Preoperative scale proposal based on clinical outcome for elderly patients with ruptured intracranial aneurysms undergoing microsurgery

INTRODUCTION

Life expectancy in individuals has increased in recent years. There is no consensus in the literature on the best treatment for a ruptured aneurysm in the elderly (> 60 years), but some places only have microsurgery as a therapeutic strategy. This work aims to develop a prognostic scale for ruptured intracranial aneurysms in the elderly.

MATERIAL AND METHODS

Two thousand five hundred thirty patients with subarachnoid hemorrhage were retrospectively evaluated in the last ten years, and 550 of them were elderly. We developed a prognostic scale from the analysis of medical records, clinical and tomographic features that had statistical significance. Glasgow Coma Outcome (GOS) was the outcome of interest and p value < 0,05 was considered statistically significant.

RESULTS

Five hundred fifty patients were evaluated, and the comorbidities that were independent variables for poor prognosis were smoking and arterial hypertension; clinical variables were Hunt-Hess, modified Rankin and Glasgow Coma Scale; tomographic was Fisher scale. Poor outcome was defined as GOS ≤ 3. Poor surgical outcomes were more remarkable in the high-risk factor categories, being 6.41 times higher among individuals who had 3 to 4 risk factors and 8.80 times higher among individuals with 5 to 6 risk factors.

CONCLUSION

In some vascular neurosurgery services worldwide, microsurgery is the only therapeutic option. This scale aimed at the elderly patient individualizes the treatment and can predict the clinical outcome in ruptured intracranial aneurysms.

POS0596 SERUM CHOLESTEROL LOADING CAPACITY ON MACROPHAGES IS LINKED TO OXIDIZED LOW-DENSITY LIPOPROTEIN AND REGULATED BY SEROPOSITIVITY AND C-REACTIVE PROTEIN IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background

Excessive cholesterol accumulation in macrophages underlies foam cell formation, initiation and progression of atherosclerosis. LDL oxidation and unregulated uptake of oxidized LDL by macrophages are critical in foam cell development. Cholesterol loading capacity (CLC) is the ability of serum to deliver cholesterol to cells and is related to foam cell formation. Rheumatoid arthritis (RA) serum increased cholesterol content in macrophages and promoted foam cell formation significantly more than control serum1. Although inflammation, LDL oxidation and antibodies to oxidized LDL (anti-oxLDL) may be higher in RA, their relationships and their individual and synergistic contributions to CLC in RA are unknown.

Objectives

To explore determinants and moderators of serum CLC in patients with RA. We also investigated whether oxidized LDL influences CLC directly or indirectly through anti-oxLDL IgG and proprotein convertase subtilisin/Kexin type-9 (PCSK9), independently or conditionally on RA-related autoantibodies such as rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) or level of inflammation.

Methods

In an observational study of 104 patients, CLC was measured fluorimetrically as intracellular cholesterol content in human THP-1-derived macrophages after incubation with patient serum. Oxidized LDL was measured as oxidized phospholipids on apoB100 particles (oxPL-apoB100). Anti-oxLDL, PCSK9 and C-reactive protein (CRP) were also quantified. Associations of oxPL-apoB100, anti-oxLDL IgG and PCSK9 with CLC were examined with multivariable linear regression. A two-stage dual moderated mediation model explored whether an indirect association of oxPL-apoB100 with CLC through parallel mediators anti-oxLDL IgG and PCSK9 varied as a function of moderators CRP and RF/ACPA positivity.

Results

OxPL-apoB100, anti-oxLDL IgG and PCSK9 positively associated with CLC (all adjusted p<0.020). In the final dual moderated mediation model oxPL-apoB100 was directly linked to CLC only in dual seropositive patients (unstandardized b [95% bootstrap confidence interval]=2.08 [0.38-3.79], Figure 1). An indirect effect of oxPL-apoB100 on CLC through anti-oxLDL IgG was present and increased along with level of CRP (index of moderated mediation=0.55 [0.05-1.17]). CRP also moderated the other indirect effect of oxPL-apoB100 on CLC through PCSK9, but only in dual seropositive patients (conditional indirect effect=0.64 [0.13-1.30]).

