Integrated 3D Anatomical Model for Automatic Myocardial Segmentation in Cardiac CT Imagery

Segmentation of epicardial and endocardial boundaries is a critical step in diagnosing cardiovascular function in heart patients. The manual tracing of organ contours in Computed Tomography Angiography (CTA) slices is subjective, time-consuming and impractical in clinical setting. We propose a novel multi-dimensional automatic edge detection algorithm based on shape priors and principal component analysis (PCA). We have developed a highly customized parametric model for implicit representations of segmenting curves (3D) for Left Ventricle (LV), Right Ventricle (RV), and Epicardium (Epi) used simultaneously to achieve myocardial segmentation. We have combined these representations in a region-based image modeling framework with high level constraints enabling the modeling of complex cardiac anatomical structures to automatically guide the segmentation of endo/epicardial boundaries. Test results on 30 short-axis CTA datasets show robust segmentation with error (mean ± std mm) of (1.46 ± 0.41), (2.06 ± 0.65), (2.88 ± 0.59) for LV, RV and Epi respectively.

Factors Related to the Acute Cellular Rejection During the First Year After Heart Transplant

INTRODUCTION

The acute cellular rejection is recognized as a factor related to the long-term viability of the heart graft. We intend to establish which factors are associated with the acute cellular rejection during the first year post heart transplant using a longitudinal model with repeated measures.

METHODS

A retrospective cohort study was performed with all the patients who underwent heart transplant between 2005-2018 at the Hospital Universitario San Ignacio in Bogota, Colombia. In order to determine the factors associated with the development of acute cellular rejection, a generalized estimating equation approach was used, with an interchangeable correlation structure. The lowest value of quasi-likelihood information criterion and P < .05 was considered significant.

RESULTS

Fifty-five patients (49.3 ± 11.1 years old) were included. The mortality during the first month was 16.3% and the accumulated mortality during the first year was 23.6%. The incidence of the acute cellular rejection was higher during the third month after the transplant (79.9%); most of them were acute cellular rejection grade 1. The factors associated with the development of the rejection were the cyclosporine levels out of the therapeutic range in several periods of evaluation (P < .03) and the age of the receptor (P = .049).

CONCLUSIONS

Using advanced modeling methodologies of longitudinal data we identified that the factors associated with acute cellular rejection during the first year after the transplant are related to the therapeutic levels of the calcineurin inhibitor (cyclosporin) during the first 6 months of follow-up and the age of the receptor.

[Efficacy and safety of fingolimod in routine clinical practice in patients with relapsing-remitting multiple sclerosis in Spain: an intermediate analysis of the MS NEXT study]

INTRODUCTION

Fingolimod is a disease modifying therapies, which has showed clinical efficacy and an acceptable safety profile in clinical trials with relapsing-remitting multiple sclerosis (RRMS) patients.

AIM

To assess fingolimod effectiveness and safety in patients with RRMS in clinical practice.

PATIENTS AND METHODS

We present an interim analysis (July 2015) of MS NEXT, an observational, retrospective and multicenter study. 442 patients were included (mean age: 41 ± 9 years; median baseline EDSS: 3.0; 70% female; 284 previously treated with first-line disease modifying therapies, 139 with natalizumab and 19 without a previous treatment; mean fingolimod treatment duration: 25 ± 9 months) treated with fingolimod from November 2011 and with at least 12 months follow-up. 56 neurology-unit Spanish hospitals enrolled patients. Basal clinical and demographic data were recorded. Relapses, EDSS scores and radiological activity were recorded at baseline and annually. Adverse events were also recorded during the follow-up period.

RESULTS

After two years of follow-up: annual relapse rates decreased by 76%, the proportion of relapse-free patients was 67%, of disability progression-free patients confirmed at 3 months was 91%, of relapse and disability progression-free patients was 63%, of radiological activity-free patients was 50%, and the proportion of relapse, disability progression and radiological activity-free patients was 35%. Only 3.9% of patients discontinued fingolimod permanently during the first year of treatment.

CONCLUSIONS

In this interim analysis, most of patients treated with fingolimod in clinical practice had a controlled clinical disease activity, stable disability progression and high persistency.

