ -light traps was highest in traps hanging from the rope near the ground, followed by those next to the continuous vertical surface. The overall negative relationship between sand fly density and ground distance was not significant for CO₂ -light traps next to the continuous vertical surface. Modelling also suggested that sand flies do not use the wire mesh to move vertically.

Bioecological aspects of triatomines and marsupials as wild Trypanosoma cruzi reservoirs in urban, peri-urban and rural areas in the Western Brazilian Amazon

In the Amazon region, Trypanosoma cruzi transmission cycles involve a great diversity of Triatominae vectors and mammal reservoirs. Some Rhodnius spp. mainly inhabit palm trees that act as microhabitats for hosts and vectors. The current study aimed to describe aspects of the bio-ecology of the vectors and reservoirs of T. cruzi in relation to human populations resident near areas with large quantities of palm trees, in rural, peri-urban and urban collection environments, located in the Western Brazilian Amazon. Rhodnius pictipes and Didelphis marsupialis were respectively the most predominant vector and reservoir, with rates of 71% for R. pictipes and 96.5% for D. marsupialis. The vast majority of T. cruzi isolates clustered with TcI. The most prevalent haplotype was TcI COII1 (69.7%). Mauritia flexuosa and Attalea phalerata were the main ecological indicators of infestation by triatomines. Birds were the most common food source (27,71%). T. cruzi isolated from R. robustus has the haplotype HUM-13, previously detected in a chronic Chagas patient living in the same area. Our results demonstrate the relevance of this study, with the occurrence of elevated infection rates in animals, and suggest the importance of the Amazon zones where there is a risk of infection in humans.

P–781 Birthweight is not affected by freezing process. Results from a quasi-experimental study using the Oocyte Donation Model

Study question

Is the freezing process responsible to increase the birthweight or the incidence of Large for Gestational Age (LGA) in Frozen Embryo Transfers (FET)?

Summary answer

Neither the birthweight nor the LGA incidence were different in embryos that underwent the freezing-thawing process.

What is known already

Freezing-thawing constitutes one of the processes with a potential impact on the health of the newborn. Data coming from register-based studies and metaanalisis have found an increase in birthweight with a higher incidence of LGA in newborns coming from FET. This is a matter of concern since epigenetic alterations have been suggested to explain this finding casting doubts on future health during childhood and adulthood. Clarifying the safety of cryotechniques should be a priority taken into account that at present frozen embryo transfers outnumber fresh embryo transfers in IVF clinics.

Study design, size, duration

This retrospective cohort study evaluated 670 women oocyte recipients who underwent fresh (367 cycles) or frozen embryo transfer (303 cycles) at Instituto Bernabeu between July 2017 and March 2019. All recipients were prepared with substitutive cycle and received single blastocyst embryo transfers on day five. All of them at the same culture medium, resulting in a singleton live birth.

Participants/materials, setting, methods

1637 patients were assessed for eligibility but 967 were excluded. The sample size has been calculated accepting an alpha risk of 5% and a beta risk of 20%. A sample size of 266 patients (133 per group) is required to detect a minimum mean difference of 275 grams with a standard deviation of 800 grams. Pearsońs Chi-square test (univariate) and binary logistic regression (multivariate for confounding factors) were used to analyze association between variables.

Main results and the role of chance

Maternal age (42.21 ± 4.45; 42.79 ± 3.83 p = 0.519), BMI (23.34 ± 3.69; 24.99 ± 15.52; p = 0.060), maternal parity (Nulliparous 81.5%; 85.5%; Multiparous 18.5%; 14.5% p = 0.177), gestational diabetes (4.9%; 4.3% p = 0.854), preeclampsia (2.7%; 5.6% p = 0.074), hypertensive disorders (3.3%; 2.3% p = 0.494), maternal smoking (10.8%; 13.0% p = 0.475), gestational age (38.96 ± 1.97; 38.77 ± 2.15; p = 0.207) and liveborn gender (Female 44.5%; 48.8%; Male 55.5%; 51.2%p=0.276) do not present statistically significant differences between fresh or frozen groups, respectively.