Conclusion

Oxidized LDL can directly influence CLC in dual seropositive RA patients, regardless of CRP. This suggests that targeting LDL oxidation in addition to inflammation may enable a more comprehensive reduction of atherosclerotic risk in these patients. Depending on CRP level, oxidized LDL also affected CLC indirectly via anti-oxLDL IgG and via PCSK9 in dual seropositive patients. If externally validated, our findings may have clinical implications for cardiovascular risk stratification and prevention.

References

[1]Voloshyna I et al. Plasma from rheumatoid arthritis patients promotes pro-atherogenic cholesterol transport gene expression in THP-1 human macrophages. Exp Biol Med (Maywood) 2013;238:1192–7.

Disclosure of Interests

George Karpouzas Speakers bureau: Sanofi-Genzyme-Regeneron, Janssen, Bristol-Meyer-Squibb, Consultant of: Sanofi-Genzyme-Regeneron, Janssen, Bristol-Meyer-Squibb, Grant/research support from: Pfizer, Bianca Papotti: None declared, Sarah Ormseth: None declared, Marcella Palumbo: None declared, Elizabeth Hernandez: None declared, Cinzia Marchi: None declared, Francesca Zimetti: None declared, Matthew Budoff Consultant of: Pfizer, Nicoletta Ronda: None declared

OP0136 SERUM CHOLESTEROL LOADING CAPACITY ON MACROPHAGES AND INTERACTIONS WITH TREATMENTS ON CORONARY ATHEROSCLEROSIS BURDEN AND EVENT RISK IN RHEUMATOID ARTHRITIS

Background

Cholesterol loading capacity (CLC) describes the ability of serum to deliver cholesterol to cells. It is linked to foam cell formation, a pivotal step in atherosclerotic plaque development. Rheumatoid arthritis (RA) serum promoted foam cell formation significantly more than control serum. Likewise, RA patients display greater plaque burden and higher-risk features than non-RA controls. bDMARDs and statins lower cardiovascular risk by reducing new coronary plaque formation, promoting regression, altering the composition and stabilizing prevalent atherosclerotic lesions.

Objectives

To evaluate the associations between CLC, coronary plaque burden and cardiovascular event risk in patients with RA. We further explored the conditioning effects of RA treatments on these relationships.

Methods

140 patients underwent coronary CT angiography for atherosclerosis evaluation and were prospectively followed for cardiovascular events over 6.0±2.4 years. Coronary artery calcium score (CAC), number of segments with plaque (segment involvement score [SIS]) and plaque composition were assessed. CLC was the macrophage cholesterol content, measured by fluorometric assay, after a 24-hour incubation with whole serum. Robust linear regression examined the effects of CLC and the interaction between CLC and bDMARD use on SIS and CAC. Negative binomial regression evaluated CLC and CLC × bDMARD interaction effects on number of high-risk (low-attenuation) plaques. With data discretized into 1-month intervals, weighted pooled logistic regression models with robust variance estimation evaluated CLC and time-varying bDMARD use as predictors of event risk, and the effect of CLC × time-varying bDMARD use on risk. Stabilized inverse probability of treatment and censoring weights were estimated as a function of ASCVD risk, SIS, RA duration, and baseline and time-varying CRP and statin use.

Results

Mean (SD) CLC was 12.67 (2.83) μg/mg protein. In analyses adjusting for ASCVD score, HDL, prednisone and statin use, CLC (per 1-SD unit) was not related to SIS (β -0.05 [95%CI -1.19,0.09]), number of high-risk plaques (rate ratio [RR] 1.20 [95%CI 0.80-1.80]) or ln-transformed CAC (β 0.017 [95%CI -0.133,0.147]). However, in analyses stratified by baseline bDMARD use, CLC (per 1-SD unit) was positively related to number of high-risk plaques (RR 2.14 [95%CI 1.04-4.40]) and ln-transformed CAC (β 0.21 [95%CI 0.01-0.41]) among bDMARD-naïve individuals (Figure 1). In addition, CLC inversely associated with SIS (per SD increment; β -0.16 [95%CI -0.32, -0.01]) only in bDMARD-treated patients. Baseline statin use did not significantly modify the effect of CLC on coronary plaque (not shown). CLC associated with cardiovascular event risk (per SD increment; adjusted odds ratio 2.02 [95%CI 1.27-3.50], p=0.011) covarying for ASCVD score and time-varying bDMARD use. The CLC × time-varying bDMARD use interaction also predicted event risk (p =0.010); current bDMARD use associated with lower event risk at higher (1 SD above the mean) CLC levels (p=0.037) but not average or lower (1 SD below the mean) CLC levels (p=0.064 and 0.756, respectively).