Characterization of Pseudomonas syringae pv. actinidiae biovar 3 on kiwifruit in north-west Portugal

AIMS

Bacterial kiwifruit canker disease, caused by Pseudomonas syringae pv. actinidiae (Psa) was detected in north-west Portugal in 2010, and has since caused significant losses. The objectives of this work were to characterize the Portuguese population(s) of Psa and to define the actual prevalence of Psa biovars in the most productive kiwifruit region in Portugal.

METHODS AND RESULTS

Isolates obtained from Actinidia deliciosa orchards were characterized by morphological, biochemical, physiological, fatty acids and molecular tests (PCR, BOX-PCR, duplex-PCR, multiplex-PCR and RFLP), phaseolotoxin, housekeeping and effector genes and pathogenicity. Results established that only Psa biovar 3 is present in the north-west of Portugal, despite phenotypic and genetic variability among the isolates.

CONCLUSIONS

This work provides new information on P. syringae pv. actinidiae (Psa) genetic profile in Portugal, indicating for the first time, that two genetically different subpopulations of Psa biovar 3 are present.

SIGNIFICANCE AND IMPACT OF THE STUDY

A new subpopulation of Psa biovar 3 was found for the first time in Portugal, contributing to increase knowledge about this population worldwide and to support further understanding of the impact of Psa.

Abstract P5-14-04: A novel implant to deliver localized hormonal therapy to prevent and treat breast cancer

Most cancer treatment and prevention strategies include removal of the respective organ or systemic therapy. Early interception and cancer prevention is fraught with uncertainties in individual risk assessment and the absence of early surrogate markers to monitor efficacy. Hence, cancer prevention studies typically require large patient numbers. They are performed in unselected populations without clearly defined risk and benefits are often small or diluted. Hence, even successful strategies with documented benefit such as tamoxifen, have found only poor uptake in the at-risk population. Many women and providers are deterred by the low benefits to risk ratio of systemic tamoxifen exposure. The opportunity to selectively treat with an effective agent would limit the need for surgery and circumvent systemic exposure.

We propose a less toxic and less debilitating approach to prevent and treat early stage breast cancer by utilizing the slow release of anti-estrogens from silastic tubing as a local drug delivery device to the breast. Our in vitro and in vivo data demonstrate consistent release of active fulvestrant through at least 52 weeks. Extrapolating from the amount of residual drug left in the tubing after 52 weeks suggests that drug release could be maintained sufficiently to and beyond 5 years. Silastic tubing released fulvestrant at clinically relevant concentrations and associated with inhibition of ER signaling and cell proliferation in vitro. In vivo anti-tumor activity was comparable to systemic administration of the anti-estrogen. The silastic tubing preferentially delivered the anti-estrogen to mammary tissue with minimal accumulation in major organs and 20-fold lower concentrations in adjacent (abdominal) and distant fat (thoracic) pads. Consistent with fulvestrant penetrance through tumors, local delivery was more effective in reducing Ki-67 immediately adjacent to the tubing but maintained concentrations comparable to systemic therapy throughout the entire tumors. We further demonstrated that human fat cells readily take up fulvestrant and then transfer the drug to breast cancer cells. These findings support the use of local drug delivery through the human breast tissue and surrounding fatty tissue. Mammary tissues are rapidly cleared of fulvestrant upon removal of the drug-loaded tubing. This would allow the long term implantation of a drug delivery device designed to be emptied or refilled.

Local drug delivery is ideally suited in a setting of local disease or recurrence with minimal risk for systemic metastases with the goal of producing high concentrations without systemic application of the drug. Our data support the concept of a local silastic tubing device as a means to locally deliver an anti-estrogen in three major applications: early interventions for localized tumors, such as ductal carcinoma in situ (DCIS) or early stage breast cancer with low metastatic potential, prevention of breast cancer in women at higher risk due genetic predisposition, or used in concert with systemic therapy to provide a localized therapeutic boost. Overall, the use of implantable silastic tubing for local drug delivery represents a promising approach and introduces a potential paradigm shift in prevention and treatment of breast cancer.

Citation Format: Munster PN, Park J, Desai P, Garcia E, Cheng S, Greier S, Pawlowska N, Chaudhuri AR, Thomas S. A novel implant to deliver localized hormonal therapy to prevent and treat breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-14-04.

Incidence and etiological mechanism of stroke in cardiac surgery

OBJECTIVE

We studied patients who had experienced a stroke in the postoperative period of cardiac surgery, aiming to analyse their progression and determine the factors that may influence prognosis and treatment.

