Pharmaceutical care in respiratory diseases: Current situation and opportunities for Hospital Pharmacy in Spain

OBJECTIVE

Respiratory diseases present a challenge for the healthcare system due to their prevalence and clinical impact. The aim of this study was to explore the current situation of hospital pharmacy in the field of respiratory diseases.

METHOD

Observational, cross-sectional study, with a national scope, divided into 2 parts. In an initial phase, the activity and level of pharmaceutical care in respiratory diseases was evaluated through an online questionnaire using REDCap. The survey was addressed to department chiefs and consisted of 17 items, divided into 2 modules: general data and general activity. The second phase was open to hospital pharmacists, with the aim of exploring their opinion on care, training, and improvement needs. The number of items in this phase was 19, divided into 5 modules: general data, pharmaceutical care, competencies, training and degree of satisfaction.

RESULTS

In the first phase, 23 hospitals were included. Most of them (n=20) had a pharmacist in charge of respiratory diseases. However, a large proportion of them dedicated less than 40% of their working day to this activity. The pharmacist's activity occurred at the level of external patients (n=20), hospitalized patients (n=16), and secondarily in management (n=8). Integration is greater in pathologies such as asthma, IPF, pulmonary hypertension, and bronchiectasis. Participation in committees was present in 15 hospitals, with variability in pathologies and degree of involvement. In the second phase, 164 pharmacists participated, who considered pharmaceutical care in cystic fibrosis, asthma and lung transplant as a priority. Fifty-one percent considered integration to be adequate and 91% considered it necessary to implement prioritization criteria. Professional competencies ranged from 6.5-6.9 out of 10 points. Only 45% of participants had received specific training in the last four years, indicating greater priority for asthma, pulmonary hypertension and IPF.

CONCLUSIONS

Most centers have pharmacists specialized in respiratory diseases. However, there is room for improvement in terms of sub specialization, participation in multidisciplinary committees, implementation of prioritization criteria, diversification in pathologies treated, as well as greater specific training in this area.

Factors affecting N-acetyl-β-D-glucosaminidase as an indicator for mastitis detection in dairy sheep

The study of new indirect methods for mastitis detection is of great relevance both at the economic level of the farm and dairies, and in terms of consumer health, and animal welfare. These methods help us to monitor the disease and speed up the decision-making process on treatment of the affected animal and the destination of the milk. The main aim of this work was to study the effect of intramammary infection and other non-infectious factors on the activity of the enzyme N-acetyl-β-D-glucosaminidase (NAGase) in milk, in order to evaluate its use as an indicator for the early diagnosis of mastitis in sheep that could be less expensive, easier to measure and a better marker of inflammation or complementary to existing methods such as somatic cell count (SCC). Seven biweekly samplings were carried out, in which NAGase activity, SCC and milk were analyzed. Glands were classified according to their sanitary status based on the results of the SCC and bacteriological analysis. Non-infectious factors such as lactation stage, parity number and milking session had a statistically significant effect on NAGase values, finding the highest NAGase values at the onset and end of the study, in infectious mastitic glands of multiparous females and at morning milking. However, among the NAGase variation factors studied, the health status of the gland was the factor that caused the highest variation in enzyme levels, with infectious mastitic glands showing higher values than healthy glands. The predictive ability of NAGase was also studied by means of several logistic regression models, with the one that included NAGase together with lactation stage and parity obtaining the best results if sensitivity is to be prioritized, or the model that included NAGase, lactation stage, parity, milking and production if specificity is to be prioritized. From the results obtained, it can be concluded that the use of NAGase as an intramammary infection detection method in sheep can be useful when non-infectious factors that cause changes in the concentration of the enzyme are also considered.

Consensus on the Approach to Hydrosaline Overload in Acute Heart Failure. SEMI/SEC/S.E.N. Recommendations

Most of the signs and symptoms of heart failure can be explained by fluid overload, which is also related to disease progression. Fluid overload is a complex phenomenon that extends beyond increased intravascular pressures and poses challenges for accurate diagnosis and effective treatment. Current recommendations advise a multiparametric approach, including clinical data (symptoms/signs), imaging tests, and biomarkers. This article proposes a practical therapeutic approach to managing hydrosaline overload in heart failure in both inpatient and outpatient settings. This document is an initiative of the Spanish Society of Internal Medicine in collaboration with the Spanish Society of Cardiology and the Spanish Society of Nephrology. Full English text available from: www.revespcardiol.org/en.

The therapeutic potential of relaxin for heart failure with preserved ejection fraction

Background and significance

Heart Failure (HF) is the leading cause of cardiovascular deaths and ∼50% of HF patients have HF with preserved ejection Fraction (HFpEF). HFpEF patients typically have co-morbidities such as atrial fibrillation (AF), diabetes, lung edema and hypertension. The latter is a predictor of mortality and is targeted to prolong survival given the lack of a direct therapy for HFpEF. To address this unmet public health problem, we investigate the therapeutic potential of the insulin-like hormone Relaxin (RLX) in a rat model of HFpEF that recapitulates most aspects of clinical HFpEF.

