Quantum Droplets of Dipolar Mixtures

Recently achieved two-component dipolar Bose-Einstein condensates open exciting possibilities for the study of mixtures of ultradilute quantum liquids. While nondipolar self-bound (without external confinement) mixtures are necessarily miscible with an approximately fixed ratio between the two densities, the density ratio for the dipolar case is free. Therefore, self-bound dipolar mixtures present qualitatively novel and much richer physics, characterized by three possible ground-state phases: miscible, symmetric immiscible, and asymmetric immiscible, which may in principle occur at any population imbalance. Self-bound immiscible droplets are possible due to mutual nonlocal intercomponent attraction, which results in the formation of a droplet molecule. Moreover, our analysis of the impurity regime shows that quantum fluctuations in the majority component crucially modify the miscibility of impurities. Our work opens intriguing perspectives for the exploration of spinor physics in ultradilute liquids, which should resemble to some extent that of ^{4}He-^{3}He droplets and impurity-doped helium droplets.

PSVII-5 Effect of maternal feed restriction at different stages of gestation on development of gastrointestinal tract of newborn goats

We assessed the effect of maternal feed restriction at different stages of gestation on growth and development of organs and small intestine of newborn goats. A total of 14 pregnant dams were randomly divided into one of the follow dietary treatments: Animals fed at 50% of maintenance requirement from 8-84 d of gestation and then fed at 100% maintenance requirement from day 85 of gestation to parturition (R-M, n = 6), and animals fed at 100% of maintenance requirement from 8-84 d of gestation and then fed at 50% maintenance requirement from day 85 of gestation to parturition (M-R, n = 8). At birth, newborns were slaughtered for collection of corporal components. No differences were observed among treatments for birth weight (P = 0.46). The weight of the complex reticulum-rumen-omasum tended to be heavier (P = 0.057) in the M-R group, when expressed per kg of body weight. The small intestine (P = 0.038) and total intestine (P = 0.038) were heavier in the offspring of the M-R group when expressed in kg of body weight. The M-R newborns had greater length of the small intestine (P = 0.043) and total intestine (P = 0.026). Maternal feed restriction did not influence the intestinal villi height (P = 0.406). However, newborn from R-M group had lower villus height:crypt depth ratio (P = 0.016), due to the tendency of the greater of crypt depth in these animals (P = 0.081). No differences among treatments were observed in mRNA expression of the MGAM and GLP-2R in the jejunum of the offspring (P > 0.12). Newborns of the M-R group tended to present greater mRNA abundance of the SLC5A1 (P = 0.091), SLC2A2 (P = 0.091), and OCLN (P = 0.061). In summary, restriction in the first half of gestation may be more detrimental to the performance and health of offspring throughout life due to increased impairment of intestinal development.

Intraventricular conduction defects in patients with st-segment elevation myocardial infarction – the paradox of right bundle branch block

 

Intraventricular conduction defects (IVCD) in patients with acute myocardial infarct (AMI) are predictors of a worse prognosis. When acquired they can be the result of an extensive myocardial damage.

Purpose

To assess the impact of IVCD, regardless of being previously known or presumed new, on in-hospital outcomes of patients with AMI with ST segment elevation (STEMI) or undetermined location.

Methods

From a series of patients included in the National Registry of Acute Coronary Syndrome between 10/1/2010 and 9/1/2019, were selected patients with STEMI or undetermined AMI, undergoing coronary angiography.

Results

7805 patients were included: 461 (5.9%) presenting left bundle branch block (LBBB), 374 (4.8%) with right bundle branch block (RBBB) and 6970 (89.3%) with no IVCD. Clinical characteristics as well as in-hospital outcomes are described in the table 1. An unexpected worse prognosis in patients with RBBB has motivated a multivariate analysis. RBBB remained an independent predictor of in-hospital mortality (OR 1.91, 95% CI 1.04–3.50, p=0.038), along with female gender (OR 1.73, 95% CI 1.11–2.68, p=0.015), Killip Class>1 (OR 2.26, 95% CI 1.45–3.53, p<0.001), left ventricular ejection fraction <50% (OR 3.93, 95% CI 2.19–7.05, p<0.001) and left anterior descending artery as the culprit lesion (OR 1.85, 95% CI 1.16–2.91, p=0.009).

Conclusion

In spite of an apparent better clinical profile, in the current large series of unselected STEMI patients, the presence of RBBB is associated with the worst in-hospital outcome. RBBB doubles the risk of death, being an independent predictor of in-hospital mortality.

Funding Acknowledgement

Type of funding source: None

Nurses' production of meaning about National Program for Access and Quality Improvement Primary Care

Introduction

The Brazil's Family Health Strategy (ESF) is one of the initiatives for the strengthening of primary health care (PHC) in Brazil. The ESF is composed of a team of professionals, with the nurse usually adding care and administrative functions. In regard to the National Program for Improving Access and Quality in Primary Care (PMAQ-AB), the nurses have played a prominent role, especially in the external evaluation phase.

Aim

Analyze the meanings produced by nurses about the PMAQ-AB in a state in the northeastern of Brazil.

Methods

A qualitative research was carried out with twenty-five nurses from the health macro-regions of the State of Piauí. Data were collected from four focus groups, with one group in each macro-region, containing at least six and at most seven participants. The meetings were held from September to October 2018, in which semi-structured interview script was used. For the analysis of information, the maps of association of ideas proposed by Spink and Gimenes (1994) were used.

Conclusions

Despite the difficulties and conflicts felt by nurses with the implementation of PMAQ-AB, the program was understood as an agent for transforming in the work process of family health teams. In addition, the realization of this study allowed another space for reflection to the nurses about the program, qualification and financing of PHC, which can contribute to the institutionalization of the culture of monitoring and evaluation and also the consequent strengthening of these services.

Key messages

Based on the expected impacts, we seek collaborate with reflection on the experience and generate consistent and useful information to contribute to the decision-making processes of health policies. The PMAQ-AB was considered a program that was able to induce substantial changes in work processes because it was a way to finance the workforce.

[Estimating the number of COVID-19 cases using a web-based tool: Results from the first week of the 'Covid-19 Trends' project in the Basque Country]

OBJECTIVE

In the Basque Country, two cases of COVID-19 were diagnosed on February 28 2020. On March 14, the Spanish Government established a state of alarm. Only cases confirmed by molecular biology (reverse-transcriptase polymerase chain reaction [RT-PCR]) were known. We launched a web-based surveillance tool to estimate the number of symptomatic cases of COVID-19 to contribute to Public Health decision-making.

