Intraoperative Blood Salvage: A New Artificial Organ?

Optimal blood supply is critical to modern medical practice. Among the different possibilities of improving the quality and safety of blood, it is generally felt that autologous donation has played an important role and has contributed to changing transfusional practices, mainly since the appearance of HIV and HCV on the blood transfusion scene. At the San Martino Hospital Immunohematology Service, the autotransfusion era began in 1985. Autologous predeposit donation was the first to be introduced, followed by intentional perioperative hemodilution, intraoperative blood salvage with DFC apparatuses and lastly post-operative blood salvage. From about 200 autologous donations in 1985 we reached 5,372 in 1993 and more than 6,000 autologus donations are expected for 1994. Only 189 intraoperative blood salvages, were carried out in 1986, 593 in 1989, 1,207 in 1993 and more than 1,500 blood salvage sessions are anticipated for 1994. In the meantime, the total number of homologous RBC units employed in the Hospital dropped from 45,000 in 1985 to 18,000 in 1994, with the Onco-hematological Divisions using approximately 10,000 units of packed RBC.

Geographic variation in responses of European yellow dung flies to thermal stress

Climatic conditions can be very heterogeneous even over small geographic scales, and are believed to be major determinants of the abundance and distribution of species and populations. Organisms are expected to evolve in response to the frequency and magnitude of local thermal extremes, resulting in local adaptation. Using replicate yellow dung fly (Scathophaga stercoraria; Diptera: Scathophagidae) populations from cold (northern Europe) and warm climates (southern Europe), we compared 1) responses to short-term heat and cold shocks in both sexes, 2) heat shock protein (Hsp70) expression in adults and eggs, and 3) female reproductive traits when facing short-term heat stress during egg maturation. Contrary to expectations, thermal traits showed minor geographic differentiation, with weak evidence for greater heat resistance of southern flies but no differentiation in cold resistance. Hsp70 protein expression was little affected by heat stress, indicating systemic rather than induced regulation of the heat stress response, possibly related to this fly group's preference for cold climes. In contrast, sex differences were pronounced: males (which are larger) endured hot temperatures longer, while females featured higher Hsp70 expression. Heat stress negatively affected various female reproductive traits, reducing first clutch size, overall reproductive investment, egg lipid content, and subsequent larval hatching. These responses varied little across latitude but somewhat among populations in terms of egg size, protein content, and larval hatching success. Several reproductive parameters, but not Hsp70 expression, exhibited heritable variation among full-sib families. Rather than large-scale clinal geographic variation, our study suggests some local geographic population differentiation in the ability of yellow dung flies to buffer the impact of heat stress on reproductive performance.

Body weight and mortality in COPD: focus on the obesity paradox

The positive association between overweight, obesity, and cardiovascular and all-cause mortality is well established, even though this relation is typically U shaped with an increased risk also in low-weight subjects. However, being overweight or obese has been associated with a better prognosis in subjects suffering from chronic diseases, id est the "obesity paradox". In both community-dwelling and hospitalized patients with COPD, several studies have reported a significant protective effect of obesity on all-cause mortality, indicating that also in obstructive pulmonary diseases, an obesity paradox may be present. Interestingly, the "paradox" is more evident for subjects with severe bronchial obstruction (i.e., a lower FEV1), while in mild-moderate conditions, the weight-related mortality shows a behavior similar to that observed in the general population. Several factors may confound the relation between COPD, obesity and mortality. The lower FEV1 found in obese people may be linked to a restrictive defect rather than to an obstructive one. Due to the modified chest wall mechanical properties-related to increased fat mass-obese COPD patients may present, respect to their lean counterpart, a lower lung hyperinflation which is associated with higher mortality. The traditional classification of COPD attributes to obese "blue bloaters" a low-grade emphysema in opposition to lean "pink puffers"; the fact that emphysema extent is related to mortality may bias the relationship between weight and survival. It is also to underline that the majority of the studies, consider BMI rather than body composition (a better predictor of mortality) when studying the intriguing relation between weight, COPD, and mortality. Reverse bias has also to be taken into account, hypothesizing that an unintentional weight loss may be the deleterious factor related to mortality, rather than considering obesity a protective one. Further prospective studies are needed to shed light on the complexity of this emerging issue.