Conclusion

CLC associated with greater CAC score and high-risk plaque burden in bDMARD-naïve RA patients and lower total plaque burden in bDMARD-treated patients at baseline. CLC also predicted long-term cardiovascular risk and its effect was mitigated by bDMARD use.

Disclosure of Interests

George Karpouzas Speakers bureau: Sanofi-Genzyme-Regeneron, Janssen, Bristol-Meyer-Squibb, Consultant of: Sanofi-Genzyme-Regeneron, Janssen, Bristol-Meyer-Squibb, Grant/research support from: Pfizer, Bianca Papotti: None declared, Sarah Ormseth: None declared, Marcella Palumbo: None declared, Elizabeth Hernandez: None declared, Cinzia Marchi: None declared, Francesca Zimetti: None declared, Matthew Budoff Consultant of: Pfizer, Nicoletta Ronda: None declared

One-step CZT electroplating from alkaline solution on flexible Mo foil for CZTS absorber

In this work, Cu-Zn-Sn (CZT) is co-electrodeposited onto a flexible Mo substrate exploiting an alkaline bath (pH 10). The plating solution is studied by cyclic voltammetry, highlighting the effects of potassium pyrophosphate (K4P2O7) and EDTA-Na2 on the electrochemical behavior and stability of the metallic ionic species. The optimized synthesis results in a homogeneous precursor layer, with composition Cu 44 ± 2 at. %, Zn 28 ± 1 at. %, and Sn 28 ± 2 at. %. Soft and reactive annealing are employed respectively to promote intermetallic phase formation and sulfurization of the precursor to obtain CZTS. Microstructural (XRD, Raman), morphological (SEM), and compositional (EDX, XRF) characterization is carried out on CZT and CZTS films, showing a minor presence of secondary phases. Finally, photo-assisted water splitting tests are performed considering a CZTS/CdS/Pt photoelectrode, showing a photocurrent density of 1.01 mA cm−2 at 0 V vs. RHE under 1 sun illumination.

Graphical abstract

Giant dumbbell C2C3 neurofibroma invading prebulbar cistern: Case report and literature review

Background:

Neurofibromatosis 1 (NF1) has a broad spectrum of clinical manifestations, most typically involving café-au-lait spots and skin neurofibromas. Only 2% of patients with NF1 have symptomatic spinal tumors.

Case Description:

A patient with a previous diagnosis of NF1 presented with cervicalgia, dysphagia/mild dysphonia, gait alteration, and progressive hypoesthesia involving all four limbs. The magnetic resonance documented a giant dumbbell neurofibroma arising between the C2 and C3 levels which extended toward the foramen magnum, causing medullary and bulbar compression. The major challenge of surgical management was the enormous size and location this C2–C3 (5 cm × 4 cm × 5.1 cm) lesion.

Conclusions:

Compression of the foramen magnum attributed to a dumbbell giant spinal neurofibroma at the C2C3 level resulting in prebulbar cisterns should be among the differential diagnostic considerations for patients presenting with tetraparesis and underlying NF1.

Vitamin D replacement ameliorates serum lipoprotein functions, adipokine profile and subclinical atherosclerosis in pre-menopausal women

BACKGROUND AND AIMS

Low vitamin D (vitD) has been linked to increased cardiovascular (CV) risk, but the effects of vitD supplementation are not clarified. We evaluated the impact of vitD normalization on HDL cholesterol efflux capacity (CEC), which inversely correlates with CV risk, the proatherogenic serum cholesterol loading capacity (CLC), adipokine profile and subclinical atherosclerosis.