Methods

ZSF1 diabetic rats were placed on a high fat diet (HFD for 11-weeks) and echocardiograms were used to track HFpEF development. At week 20, osmotic mini-pumps were implanted to release vehicle (Na-acetate) or RLX (400μg/kg/day, 2-weeks). Hearts were then perfused with a voltage-sensitive dye (RH237) and a Ca2+ indicator (Rhod-2/AM) to optically map action potentials and Ca2+ transients and analyze arrhythmia phenotype. Left ventricular (LV) tissue sections were used for immune-fluorescence (IF) imaging for changes in fibrosis (collagen 1), connexin 43, Wnt1 and β-catenin in LV myocytes. Blood draws were taken to measure changes in serum NT-pro-ANP, ET-1 and RLX.

Results

ZSF1 rats on a HFD developed HFpEF with E/e' (an echo marker of diastolic dysfunction) decreasing to −24.4 from −17.9 MV (n=12) and was reversed to −18.6 MV by RLX (n=6, p<0.0001). In HFpEF rats that received the vehicle (n=6), a premature stimulus (S1-S2= 40 ms) elicited: a) no arrhythmia b) non-sustained AF or c) sustained AF, with (1/3 of rats in each group). RLX blocked sustained supraventricular (n=0/12) and n=4/12 had non-sustained AF. RLX improved conduction velocity (CV), at short cycle lengths (150 ms) from 0.74 to 0.9 m/s (n=4/group). IF indicated that RLX increased Cx43 (26.8±0.03%, p<0.0001, n=6), and β-catenin (52.8±0.05%, p<0.0001) at intercalated disks. RLX reduced collagen deposition in HFpEF rats (25±0.04%, p<0.04, back to normal) and caused a marked increase of cytosolic Wnt1 (47.3±0.06%, p<0.0001). IF data are given as mean ± SEM.

Conclusions

The ZSF1 diabetic rat on a high-fat diet recapitulates most of the phenotypes associated with human HFpEF, including atrial arrhythmias, fibrosis, and lung edema. RLX treatment post-development of HFpEF reversed the pro-arrhythmic phenotype, increased conduction velocity particularly at fast heart rates, reversed fibrosis, reduced NT-pro-ANP and ET-1 in male rats. Most intriguing, RLX treatment activated Wnt1 and β-catenin indicating that the beneficial actions of RLX occur via genomic remodeling of the heart.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Relaxera Pharmazeutische Gesellschaft mbH & Co. KGStubenwald-Allee 8a, 64625 Bensheim, Germany & Uhlandstraße 4-5, 10623 Berlin, Germany

Comparison of ELISA using recombinant LipL32 and sonicated antigen of leptospira for detecting bovine leptospirosis

Leptospirosis is one of the most widely distributed zoonosis in the world. Bovine leptospirosis is a serious problem in bovine production, causing reproductive losses. The aim of this work was to compare recombinant LipL32 with sonicated antigen for detecting anti-Leptospira IgG antibodies in bovine serum using ELISA. The Microscopic Agglutination Test (MAT) is used as the gold standard. Sonicated antigen from cultures of Leptospira interrogans serogroup Icterohaemorrhagiae serovar copenhageni (strain M20) was used for the eELISA and rLipL32 for the rELISA. The performance of these assays was evaluated using serum samples from 166 bovines, 69 MAT positive and 97 MAT negative. At the optimal cut-off point recommended by the receiver operating characteristic (ROC) curve analysis, the sensitivity and specificity values were 98.6% and 97.9%, respectively, for eELISA, and 85.5% and 86.6% respectively, for rELISA. The value for the area under the ROC curve was 0.998 (0.994-1.0) (CI 95%) for eELISA and 0.929 (0.891-0.968) (CI 95%) for rELISA. The ROC curves for rLipL32 and sonicated antigen showed statistically significant differences (z = -3.826; p = 0.000). A three-way comparison showed statistically significant differences in the sensitivity and specificity of rELISA and eELISA. Our results showed that eELISA was more specific and sensitive than rELISA. The difference in performance (eELISA-rELISA) was 13.4% (4.03-23.28) (CI 95%) for sensitivity and 11.34 % (4.07-19.56) (CI 95%) for specificity. Our results show that the eELISA has a better diagnostic performance than rELISA for the detection of anti-Leptospira IgG antibodies in bovine serum.

