P1881High-sensitivity cardiac troponin T in patients with acute atrial fibrillation

Background

Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia encountered in clinical practice and confers a significant burden to morbidity and mortality. High-sensitivity cardiac troponin T (hs-cTnT) levels have provided a significant contribution in the early diagnosis of cardiovascular events; however, the significance of hs-cTnT elevation in the setting of acute AF is not clearly understood.

Purpose

The aim of this study was to evaluate the factors associated with hs-cTnT elevation and its prognostic implication in patients with acute AF.

Methods

This single-center prospective study included 406 consecutive patients who presented to the emergency department (ED) with acute AF. Acute AF was defined as a rapid, irregular, and chaotic atrial activity of <48 hours' duration including both the first symptomatic onset of chronic or persistent AF, and episodes of paroxysmal AF. The association between hs-cTnT and outcomes were evaluated using multivariate analyses.

Results

The mean age of the population was 67.3±12.2 and 74% were male. The median time from the onset of symptoms to ED consultation was 230 minutes (interquartile range: 123–450 minutes). The median hs-cTnT value was 12 ng/L, with 39% of patients with values above the 99 thpercentile. AF was reverted to sinus rhythm in 76% of the patients (83% attempted cardioversion). At one-year, AF recurrence was observed in 38% of the patients and major adverse cardiovascular events (MACE) (death, myocardial infarction, acute coronary syndrome or stroke) were observed in 6% of the patients. After adjusting for demographic and clinical characteristics in multivariate analysis, hs-cTnT elevation was associated with increasing age and left atrial area (p=0.001). Hs-cTnT levels were not associated with 1-year AF recurrence (p=0.132) or with AF reversion (p=0.869). Hs-cTnT levels were significantly higher in patients who experienced MACE at 1-year (12 ng/L vs 24 ng/L, p=0.001) and hs-cTnT was a predictor of MACE on multivariate analysis (OR 3.486, 95% CI 1.256–5.379, p=0.009).

Variable Result AF rate 110 (90–118) Atrial area, cm2 22 (19–27) Cardioversion attemped 82.5%

Conclusions

Hs-cTnT elevation accounted for a large proportion of patients with acute AF. Elevated levels of hs-cTnT were not associated with AF reversion or with 1-year AF recurrence, however hs-cTnT was highly predictive of MACE at 1-year.

248Real-world Outcome of the ESC 0/1-hour Algorithm when Routinely Applied in Early Presenters

Background

The European Society of Cardiology (ESC) recommends the use of a 0/1h-algorithm for rapid triage of patients with suspected non-ST-elevation myocardial infarction (NSTEMI) using high-sensitivity cardiac troponin (hs-cTn). Concerns were articulated about its efficacy and particularly safety when applied in patients presenting early (≤3 hours) after chest pain onset, as hs-cTn concentrations might still be very low or even undetectable in these high-risk patients.

Purpose

We aimed to assess the real-world effectiveness, efficacy, and ultimately safety of the ESC 0/1h-algorithm when routinely applied in early presenters.

Methods

In a prospective international multicenter study enrolling unselected patients presenting with suspected NSTEMI to the ED, patients were assessed according to the ESC 0/1h-algorithm using high-sensitivity cardiac troponin T embedded in routine clinical care. Patients with ST-segment elevation myocardial infarctions were excluded. Safety was quantified by the 30-day incidence of major adverse cardiac events (MACE, defined as the composite of cardiovascular death and myocardial infarction including the index event) in the rule-out group and in outpatients.

Results

Among 2296 patients, 819 (36%) were early presenters. NSTEMI prevalence in early presenters was 11%. Effectiveness was very high as 97% of patients triaged towards rule-out by the ESC 0/1h-algorithm did not require additional cardiac investigations including hs-cTnT measurements at later time points (e.g. 3–12h) or coronary CT-angiography in the ED. Median time to discharge or transfer from the ED was 150 minutes [q1130, q3215]. Efficacy of the ESC 0/1h-algorithm was very high: 67% of patients were triaged towards rule-out and 14% towards rule-in of NSTEMI. Overall, 75% of early presenters underwent outpatient management. Safety of rule-out and outpatient management were excellent in early presenters with a 30-day MACE incidence of both 0% and comparable with 0.3% and 0.1% in late presenters, respectively (p=ns).

Conclusions

These real-world data document for the first time the excellent effectiveness, efficacy and particularly safety of the ESC 0/1h-algorithm when routinely applied in early presenters. No differences in safety could be observed when compared with late presenters.