MATERIAL AND METHODS

We implemented an anonymous web questionnaire and disseminated it through online social media social. We collected epidemiological information about «time» (date of onset of symptoms), «place» (zip code), and «person» (gender, age). We compared cases detected by RT-PCR with the estimated cases, according to the case definition of the Ministry of Health. We calculated the questionnaire response rate and the cumulative incidence at 14days.

RESULTS

Between March 19 and 26, 128,009 people answered the questionnaire (5.5% of the Basque population). Of these, 26,375 met the case definition (symptom prevalence of 21.4%). The estimated cases were almost six times more than COVID-19 positive RT-PCR. The estimated 14-day cumulative incidence was 578.3 per 100,000 population compared to RT-PCR positive cases, which was 139.6 per 100,000 population.

CONCLUSIONS

This tool was useful in estimating the minimum number of symptomatic cases in the Basque Country, which could support Public Health actions.

OP0269-HPR ASSOCIATION OF SARC-F PERFORMANCE WITH COMORBIDITIES, PHYSICAL DISABILITY AND LOWER ALBUMIN LEVELS IN SYSTEMIC SCLEROSIS PATIENTS

Background:

Systemic sclerosis (SSc) is a multisystem autoimmune disease of complex etiopathogeny, heterogeneous in its phenotypic expression and with a limited prognosis (1). The loss of muscle mass is a serious consequence of many chronic diseases and also is observed in SSc (2). This body composition alterations results in weakness, limitations and physical disability (3). SARC-F simple questionnaire, validated, is a key diagnostic feature for the fast assessment of geriatric syndromes associated with skeletal muscle wasting. However, there is no data about the SARC-F in SSc.

Objectives:

To assess the association between the SARC-F questionnaire with clinical features in patients with systemic sclerosis (SSc).

Methods:

Ninety-four patients diagnosed with systemic sclerosis were recruited and evaluated. Sarcopenia was assessed by the SARC-F questionnaire. Clinical features as disease duration time, comorbidities, body mass index (BMI), functional capacity by the Health Assessment Questionnaire (HAQ), inflammatory markers (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), creatine phosphokinase (CPK), hemoglobin, creatinin and albumin) were medical record. Frequency analysis, descriptive analysis and Pearson’s correlation were performed. Statistical significance was considered as p<0,05.

Results:

Of the 94 patients analyzed, most were women (87/94;92.6%) with mean age of 60.5±10.3 years, median disease duration time of 11.2 (7.5-18.9) and median number of comorbidities was 1.00 (1.00-2.00). The mean of BMI was 25.9±4.7 Kg/m2. Twenty-one of the patients were classified as active or passive smokers, thirty-five said they were former smokers and thirty-eight never smoked. Sixty-nine (80, 2%) out of the ninety-four patients in the study had at least one type of comorbidity (mean 1, 44±1, 04). Eighty-three patients (88.3%) showed a SARC-F score without signs suggestive of sarcopenia (0-5) and eleven patients (11.7%) showed suggestive to sarcopenia (6-10). In HAQ, fifty-seven (60.6%) patients had mild incapacity, thirty-five (37.2%) had moderate incapacity, and two patients (2.2%) had severe incapacity. Higher SARC-F scores were associated with greater number of comorbidities (r=0.2; p=0.027), higher physical disability by HAQ (r= 0.5;p=0.000) and lower albumin levels (r= -0.3; p= 0.048). On other hand, SARC-F was not associated with time of diagnosis, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), creatine Phosphokinase (CPK), hemoglobin, hematocrit and creatinine.

Conclusion:

SARC-F scores were associated with comorbidities, physical disability and lower albumin levels in systemic sclerosis patients. Considering that comorbidities, physical disability and the albumin deficit enhances the patient’s muscle loss, SARC-F appears to be a good tool to screen sarcopenia risk factors in systemic sclerosis patients. Longitudinal studies are necessary to validate the SARC-F questionnaire in this population.

References:

[1]Hochberg MC et al. Sixth edit. (Elsevier, ed.). Philadelphia; 2015;

[2]Sakuma K et al. Pflügers Arch - Eur J Physiol. 2017;469(5-6):573-591.

[3]Caimmi C, et al. Clin Rheumatol. 2018;37(4):987-997.

Acknowledgments:

We thank the Coordination for the Improvement of Higher Level Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—CAPES) institution, the Foundation for Research Support of the Rio Grande do Sul State (Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul—FAPERGS), the Research and Events Incentive Fund (Fundo de Incentivo à Pesquisa e Eventos—FIPE) of HCPA and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico—CNPq).

Disclosure of Interests:

Leonardo Santos: None declared, Rafaela Cavalheiro do Espírito Santo: None declared, Vanessa Hax: None declared, Rafael Mendonça da Silva Chakr: None declared, Ricardo Xavier Consultant of: AbbVie, Pfizer, Novartis, Janssen, Eli Lilly, Roche

THU0610-HPR PREDICTION EQUATION FOR MUSCLE MASS OVERESTIMATES MUSCLE MASS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Rheumatoid Arthritis (RA) is a chronic, progressive, inflammatory autoimmune disease characterized by systemic manifestations. Often is observed in RA patients changes in body composition, such as reduced muscle mass (sarcopenia) with stable or increased fat mass (FM) [1]. Total-body skeletal muscle mass (SMM), specifically appendicular skeletal muscle, is a key diagnostic feature for the assessment of geriatric syndromes associated with skeletal muscle wasting, such as sarcopenia [2]. Estimation of SMM can be accomplished by a variety of methods, but the majority that considered the gold standard for this purpose are high cost. Due high cost, this methods are unfeasible in population studies and increases the difficulty of use in different clinical contexts. Predictive equations have been developed for estimation of whole-body skeletal muscle mass on the basis of anthropometric data, which can be collected in a more affordable manner, in an attempt to make SMM calculation easier and enable its use in epidemiological research and in clinical settings [3]. However, these equations were not developed for RA populations.

Objectives:

To compare the anthropometric equation that estimate SMM with body composition measurements derived from DXA in RA patients.

Methods:

Ninety patients diagnosed with RA according to ACR/EULAR criteria were recruited. Body composition was assessed by total body dual-energy x-ray absorptiometry (DXA) for measurement of appendicular lean mass index (ALMI, kg/m2). The prediction equation for muscle mass proposed by Lee et al (variables included: body weight, height, age, sex and race) was used to generate estimates of SMM, stratified by BMI. Frequency analysis, independent student’s t test and intraclass correlation coefficients (ICC) were performed. Statistical significance was considered as p<0.05

Results:

Of the 90 patients analyzed, most were women (86.7%; 78/91), with mean age of 56.5±7.3 and median disease duration time of 8.5 (3-18) years. The mean of BMI was 27.39±5.14. Thirty (33.3%) RA patients had normal weight, forty patients (44.4%) were overweight and twenty patients (22.2%) were obese. In normal weight patients, just like overweight and obese patients, the estimates of SMM obtained by Lee equation were higher than those obtained by DXA measurements(Obese: Lee 10.66±1.19 vs DXA 7.10±0.73; Overweight: Lee 8.63±0.99 vs DXA 6.57±0.82; Normal weight: Lee 7.14±0.85vs DXA 6.03±0.71; p<0.05). The Lee equation estimates showed ICC of 0.78 (0.66 - 0.85) with DXA measurements. When stratified by BMI, Lee equation showed ICC of 0.87 (0.72 - 0.94) for normal weight, 0.83 (0.68 - 0.91) for overweight and 0.77 (0.42 - 0.90) for obese with DXA.