METHODS

We established a protocol for early detection of stroke after cardiac surgery and collected data on stroke onset and a number of clinical, surgical, and prognostic variables in order to perform a descriptive analysis.

RESULTS

Over the 15-month study period we recorded 16 strokes, which represent 2.5% of the patients who underwent cardiac surgery. Mean age in our sample was 69 ± 8 years; 63% of patients were men. The incidence of stroke in patients aged 80 and older was 5.1%. Five patients (31%) underwent emergency surgery. By type of cardiac surgery, 7% of patients underwent mitral valve surgery, 6.5% combined surgery, 3% aortic valve surgery, and 2.24% coronary surgery. Most cases of stroke (44%) were due to embolism, followed by hypoperfusion (25%). Stroke occurred within 2 days of surgery in 69% of cases. The mean NIHSS score in our sample of stroke patients was 9; code stroke was activated in 10 cases (62%); one patient (14%) underwent thrombectomy. Most patients progressed favourably: 13 (80%) scored≤2 on the modified Rankin Scale at 3 months. None of the patients died during the postoperative hospital stay.

CONCLUSION

In our setting, strokes occurring after cardiac surgery are usually small and have a good long-term prognosis. Most of them occur within 2 days, and they are mostly embolic in origin. The incidence of stroke in patients aged 80 and older and undergoing cardiac surgery is twice as high as that of the general population.

[Medullar thoracic compression by tophaceous gout: presentation of a case and review of the literature]

INTRODUCTION

Spine involvement in gout is an extremely uncommon complication. Dorsalgia and quadriplegia are some manifestations that may occur, although these symptoms are seen more frequently in other more prevalent pathologies, such as spinal tumors.

CASE REPORT

We present an unusual case of thoracic spinal cord compression at T10-T11 level caused by the extradural deposit of tophaceous material in a 52-year-old woman with uncontrolled chronic tophaceous gout. In addition to intensive medical treatment, the patient required surgery (hemilaminectomy and spinal decompression) and subsequent rehabilitation. Overall and neurological evolution were satisfactory.

Protecting children and families from tobacco and tobacco-related NCDs in the Western Pacific: good practice examples from Malaysia, Philippines and Singapore

BACKGROUND

Non-communicable diseases (NCDs) are generally considered diseases of adulthood, but NCD risk factors like tobacco use often are taken up during childhood and adolescence, and second-hand smoke exposure affects child survival and development.

METHODS

At a regional meeting of the Asia Pacific Child and Family Health Alliance for Tobacco Control, members reviewed existing good practices of child-focused tobacco control approaches using health promotion strategies. These interventions were implemented nationally in Malaysia, the Philippines and Singapore.

RESULTS

Three good practice national examples were identified that focused on creating supportive tobacco-free environments and upgrading cessation skills among paediatricians. These country examples highlight strategic areas to protect children and families from the harms of tobacco, as part of NCD prevention and control. Training paediatricians in brief cessation advice has enabled them to address tobacco-using parents. Fully enforcing smoke-free public areas has led to an increase in smoke-free homes. The Tobacco Free Generation is a tobacco control 'endgame' strategy that taps into a social movement to deglamorize tobacco use and empower youth born in and after year 2000 to reject tobacco and nicotine addiction.

CONCLUSION

Tobacco control is pivotal in the fight against NCDs; health promotion strategies to protect children and youth from tobacco have a critical role to play in NCD prevention and control. Frontline health workers, including primary care paediatricians, need to step up and actively advocate for full implementation of the WHO Framework Convention on Tobacco Control, including tobacco tax increases and smoke-free areas, while monitoring patients and their parents for tobacco use and second-hand smoke exposure, preventing adolescent smoking uptake, and offering cessation support. A life-course approach incorporating child-focused efforts to prevent initiation of smoking and second-hand smoke exposure with measures promoting cessation among parents will offer the greatest chance of overcoming future tobacco-related NCD burden.