LEVEL OF EVIDENCE

Level V: Narrative Review.

Updated clinical overview on cardiac laminopathies: an electrical and mechanical disease

Cardiac laminopathies, associated with mutations in the LMNA gene, encompass a wide spectrum of clinical manifestations, involving electrical and mechanical alterations of cardiomyocytes. Thus, dilated cardiomyopathy, bradyarrhythmias and atrial or ventricular tachyarrhythmias may occur in a number of combined phenotypes. Nowadays, some attempt has been made to identify clinical predictors for the most life-threatening complications of LMNA-associated heart disease, i.e. sudden cardiac death and end-stage heart failure. The goal of this manuscript is to combine the most recent evidences in an updated review to show the state-of-the-art of such a complex disease group. This is supposed to be the starting point to collect more data and design new ad hoc studies to identify clinically useful predictors to stratify risk in mutation carriers, including probands and their asymptomatic relatives.

Effect of Finishing and Polishing on Roughness and Gloss of Lithium Disilicate and Lithium Silicate Zirconia Reinforced Glass Ceramic for CAD/CAM Systems

Objective:

To assess the efficacy of dedicated finishing/polishing systems on roughness and gloss of VITA Suprinity and IPS e.max CAD.

Method:

A total of 24 blocks of Suprinity and 24 of e.max were cut into a wedge shape using an InLab MC-XL milling unit. After crystallization, the 24 Suprinity wedges were divided into four subgroups: group A.1: Suprinity Polishing Set Clinical used for 30 seconds and group A.2: for 60 seconds; group A.3: VITA Akzent Plus Paste; and group A.4: spray. The 24 e.max wedges (group B) were divided into four subgroups according to the finishing procedure: group B.1: Optrafine Ceramic Polishing System for 30 seconds and group B.2: for 60 seconds; group B.3: IPS e.max CAD Crystall/Glaze paste; and group B.4: spray. After finishing/polishing, gloss was assessed with a glossmeter and roughness evaluated with a profilometer. Results were analyzed by applying a two-way analysis of variance for gloss and another for roughness (α=0.05). One specimen per each subgroup was observed with a scanning electron microscope.

Results:

For roughness, materials and surface were significant factors (p<0.001). Suprinity exhibited significantly lower roughness than e.max. Also the Material-Surface Treatment interaction was statistically significant (p=0.026). For gloss, both material and surface treatment were significant factors (p<0.001). VITA Suprinity showed significantly higher gloss than e.max. Also the Material-Surface Treatment interaction was statistically significant (p<0.001).

Conclusions:

Manual finishing/polishing for 60 seconds and glazing paste are the most effective procedures in lowering the roughness of CAD/CAM silica-based glass ceramics. Manual finishing/polishing for 60 seconds allows milled silica-based glass ceramics to yield a higher gloss. VITA Suprinity displayed higher polishability than IPS e.max CAD.

Comparative analysis of pathways to early intervention services and duration of untreated psychosis in two Canadian cities

AIM

Understanding pathways to early intervention services for psychosis in the local context is crucial, as the structure and organization of services need to be considered. This study compared pathways to early intervention services in two Canadian cities.

METHODS

Data on pathways to care and duration of untreated psychosis were collected from 171 people admitted to early intervention services in Toronto (n = 150) and Hamilton (n = 21). We compared the cities on several indicators of pathway to care and duration of untreated psychosis.

RESULTS

Pathways to care were more complex in Toronto, where people saw a greater number of health care services (median = 6, interquartile range = 3-9) than those in Hamilton (median = 3, IQR = 1-4). General practitioner involvement was higher in Toronto (56.0% vs. 33.3%). We did not find differences in the median duration of untreated psychosis.

CONCLUSIONS

Pathways to early intervention services could be streamlined, and general practitioners may be a target for strategies to improve pathways to care.