Conclusion:

The muscle mass index by Lee equation overestimates the muscle mass in overweight or obese RA patients compared to DXA. Thus, sarcopenic RA patients may be wrongly classified as normal by the equation. This is probably related to the obese cachexia that these patients often present. More studies are necessary to analysis to better prediction equations for muscle mass in RA patients.

References:

[1]Smolen JS et al. Nat Rev Dis Prim. 2018;4:18001; [2] Kim J et al. Am J Clin Nutr 2002; 76: 378–83.; [3] Lee RC et al. Am J Clin Nutr 2000;72:796-803.

Acknowledgments:

We thank the Coordination for the Improvement of Higher Level Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—CAPES) institution, the Foundation for Research Support of the Rio Grande do Sul State (Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul—FAPERGS), the Research and Events Incentive Fund (Fundo de Incentivo à Pesquisa e Eventos—FIPE) of HCPA and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico—CNPq).

Disclosure of Interests:

Rafaela Cavalheiro do Espírito Santo: None declared, Leonardo Santos: None declared, Lidiane Filippin: None declared, Priscila Lora: None declared, Ricardo Xavier Consultant of: AbbVie, Pfizer, Novartis, Janssen, Eli Lilly, Roche

THU0346 SARC-F PERFORMANCE FOR SARCOPENIA SCREENING IN PATIENTS WITH SYSTEMIC SCLEROSIS

Background:

Because the method of diagnosing sarcopenia is complex and is considered to be difficult to introduce into routine practice, the European Working Group on Sarcopenia in Older People’s (EWGSOP) recommends use of the SARC-F questionnaire as a way to introduce assessment and treatment of sarcopenia into clinical practice1. Only recently, some studies have focused their attention on the presence of sarcopenia in systemic sclerosis (SSc) and there is no data about the performance of SARC-F in this population.

Objectives:

To test the diagnostic properties of the SARC-F questionnaire for sarcopenia screening in SSc patients.

Methods:

Cross-sectional study, including 94 SSc patients assessed by clinical evaluation, laboratory and pulmonary function tests. Sarcopenia was evaluated using the EWGSOP diagnostic criteria updated in 2019 (EWGSOP2): dual-energy X-ray absorptiometry, handgrip strength, and short physical performance battery (SPPB)1. Participants also completed the SARC-F questionnaire. The questionnaires’ performances were evaluated through receiver operating characteristic (ROC) curves and standard measures of diagnostic accuracy were computed using the EWGSOP2 criteria as the gold standard for diagnosis of sarcopenia.

Results:

Sarcopenia was identified in 15 (15,9%) SSc patients by the EWGSOP2 criteria. Area under the ROC curve of SARC-F screening for sarcopenia was 0.588 (95% confidence interval (CI) 0.482, 0.688) (figure 1). The results of sensitivity, specificity, positive likelihood ratio (PLR) and negative likelihood ratio (NLR) with the EWGSOP2 criteria as the reference standard were 35.71 [95% CI, 12.76-64.86], 81.01 (95% CI, 70.62-88.97), 1.88 (95% CI, 0.81-4.35) and 0.79 (95% CI, 0.53-1.19), respectively. The optimal cut-off point of SARC-F in our sample was ≥ 4 (Youden index: 0.21), the same cut-off point recommended in the literature2,3. Only 6 (40%) out of the 15 participants with sarcopenia were identified by the SARC-F questionnaire in our population. However, the SARC-F properly identified 4 out of 5 patients who had severe sarcopenia.

Conclusion:

This is the first study to evaluate the performance of SARC-F questionnaire for sarcopenia screening in patients with SSc. Although it appropriately identifies severe cases of sarcopenia, the SARC-F alone may not be an adequate screening tool in high-risk populations, such as SSc, that may benefit from early intervention and treatment.

References:

[1]Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: Revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31.

[2]Malmstrom TK, Morley JE. SARC-F: A simple questionnaire to rapidly diagnose sarcopenia. J Am Med Dir Assoc. 2013;14(8):531-532.

[3]Ida S, Kaneko R, Murata K. SARC-F for Screening of Sarcopenia Among Older Adults: A Meta-analysis of Screening Test Accuracy. J Am Med Dir Assoc. 2018;19(8):685-689.

Disclosure of Interests:

Vanessa Hax: None declared, Rafaela Santo: None declared, Leonardo Santos: None declared, Mirian Farinon: None declared, Marianne de Oliveira: None declared, Guilherme Levi Três: None declared, Andrese Aline Gasparin: None declared, M Bredemeier: None declared, Ricardo Xavier Consultant of: AbbVie, Pfizer, Novartis, Janssen, Eli Lilly, Roche, Rafael Mendonça da Silva Chakr: None declared

Preliminary Data from Famidem Survey: Can we assume who is at Risk Regarding Informal Caregiving in Dementia?

Background and aims:

In meridional European countries such as Portugal, informal caregivers are almost always close relatives, either key-relatives (those more involved) or not. There are few systematic comparisons between the experience of key-relatives/primary caregivers (PC) and other/secondary caregivers (SC) in psychogeriatrics. We present some preliminary data from the FAMIDEM (Families of People with Dementia) survey.

Methods:

Non-randomised cross-sectional study comparing two related samples of caregivers (PC versus SC) of 41 patients with DSM-IV dementia from outpatient practices in Lisbon (Portugal). Caregivers’ assessments included: Zarit Burden Interview, Caregiver Activity Survey (CAS), Positive Aspects of Caregiving, GHQ-12, Social Network Questionnaire and Dementia Knowledge Questionnaire.

Results:

Patients’ mean age was 78,7 years (SD 7,9). 24 (58,5%) were women and 58,5% had Alzheimer disease.PC were older than SC (p=0,000) and tended to live with the patient (p=0,000). They reported less emocional support (p=0,021) but higher objective burden-CAS (p=0,002). Regarding all other outcome variables, significant differences between groups were not found. Within the global sample, comparing spousals (n=23) and adult children/other relatives (n=59) yielded interestingly different preliminary results, eg higher GHQ-12 levels (p=0,010).