Closer versus Long Range Interaction Effects on the Non-Arrhenius Behavior of Quasi-Resonant O2 + N2 Collisions

We report in this paper an investigation on energy transfer processes from vibration to vibration and/or translation in thermal and subthermal regimes for the O₂ + N₂ system performed using quantum-classical calculations on different empirical, semiempirical, and ab initio potential energy surfaces. In particular, the paper focuses on the rationalization of the non-Arrhenius behavior (inversion of the temperature dependence) of the quasi-resonant vibration-to-vibration energy transfer transition rate coefficients at threshold. To better understand the microscopic nature of the involved processes, we pushed the calculations to the detail of the related cross sections and analyzed the impact of the medium and long-range components of the interaction on them. Furthermore, the variation with temperature of the dependence of the quasi-resonant rate coefficient on the vibrational energy gap between initial and final vibrational states and the effectiveness of quantum-classical calculations to overcome the limitations of the purely classical treatments were also investigated. These treatments, handled in an open molecular science fashion by chaining data and competencies of the various laboratories using a grid empowered molecular simulator, have allowed a rationalization of the dependence of the computed rate coefficients in terms of the distortion of the O₂-N₂ configuration during the diatom-diatom collisions. A way of relating such distortions to a smooth and continuous progress variable, allowing a proper evolution from both long to closer range formulation of the interaction and from its entrance to exit channel (through the strong interaction region) relaxed graphical representations, is also discussed in the paper.

NMR quantification of trimethylamine-N-oxide in human serum and plasma in the clinical laboratory setting

BACKGROUND AND OBJECTIVES

Trimethylamine-N-oxide (TMAO) produced by gut microbiota metabolism of dietary choline and carnitine has been shown to be associated with increased risk of cardiovascular disease (CVD) and to provide incremental clinical prognostic utility beyond traditional risk factors for assessing a patient's CVD risk. The aim of this study was to develop an automated nuclear magnetic resonance (NMR) spectroscopy assay for quantification of TMAO concentration in serum and plasma using a high-throughput NMR clinical analyzer.

METHODS

Key steps in assay development included: (i) shifting the TMAO analyte peak to a less crowded region of the spectrum with a pH buffer/reagent, (ii) attenuating the broad protein background signal in the spectrum and (iii) using a non-negative least squares algorithm for peak deconvolution. Assay performance was evaluated according to Clinical and Laboratory Standards Institute guidelines. A method comparison study was performed to compare TMAO concentrations quantified by NMR and mass spectrometry (MS).

RESULTS

The within-run and within-lab imprecision ranged from 4.3 to 14.5%. Under the acquisition method employed, the NMR assay had a limit of blank, detection and quantitation of 1.6, 3.0 and 3.3μM, respectively. Linearity was demonstrated within the reportable range of 3.3 to 3000μM. TMAO measurements using the NMR assay, which involves minimal sample preparation, compared well with values obtained with the MS-based assay (R²=0.98).

CONCLUSIONS

The NMR based assay provides a simple and accurate measurement of circulating TMAO levels amenable to the high-throughput demands of the clinical chemistry laboratory. Moreover, assay performance enables the levels of TMAO to be quantified in serum or plasma at clinically actionable concentrations for the assessment of cardiovascular disease risks and individualized dietary monitoring.

The link between developmental psychiatry and dual disorders from early attachment to first drugs abuse

Since Dual Disorders expression was used for the first time, the old dilemma between cathegorial and dimensional grew again as a main issue because many authors wondered about its utility. The question was how far we can speak about two different entities, because doing so we are assuming comorbidity instead of a complex syndrome, with different clinical presentations (i.e. Talking about fever and cough instead of pneumonia). Child and adolescence psychiatry uses developmental psychiatry as a very useful tool to understand patients. Syndromes are seen as dynamic as patients. At the same time that patients grow their clinical presentations, evolves new symptoms or signs. We have reviewed retrospectively a group of twenty parents that were named as dual disorders, with different substance abuse but a common path in their childhood; all of them were diagnosed of ADHD and Conduct Disorder. We chose them because of the differences that DSM, ICD and main researchers have about this group, which some consider better described as a Disocial hiperquinetic disorder (ICD) than a AHDH with a conduct disorder associated (DSM), comorbidity again. We agreed with ICD opinion and will discuss how in some way we are somehow as those blind people describing different parts of the same elephant when we talk sometimes about dual. Truth is that opposite dual view or its syndromic treatment developmental psychiatry has all the time underlined the role of reward circuits/executive functions as epigenetic issues, both modulated by gene and environment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Genome- and CD4+ T-cell methylome-wide association study of circulating trimethylamine-N-oxide in the Genetics of Lipid Lowering Drugs and Diet Network (GOLDN)

BACKGROUND

Trimethylamine-N-oxide (TMAO), an atherogenic metabolite species, has emerged as a possible new risk factor for cardiovascular disease. Animal studies have shown that circulating TMAO levels are regulated by genetic and environmental factors. However, large-scale human studies have failed to replicate the observed genetic associations, and epigenetic factors such as DNA methylation have never been examined in relation to TMAO levels.