METHODS AND RESULTS

Healthy premenopausal women with vitD deficiency (n = 31) underwent supplementation. Subclinical atherosclerosis was evaluated by flow-mediated dilation (FMD), pulse wave velocity (PWV) and augmentation index (AIx), measured with standard techniques. HDL CEC and serum CLC were measured by a radioisotopic and fluorimetric assay, respectively. Malondialdehyde (MDA) in HDL was quantified by the TBARS assay. Pre-β HDL was assessed by 2D-electrophoresis. Serum adipokines were measured by ELISA. VitD replacement restored normal levels of serum 25-hydroxyvitamin D (25OHD) and significantly improved FMD (+4%; p < 0.001), PWV (-4.1%: p < 0.001) and AIx (-16.1%; p < 0.001). Total CEC was significantly improved (+19.5%; p = 0.003), with a specific increase in the ABCA1-mediated CEC (+70.8%; p < 0.001). HDL-MDA slightly but significantly decreased (-9.6%; p = 0.027), while no difference was detected in pre-β HDL. No change was observed in aqueous diffusion nor in the ABCG1-mediated CEC. Serum CLC was significantly reduced (-13.3%; p = 0.026). Levels of adiponectin were increased (+50.6%; p < 0.0001) and resistin levels were decreased (-24.3%; p < 0.0001). After vitD replacement, an inverse relationship was found linking the ABCA1-mediated CEC with pre-β HDL (r² = 0.346; p < 0.001) and resistin (r² = 0.220; p = 0.009).

CONCLUSION

Our data support vitD supplementation for CV risk prevention.

Abducent nerve palsy after microballoon compression of the trigeminal ganglion: Case report

Background:

Trigeminal neuralgia (TN) is the most common type of facial neuralgia with incidence of 26.8/100,000 person year. In general, this scenario is characterized by a lancinating, unilateral, paroxysmal pain in the area of the fifth cranial nerve. Several treatment methods, including the injection of ethyl alcohol or butyl alcohol into the ganglion, the glycerol injection into the trigeminal cistern, peripheral nerve divisions, the radiofrequency thermocoagulation of the preganglionic fibers, and radiosurgery has been used for TN.

Case Description:

A case of a 74-year-old woman patient who undergone a treatment of TN through a compression of Meckel cave and developed a transient abducent palsy is presented. Complication regarding to a palsy of abducent nerve is discussed as well as the analysis of presumable evolving physiopathology. A critical review of literature was performed.

Conclusions:

Among the procedures, we mean that percutaneous microballoon compression (PMC) is the best choice for elderly frail patients, because it had a very low associated mortality-morbidity rate and does not damage permanent the Gasserian ganglion.

Gene flow and population structure of a common agricultural wild species (Microtus agrestis) under different land management regimes

The impact of landscape structure and land management on dispersal of populations of wild species inhabiting the agricultural landscape was investigated focusing on the field vole (Microtus agrestis) in three different areas in Denmark using molecular genetic markers. The main hypotheses were the following: (i) organic farms act as genetic sources and diversity reservoirs for species living in agricultural areas and (ii) gene flow and genetic structure in the agricultural landscape are influenced by the degree of landscape complexity and connectivity. A total of 443 individual voles were sampled within 2 consecutive years from two agricultural areas and one relatively undisturbed grassland area. As genetic markers, 15 polymorphic microsatellite loci (nuclear markers) and the central part of the cytochrome-b (mitochondrial sequence) were analysed for all samples. The results indicate that management (that is, organic or conventional management) was important for genetic population structure across the landscape, but that landscape structure was the main factor shaping gene flow and genetic diversity. More importantly, the presence of organically managed areas did not act as a genetic reservoir for conventional areas, instead the most important predictor of effective population size was the amount of unmanaged available habitat (core area). The relatively undisturbed natural area showed a lower level of genetic structuring and genetic diversity compared with the two agricultural areas. These findings altogether suggest that political decisions for supporting wildlife friendly land management should take into account both management and landscape structure factors.