Self-compassion is associated with optimum self-care behaviour, medical outcomes and psychological well-being in a cross-sectional sample of adults with diabetes

AIM

To investigate the role of self-compassion in diabetes outcomes. Self-compassion is a construct which may be relevant to chronic conditions, given its focus on compassion toward oneself, especially in times of difficulty.

METHODS

In this cross-sectional study we collected data online from 310 adults diagnosed with diabetes. The questionnaire measured three primary outcomes: self-management behaviours; HbA_1c levels and psychological well-being. Potential predictors were also assessed, including self-compassion, locus of control, social support and demographics.

RESULTS

Multiple regression analyses showed that self-compassion had the most consistent association with better outcomes, including all forms of self-management behaviour, HbA_1c levels and psychological well-being. Self-compassion was independently associated with 55.1% of the variance in well-being. Internal locus of control was also significantly associated with better well-being and HbA_1c outcomes. Chance and external locus of control and social support were generally associated with poorer outcomes.

CONCLUSIONS

Higher levels of self-compassion are typically associated with improved self-management behaviour, medical outcomes and psychological well-being in adults with diabetes mellitus. The present findings suggest that self-compassion may be a parsimonious and suitable intervention target. Future interventions and consultations with medical professionals may benefit from fostering self-compassion in adults with diabetes mellitus.

Radiation resistance of elastomeric O-rings in mixed neutron and gamma fields: Testing methodology and experimental results

Materials and components employed in the presence of intense neutron and gamma fields are expected to absorb high dose levels that may induce deep modifications of their physical and mechanical properties, possibly causing loss of their function. A protocol for irradiating elastomeric materials in reactor mixed neutron and gamma fields and for testing the evolution of their main mechanical and physical properties with absorbed dose has been developed. Four elastomeric compounds used for vacuum O-rings, one fluoroelastomer polymer (FPM) based and three ethylene propylene diene monomer rubber (EPDM) based, presently available on the market have been selected for the test. One EPDM is rated as radiation resistant in gamma fields, while the other elastomers are general purpose products. Particular care has been devoted to dosimetry calculations, since absorbed dose in neutron fields, unlike pure gamma fields, is strongly dependent on the material composition and, in particular, on the hydrogen content. The products have been tested up to about 2 MGy absorbed dose. The FPM based elastomer, in spite of its lower dose absorption in fast neutron fields, features the largest variations of properties, with a dramatic increase in stiffness and brittleness. Out of the three EPDM based compounds, one shows large and rapid changes in the main mechanical properties, whereas the other two feature more stable behaviors. The performance of the EPDM rated as radiation resistant in pure gamma fields does not appear significantly better than that of the standard product. The predictive capability of the accelerated irradiation tests performed as well as the applicable concepts of threshold of radiation damage is discussed in view of the use of the examined products in the selective production of exotic species facility, now under construction at the Legnaro National Laboratories of the Italian Istituto Nazionale di Fisica Nucleare. It results that a careful account of dose rate effects and oxygen penetration in the material, both during test irradiations and in operating conditions, is needed to obtain reliable predictions.

Youth Mental Health, Family Practice, and Knowledge Translation Video Games about Psychosis: Family Physicians' Perspectives

OBJECTIVE

Family practitioners face many challenges providing mental healthcare to youth. Digital technology may offer solutions, but the products often need to be adapted for primary care. This study reports on family physicians' perspectives on the relevance and feasibility of a digital knowledge translation (KT) tool, a set of video games, designed to raise awareness about psychosis, marijuana use, and facilitate access to mental health services among youth.

METHOD

As part of an integrated knowledge translation project, five family physicians from a family health team participated in a focus group. The focus group delved into their perspectives on treating youth with mental health concerns while exploring their views on implementing the digital KT tool in their practice. Qualitative data was analyzed using thematic analysis to identify patterns, concepts, and themes in the transcripts.

RESULTS

Three themes were identified: (a) challenges in assessing youth with mental health concerns related to training, time constraints, and navigating the system; (b) feedback on the KT tool; and, (c) ideas on how to integrate it into a primary care practice.