METHODS AND RESULTS

We used data from the family-based Genetics of Lipid Lowering Drugs and Diet Network (GOLDN) to investigate the heritable determinants of plasma TMAO in humans. TMAO was not associated with other plasma markers of cardiovascular disease, e.g. lipids or inflammatory cytokines. We first estimated TMAO heritability at 27%, indicating a moderate genetic influence. We used 1000 Genomes imputed data (n=626) to estimate genome-wide associations with TMAO levels, adjusting for age, sex, family relationships, and study site. The genome-wide study yielded one significant hit at the genome-wide level, located in an intergenic region on chromosome 4. We subsequently quantified epigenome-wide DNA methylation using the Illumina Infinium array on CD4+ T-cells. We tested for association of methylation loci with circulating TMAO (n=847), adjusting for age, sex, family relationships, and study site as the genome-wide study plus principal components capturing CD4+ T-cell purity. Upon adjusting for multiple testing, none of the epigenetic findings were statistically significant.

CONCLUSIONS

Our findings contribute to the growing body of evidence suggesting that neither genetic nor epigenetic factors play a critical role in establishing circulating TMAO levels in humans.

Characterisation of new gated optical image intensifiers for fluorescence lifetime imaging

We report the characterisation of gated optical image intensifiers for fluorescence lifetime imaging, evaluating the performance of several different prototypes that culminate in a new design that provides improved spatial resolution conferred by the addition of a magnetic field to reduce the lateral spread of photoelectrons on their path between the photocathode and microchannel plate, and higher signal to noise ratio conferred by longer time gates. We also present a methodology to compare these systems and their capabilities, including the quantitative readouts of Förster resonant energy transfer.

Preserved vagus nerve stimulator function after radiation therapy

BACKGROUND

Epilepsy and breast cancer are both prevalent conditions. A subset of women with medically refractory epilepsy and vagus nerve stimulators (VNS) may later develop breast cancer and may require adjuvant radiation as part of their treatment regimen. However, to date, little data are available on the effects of radiation on VNS function.

CASE PRESENTATION

We present a young woman with tuberous sclerosis, developmental delay, and medically refractory epilepsy who developed left-sided breast cancer. Her epilepsy became controlled with a recent addition of a VNS implanted in her left chest wall. She required adjuvant radiation therapy to her left breast, and this raised the novel question of the safety of radiation on the integrity and functioning of the device, which we explore in this article.

CONCLUSION

This case is the first report of a patient with VNS for epilepsy and breast cancer who received radiation therapy proximal to the device. The device continued to function properly despite the exposure.

A Single-Blind Randomized Trial About the Effect of Hydrogen Peroxide Concentration on Light-Activated Bleaching

Objective: To compare the bleaching efficacy and tooth sensitivity (TS) of two hydrogen peroxide (HP) concentrations (20% and 35%) used for in-office bleaching associated or not with a light-emitting diode (LED)/laser light activation.

Method: Seventy-seven patients with a right maxillary canine darker than A3 were selected for this single-blind randomized trial. The participants were distributed in four groups: bleaching with 35% HP, 35% HP + LED/laser, 20% HP, and 20% HP + LED/laser. The anterior teeth were bleached in two sessions, using a 35% or 20% HP gel with a one-week interval. Each session had three applications of 15 minutes. For the light-activated groups, the LED/laser energy (Whitening Laser Light Plus, DMC) was employed according to the manufacturer's instructions. The color change was evaluated by subjective and objective methods. Participants recorded TS with five-point verbal and visual analog scales. Color change in ΔE was evaluated by analysis of variance and Tukey tests (α=0.05) and in ΔSGU with Kruskall-Wallis and Dunn test. The absolute risk of TS and TS intensity were evaluated by Fisher exact test and Kruskall-Wallis test, respectively (α=0.05).

