Upgrading of diesel engine exhaust waste into onion-like carbon nanoparticles for integrated degradation sensing in nano-biocomposites

Onion-like carbon nano particles are separated from diesel engine exhaust “pollutant soot” and used in the structural health monitoring of a biocomposite.

Cobimetinib plus atezolizumab in BRAFV600 wild-type melanoma: primary results from the randomized phase III IMspire170 study

BACKGROUND

Emerging data suggest that the combination of MEK inhibitors and immunotherapeutic agents may result in improved efficacy in melanoma. We evaluated whether combining MEK inhibition and immune checkpoint inhibition was more efficacious than immune checkpoint inhibition alone in patients with previously untreated BRAF^V600 wild-type advanced melanoma.

PATIENTS AND METHODS

IMspire170 was an international, randomized, open-label, phase III study. Patients were randomized 1 : 1 to receive cobimetinib (60 mg, days 1-21) plus anti-programmed death-ligand 1 atezolizumab (840 mg every 2 weeks) in 28-day cycles or anti-programmed death-1 pembrolizumab (200 mg every 3 weeks) alone until loss of clinical benefit, unacceptable toxicity, or consent withdrawal. The primary outcome was progression-free survival (PFS), assessed by an independent review committee in the intention-to-treat population.

RESULTS

Between 11 December 2017, and 29 January 2019, 446 patients were randomized to receive cobimetinib plus atezolizumab (n = 222) or pembrolizumab (n = 224). Median follow-up was 7.1 months [interquartile range (IQR) 4.8-9.9] for cobimetinib plus atezolizumab and 7.2 months (IQR 4.9-10.1) for pembrolizumab. Median PFS was 5.5 months [95% confidence interval (CI) 3.8-7.2] with cobimetinib plus atezolizumab versus 5.7 months (95% CI 3.7-9.6) with pembrolizumab [stratified hazard ratio 1.15 (95% CI 0.88-1.50); P = 0.30]. Hazard ratios for PFS were consistent across prespecified subgroups. In exploratory biomarker analyses, higher tumor mutational burden was associated with improved clinical outcomes in both treatment arms. The most common grade 3-5 adverse events (AEs) were increased blood creatine phosphokinase (10.0% with cobimetinib plus atezolizumab versus 0.9% with pembrolizumab), diarrhea (7.7% versus 1.9%), rash (6.8% versus 0.9%), hypertension (6.4% versus 3.7%), and dermatitis acneiform (5.0% versus 0). Serious AEs occurred in 44.1% of patients with cobimetinib plus atezolizumab and 20.8% with pembrolizumab.

CONCLUSION

Cobimetinib plus atezolizumab did not improve PFS compared with pembrolizumab monotherapy in patients with BRAF^V600 wild-type advanced melanoma.

Evolving concepts in ventral hernia repair and physical therapy: prehabilitation, rehabilitation, and analogies to tendon reconstruction

PURPOSE

The abdominal wall and musculoskeletal tendons share many anatomic, physiologic, and functional characteristics. This review aims to highlight these similar characteristics and to present a rationale why the treatment principles of successful musculoskeletal tendon reconstruction, including principles of surgical technique and physical therapy, can be used in the treatment of complex abdominal wall reconstruction or ventral hernia repair.

METHODS

The MEDLINE/PubMed database was used to identify published literature relevant to the purpose of this review.

CONCLUSIONS

There are several anatomical and functional similarities between the linea alba and musculoskeletal tendons. Because of this reason, many of the surgical principles for musculoskeletal tendon repair and ventral hernia repair overlap. Distribution of tension is the main driving principle for both procedures. Suture material and configuration are chosen to maximize tension distribution among the tissue edges, as seen in the standard of care multistrand repairs for musculoskeletal tendons, as well as in the small bites for laparotomy technique described in the STITCH trial. Physical therapy is also one of the mainstays of tendon repair, but surprisingly, is not routine in ventral hernia repair. The evidence surrounding physical therapy prehabilitation and rehabilitation protocols in other disciplines is significant. This review challenges the fact that these protocols are not routinely implemented for ventral hernia repair, and presents the rationale and feasibility for the routine practice of physical therapy in ventral hernia repair.