Conclusions:

The experience of caregiving is possibly different regarding PC and SC, but further research is warranted in order to define who really is at risk. Being a spouse may be much more determinant, although most spouses are PC as well. for the moment, it seems prudent not to exclude SC from risk assessments. the final FAMIDEM results, even lacking generalizability, will probably provide interesting clues.

Disorderless Quasi-localization of Polar Gases in One-Dimensional Lattices

One-dimensional polar gases in deep optical lattices present a severely constrained dynamics due to the interplay between dipolar interactions, energy conservation, and finite bandwidth. The appearance of dynamically bound nearest-neighbor dimers enhances the role of the 1/r^{3} dipolar tail, resulting in the absence of external disorder, in quasi-localization via dimer clustering for very low densities and moderate dipole strengths. Furthermore, even weak dipoles allow for the formation of self-bound superfluid lattice droplets with a finite doping of mobile, but confined, holons. Our results, which can be extrapolated to other power-law interactions, are directly relevant for current and future lattice experiments with magnetic atoms and polar molecules.

P631 A misleading EKG and the saviour echo

Introduction

Floating right heart thrombi (in transit from the legs to the pulmonary arteries) are a severe form of venous thromboembolism, with a high early mortality rate without treatment. Evidence-based recommendations do not adequately address the treatment of right heart thrombi in patients who present with acute symptomatic pulmonary embolism.

Case Report

Woman, 76 years old. Previous medical history of hypertension, dyslipidaemia, mitral valve repair and hypothyroidism. Recent admission in our cardiology department with de diagnosis of NSTEMI. She performed an echocardiogram that revealed only an enlarged left atrium, with no other changes. EKG only revealed inversion of T waves in V2-V4 with posterior normalization during hospital stay. She underwent to coronary angiography and right dominance without any coronary lesions was showed. The presence of a fistula, with a badly defined route, was also pointed in the coronary angio.

One month after this episode she was admitted again in our emergency department due to onset of dyspnoea and productive cough. The physical examination showed SatO2: 90%; BP: 95/53 mmHg; HR: 100 bpm; Respiratory rate: 27 cpm; Apyretic (36,9ºC). Normal pulmonary and cardiac auscultation, without any other pathological findings on physical examination. EKG revealed a sinus tachycardia, HR 122 bpm, with ST elevation in aVR and ST depression in DI, DII, aVL and V2-V6. Presence of S wave in DI and Q wave in DIII. While the EKG was being performed the patient presented a sudden cardiovascular deterioration (with blood pressure (BP: 67/35mmHg) drop and appearance of chest pain). We performed an arterial-blood gas test that revealed: pH7,16; pCO2 26,5; pO78,7; Potassium 4; Sodium 138; lactates 8,8. With these findings we decided to perform an echocardiogram to identify a possible cause for the shock. The echo showed right dilated chambers (with D-shape in parasternal short axis) with dilated IVC. We also point out the presence of a mobile intra-cardiac mass at the level of right atrium, suggestive of thrombus.

We assumed the presence of obstructive shock in the context of pulmonary embolism. Thrombolysis was performed with clinical improvement of the patient. Medical therapy was optimized and heparin was initiated after the patient finished alteplase perfusion.

During hospital stay the patients didn’t have any other cardiovascular complication and went home after 7 days in hospital. A venous doppler was performed before hospital discharge and it revealed the presence of a deep venous thrombosis at the level of right femoral vein.

Conclusion

The authors presented a didactic clinical case where the EKG mislead us to a possible Acute Coronary Syndrome involving the left main artery. Although there is no clear consensus for the management of right heart thrombus associated with pulmonary embolism, thrombolysis is readily available and can be effective in carefully selected patients.

P629 An uncommon cause for a frequent problem

Case Report

Man, 52 years old. Active smoker and with previous peptic ulcer history. Admitted to our emergency department due to sudden onset of confusion and incoherent speech. The physical examination showed only a Glasgow Coma Scale of 9 and the presence of expressive aphasia. Normal pulmonary and cardiac auscultation, without any other pathological findings on physical examination.

Investigations showed a normal EKG, chest X-Ray and arterial-blood gas test. Blood test showed only the presence of thrombocytopenia, leucocytosis and renal disfunction. Brain CT revealed left-sided thalamic lacunar lesion. We assumed an ischemic stroke and admitted the patient in our emergency department. Neurological deterioration in the first 24h. A new brain CT was performed and showed multiple lesions in the middle cerebral artery territory. The echocardiogram was performed and showed the presence of multiples vegetations in both mitral leaflets with moderate to severe mitral regurgitation associated. We assume an ischemic stroke in the context of possible infective endocarditis. Medical therapy was optimized and empirical antimicrobial therapy was started (ampicillin + gentamicin + flucoxacillin).

The patient never had fever during hospital stay. Duke criteria with only 1 major criteria. Persistent negative microbiological cultures with decreasing inflammatory parameters. Blood tests revealed a progressive increase level of INR (2-4) and renal function deterioration. Patient began with massive episodes of diarrhea and sudden decrease of haemoglobin level (sudden reduction of 3g/dl). Endoscopic studies were performed and multiple ischemic lesions of embolic etiology and small vessel disease had been described. Serology test revealed a positive IgG for Mycoplasma pneumoniae. Autoimmune lab tests showed positivity for lupus anticoagulant, anticardiolipin and anti–beta-2 glycoprotein I.

We discussed the clinical case with our autoimmune experts team and the diagnosis of Systemic Lupus Erythematosus + Antiphospholipid Syndrome + Libman-Sacks Endocarditis was assumed. The patient started immunosuppressive therapy (Azathioprine + Mycophenolate Mofetil + Prednisolone).

Despite the used therapy the size of vegetation persisted and mitral regurgitation didn’t improve.

In this context, the patient was presented to our cardiac surgery team and underwent surgical intervention (vegetation removal + mitral valve repair). Evaluation one year after surgery revealed progressive functional and echocardiographic improvement.

Conclusion

The authors presented a didactic clinical case where valvular surgery was required thanks to a hemodynamically significant valvular dysfunction and embolic events.