Large scale, prospective screening of EGFR mutations in the blood of advanced NSCLC patients to guide treatment decisions

Background

In a significant percentage of advanced non-small-cell lung cancer (NSCLC) patients, tumor tissue is unavailable or insufficient for genetic analyses. We prospectively analyzed if circulating-free DNA (cfDNA) purified from blood can be used as a surrogate in this setting to select patients for treatment with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs).

Patients and methods

Blood samples were collected in 119 hospitals from 1138 advanced NSCLC patients at presentation (n = 1033) or at progression to EGFR-TKIs (n = 105) with no biopsy or insufficient tumor tissue. Serum and plasma were sent to a central laboratory, cfDNA purified and EGFR mutations analyzed and quantified using a real-time PCR assay. Response data from a subset of patients (n = 18) were retrospectively collected.

Results

Of 1033 NSCLC patients at presentation, 1026 were assessable; with a prevalence of males and former or current smokers. Sensitizing mutations were found in the cfDNA of 113 patients (11%); with a majority of females, never smokers and exon 19 deletions. Thirty-one patients were positive only in plasma and 11 in serum alone and mutation load was higher in plasma and in cases with exon 19 deletions. More than 50% of samples had <10 pg mutated genomes/µl with allelic fractions below 0.25%. Patients treated first line with TKIs based exclusively on EGFR positivity in blood had an ORR of 72% and a median PFS of 11 months. Of 105 patients screened after progression to EGFR-TKIs, sensitizing mutations were found in 56.2% and the p.T790M resistance mutation in 35.2%.

Conclusions

Large-scale EGFR testing in the blood of unselected advanced NSCLC patients is feasible and can be used to select patients for targeted therapy when testing cannot be done in tissue. The characteristics and clinical outcomes to TKI treatment of the EGFR-mutated patients identified are undistinguishable from those positive in tumor.

From mental hygiene to mental health: ideology, discourses and practices in Franco's Spain (1939-75)

Based on an analysis of the discourses, the ideological appropriation and the practical influence of mental hygiene in Spanish psychiatry during the early years of the Francoist regime, this article examines its decline and subsequent replacement by the new concept of mental health promoted by the World Health Organization and other international bodies from the mid-twentieth century. The old approach, essentially focused on the prophylaxis of insanity within the framework of a set of interventionist policies of social defence, was thus transformed from the beginning of the 1960s into a much more ambitious and comprehensive project which sought to promote the psychosocial balance and performance of individuals in the context of increasingly socialized health-related discourses and networks of care.

False belief attribution in children with Williams syndrome: the answer is in the emotion

BACKGROUND

Individuals with Williams syndrome (WS) show difficulties in attributing false beliefs, whereas they are better at attributing emotions. This study examines whether being asked about the emotion linked to a false belief, instead of explicitly about the belief, facilitates performance on theory of mind (ToM) tasks.

METHOD

Thirty children with WS and 90 typically developing children, who were individually matched on mental age (50-112 months), were administered six explicit (i.e. questions on belief) and six implicit (i.e. questions on emotion) trials of false belief tasks.

RESULTS

Theory of mind competences were related to cognitive development. Children with WS performed comparably to typically developing children on the emotion questions.

CONCLUSION

Correct answers to questions on emotion reveal an implicit understanding of false belief. The Representational redescription process could be impaired in the domain of ToM in this population. This finding has relevant implications for the design of supports aiming to optimise the development of ToM competences in individuals with WS.

Evaluación de diferentes niveles de inclusión de plantas nativas de sabanas inundables sobre una dieta basal de Brachiaria humidicola y su efecto sobre la producción de metano in vitro

Se evaluó el efecto sobre la producción de metano de la inclusión creciente (25, 50 y 75 %) de cinco plantas nativas de sabanas inundables (Senna occidentalis, Enterolobium schomburgkii, Galactia jussiaeana, Belencita nemorosa y Ambrosia peruviana), sobre una dieta base de Brachiaria humidicola. Los tratamientos fueron incubados anaeróbicamente con fluido ruminal a 39°C por 24 h y después del proceso de fermentación, se determinó la producción de gas, metano, ácidos grasos volátiles (AGV), amonio y degradación de la materia seca (MSD). La inclusión en la dieta de 50 y 75% de todas las plantas, incrementaron el contenido de amonio ruminal, con valores entre 189 - 282 mg/L. Ninguna de las plantas modificó la concentración de AGVT (44-62 mmol/L). La producción de metano no se redujo significativamente con ningún tratamiento (p>0,05), aunque con S. occidentalis (75%) este parámetro fue inferior en un 18%, además, se incrementó la MSD y los niveles de butirato, isobutirato y valerato. Con E. schomburgkii (75%), la metanogénesis también se redujo en un 15%, sin embargo, este efecto estuvo acompañado de una disminución en la MSD y producción de gas. En conclusión, ninguna de las plantas mostró potencial para reducir la producción de metano, no obstante, las especies se convierten en alternativas nutricionales útiles para complementar el aporte proteico de la dieta en los sistemas ganaderos ubicados en condiciones de sabanas inundables.