Understanding gold toxicity in aerobically-grown Escherichia coli

Background

There is an emerging field to put into practice new strategies for developing molecules with antimicrobial properties. In this line, several metals and metalloids are currently being used for these purposes, although their cellular effect(s) or target(s) in a particular organism are still unknown. Here we aimed to investigate and analyze Au³⁺ toxicity through a combination of biochemical and molecular approaches.

Results

We found that Au³⁺ triggers a major oxidative unbalance in Escherichia coli, characterized by decreased intracellular thiol levels, increased superoxide concentration, as well as by an augmented production of the antioxidant enzymes superoxide dismutase and catalase. Because ROS production is, in some cases, associated with metal reduction and the concomitant generation of gold-containing nanostructures (AuNS), this possibility was evaluated in vivo and in vitro.

Conclusions

Au³⁺ is toxic for E. coli because it triggers an unbalance of the bacterium’s oxidative status. This was demonstrated by using oxidative stress dyes and antioxidant chemicals as well as gene reporters, RSH concentrations and AuNS generation.

Relationship between lower limb asymmetries, impulsion and balance in senior football players

Introduction Football is the most popular sport in the world and there are over 38 million players practicing it worldwide. In this sport, players usually have a prefered lower limb over other. This preference can lead to bilateral asymmetries and improve the risk of injury in the players. It is important to understand if asymmetries have an influence on athletes’ performance, on balance or impulsion.

Objectives The main objective of this study is to evaluate the bilateral and unilateral asymmetries related to the lower limb muscle strength of individuals who practice senior football, and relate them to eventual impulse and balance deficits.

Methodology 11 soccer players (age 21.91 ± 3.14 years; weight: 73.45 ± 7.59 Kg; height: 178.91 ± 8.02; BMI: 22.97 ± 2,12) were evaluated. The protocol defined in this study consisted of collecting data on maximum concentric torque at 60o/s, 180o/s and 300o/s in Biodex System 3. Both lower limbs were tested. Then the Y-balance test was performed on a force platform and the athletes’ flight time were recorded. We also calculated the bilateral deficit between the dominant lower limb and the non-dominant lower limb for the quadriceps and hamstrings and the hamstring/quadriceps (H/Q) ratio for each lower limb

Results There were no statistically significant differences between the maximum torque produced by the dominant lower limb and the maximum force torque produced by the dominant lower limb (p < 0.05). The conventional I / Q ratio has values similar to those described in the literature. The relationship between bilateral asymmetry of lower limb strength, balance and impulsion was not statistically significant (p > 0.05) at any angular velocity.

Conclusion There are no statistically significant differences between bilateral and unilateral asymmetries of lower limb strength, balance and impulsion.

High-pressure homogenization and high hydrostatic pressure processing of human milk: Preservation of immunological components for human milk banks

Human milk (HM) constitutes the first immunological barrier and the main source of nutrients and bioactive components for newborns. Immune factors comprise up to 10% of the protein content in HM, where antibodies are the major components (mainly IgA, IgG, and IgM). In addition, antibacterial enzymes such as lysozyme and immunoregulatory factors such as soluble cluster of differentiation 14 (sCD14) and transforming growth factor β2 (TGF-β2) are also present and play important roles in the protection of the infant's health. Donor milk processed in HM banks by Holder pasteurization (HoP; 62.5°C, 30 min) is a safe and valuable resource for preterm newborns that are hospitalized, but is reduced in major immunological components due to thermal inactivation. We hypothesized that high hydrostatic pressure (HHP) and high-pressure homogenization (HPH) are 2 processes that can be used on HM to reduce total bacteria counts while retaining immunological components. We studied the effects of HHP (400, 450, and 500 MPa for 5 min applied at 20°C) and HPH (200, 250, and 300 MPa, milk inlet temperature of 20°C) applied to mature HM, on microbiological and immunological markers (IgA, IgG, IgM, sCD14, and TGF-β2), and compared them with those of traditional HoP in HM samples from healthy donors. The HHP processing between 400 and 500 MPa at 20°C reduced counts of coliform and total aerobic bacteria to undetectable levels (<1.0 log cfu/mL) while achieving approximately 100% of immunological component retention. In particular, comparing median percentages of retention of immunological components for 450 MPa versus HoP, we found 101.5 versus 50.5% for IgA, 89.5 versus 26.0% for IgM, 104.5 versus 75.5% for IgG, 125.0 versus 72.5% for lysozyme, 50.6 versus 0.1% for sCD14, and 88.5 versus 61.1% for TGF-β2, respectively. Regarding HPH processing, at a pressure of 250 MPa and inlet temperature of 20°C, the process showed good potential to reduce coliforms to undetectable levels and total aerobic bacteria to levels slightly above those obtained by HoP. The median percentages of retention of immunological markers for HPH versus HoP were 71.5 versus 52.0%, 71.0 versus 27.0%, 104.0 versus 66.5%, and 30.9 versus 0.2%, for IgA, IgM, IgG, and sCD14, respectively; results did not significantly differ for lysozyme and TGF-β2. The HPH at 300 MPa produced higher inactivation of immunological components, similar to values achieved with HoP.