Results: All groups achieved the same level of whitening, except for the 20% HP group, which showed the lowest degree of whitening in the subjective analysis. The use of light did not increase the absolute risk or intensity of TS. No significant difference among groups was observed when color changes were assessed with the spectrophotometer.

Conclusion: According to the value-oriented shade guide, the use of LED/laser light activation was able to increase the degree of whitening of the 20% HP group, but this association was not useful for the 35% HP gel. The spectrophotometer, however, did not detect significant differences among groups.

Plasma phospholipid transfer protein activity is inversely associated with betaine in diabetic and non-diabetic subjects

Background

The choline metabolite, betaine, plays a role in lipid metabolism, and may predict the development of cardiovascular disease and type 2 diabetes mellitus (T2DM). Phospholipid transfer protein (PLTP) and lecithin:cholesterol acyltransferase (LCAT) require phosphatidylcholine as substrate, raising the possibility that there is an intricate relationship of these protein factors with choline metabolism. Here we determined the relationships of PLTP and LCAT activity with betaine in subjects with and without T2DM.

Methods

Plasma betaine (nuclear magnetic resonance spectroscopy), PLTP activity (liposome-vesicle HDL system), LCAT activity (exogenous substrate assay) and (apo)lipoproteins were measured in 65 type 2 diabetic (T2DM) and in 55 non-diabetic subjects.

Results

PLTP and LCAT activity were elevated in T2DM (p < 0.05), whereas the difference in betaine was not significant. In age-, sex- and diabetes status-controlled correlation analysis, betaine was inversely correlated with triglycerides and positively with HDL cholesterol (p < 0.05 to 0.01). PLTP and LCAT activity were positively correlated with triglycerides and inversely with HDL cholesterol (p < 0.05 to 0.001). PLTP (r = −0.245, p = 0.006) and LCAT activity (r = −0.195, p = 0.035) were correlated inversely with betaine. The inverse association of PLTP activity with betaine remained significant after additional adjustment for body mass index and lipoprotein variables (β = −0.179, p = 0.034), whereas its association with LCAT activity lost significance (β = −0.056, p = 0.44).

Conclusions

Betaine may influence lipoprotein metabolism via an effect on PLTP activity.

Enhanced Flexibility of the O2 + N2 Interaction and Its Effect on Collisional Vibrational Energy Exchange

Prompted by a comparison of measured and computed rate coefficients of Vibration-to-Vibration and Vibration-to-Translation energy transfer in O2 + N2 non-reactive collisions, extended semiclassical calculations of the related cross sections were performed to rationalize the role played by attractive and repulsive components of the interaction on two different potential energy surfaces. By exploiting the distributed concurrent scheme of the Grid Empowered Molecular Simulator we extended the computational work to quasiclassical techniques, investigated in this way more in detail the underlying microscopic mechanisms, singled out the interaction components facilitating the energy transfer, improved the formulation of the potential, and performed additional calculations that confirmed the effectiveness of the improvement introduced.

Experimental evaluation of the Dideco Masterflo paediatric hollow-fibre membrane oxygenator

Nine mongrel dogs (mean bodyweight: 29 ± 6kg) were connected to cardiopulmonary bypass byfemorojugularvenous and femoral arterial cannulation, classic roller pump and the integrated Dideco D702 Masterflo hollow-fibre membrane oxygenatorwith a mean flow rate of 70ml/kg/min for six hours. Then the animals were weaned from cardiopulmonary bypass and thereafter weaned from the ventilator. After seven days all animals were sacrificed electively for necropsy. A standard battery of blood samples was taken before the bypass, after mixing (10 minutes), after two hours, five hours and six hours of perfusion. Further samples were taken 30 minutes after bypass (spontaneous breathing), 60 minutes after bypass (after extubation), 24 hours after bypass, 48 hours after bypass and seven days after bypass. Physiologic blood gas values could be maintained throughout perfusion in all animals. Mean arterial oxygen saturation varied between 99.7% and 99.9% for the arterial side of the oxygenator compared to 77.8% and 86.6% on the venous side. Post bypass blood gas analyses showed physiologic values and no evidence of major lung trauma or pulmonary oedema in relation to the six hours' bypass. Red blood count was 5.84 ± 0.02 before and 4.63 + 0.1 million/mm3 after mixing and dropped to 3.89 ± 0.52 till the end of the bypass. After seven days the red blood count was practically normalized with over 5,000,000 erythrocytes per mm3 at the end of the observation. Blood trauma evaluated in function of plasma haemoglobin and (thrombocyte) depletion showed the following results: prebypass: 2.3 ± 0.7 μmol/l plasma haemoglobin and (220 ± 24 thousand thrombocytes per mm3); after six hours perfusion: 26.2 ± 15.5 and (137 ± 12); after seven days: 9.3 ± 4.1 and (400 ± 125). Post mortem studies did not demonstrate any deleterious lesions.