However endometrial thickness was statistically signiticantly different in both groups (8.83mm ± 1.73 fresh; 8.57mm ± 1.59 frozen p = 0.035)

The mean birthweight did not present statistically significant differences (3239.21 ± 550.43 fresh; 3224.56 ± 570.83 frozen p = 0.211). There were also no differences regarding macrosomy (7.1% fresh; 6.3% frozen p = 0.317), LGA (6.0% fresh; 6.7% frozen p = 0.866), pre-term birth (10.9% fresh; 9.0% frozen p = 0.988), very pre-term birth (0.8% fresh; 1.3% frozen p = 0.999), and extremely pre-term birth (0% fresh; 1.0% frozen p = 0.998).

There were statistically significant differences regarding underweight (10.0% fresh; 7.0% frozen p = 0.020), but there were no differences in very low weight (0.6 fresh; 1.1% frozen p = 0.972) and SGA (1.9% fresh; 0.7% frozen p = 0.432).

Limitations, reasons for caution

Despite a quasi-experimental design, the synchronization in fresh embryo transfer drove to a longer preparation with a thicker endometrium. It’s not possible to rule-out the influence in the results of this parameter.

Wider implications of the findings: As a hypothesis, the increase in birthweight and/or an abnormal placentation in FET could be explained by the endometrial preparation more than the freezing process. Studies must be planned in the future to explore the possibility of changes in the birthweight between embryos transferred in natural vs artificial endometrial preparations.

Trial registration number

Not applicable

Kidney transplant surgical director training: Urologists represent a functional alternative to general surgeons

INTRODUCTION

Kidney transplant (KT) directors are general surgeons or urologists. All KT centers must meet established performance standards. However, it has not been established if general surgery and urology led programs have disparate outcomes.

METHODS

Transplant outcomes and donor-recipient characteristics by director training were investigated. Organ Procurement and Transplantation Network (OPTN) directory, program websites were analyzed for surgical director demographics. Scientific Registry of Transplant Recipients (SRTR) 1-year kidney survival and deceased donor (DD) wait-time rankings were evaluated. A retrospective analysis of 142 157 KT recipients from 2010 to 2019 was performed using the United Network for Organ Sharing (UNOS) database.

RESULTS

One hunderd and seventy three (90.6%) KT programs were led by general surgeons. There were no significant differences in gender, ethnicity, region, credentials, or fellowship completion. Recipients undergoing KT with urology led programs were older (P = .002) and had longer wait-times (P < .001). These centers used higher KDPI (.47 vs. .45, P < .001) and higher HLA mismatch (3.92 vs. 3.89, P = .02) kidneys. Urology led centers utilized living donors less frequently (32.1% vs. 35.8%, P < .001) and had longer CIT (15.44 vs. 12.21, P < .001). Both had similar SRTR ranking of 1-year survival and DD wait-time.

CONCLUSION

Most directors were general surgeon. Patient outcomes did not differ by transplant director training. Urologists represent a viable option for KT leadership and recruitment should be encouraged.

Plastinated macroparasites, an alternative resource for use in practical lessons

The plastination technique is a recently developed option to preserve biological tissues widely used in human and veterinary anatomy. This process allows one to obtain real, safe, clean, dry, resistant and permanently stable material without any additional treatment or maintenance. All these advantages are associated with the rapid expansion of plastination during recent decades in a high number of educational institutions. However, the studies of parasite conservation through plastination are scarce, although the material obtained has a high quality, as prior references have shown. In this study, 141 students of veterinary medicine and pharmacy university degrees used, in a blind study, plastinated specimens (experimental group) or wet specimens (control group) during three consecutive practical sessions. Afterwards all the students completed anonymous questionnaires on both knowledge and satisfaction. The results demonstrated that plastinated parasites are a valid and satisfactory alternative to be used as a teaching/learning tool during practical lessons. Moreover, with regard to the knowledge of morphological structures, the results from the questionnaire of assimilated knowledge showed no differences between the use of plastinated and formaldehyde-preserved parasites.