A Brazilian multicentre study evaluating pregnancies induced by cabergoline in patients harboring prolactinomas

OBJECTIVE

To evaluate the maternal-fetal outcomes of CAB-induced pregnancies in patients with prolactinoma in a large cohort.

METHODS

The prevalence of tumor growth, miscarriage, preterm, low birth weight, congenital malformations and impairment in neuropsychological development in children among women treated with CAB were assessed in a Brazilian multicentre retrospective observational study, RESULTS: We included 194 women with a mean age of 31 (17-45) years, 43.6% presenting microadenomas and 56.4% macroadenomas, at prolactinoma diagnosis. In 233 pregnancies, CAB was withdrawn in 89%, after pregnancy confirmation. Symptoms related to tumor growth occurred in 25 cases, more frequently in macroadenomas. The overall miscarriage rate was 11%, although higher in the subgroup of patients with CAB maintainance after pregnancy confirmation (38% vs. 7.5%). Amongst the live-birth deliveries, preterm occurred in 12%, low birth weight in 6% and congenital malformations in 4.3%. Neuropsychological development impairment was reported in 7% of cases.

CONCLUSIONS

Our findings confirm previous results of safety in maternal and fetal outcomes in CAB-induced pregnancies; nevertheless, CAB maintenance after pregnancy confirmation was associated with higher miscarriage rate; result that must be further confirmed.

P1598 Ruptured Sinus of Valsalva: clinical and echocardiographic features at presentation and long-term results after surgical and percutaneous repair

Background

Rupture of Sinus of Valsalva (rSOV) is a rare and potentially life-threatening condition often misdiagnosed. Percutaneous device closure has been replacing surgical repair as a treatment of choice. However, long-term outcome is poorly documented.

Methods

Echo database (2001-2019) was searched for patients &gt;16y with rSOV. Clinical data were collected from ACHD database. Marfan Syndrome patients were excluded.

Results

Fifteen patients (42.2y, 10M) were diagnosed with rSOVbetween 1979 and 2019. HF symptoms at initial presentation were reported in 50%. All cases were diagnosed by TTE with finding of high velocity continuous flow from SOV to right heart. Two were initially misdiagnosed as VSD. Digital imaging recordings of 10/15 were available. The aortic root was dilated in 8/10. Four had asymmetrical SOV dilatation. LV and LA were dilated in 7/10 and 9/10. Significant aortic regurgitation was in 4. Two had RVOTO. RVSP was always raised. Echo findings are summarised in the Table.

Mean FU after repair was 10,7y (0,9-39). Ten patients had surgical repair and 5 device closure. Seven had repair of concomitant lesions (4 VSD closure and 3 AVR) at the time of the procedure. One redo device closure was performed. During FU 1 died from Cardiomyopathy. At the latest FU significant improvement in functional class, LV and LA size and RVSP was found.