CONCLUSIONS

Family practitioners felt that the proposed video game KT tool could be used to address youth's mental health and addictions issues in primary care settings.

A composite smeared finite element for mass transport in capillary systems and biological tissue

One of the key processes in living organisms is mass transport occurring from blood vessels to tissues for supplying tissues with oxygen, nutrients, drugs, immune cells, and - in the reverse direction - transport of waste products of cell metabolism to blood vessels. The mass exchange from blood vessels to tissue and vice versa occurs through blood vessel walls. This vital process has been investigated experimentally over centuries, and also in the last decades by the use of computational methods. Due to geometrical and functional complexity and heterogeneity of capillary systems, it is however not feasible to model in silico individual capillaries (including transport through the walls and coupling to tissue) within whole organ models. Hence, there is a need for simplified and robust computational models that address mass transport in capillary-tissue systems. We here introduce a smeared modeling concept for gradient-driven mass transport and formulate a new composite smeared finite element (CSFE). The transport from capillary system is first smeared to continuous mass sources within tissue, under the assumption of uniform concentration within capillaries. Here, the fundamental relation between capillary surface area and volumetric fraction is derived as the basis for modeling transport through capillary walls. Further, we formulate the CSFE which relies on the transformation of the one-dimensional (1D) constitutive relations (for transport within capillaries) into the continuum form expressed by Darcy's and diffusion tensors. The introduced CSFE is composed of two volumetric parts - capillary and tissue domains, and has four nodal degrees of freedom (DOF): pressure and concentration for each of the two domains. The domains are coupled by connectivity elements at each node. The fictitious connectivity elements take into account the surface area of capillary walls which belongs to each node, as well as the wall material properties (permeability and partitioning). The overall FE model contains geometrical and material characteristics of the entire capillary-tissue system, with physiologically measurable parameters assigned to each FE node within the model. The smeared concept is implemented into our implicit-iterative FE scheme and into FE package PAK. The first three examples illustrate accuracy of the CSFE element, while the liver and pancreas models demonstrate robustness of the introduced methodology and its applicability to real physiological conditions.

Diallel and prediction (REML/BLUP) for yield components in intervarietal maize hybrids

Genetic improvement is essential to achieve increments in maize (Zea mays L.) grain yield components. It may be obtained through crosses, which enable to exploit the effects of intervarietal heterosis, allelic complementarity, as well as gene actions and effects. This study estimated the components of variance and genetic parameters (REML/BLUP) of an intervarietal diallel to select and predict the best genotypes for maize yield components. The experimental design was randomized blocks containing 60 intervarietal maize hybrids arranged in three repetitions. They were obtained through intervarietal crosses and evaluated in a diallel scheme, where 14 open-pollinated varieties were designated as parentals. Thus, 10 crosses were performed for each hybrid combination to obtain the number of seeds necessary for the competition test. The measured traits were: grain volume relative index, the mass of one hundred grains, and grain yield. The male parents and the additive genetic fraction were determinants for grain volume relative index. Mass of one hundred grains and grain yield were defined by the specific combining ability, and female parents revealed low narrow sense heritability. The female parent Taquarão and male parent Argentino Amarelo presented the best general combining abilities for the measured traits. The specific combining abilities were expressed for crosses AL 25 x Dente de Ouro Roxo, AL 25 x BRS Pampeano, and Taquarão x Argentino Branco. Genetic estimates and predictions were consistent and applicable to breeding programs and could be applied in future quantitative genetic studies of maize.

Patients' Mental Health Journeys: A Qualitative Case Study with Interactive Computer-Assisted Client Assessment Survey (iCASS)

Despite growing concerns about common mental disorders (CMDs), challenges persist in accessing timely and appropriate care, especially for immigrant, refugee, racialized and low-income groups. Partnering with a community health centre serving these populations in Toronto, we examined the Interactive Computer-assisted Client Assessment Survey (iCCAS) that screens for CMDs (depression, generalized anxiety, post-traumatic stress, and alcohol overuse) and related social factors. In this case study design with embedded units, we explored the mental health care journeys of patients who screened positive for a CMD. The analysis identified three major pathways of care: (1) early detection of previously unidentified CMDs; (2) detection of comorbid mental health conditions; and (3) prevention of possible relapse and/or management of existing previously recognized mental health condition. These cases indicate iCCAS holds potential to facilitate more open, tailored, and informed collaborations between patients and clinicians regarding mental health care plans.