A spatial ecology study in a high-diversity host community to understand blood-feeding behaviour in Phlebotomus sandfly vectors of Leishmania

Molecular studies indicate that Phlebotomine sandflies (Diptera: Psychodidae) blood feed on many vertebrate species, of which only a few are proven parasite reservoirs. Investigating sandfly vector feeding preferences is therefore important and requires taking into account the availability and accessibility of host species. In terms of the latter, it is necessary to consider the metabolic cost to the insect of reaching the host and moving on to a suitable breeding site. The present study used statistical modelling to compare the feeding patterns of Phlebotomus perniciosus (n = 150), Phlebotomus papatasi (n = 35) and Phlebotomus ariasi (n = 7) on each of an average of 30 host species in a wildlife park in Murcia, Spain. Sandfly feeding movement costs were estimated as a function of the distance and altitude gradients saved by the insect, assuming that they displayed 'site fidelity'. Most (87%) engorged females were caught <100 m from the host on which they had fed. Although the percentage of bloodmeals was highest on fallow deer (Dama dama) (30%) and red deer (Cervus elaphus) (26%), the predicted feeding probability after considering movement cost was highest for red deer and common eland (Taurotragus oryx), and positively associated with host census. These results suggest that, under similar circumstances, sandflies prefer to feed on some host species more than on others.

Risk-adjusted early invasive strategy in patients with non-ST-segment elevation acute coronary syndrome in Intensive Cardiac Care Units

OBJECTIVE

Current guidelines recommend a risk-adjusted early invasive strategy (EIS) in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). The present study assesses the application if this strategy, the conditioning factors and prognostic impact upon patients with NSTEACS admitted to Intensive Cardiac Care Units (ICCU).

DESIGN

A prospective cohort study was carried out.

SETTING

The ICCUs of 8 hospitals in Catalonia (Spain).

PATIENTS

Consecutive patients with NSTEACS between October 2017 and March 2018. The risk profile was defined by the European Society of Cardiology criteria.

INTERVENTIONS

EIS was defined as the performance of coronary angiography within the first 6hours in patients at very high-risk or within 24hours in high-risk patients.

OUTCOME VARIABLES

Mortality or readmission at 6 months.

RESULTS

A total of 629 patients were included (mean age 66.6 years), of whom 225 (35.9%) were at very high risk, and 392 (62.6%) at high risk. Most patients (96.2%) underwent an invasive strategy. EIS was performed in 284 patients (45.6%), especially younger patients with fewer comorbidities. These patients had a shorter ICCU and hospital stay, as well as a lesser incidence of ACS, revascularization and death or readmission at 6 months. After adjusting for confounders, the association between EIS and death or readmission at 6 months remained significant (hazard ratio: .66, 95% confidence interval .45-.97; P=.035).

CONCLUSIONS

The EIS was performed in a minority of NSTEACS admitted to ICCU, being associated with better outcomes.

Predictive capacity of prodromal symptoms in first-episode psychosis of recent onset

BACKGROUND

Both the nature and number of a wide range of prodromal symptoms have been related to the severity and type of psychopathology in the psychotic phase. However, at present there is an incomplete picture focused mainly on the positive pre-psychotic dimension.

AIM

To characterize the prodromal phase retrospectively, examining the number and nature of prodromal symptoms as well as their relationship with psychopathology at the onset of first-episode psychosis.

METHODS

Retrospective study of 79 patients experiencing a first-episode psychosis of less than 1 year from the onset of full-blown psychosis. All patients were evaluated with a comprehensive battery of instruments including socio-demographic and clinical questionnaire, IRAOS interview, PANSS, stressful life events scale (PERI) and WAIS/WISC (vocabulary subtest). Bivariate associations and multiple regression analysis were performed.

RESULTS

Regression models revealed that several prodromal dimensions of IRAOS (delusions, affect, language, behaviour and non-hallucinatory disturbances of perception) predicted the onset of psychosis, with positive (22.4% of the variance) and disorganized (25.6% of the variance) dimensions being the most widely explained.

CONCLUSION

In addition to attenuated positive symptoms, other symptoms such as affective, behavioural and language disturbances should also be considered in the definitions criteria of at-high-risk people.