Conclusion

Patients with rSOV may present with acute HF. High velocity continuous flow from SOV to right heart on TTE is characteristic feature for diagnosis. Percutaneous closure is an attractive alternative to surgery in patients with isolated lesion. Significant haemodynamic improvement can be achieved with good long-term haemodynamic results

Tot = 15 Initial findings Latest FU NYHA class 4 class I 2 class II 2 class III 4 class IV 3 unknown 11 class I 2 class II 1 class III 0 class IV* SOV (mm) 38.2 (33-44) STJ (mm) 36.2 (26-42 Asc Ao (mm) 30.3 (25-34) rupture site 8 RC sinus, 2 NC sinus Shunt to 8 RVOT, 1 RA, 1 RVOT + RA LVEDV (ml) 169.7 (114-330) 120 (67-230)* LVESV (ml) 66(42-130) 46 (28-80)* LAVi (ml/m2) 53.1 (30-129) 35 (24-53)* LV EF% 61.2 (57-65) 60.4 (50-70) RVSP (mmHg) 53.2 (37-130) 24.06 (15-32)** Pre VS post procedure p-value: * P &lt; 0,05 **P &lt; 0,01

Abstract P1598 Figure. PLAX in patient with ruptured RC sinus

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

BACKGROUND

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

OR19-3 Utility of the Levothyroxine Absorption Test: The Mayo Clinic Experience

Introduction: While hormone replacement with levothyroxine (LT4) is the most effective management for hypothyroidism, there is a subset of patients who remain hypothyroid despite high doses of LT4. These patients warrant evaluation for conditions that may contribute to poor LT4 absorption. Several case reports have documented a condition known as LT4 pseudomalabsorption, a factitious disorder in which overt hypothyroidism persists despite endorsed medication adherence and absent evidence for gastrointestinal malabsorption. LT4 absorption testing (LT4AT) is a non-invasive method for effectively distinguishing malabsorption from pseudomalabsorption. Given the lack of standardization of this test and the morbidity associated with uncontrolled hypothyroidism, we reviewed our institution’s experience with LT4AT and investigated the impact of this test on long-term management in patients with primary refractory hypothyroidism. Methods: We conducted chart reviews between 2015 to 2018 for patients who had undergone LT4AT at our institution for primary refractory hypothyroidism. Pertinent information collected included medications known to interfere with LT4 absorption or metabolism, adherence and timing of ingestion in relation to food intake, and comorbidities including celiac disease, heart failure, nephrotic syndrome, cirrhosis, gastritis, or short bowel syndrome. Our LT4AT protocol involves observed administration of LT4 dosed according to age and BMI (600mcg, 1000mcg, or 1500mcg). Total thyroxine is measured at baseline, 1 hour, 2 hours, 3 hours, 4 hours, and 6 hours. TSH is measured at baseline and at 6 hours. Percent LT4 absorption is calculated using the following formula: [[Increment TT4 (mcg/dL) x 10] / total administered LT4 (mcg)]] x Vd (L) x100. Absorption of >60% is considered normal. Results: Fifteen patients completed LT4AT during the search period, and 14 demonstrated normal absorption. One patient had virtually no LT4 absorption and was diagnosed with atrophic gastritis. Ten patients had follow up ranging from 2 months to 2 years. Three achieved normal TSH values within one year, 5 demonstrated improvement, but had yet to achieve TSH normalization, and 2 remained poorly controlled. Direct observation of LT4 administration was performed in 2 patients, both of whom achieved a normal TSH at 3 and 7 months, respectively. Conclusions: Our review confirms the utility of LT4AT for differentiating pseudomalabsorption from gastrointestinal malabsorption. Most of our patients had improvement in thyroid function during follow up, contending that performance of this test may enhance compliance by establishing an objective framework from which both clinicians and patients can work to develop effective, long-term management strategies.

[Psychomotor development from 0 to 4 years in indigenous children. A sistematic literature search]

INTRODUCTION

The objective of this study was to evaluate published articles regarding the development of indigenous children aged 0 to four years.

SUBJECTS AND METHOD

Systematic literature search. Parti cipants: Primary studies with populations of indigenous children aged 0 to four years. Type of studies: Primary studies with qualitative or quantitative methodologies published in the last ten years until November 2015. Databases: MEDLINE, Digital Library of the University of Girona: CERCADOR, EMBASE, Scielo.

SEARCH STRATEGY

sensitive and specific. Free terms, MeSH, and Boolean.