Efficiency of Collisional O2 + N2 Vibrational Energy Exchange

By following the scheme of the Grid Empowered Molecular Simulator (GEMS), a new O2 + N2 intermolecular potential, built on ab initio calculations and experimental (scattering and second virial coefficient) data, has been coupled with an appropriate intramolecular one. On the resulting potential energy surface detailed rate coefficients for collision induced vibrational energy exchanges have been computed using a semiclassical method. A cross comparison of the computed rate coefficients with the outcomes of previous semiclassical calculations and kinetic experiments has provided a foundation for characterizing the main features of the vibrational energy transfer processes of the title system as well as a critical reading of the trajectory outcomes and kinetic data. On the implemented procedures massive trajectory runs for the proper interval of initial conditions have singled out structures of the vibrational distributions useful to formulate scaling relationships for complex molecular simulations.

Case report: Hallucinations as depressive equivalents

We comment the case of a 12 years old girl who started with visual and auditive hallucinations. Hallucinations are not a common symptom between children. They may also be linked to many conditions, some of them with poor outcome as schizophrenia. Symptoms appeared in a short time, after a previous normal development. She talked about a man who followed her and that was always behind, she also had heard some insults of undeterminated voices. These symptoms were just of one-month duration and made her feel anxious and very afraid. After a normal organical study and a first proposal of medication they asked for our consultation. We found that the patient was alone at home every afternoon. Family, from other country, hadn’t any social support, and the father had had to travel away some days before the child began to suffer hallucinations. Suspecting an affective disorder as the basis of anxious symptoms, and hallucinations as a cultural presentation of them, we started with a social intervention mixed with support therapy. After some sessions the patient could talk about her loneliness and fears, disappearing the other symptoms. We will resume this case and literature about other cultural presentations that may difficult diagnosis or treatment.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Related factors with substance use in old adults

Intro

Substance use disorder is a growing phenomenon among the elderly. It is undervalued, misidentified, underdiagnosed and poorly treated.

Aim

Study prevalence, characteristics and risk factors associated with drug use among the elderly.

Method

A 6-month prospective study of substance use in elderly patients (65+) who attended the addiction and dual diagnosis unit, Vall d’Hebron University Hospital.

Results

Fifty-nine patients evaluated, mean age 70.04 years, 60% men. A total of 49.1% are married, 35.8% divorced and 53.8% live with a partner and/or children. A total of 67.3% have basic studies and 78.8% are pensioners. A total of 82.7% have no criminal record.

Medical comorbidity presents in 90.4% of the sample, psychiatric and addictive family background in 42.3% and 37.3%. A total of 67.3% have comorbid Axis I (mainly affective disorders) and 25% Axis II (cluster B most). A total of 7.7% attempted suicide at least once.

The main substance is alcohol (76.9%), followed by prescription drugs (19.3%). A total of 28.8% are multi-drug users. A total of 67.3% have used tobacco in their life and 63.5% are currently dependent. The average age of onset for a disorder for any substance consumption is 28.19, being lower for alcohol and illegal substances and higher for prescription drugs.

A total of 61.5% have gone through treatment before but only 32.7% has been admitted because of addiction. The adherence rate is 90.4% and the relapse rate 8.3% at first month and 13% at 6 months.

Conclusions

Old adults present differences compared to overall drug user population: prevalence by gender is almost equal, lower Axis II, less multi-drug consumption and both dropout and relapse rate are drastically lower.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Multifactorial Ethiopathogenic In Eating Disorders

Eating Disorders is a heterogeneous group of syndromes which includes many factors in their develop. The three main syndromes, AN, BN and EDNOS has been defined in last DSM as independent entities. However is well known that a group of patients may change its presentation along time, so also been at first diagnosed of AN, lately will fulfil criteria for BN or EDNOS.