OTIMIZAÇÃO E VALIDAÇÃO DE MÉTODO ENZIMÁTICO SEMIQUANTITATIVO SIMPLES E DE BAIXO CUSTO PARA A BUSCA DE INIBIDORES DE CISTEINO PROTEASES

OPTIMIZATION AND VALIDATION OF A SIMPLE AND LOW-COST SEMI-QUANTITATIVE ENZYMATIC METHOD TO SEARCH FOR CISTEINE PROTEASES INHIBITORS. Cysteine proteases are an important class of enzymes involved in several essential biological processes. For this reason, these enzymes are important therapeutic targets, and therefore can be used in enzymatic assays for the search of hits. The most widely used methods in the search of enzyme inhibitors are spectrophotometric, however they have relatively high operational costs. For this reason, simpler, and cheaper methods can be useful in the search for enzyme inhibitors. In this work, a simple and low-cost semi-quantitative method was optimized and validated using papain and skimmed powdered milk (casein) as a substrate. The ideal condition for the method was the one that used powdered milk, 0.250%, papain solution, 9.4 mg mL-1 and incubation time, 18 h. The method validation was performed using the inhibitor E64 and herb extracts, in different concentrations. After carrying out the experiments and statistical analyses, a high reproducibility can be observed, with relative standard deviations below 2.1%. Plant extracts were used to test the method and the results indicated that these extracts are promising for the search of cysteine protease inhibitors. The method developed here has simplicity and reproducibility and has great application, as preliminary study, in the search for inhibitors of cysteine proteases.

Heralded Generation of Macroscopic Superposition States in a Spinor Bose-Einstein Condensate

Macroscopic superposition states enable fundamental tests of quantum mechanics and hold a huge potential in metrology, sensing, and other quantum technologies. We propose to generate macroscopic superposition states of a large number of atoms in the ground state of a spin-1 Bose-Einstein condensate. Measuring the number of particles in one mode prepares with large probability highly entangled macroscopic superposition states in the two remaining modes. The macroscopic superposition states are heralded by the measurement outcome. Our protocol is robust under realistic conditions in current experiments, including finite adiabaticity, particle loss, and measurement uncertainty.

P3808iBox-CRT: Better response, less complicated, equally fast

Introduction

The optimization of the left ventricle (LV) pacing site guided by the electrical delay increases CRT response rate (RR), however it's necessary to develop technology that allows its universal use.

Purpose

The aim is automatically, and operator-independent, access the conduction delay between the right ventricular (RV) stimulus and the LV available veins in order to select the LV pacing site. It is further intended to compare the total procedure and radiation times in relation to an historical control group.

Methods

Prospective, single-center study that included patients undergoing CRT implant according to the current ESC Guidelines. All patients were submitted to a clinical, electrocardiographic and echocardiographic basal evaluation prior to CRT implantation and at 6 months of follow-up.

To evaluate conduction delays between the RV lead and the LV available veins (RV-LV delay), an external interface - intelligent Box for CRT (iBox-CRT) was used. Four measurements in at least two different tributary veins were made. The implant of all the LV leads was guided by the longest measured delay.

A positive response to CRT was defined as an improvement of >10% in left ventricle ejection fraction (LVEF) or a reduction of end-systolic volume (ESV)>15%. The results were compared to a control group (CG) of pts submitted to CRT implantation in the conventional way.

Results

60 patients were included (68.3% males, 38% ischemic, mean age 67.4±10.2 years) and submitted to CRT implant (37 CRT-P; 23 CRT-D). At basal evaluation, LVEF was 28±7%, end-diastolic volume (EDV) was 200±73ml and ESV 145±64ml. CG (n=51) had similar characteristics.

The RR was 85.7%, significantly higher compared to the CG (55.9%, p=0.003). The ESV reduced 38.2±3% in responders vs 5.7±2% in non-responders (NR) (p=0,005), EDV reduced 33.3±16% in responders vs 13.6±10% in NR (p=0.002), the mean LVEF improved 11% in responders vs −1% in NR (p=0.02).

At follow-up, the mean ESV in the study group (SG) was 89±44 ml vs 132±75ml in the CG (p=0.002) and the EDV 136±51 vs 190±78 (p=0.007).

In addition to a much better response rate, the responders in the study group had significantly higher mean LVEF at follow-up (39±11% vs 37±7%, p=0.032).

The mean intra-procedure RV-LV delay was 187±34mseg. In the responder group the baseline delay was usually higher (190±35 msec) vs NR group RV-LV delay (165±23 msec; p=NS).

Compared with CG, the automatic assessment of RV-LV delay with iBox-CRT did not increase fluoroscopy time (15±16min vs 18±16; p=NS) and shortened procedure time (65±34 vs 108±83min, p<0.005).

Conclusions

The iBox-CRT use enabled an automatic and operator independent RV-LV delays measurement, in order to implant the LV lead at the most delayed site. This technique translated into a major increase in CTR response rate, not compromising the procedure duration nor increasing the radiation exposure.

Candidemia in a Portuguese tertiary care hospital: Analysis of a 2-year period

BACKGROUND

Candidemia is a nosocomial infection of increasing importance, associated with high morbidity and mortality. The aim of this study is to describe the species distribution, risk factors, management and outcomes of patients with candidemia.

METHODS

We conducted a retrospective study at Centro Hospitalar Universitário de São João, Portugal, between January 2016 and December 2017.

RESULTS

A total of 117 candidemia episodes (n=114 patients) were included. Median age was 65 years, with an increased prevalence of older ages. Candida albicans (51.3%) was the most prevalent species, followed by C. glabrata (22.2%), C. parapsilosis (15.4%), C. tropicalis (4.3%) and C. lusitaniae (2.6%). Forty-two patients (35.9%) did not receive antifungal drugs after diagnosis of candidemia. Echinocandins were used as first-line drug therapy in half of the treated patients (50.7%). The median EQUAL Candida Score was 6/17 (IQR 6-9) for patients without central venous catheter (CVC) and 11/20 (IQR 6-14) for patients with CVC. The 30 days-mortality was 31,6% and was not significantly associated with the timing of antifungal therapy and the EQUAL Candida Score.

CONCLUSION

The distribution of Candida species has changed in recent years, with an increase in the proportion of C. albicans and C. glabrata. Rapid diagnostic tests, empiric antifungal therapy and source control are essential to improve the prognosis of patients with candidemia. More multicentric prospective studies are needed to evaluate the association of mortality with the timing of antifungal therapy or the EQUAL Candida Score.