RESULTS

Nine articles remain for analysis. There are six central subjects related to intracultural patterns of expected development in indigenous childhood: 1) physical, 2) language, 3) socio-cognitive, 4) emo tional, 5) teaching-learning, 6) psychosocial, which reveal the existence of categories of sociocultural and spiritual contents. There is no defined period of time associated with the education. Learning is through observation and participation. Development is understood as a whole, intertwining the social, cultural, natural and spiritual.

CONCLUSION

Spirituality and nature are at the center. Time as a goal to gain skills does not have a cultural function to demonstrate the acquisition of the inherent va lues to the culture. To base the assessment of development exclusively on psychomotor development as monitoring guide is insufficient to assess the integrality and complexity of the advances, abilities, and skills of indigenous children.

Effectiveness of renoprotective approaches for persistent proteinuria in lupus nephritis: more than just immunosuppression

OBJECTIVE

The objective of this study is to evaluate the efficacy of a tightly controlled renoprotective protocol in systemic lupus erythematosus (SLE) patients with persistent proteinuria.

METHODS

Thirteen SLE patients with nephritis and persistent proteinuria (>1 g/24 hours) were included. The protocol consisted of regular clinical evaluations every two weeks to assess blood pressure (BP, target <130/80 mmHg), adherence to therapy, diet and smoking. No change in immunosuppressive drugs was allowed but reduction of glucocorticoid dose was permitted if indicated. Clinical, laboratory and treatment evaluations were performed at baseline and at the end of the study (after three months).

RESULTS

SLE patients had a mean age of 37.85 ± 7.68 years and disease duration of 9.85 ± 7.29 years. At baseline, patients had a mean duration of maintenance therapy of 10.38 ± 7.56 months, 12 with mycophenolate mofetil (92.3%) and one with azathioprine (7.7%). At least one dose optimization of antihypertensive regimen was required in all patients during the study. Seven patients (53.8%) had BP>130/80mmHg at baseline. At the end, 11 patients (84.6%) achieved stable BP target; 92.3% were using an angiotensin-converting enzyme inhibitor, 53.9% an angiotensin receptor blocker, and 46.2% were using combined therapy. All patients had a significant reduction in proteinuria levels (2.26 ± 1.09 vs 0.88 ± 0.54 g/24 hours, p < 0.001) and 61.5% achieved proteinuria <1 g/24 hours. A significant decrease in mean prednisone dose was observed (10.96 ± 6.73 vs 5.38 ± 3.36 mg/day, p = 0.013) as well as mean Systemic Lupus Erythematosus Disease Activity Index score (4.38 ± 0.72 vs 3.08 ± 1.86, p = 0.043). No significant changes were identified in serum creatinine, albumin, potassium, complement 3 and complement 4 levels ( p > 0.05).

CONCLUSION

This study provides evidence that a tightly controlled renoprotective protocol is effective in reducing persistent proteinuria in lupus nephritis. The concomitant reduction of prednisone without any change in immunosuppression reinforces the importance of strategies beyond the treatment of nephritis activity.

The Many Faces of Carbohydrate Metabolism in Male Germ Cells: From Single Molecules to Active Polymers

Spermatogenesis is a complex physiological process that involves cell proliferation, meiotic division and a final cell differentiation of post-meiotic cells into spermatozoa. During this process male germ cells also undergo a metabolic differentiation process, in which post-meiotic spermatogenic cells (spermatids) but not meiotic spermatogenic cells (spermatocytes) respond differentially to D-glucose metabolism, glucose transporters (GLUTs) distribution and utilization of non-hexose substrates, such as lactate/pyruvate or dihydroxyacetone. These differences might be explained by the requirement for a specific metabolic process to support cell differentiation or in some cases, cell viability. In addition, though glycogen is considered to be the main glucose store, in male germ cells this polymer may play a novel role in cell proliferation, acting as a new marker for apoptotic events in testicular tissue via a yet unknown mechanism. In this article, we summarize the main metabolic changes that occur during male germ differentiation, with a specific focus on metabolic sources during spermatocyte to spermatid transition. The latter considering that these cells come from the same cell linage as specialized cells, but are not isolated from their environment, describing the roles from single molecules to polymers on the viability of male germ cells.