How long does the volumizing effect of a Zingiber officinale-based lip plumper last?

OBJECTIVE

Lip plumpers should enhance lip volume. It has been shown that no noticeable result was obtained after long term use of these products. The present study has been carried out to assess lip plumpers' short term effectiveness within 2 h from application.

METHODS

Effectiveness was assessed using non-invasive techniques. The effect on vascularisation was analyzed with the Mexameter MX 16® , and the volume enhancing effect was assessed by anthropometric measures and profilometry analysis from 3D scanning electron microscope (SEM) images using Alicona's MEX software. Sixty female volunteers were recruited for the study and the measurements were taken 15, 30, 60, 90 and 120 min after product application.

RESULTS

Product application produced a statistically significant increase of lip vascularisation during the first 15 min, which stayed unchanged until the 30th min, then decreased in intensity. The volumizing effect was revealed by 3D profilometry analysis only, not by anthropological measurements. The use of 3D SEM images showed an increase of 0.50 mm in the protrusion of the lip vermilion (MHP parameter) during the first 15 min from product application.

CONCLUSION

Results suggest that the lip plumper temporarily enhances vasodilation and increases lip volume.

No evidence for punishment in communally nursing female house mice (Mus musculus domesticus)

Punishment is claimed as an important mechanism to stabilise costly cooperation in humans, but its importance in social animals has been questioned recently due to both conceptual considerations and a lack of empirical evidence (only few published studies). We empirically tested whether there is evidence for punishment in communally nursing house mice (Mus musculus domesticus, direct descendants of “wild” animals). Communally breeding females pool their litters and raise all offspring together, indiscriminately caring for own and other offspring. Such a situation resembles a public good and provides scope for exploitation if females vary in their relative contributions to the joint nest (offspring number). We allowed two females to communally breed and conducted removal experiments both in the presence and absence of pups. We aimed to test whether reduced investment by one of the females (induced through separation from the partner and their combined offspring for 4 or 12 hours) leads to increased aggression by the other female after the reunion. We found no evidence for punishment, on the contrary, females increased socio-positive behaviours. The costs of losing a partner in a communally breeding species might be too high and hinder the evolution of punishment. Our findings add to a growing list of examples questioning the role of punishment in cooperating non-human animals and emphasise the importance of empirical testing of its assumptions and predictions.

Ideal cardiovascular health and inflammation in European adolescents: The HELENA study

BACKGROUND AND AIMS

Inflammation plays a key role in atherosclerosis and this process seems to appear in childhood. The ideal cardiovascular health index (ICHI) has been inversely related to atherosclerotic plaque in adults. However, evidence regarding inflammation and ICHI in adolescents is scarce. The aim is to assess the association between ICHI and inflammation in European adolescents.

METHODS AND RESULTS

As many as 543 adolescents (251 boys and 292 girls) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, a cross-sectional multi-center study including 9 European countries, were measured. C-reactive protein (CRP), complement factors C3 and C4, leptin and white blood cell counts were used to compute an inflammatory score. Multilevel linear models and multilevel logistic regression were used to assess the association between ICHI and inflammation controlling by covariates. Higher ICHI was associated with a lower inflammatory score, as well as with several individual components, both in boys and girls (p < 0.01). In addition, adolescents with at least 4 ideal components of the ICHI had significantly lower inflammatory score and lower levels of the study biomarkers, except CRP. Finally, the multilevel logistic regression showed that for every unit increase in the ICHI, the probability of having an inflammatory profile decreased by 28.1% in girls.

CONCLUSION

Results from this study suggest that a better ICHI is associated with a lower inflammatory profile already in adolescence. Improving these health behaviors, and health factors included in the ICHI, could play an important role in CVD prevention.