In the other hand, if we compare two patients with the same syndrome, as BN, or AN…

We may easily find big differences in personality, stressors…and in some cases the only common factor is the clinical presentation.

Behind all of this is the fact that syndromic classification drives to empiric treatments that are far the most validated.

But although there is a well known evolution in this disorders, with a not so bad income as one could think initially (in some cases one third could recover without treatment), what may we do with those patients that are resistant for empiric treatments?

And it is our opinion that a deeper knowledge of all the factors that contribute to the syndrome or its presentation, as well as those related to treatments results, should be taken into account.

We have reviewed all knowledge about these issues and we have completed it with our clinical practise using a 50 patients data base, here we will show our results, that are basically that even the same factors interact in different ways in each patient, so it is not just the ingredients but the recipe.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Brief psychotherapy in eating disorders

First time we began to work with eating disorders, we used to hear the chronic course of the illness and the long-term treatment that our patients would need. When you have a team trained in brief psychotherapy, but not in this specific area, it sounds as just the opposite you try to reach with your patients. National guidelines however are full of psycho-educational and cognitive-conduct treatment's models, without any other validated kind of treatment. However, it was our experience that solution focused or problem focused therapy were also two clinical effective approaches to many psychiatric problems. In fact, we had a mature consult, in which as far as two thirds of patients had become, some way chronic. Problem was, as far as we can imagine, if that was a disease's effect or a lack of a deeper intervention, which were wider than those classic. So, we classified our patients in resistant or not resistant, and doing so we add brief therapy to the first group, reevaluating every week each intervention and the course of the illness. By doing so, we found that chronicity was, in same cases, just the result of limited treatments. Here we have analysed some chronic patients with a bad course and the alternatives that let them to recover.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Highly Electrically Conducting Glass-Graphene Nanoplatelets Hybrid Coatings

Hybrid coatings consisting of a heat resistant Y2O3-Al2O3-SiO2 (YAS) glass containing 2.3 wt % of graphene nanoplatelets (GNPs) were developed by flame spraying homogeneous ceramic powders-GNP granules. Around 40% of the GNPs survived the high spraying temperatures and were distributed along the splat-interfaces, forming a percolated network. These YAS-GNP coatings are potentially interesting in thermal protection systems and electromagnetic interference shields for aerospace applications; therefore silicon carbide (SiC) materials at the forefront of those applications were employed as substrates. Whereas the YAS coatings are nonconductive, the YAS-GNP coatings showed in-plane electrical conductivity (∼10(2) S·m(-1)) for which a low percolation limit (below 3.6 vol %) is inferred. Indentation tests revealed the formation of a highly damaged indentation zone showing multiple shear displacements between adjacent splats probably favored by the graphene sheets location. The indentation radial cracks typically found in brittle glass coatings are not detected in the hybrid coatings that are also more compliant.

Feasibility and safety of biventricular repair in neonates with hypoplastic left heart complex

Hypoplastic left heart syndrome is a spectrum of structural cardiac malformations characterized by variable underdevelopment of the left heart-aorta complex. A minority of patients having a milder degree of left ventricular hypoplasia, described as hypoplastic left heart complex (HLHC), may be selected for biventricular repair. The objective of this study was to assess the outcome of the biventricular approach in HLHC. We evaluated retrospectively 30 neonates diagnosed with HLHC from the "12 de Octubre" University Hospital, following established criteria. We analyzed the echocardiographic data recorded just after birth and at last follow-up after surgery. All patients were operated on in the neonatal period using various surgical techniques. There were no early deaths and only 1 late death after a mean follow-up of 62.9 ± 43.8 months. All patients presented a significant growth of the left ventricular structures, with a Z-score increase of 1.17 ± 1.05 for mitral annulus, 1.72 ± 1.23 for aortic annulus, and 1.33 ± 1.46 for left ventricular end-diastolic diameter. Postoperatively, 18 patients showed a left valvular stenosis, and 17 patients underwent a reoperation and/or an interventional procedure. Freedom from surgery or interventional catheterizations at 1, 3 and 5 years was 53, 49 and 43%, respectively. The 29 current survivors are all in a good functional status. In our experience, we achieved good results from biventricular repair in patients with HLHC, with a significant growth of left heart structures and an excellent clinical status at a medium-term follow-up. Nevertheless, there was a high rate of reoperations and/or interventional catheterizations.