Monitoring Effect of Fire on Ant Assemblages in Brazilian Rupestrian Grasslands: Contrasting Effects on Ground and Arboreal Fauna

Fire is one of the most relevant ecological disturbances in nature. Little is known about the effects of fire on biodiversity in ecosystems like rupestrian grasslands, which share characteristics with savanna and forest biomes. Brazilian rupestrian grasslands are part of an endangered ecosystem that has been modified by anthropogenic fire events that have become more intense in recent decades. In this study, we evaluated the effects of fire on ground and arboreal ant assemblages through a two-year monitoring program (24 monthly samplings). We found that fire does not change cumulative species richness after 24 months, and that fire does not affect mean ant richness, abundance, and species composition in arboreal ants. On the other hand, fire increased mean ground ant species richness and abundance, and caused a significant change in species composition. Our results indicate a weak and beneficial effect of fire only for ground ant communities, which generally agrees with results from other studies in Brazilian savannas. Taken together, results from these studies may be useful for improvement of fire suppression policy in fire-prone habitats in Brazil.

Mental hygiene in early Francoism: from racial hygiene to the prevention of mental illness (1939-1960)

In this paper, we study the ideological bases of mental hygiene, understood as racial and moral hygiene, during the first years of Franco's regime and their evolution until 1960. First, we discuss the conceptualization of mental hygiene in the 1940s and its role as a tool for the legitimization of dictatorship, revealing the involvement of orthodox Catholicism and its links with moral and racial hygiene. Second, we assess the transformation of mental hygiene during the 1950s towards modernization and a stronger linkage with the dominant trends of contemporary psychiatry without ever leaving the ideological background of Catholicism. For this purpose, we will focus on analysis of the activities of the Mental Hygiene Week held in Barcelona in 1954 and on the creation in 1955 of the National Board of Psychiatric Care, which took on mental hygiene as one of its functions. This paper shows the close relationship of mental hygiene during the early years of Francoism with the political principles of the Dictatorship. The 1940s witnessed the deployment of a harsh discourse in which mental hygiene was a tool for the (moral and spiritual) education of the Spanish people in the political principles of the "New State", pathologizing political dissent and ideologically purifying the country. In the 1950s, Francoist mental hygiene underwent a process of aggiornamento marked by international political events following the defeat of fascism in World War II, advancing a project for (authoritarian) modernization in an international context already directed towards mental health.

Authoritarianism and punitive eugenics: racial hygiene and national Catholicism during Francoism, 1936-1945

This paper examines some of the main elements that shaped eugenic discourse and practices during the first decades of the Franco regime. It primarily addresses the ideological basis of racial hygiene stemming from Francoist medicine and psychiatry, examining its relationship with the concept of Spanishness (Hispanidad). It shows that Francoist eugenics had punitive and coercive aspects and outlines the role it played in the brutal repression unleashed against the regime's political enemies, constructing its anti-Spanish identity. The paper also explores how the Catholic Church accepted eugenics as long as it was not linked to neo-Malthusianism and did not propagate sterilization, contraception, and abortion. In this respect, the paper examines the Catholic Church's position on the premarital certificate and counseling.

Progress towards human primordial germ cell specification in vitro

Primordial germ cells (PGCs) have long been considered the link between one generation and the next. PGC specification begins in the early embryo as a result of a highly orchestrated combination of transcriptional and epigenetic mechanisms. Understanding the molecular events that lead to proper PGC development will facilitate the development of new treatments for human infertility as well as species conservation. This article describes the latest, most relevant findings about the mechanisms of PGC formation, emphasizing human PGC. It also discusses our own laboratory's progress in using transdifferentiation protocols to derive human PGCs (hPGCs). Our preliminary results arose from our pursuit of a sequential hPGC induction strategy that starts with the repression of lineage-specific factors in the somatic cell, followed by the reactivation of germ cell-related genes using specific master regulators, which can indeed reactivate germ cell-specific genes in somatic cells. While it is still premature to assume that fully functional human gametes can be obtained in a dish, our results, together with those recently published by others, provide strong evidence that generating their precursors, PGCs, is within reach.

