Preserved vagus nerve stimulator function after radiation therapy

BACKGROUND

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

CASE PRESENTATION

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

CONCLUSION

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

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

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

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

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

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

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

Background

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

Methods

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

Results

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

Conclusions

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

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

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

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

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

Efficiency of Collisional O2 + N2 Vibrational Energy Exchange

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

Case report: Hallucinations as depressive equivalents

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

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Related factors with substance use in old adults

Intro

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

Aim

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

Method

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

Results

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

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

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

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

Conclusions

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

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Multifactorial Ethiopathogenic In Eating Disorders

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

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

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

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

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

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

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

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Brief psychotherapy in eating disorders

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

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Highly Electrically Conducting Glass-Graphene Nanoplatelets Hybrid Coatings

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

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

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