A Rare Manifestation of Tuberculosis in a Renal Transplant Patient: A Case Report

Cutaneous lesions in the presence of fever in patients undergoing immunosuppressive therapy are a diagnostic challenge and may represent manifestations of multiple diseases, such as fungal infections, nocardiosis, lymphoproliferative diseases, zoonosis, and tuberculosis. The authors report a case of a 66-year-old white man with chronic kidney disease since 2014 (chronic pyelonephritis) who had a renal transplant in the previous 6 months. Induction therapy was performed with thymoglobulin, and his current immunosuppression scheme included tacrolimus, mycophenolate mofetil, and prednisolone. The patient had no history of pulmonary tuberculosis. The patient presented with 2 cutaneous lesions, localized on the back and abdomen, that appeared to be firm, painful, subcutaneous, erythematous nodules with an approximately 5 cm diameter overlying an infected focus and purulent material inside. The patient also had a fever and fatigue. Blood analysis showed pancytopenia with an elevation of inflammatory markers and graft dysfunction. Tissue cultures and skin biopsy with histological analysis were performed. Histopathology of the lesion showed a nonspecific inflammatory infiltrate without granulomas, and acid-fast bacillus staining was negative. Nevertheless, serum QuantiFERON testing was positive. But polymerase chain reaction finally confirmed the presence of Mycobacterium tuberculosis, which confirmed the diagnosis of cutaneous tuberculosis. A chest computed tomography scan showed a lung pattern of miliary tuberculosis. The patient was treated with multidrug tuberculosis therapy, resulting in lesion clearance after 3 weeks. Tuberculosis is a serious infection, especially in high-risk patients, such as those in an immunocompromised state. The incidence of cutaneous tuberculosis is rare, but it should be considered in patients presenting with atypical skin lesions suggestive of an underlying infectious etiology.

One-Dimensional Quasicrystals with Power-Law Hopping

One-dimensional quasiperiodic systems with power-law hopping, 1/r^{a}, differ from both the standard Aubry-André (AA) model and from power-law systems with uncorrelated disorder. Whereas in the AA model all single-particle states undergo a transition from ergodic to localized at a critical quasidisorder strength, short-range power-law hops with a>1 can result in mobility edges. We find that there is no localization for long-range hops with a≤1, in contrast to the case of uncorrelated disorder. Systems with long-range hops rather present ergodic-to-multifractal edges and a phase transition from ergodic to multifractal (extended but nonergodic) states. Both mobility and ergodic-to-multifractal edges may be clearly revealed in experiments on expansion dynamics.

Pretransplant Biopsy of Marginal Kidneys: Is It Necessary?

INTRODUCTION

Pretransplant kidney biopsy from marginal donors is used to guide the decision of whether to accept or discard organs for transplantation; however, there is controversy about this procedure, and the need for a pretransplant biopsy is still a debate. We sought to determine if histologic evaluation before implantation of marginal kidneys would influence the outcome.

METHODS

A retrospective observational cohort study of marginal donor transplants at Centro Hospitalar e Universitário de Coimbra was done. From 2009 to 2016, 650 marginal kidney transplants were analyzed. We evaluated long-term graft survival in a cohort of patients who received marginal kidneys. The recipients were divided into 2 groups based on whether a pretransplant donor biopsy was performed. Continuous variables were summarized by mean and standard deviation or median and range, as applicable. Categorical variables were summarized by relative and absolute frequencies. The survival analysis was obtained and plotted using the Kaplan-Meier method and compared with the log-rank test.

RESULTS

The median age of recipients and donors were statistically different between both groups (P < .001), with the donors and the recipients being younger in the group without a pretransplant biopsy. The median cold ischemia time was higher in the biopsy group (P = .01). The survival analysis showed that graft survival didn't differ between the groups (P = .2).

CONCLUSIONS

Selection of kidneys based on histological findings may not influence the graft survival and implies a higher cold ischemia time. More data are necessary to provide insight into which clinical, histologic, and biochemical parameters are necessary for decision making on kidney acceptance.

Observation of a Dipolar Quantum Gas with Metastable Supersolid Properties

The competition of dipole-dipole and contact interactions leads to exciting new physics in dipolar gases, well illustrated by the recent observation of quantum droplets and rotons in dipolar condensates. We show that the combination of the roton instability and quantum stabilization leads under proper conditions to a novel regime that presents supersolid properties due to the coexistence of stripe modulation and phase coherence. In a combined experimental and theoretical analysis, we determine the parameter regime for the formation of coherent stripes, whose lifetime of a few tens of milliseconds is limited by the eventual destruction of the stripe pattern due to three-body losses. Our results open intriguing prospects for the development of long-lived dipolar supersolids.

The Reference Site Collaborative Network of the European Innovation Partnership on Active and Healthy Ageing

Seventy four Reference Sites of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) have been recognised by the European Commission in 2016 for their commitment to excellence in investing and scaling up innovative solutions for active and healthy ageing. The Reference Site Collaborative Network (RSCN) brings together the EIP on AHA Reference Sites awarded by the European Commission, and Candidate Reference Sites into a single forum. The overarching goals are to promote cooperation, share and transfer good practice and solutions in the development and scaling up of health and care strategies, policies and service delivery models, while at the same time supporting the action groups in their work. The RSCN aspires to be recognized by the EU Commission as the principal forum and authority representing all EIP on AHA Reference Sites. The RSCN will contribute to achieve the goals of the EIP on AHA by improving health and care outcomes for citizens across Europe, and the development of sustainable economic growth and the creation of jobs.

Application of experimental design methodology to optimize antibiotics removal by walnut shell based activated carbon

Three-level Box-Behnken experimental design with three factors (pH, temperature and antibiotic initial concentration) combined with response surface methodology (RSM) was applied to study the removal of Metronidazole and Sulfamethoxazole by walnut shell based activated carbon. This methodology enabled to identify the effects of the different factors studied and their interactions in the response of each antibiotic. The relationship between the independent variable (sorption capacity) and the dependent variables (pH, temperature and antibiotic concentration) was adequately modelled by second-order polynomial equation. The pH factor exerted a significant but distinct influence on the removal efficiency of both antibiotics. The removal of Metronidazole is favoured by increasing pH values, with the maximum value obtained for pH 8 - upper limit of the study domain; while Sulfamethoxazole displays a maximum value around 5.5, with a decrease in the extent of adsorption as the pH increases. The best conditions, predicted by the model, for the removal of the antibiotic Sulfamethoxazole (106.9 mg/g) are obtained at a temperature of 30 °C, initial concentration of 40 mg/L and a pH value of 5.5. For the antibiotic Metronidazole, the highest removal value (127 mg/g) is expected to occur at the maximum levels attributed to each of the factors (pH = 8, C_in = 40 mg/L, T = 30 °C). The results of isotherm experiments (at 20 °C and pH 6) displayed a good agreement with the models predictions. The maximum sorption capacity, estimated by the Langmuir model, was 107.4 mg/g for Metronidazole and 93.5 mg/g for Sulfamethoxazole.