Efficient Design of Thin Wall Seating Made of a Single Piece of Heavy-Duty Corrugated Cardboard

Corrugated cardboard has waved cores with small flutes that prevent the use of detailed numerical models of whole structures. Many homogenization methods in the literature overcome this drawback by defining equivalent homogeneous plates with the same mechanical behaviour at a macro-mechanical scale. However, few homogenization works have considered complete structures, focusing mainly on beams or plates. For the first time, this study explores the application of homogenization approaches to larger structures as an aid in their design process. We also considered triple-wall boards rather than single- and double-wall configurations commonly addressed in the literature. To this end, we adapted the homogenization methods proposed by Talbi and Duong to analyze thin-walled stools made of triple-wall corrugated cardboard. Using a progressive design process, we performed an efficient stool design by removing material zones with lower stresses, with 35% less material, 35% lower vertical deflections, and 66% lower stresses than the initial design. Unlike other corrugated cardboard stools, this design comprises just one folded piece instead of three, thus saving storage space. These results demonstrate the utility of homogenization techniques as an aid in the design process of whole structures made of corrugated cardboard. Further research will consider buckling analysis.

FC 134WATER SAVING COMPARISON AT DIFFERENT DIALYSATE FLOWS IN EXPANDED HEMODIALYSIS

Background and Aims

Expanded hemodialysis (HDx) improves clearance of middle molecules as a target for uremia treatment. According to previously published results, high cut off filters have high enough clearance to allow diminishing of dialysate flow (Qd) without detrimental in HD adequacy outcomes with less water waste.

According to World Health Organization (WHO), globally, almost 800 million people lack access to safe water and 2.5 billion lack access to optimal sanitation. Is our duty to search for ways to avoid water waste.

Our aim is to describe the differences in water use between HDX patients receiving Qd 400 mL/min (Group 1) vs 500 ml/min (group 2) in HD patients from 10 renal clinics in Colombia as an alternative to reduce water waste in chronic HD as a strategy from Blue Planet Dialysis initiatives.

Method

We performed a Sub-analysis of CORHEX Study: We calculated water use at different Qd from our database: prospective, multicentre, observational cohort study of 992 adult patients undergoing chronic HD from 12 renal clinics in Colombia who were switched from high-flux HD to MCO therapy and observed for 12 months. All patients were prescribed with HDX three times a week for a minimum of 4 hours.

We analysed patients with weight lower than 70 Kg at different Qd prescriptions to calculate water use at different Qd prescriptions and performed a prediction analysis, adjusting to Qd 400 mL/min, the whole potential population with weight lower than 70 Kg.

Results

462 patients with weight lower than 70 Kg were analysed, 127 patients received Qd 400 mL/min.

When diminishing Qd from 500 to 400 mL/min, 24 litres were saved per session per patient without detriment of middle molecule clearance. There were no differences in adequacy HD parameters between Qd prescriptions (Table 1 and 2).

Conclusion

HDX allows lowering of Qd to 400 mL/min without harm for patients and with remarkable savings of potable water: 24 Litres were saved in each session per patient that can be translated in almost 3500 Litres of water each year by patient which is enough for one year for 47 adults. (Based on the WHO minimum for basic health protection of at least 20 L per person/day) (2).

We consider our results especially relevant since the World Health Organization estimates that within the next 5 years, over 50% of world population could reside in geographies lacking sufficient access to water.

We hope that our results from the Blue Planet dialysis research group, alongside with Dr. Agar`s and Dr. Barraclough`s green nephrology initiatives, can help educate the nephrology community on the ecological impact of dialysis and can present an innovative solution to offer HD therapy even in countries suffering from limited access to potable water.

MO301RITUXIMAB FOR RELAPSING MEMBRANOUS NEPHROPATHY: A SPANISH HOSPITAL EXPERIENCE

Background and Aims

B cell targeting agent Rituximab has been proven to be effective and safe for the treatment of idiopathic membranous nephropathy (iMN) in previous studies with nearly 75% achievement of partial or complete remission of nephrotic syndrome. The aim of this study was to evaluate this treatment in a cohort of patients at Complejo Hospitalario de Navarra with relapsing disease.

Method

This is a retrospective, cross sectional study including 12 patients with membranous nephropathy diagnosed by means of a kidney biopsy. All of them were treated before with different immunosuppressive regimens and had a relapse at the time of the inclusion. All of them were treated with two iv infusions of Rituximab. In this study we report patient clinical and immunological baseline characteristics and treatment response at 12 months of follow up.

Results

Between 2015-20 a total of 12 patients (41,6% women and 58,3% men) were treated with two iv infusions of Rituximab with a total mean dose of 2gr. All of them diagnosed previously of iMN, and 10/12 were PLA2r positive. Baseline laboratory data showed serum creatinine levels 1,3±0,9 mg/dl, serum albumin 29±9 g/L, 24 hour- urinary protein excretion of 6,8±3,2 and serum PLA2R levels of 50,54±63,2 RU/ml. Either complete or partial response (CR and PR) were achieved in 83,3% of the cases, however only 3/12 (25%) patients had a complete response at 12 months follow up. All patients who responded had also a significative decrease PLA2r antibodies. Three of the patients who did a PR were treated with an incomplete dose of iv Rituximab (two infusions of 500mg).