Fluctuations in Trypanosoma cruzi discrete typing unit composition in two naturally infected triatomines: Mepraia gajardoi and M. spinolai after laboratory feeding

Mepraia species are hematophagous insects and the most important wild vectors of Trypanosoma cruzi, the causative agent of Chagas disease in southeastern South America. Because the domestic Triatoma infestans is already controlled, the transmission of different T. cruzi discrete typing units (DTUs) by Mepraia species deserves attention. Our aim is to gather information on the diversity of T. cruzi DTUs circulating in natural insect populations. Two groups of naturally infected bugs 21 Mepraia gajardoi and 26 Mepraia spinolai were followed-up after two or more laboratory feedings by means of minicircle-PCR assays to evaluate the composition of four T. cruzi DTUs by hybridization tests. Fluctuations from positive T. cruzi detection to negative and the converse, as well as single to mixed infections with different T. cruzi DTUs and the opposite were frequent observations after laboratory feeding in both Mepraia species. Single and mixed infections with more than two T. cruzi DTUs were detected after the first feeding; however mainly mixed infections prevailed after the second feeding. Laboratory feeding on three or more occasions resulted in a decreasing trend of the parasite burden. In a comparison with 28 infected and fed M. gajardoi collected one year before from the same vector colony T. cruzi DTUs composition changed, indicating that temporal variations occur in T. cruzi. Natural populations of Mepraia species can transmit complex mixtures T. cruzi DTUs which fluctuate over time after feeding, with a tendency to eliminate the parasitism after prolonged feeding.

Hepatitis C virus long-term persistence in peripheral blood mononuclear cells in patients with haemophilia. Detection of occult genotype 1

Peripheral blood mononuclear cells (PBMC) from chronic hepatitis C virus-infected persons can harbour viral variants that are not detected in plasma samples. We explored the presence and persistence of HCV genotypes in plasma and PBMC cultures from 25 HCV-monoinfected and 25 HIV/HCV-coinfected patients with haemophilia. Cell cultures were performed at different time points between 1993 and 2010-2011, and the HCV genome was examined in culture supernatants. Sequential plasma samples were studied during the same time period. Analysing sequential plasma samples, 21% of patients had mixed-genotype infections, while 50% had mixed infections determined from PBMC culture supernatants. HIV coinfection was significantly associated with the presence of mixed infections (OR = 4.57, P = 0.02; 95% CI = 1.38-15.1). In our previous study, genotype 1 was found in 72% of 288 patients of this cohort. Similar results were obtained with the sequential plasma samples included in this study, 69% had genotype 1. However, when taking into account plasma samples and the results from PBMC supernatants, genotype 1 was identified in 94% of the population. The PBMC-associated variants persisted for 10 years in some subjects, emphasizing their role as long-term reservoirs. The presence of genotype 1 in PBMC may be associated with therapeutic failure and should not be disregarded when treating haemophilic patients who have been infected by contaminated factor concentrates. The clinical implications of persistent lymphotropic HCV variants deserve further examination among multiple exposed groups of HCV-infected patients.

Graphene oxide nanocapsules within silanized hydrogels suitable for electrochemical pseudocapacitors

Soft biocompatible gels comprised of rolled up graphene oxide nanocapsules within the pores of silanized hydrogels may be used as electrochemical pseudocapacitors with physiological glucose or KOH as a reducing agent, affording a material suitable for devices requiring pulses with characteristic time less than a second.

Genetic variability of hepatitis B virus in Uruguay: D/F, A/F genotype recombinants

Hepatitis B virus (HBV) infection is a serious global health problem. Approximately 2 billion people worldwide have been infected, and approximately 350 million individuals currently suffer from HBV-induced chronic liver infection, which causes 600,000 deaths annually from chronic hepatitis, cirrhosis and hepatocellular carcinoma. HBV is classified in eight genotypes (A-H), and two more have been proposed (I-J). In this paper, complete genome sequences of nine Uruguayan HBV are reported. Five samples belong to genotype F1b and one to genotype A2. Three HBV recombinants were detected: A1/F1b, A2/F1b and D3/F1b. The following mutations were detected: a G1896A substitution, a 33-nucleotide deletion from position 2896 to 2928 in the Pre-S1 region involving Pre-S1 residues 3-13, a 33-nt deletion in the Pre-S1 region involving nt 2913-2945 and Pre-S1 residues 9-19. More F genotypes strains than expected were detected in this study, supporting the hypothesis that there are more people of indigenous origin than declared in our population. Also, one third of the samples analyzed were recombinants. This cannot be explained by the low HBV prevalence in Uruguay, but a high HBV infection rate in drug addicts and dialysis patients could act in favor of multiple-genotype HBV infections that could lead to recombination.