Characterization of a new genotype of Betapapillomavirus HPV 17 through L1, E7, E7 and LCR sequences

Human papillomavirus (HPV) exhibits epithelial and mucosal tropism. HPV type 17 belongs to the Betapapillomavirus genus and molecular cloning experiments have identified two subtypes (17a and 17b) isolated from epidermodysplasia verruciformis (EV). HPV subtypes are characterized by dissimilarities from 2 to 10% at the nucleotide level from their referenced HPV. The aim of this study was to characterize the L1, E6, E7 and LCR sequences from an isolate, which was recovered from the oral mucosa of an asymptomatic 63 year-old woman. The whole late gene 1 (L1) was amplified using several sets of primers. The complete early genes 6 and 7 (E6, E7) and the long control region (LCR) were amplified using specific primers. Potential binding sites for transcriptional factors within the LCR were also investigated. Within these sets, the DNA sequence was altered at 91 positions (68 in L1, 13 in E6, 8 in E7, and 2 in LCR sequences). L1 analysis showed high dissimilarity compared with the HPV 17 prototype, reaching 4% of nucleotide substitutions and leading to a probable third 17 subtype. The E6 oncoprotein presented the highest modification among the sequences studied, with four amino acid changes in comparison with the prototype isolate. One amino acid was modified at a position 62 (S-T), a zinc-binding domain (CxxC(C)29 CxxC). Our findings provide data on genetic variations seen in this genotype, reaching to dichotomic branching and pointing to an evolutionary process.

Observation of Roton Mode Population in a Dipolar Quantum Gas

The concept of a roton, a special kind of elementary excitation, forming a minimum of energy at finite momentum, has been essential to understand the properties of superfluid ⁴He 1. In quantum liquids, rotons arise from the strong interparticle interactions, whose microscopic description remains debated 2. In the realm of highly-controllable quantum gases, a roton mode has been predicted to emerge due to magnetic dipole-dipole interactions despite of their weakly-interacting character 3. This prospect has raised considerable interest 4-12; yet roton modes in dipolar quantum gases have remained elusive to observations. Here we report experimental and theoretical studies of the momentum distribution in Bose-Einstein condensates of highly-magnetic erbium atoms, revealing the existence of the long-sought roton mode. Following an interaction quench, the roton mode manifests itself with the appearance of symmetric peaks at well-defined finite momentum. The roton momentum follows the predicted geometrical scaling with the inverse of the confinement length along the magnetisation axis. From the growth of the roton population, we probe the roton softening of the excitation spectrum in time and extract the corresponding imaginary roton gap. Our results provide a further step in the quest towards supersolidity in dipolar quantum gases 13.

Staphylococcus Infection-Associated Glomerulonephritis in a Kidney Transplant Patient: Case Report

BACKGROUND

Staphylococcus infection-associated glomerulonephritis is a rare cause of graft dysfunction in kidney transplant. Suspicion should be high in the setting of elevation of serum creatinine, active urinary sediment, with or without hypocomplementemia, and simultaneous Staphylococcus aureus infection. A kidney biopsy is usually diagnostic.

CASE REPORT

A 56-year-old man, who received a kidney transplant in 1998, with basal serum creatinine of 1.2 mg/dL and normal urinary sediment, was admitted to our kidney transplantation unit with graft dysfunction and a urinary tract infection caused by S aureus with septicemia, treated with antibiotics, in the context of recently intensified immunosuppression for a primary immune thrombocytopenia diagnosed 3 weeks earlier. After antibiotic treatment, the patient persisted with graft dysfunction, edema, and hypertension, with a S aureus isolation in the urine culture, active urinary sediment, and low C3. A kidney biopsy was performed, showing diffuse proliferative endocapillary and mesangial glomerulonephritis, with IgA(++) and C3(++) mesangial and endocapillary deposits in immunofluorescence. The patient was treated symptomatically and maintained his regular immunosuppression. At the last follow-up, his serum creatinine value was stable at 2.5 mg/dL.

CONCLUSIONS

The onset of a nephritic syndrome with a simultaneous S aureus infection should lead to suspicion of this uncommon entity, confirmed histologically. Despite its association with poor graft survival, our patient's graft survival remained stable.

Life-Threatening Everolimus-Associated Pneumonitis: A Case Report and a Review of the Literature

INTRODUCTION

Noninfective pneumonitis is a class-related effect within mammalian target of rapamycin (mTOR) inhibitors, including everolimus, and can occasionally be severe.

CASE REPORT

A 62-year-old man, medicated with everolimus due to a heart transplantation 17 years previously and with chronic kidney disease, was admitted to the intensive care unit (ICU) with acute respiratory failure, cardiovascular shock, and impaired renal function requiring dialysis. Computed tomography (CT) scan revealed right upper lobe consolidation. Extensive microbiological workup, autoimmune testing, and cytology were negative and echocardiography showed preserved heart function. Everolimus levels were normal (5.7-6.1 ng/mL) and the drug was suspended at day 9. The patient was difficult to ventilate and responded poorly to broad-spectrum antibiotic and antifungal therapy. On day 25, CT scan and bronchoscopy revealed left-sided alveolar hemorrhage, and corticosteroid pulses were performed. The patient gradually improved. After discharge and 6 months of follow-up, clinical recovery was complete and chest imaging substantially improved.

DISCUSSION

Pneumonitis occurs in up to 4.3% of transplant recipients using everolimus for immunosuppression. Despite usually presenting as a mild and self-limited disease, severe cases have been described. Alveolar hemorrhage can occur and is associated with poor outcome. Everolimus levels do not seem to accurately predict toxicity. Corticosteroid therapy has been used with success in severe disease. We review the pathophysiological, clinical, and management-related aspects of this entity with emphasis on its potential severity.

CONCLUSION

Our case was a rare occurrence of severe life-threatening pulmonary disease related to everolimus. Awareness of the potential severity of this entity is important for the management of patients using mTOR inhibitors.

Duality in Power-Law Localization in Disordered One-Dimensional Systems

The transport of excitations between pinned particles in many physical systems may be mapped to single-particle models with power-law hopping, 1/r^{a}. For randomly spaced particles, these models present an effective peculiar disorder that leads to surprising localization properties. We show that in one-dimensional systems almost all eigenstates (except for a few states close to the ground state) are power-law localized for any value of a>0. Moreover, we show that our model is an example of a new universality class of models with power-law hopping, characterized by a duality between systems with long-range hops (a<1) and short-range hops (a>1), in which the wave function amplitude falls off algebraically with the same power γ from the localization center.

Early Rehospitalization Post-Kidney Transplant Due to Infectious Complications: Can We Predict the Patients at Risk?

INTRODUCTION

Rehospitalization early post-kidney transplant is common and has a negative impact in morbidity, graft survival, and health costs. Infection is one the most common causes, and identifying the risk factors for early readmission due to infectious complications may guide a preventive program and improve outcome. The aim of this study was to evaluate the incidence, characterize the population, and identify the risk factors associated with early readmission for infectious complications post-kidney transplantation.

METHODS

We performed a retrospective cohort study of all the kidney transplants performed during 2015. The primary outcome was readmission in the first 3 months post-transplant due to infectious causes defined by clinical and laboratory parameters.