Permanent genetic resources added to Molecular Ecology Resources Database 1 August 2012 - 30 September 2012

This article documents the addition of 83 microsatellite marker loci and 96 pairs of single-nucleotide polymorphism (SNP) sequencing primers to the Molecular Ecology Resources Database. Loci were developed for the following species: Bembidion lampros, Inimicus japonicus, Lymnaea stagnalis, Panopea abbreviata, Pentadesma butyracea, Sycoscapter hirticola and Thanatephorus cucumeris (anamorph: Rhizoctonia solani). These loci were cross-tested on the following species: Pentadesma grandifolia and Pentadesma reyndersii. This article also documents the addition of 96 sequencing primer pairs and 88 allele-specific primers or probes for Plutella xylostella.

Effects of antihypertensive treatments on incidence of diabetes: a case-control study

AIMS

Aim of this case-control study is the assessment of the relationship between antihypertensive treatment and incidence of diabetes in an unselected cohort of subjects participating in a screening program for diabetes.

METHODS

A case-control study nested within a cohort of nondiabetic subjects with a mean follow-up of 27.7 ± 11.3 months was performed, comparing 40 cases of incident diabetes and 160 controls matched for age, sex, body mass index, fasting plasma glucose, 2-h post-load glycemia, smoking and alcohol abuse.

RESULTS

When considering antihypertensive treatment at enrolment, a lower proportion of cases was exposed to ACE-inhibitors/angiotensin receptor blockers (ACE-i/ARB) in comparison with controls. A non-significant trend toward a higher exposure to diuretics, which were mainly represented by thiazide diuretics, was observed in cases. In a multivariate analysis, including both ACE-i/ARB and diuretics, a protective effect of ACEi/ARB, and an increased risk with diuretics were observed. Similar results were obtained in alternative models, after adjusting for systolic and diastolic blood pressure at enrolment, diagnosis of hypertension, concurrent treatment with β-blockers or calcium-channel blockers, and number of antihypertensive medications.

CONCLUSIONS

Diuretics seem to be associated with a higher incidence of diabetes, whereas treatment with ACEi/ARB could have a protective effect.

[Extensive cardiac angiosarcoma in the course of immunosuppressive therapy after kidney transplant]

We present a case of a 49-year-old man who underwent a kidney transplant. Treatment with azathioprine and steroid was increased due to an initial rejection of the allograft. Six months later, the patient experienced palpitations and precordial pain: the electrocardiogram recorded atrial fibrillation and the echocardiogram showed moderate pericardial effusion and the presence of a right atrial mass with infiltration into the interatrial septum and right ventricle. Computed tomography imaging confirmed the tumoral mass and magnetic resonance imaging revealed the extensive involvement of the right atrium, right ventricle and superior vena cava, suggesting the presence of an angiosarcoma of the heart. Despite chemotherapy the patient died within 1 month. The diagnosis was confirmed by autopsy, histological section, and electron microscopy examination.

[Lymphadenopathy caused by Toxoplasma in an intramammary lymph node: role of molecular biology in the diagnosis]

We describe a case of Toxoplasma gondii lymphoadenopathy in an intramammary lymph node in a 22 year old woman. Clinical evidence and ultrasound were suggestive for fibroadenoma, while cytology on fine needle aspiration suspected a lymphomatous lesion. The pathological examination demonstrated a lymph node with granulomatous foci with epithelioid histiocytes, consistent with Toxoplasma gondii lymphadenopathy. The pathological finding was confirmed by serological tests and by PCR (Polymerase Chain Reaction) using specific primers designed on ribosomal 18s DNA sequence of Toxoplasma gondii. The aim of this work is to emphasize the role of molecular biology techniques as an aid to pathological diagnosis in parasite diseases.

Control of post-operative infection in orthopaedic surgery. Clinical and bacteriological findings in 2555 elective operations

Post-operative infection is still a serious problem in orthopaedic surgery. Technological advances aimed at achieving aseptic conditions in the operating theatre, and the prophylactic use of antibiotics during operation have considerably reduced this complication during the last decade. Two indispensable factors in monitoring the effectiveness of these preventive measures are the determination of the incidence of post-operative infection and monitoring of the microbacterial population of the hospital.