RESULTS

We evaluated 141 kidney transplants; 71% of subjects were men, with an overall mean age of 50.8 ± 15.4 years. Prior to transplant, 98% of the patients were dialysis dependent and 2% underwent pre-emptive living donor kidney transplant. The global readmission rate was 49%, of which 65% were for infectious complications. The most frequent infection was urinary tract infection (n = 28, 62%) and the most common agent detected by blood and urine cultures was Klebsiella pneumonia (n = 18, 40%). The risk factors significantly associated with readmission were higher body mass index (P = .03), diabetes mellitus (P = .02), older donor (P = .007), and longer cold ischemia time (P = .04). There were 3 graft losses, but none due to infectious complications.

CONCLUSION

There was a high incidence of early rehospitalization due to infectious complications, especially urinary tract infections to nosocomial agents. The risk factors identified were similar to other series.

Long-Term Outcomes of Kidney Transplantation From Expanded-Criteria Deceased Donors: A Single-Center Experience

BACKGROUND

Organ shortage has prompted the use of expanded-criteria donors (ECDs). Our objective was to compare long-term outcomes of kidney transplants from ECDs with those from concurrent standard-criteria donors (SCDs). In addition, we evaluated variables associated with graft survival in both groups.

METHODS

We retrospectively reviewed all 617 deceased-donor kidney transplantations performed from 2005 to 2009 in our department. The population was divided according to donor status into ECD or SCD. Patients were followed until 5 years after transplantation, death, graft failure, or loss to follow-up.

RESULTS

We transplanted 150 deceased-donor kidneys from ECDs and 467 from SCDs. ECD were older, more frequently women, had a lower pre-retrieval glomerular filtration rate, and more frequently died due to cerebrovascular accident. ECD recipients were older, presented a lower proportion of black race, more frequently were on hemodialysis, and presented a higher rate of first kidney transplants. Mean glomerular filtration rate was consistently lower in the ECD group. Patient and graft survivals were lower in the ECD group, but statistical significance was present only in graft survival censored for death with a functioning graft at 3 years and graft survival noncensored for death with a functioning graft at 5 years. Younger recipient ages, longer time on dialysis, acute rejection episodes, and glomerular filtration rate at 1 year after transplantation were independent risk factors for lower graft survival.

CONCLUSIONS

Transplantation with the use of ECD kidneys provide quite satisfactory patient and graft survival rates despite their poorer long-term outcomes.

Polyomavirus Nephropathy: Ten-Year Experience

BACKGROUND

Polyomavirus nephropathy (BKVN) is an important cause of chronic allograft dysfunction (CAD). Recipient determinants (male sex, white race, and older age), deceased donation, high-dose immunosuppression, diabetes, delayed graft function (DGF), cytomegalovirus infection, and acute rejection (AR) are risk factors. Reducing immunosuppression is the best strategy in BKVN. The objective of our study was to evaluate CAD progression after therapeutic strategies in BKVN and risk factors for graft loss (GL).

METHODS

Retrospective analysis of 23 biopsies, from patients with CAD and histological evidence of BKVN, conducted over a period of 10 years. Glomerular filtration rate was <30 mL/min in 16 patients at the time of the BKVN diagnosis.

RESULTS

BKVN was histologically diagnosed in 23 recipients (19 men, 4 women). All patients were white, with age of 51.2 ± 12.1 years (6 patients, age >60 years), and 22 had a deceased donor. Diabetes affected 4 patients, DGF occurred in 3, cytomegalovirus infection in 2, and AR in 15. All patients were medicated with calcineurin inhibitors (CNI) (95.7% tacrolimus) and corticoids, and 16 also received an antimetabolite. One year after antimetabolite reduction/discontinuation and/or CNI reduction/switching and/or antiviral agents, graft function was decreased in 11 patients, increased/stabilized in 10, and unknown in 2. GL occurred in 9 patients. Older age (hazard ratio, 1.76; 95% confidence interval, 0.94-3.28) and DGF (hazard ratio, 2.60; 95% confidence interval, 0.54-12.64) were the main risk factors for GL. The lower GFR at the time of the BKVN diagnosis was associated with an increased risk of initiation of dialysis.

CONCLUSIONS

GL occurred in 39.1% of patients with BKVN and DGF; older age and lower GFR at the time of diagnosis were important risk factors. Early diagnosis of BKVN is essential to prevent GL.

Hidden Order and Symmetry Protected Topological States in Quantum Link Ladders

We show that, whereas spin-1/2 one-dimensional U(1) quantum-link models (QLMs) are topologically trivial, when implemented in ladderlike lattices these models may present an intriguing ground-state phase diagram, which includes a symmetry protected topological (SPT) phase that may be readily revealed by analyzing long-range string spin correlations along the ladder legs. We propose a simple scheme for the realization of spin-1/2 U(1) QLMs based on single-component fermions loaded in an optical lattice with s and p bands, showing that the SPT phase may be experimentally realized by adiabatic preparation.

Can coastline plant species be used as biosamplers of emerging contaminants? - UV-filters and synthetic musks as case studies

Personal care products, an important class of emerging contaminants, have been frequently detected in different environmental matrices. Included in this category are synthetic musks compounds (SMCs) and UV-filters. Their occurrence in the coastal environment has been poorly studied. Therefore, this work aimed to verify whether five coastline plant species (Carpobrotus edulis, Cakile maritima, Medicago marina, Elymus farctus borealis-atlanticus and Euphorbia paralias) have the ability to accumulate 11 SMCs (cashmeran, celestolide, phantolide, galaxolide, tonalide, exaltolide, musk moskene, tibetene, ambrette, xylene and ketone) and 2 organic UVB filters (3-(4'-methylbenzylidene) camphor and octocrylene), functioning as biosamplers. To accomplish this task, a QuEChERS technique ("Quick, Easy, Cheap, Effective, Rugged, and Safe") was employed to extract the target compounds from the plant material collected in 15 beaches of Matosinhos and Vila Nova de Gaia (Portugal). The resulting extracts were analysed by gas chromatography-mass spectrometry. Limits of detection ranged from 0.02 ng g^-1 for celestolide and tonalide to 1.32 ng g^-1 for musk ambrette. The obtained recoveries were around 93% and relative standard deviation was generally less than 15%. SMCs were detected at levels ranging from 1.56 to 350 ng g^-1 dw and UV-filters from 2.9 to 264 ng g^-1 dw. Galaxolide and 3-(4'-methylbenzylidene) camphor were the synthetic musk and UV-filter detected in higher concentrations, respectively. Plants with higher water content accumulate better SMCs (hottentot-fig), while those with higher lipid content retain better the UV-filters (sea spurge).