Conclusion

Rituximab was effective in our cohort of patients with iMN with achievement of 83,3% response at 12 months of follow up, however only 25% of patients had complete response maybe due to incomplete dosing. Immunological response was seen in all patients. Still, a longer follow up of these patients is needed in order to evaluate Rituximab response.

MO401RENAL ANGINA INDEX IN ADULT CRITICAL CARE PATIENTS IN A POPULATION FROM BOGOTÁ – COLOMBIA

Background and Aims

Clinical outcomes of Acute Kidney Injury (AKI) in ICU mainly depend on opportune preventive strategies. Thus, early identification of AKI is mandatory, and alternative diagnostic strategies become plausible: one of them, Renal Angina Index (RAI), described by Matsuura¹, predicts the development of AKI KDIGO 2-3, at 7th day after admission to the intensive care unit according to a cut-off point >6 on a scale with a “creatinine score” (determined by the difference in serum creatinine between that at ICU admission and the first 24 hours in the ICU) and the impact of the patients medical history.

¹Kidney Int Rep (2018) 3, 677-683.

Our aim is to describe predictive capacity of the Renal Angina Index (RAI) in adult critical care patients in our population.

Method

We retrospectively selected from our Critical Care Nephrology database adult patients admitted in any of our hospital`s ICU between February to August 2020, excluding those at admission with diagnosis of AKI, serum creatinine > 2.5 mg/dl, or those receiving dialysis (acute or chronic) or kidney transplantation. We defined AKI according to KDIGO criteria. The RAI score was defined as the worst condition score multiplied by the creatinine score. The performance of the RAI score was assessed by Receiver Operating Characteristic (ROC) analysis power to detect a difference of 0.2 between the area under the curve (AUC), under the null hypothesis of AUC = 0.5 (no diagnostic accuracy). The optimal cut point was estimated with the Youden method.

Results

From 1204 new ICU patients, we included 372 patients (women 40.3%), with mean age 60.9 (18-98) (table 1). Main indication for ICU admission was medical conditions. Mean APACHE II was 22.9, hemodinamic support was required in 41,1% patients, mechanical ventilation in 58.6% patients and diabetes mellitus was present in 21.5% patients.

AKI KDIGO 2-3 developed in 26.8% of patients.

Mean creatinine at admission was statistically different in patients with AKI (CI 0.95 –0.51 - --0.15 mg/dl, p=0.0004). The requirement of hemodynamic (p = 0.003) and ventilatory support (p = 0.009), sepsis (p = 0.003), and COVID-19 (p = 0.03) were more frequent in patients who developed AKI. Renal replacement therapy was required in 39 (60%) of patients with severe AKI (incidence 10,5%).

RAI cutt-off point determined by Youden method in the overall sample was 24, being significantly higher in patients who developed AKI (16.54 Vs 7.47, CI 0.95 –13.5--4.99, p <0.001).

A cut-off point of 24 was required for the Best predictive capacity for severe AKI, with sensitivity, specificity, positive and negative likelihood ratio of 34%, 94%, 5.5 and 0.7 respectively.

Conclusion

In our population, RAI score requires a cutoff point much higher than that originally described to predict the development of severe AKI. Losing its discriminatory capacity.

Numerical modelling of blood clot extraction by aspiration thrombectomy. Evaluation of aspiration catheter geometry

Aspiration thrombectomy is one of the most effective systems for blood clot removal and vessel recanalization. We present the results of a study involving the modelling and extraction of blood clots in the arteries of the human body using the following computer tools: Bond-Graph methodology for the fluid domain and Multi-Body Simulation for the mechanical domain. The modelling for the mechanical domain focuses on the clot and the distal end section of an aspiration device. Our final model considers an elastic characterization of the blood clot with progressive detachment from the vessel wall. We conclude that the results of such modelling could potentially improve the effectiveness of blood clot removal by reducing the risk of clot fragmentation. Such modelling could also potentially provide an adjunct technique in improving recanalization of arteries over a range of given parameters (mechanical properties of the vessel, mechanical properties of the blood clot, blood clot length, suction pressure, catheter - clot distance, catheter shape, catheter diameter and vessel occlusion).

Effect of the pulsation type (alternate or simultaneous) on milk yield and health status of the mammary gland of Murciano-Granadina goats

Recent research into how the pulsation type affects goat milking concluded that alternate pulsation (AP) and simultaneous pulsation (SP) similarly affect the milking efficiency (milking duration and milking fractioning) and teat end condition after milking when both pulsations are employed in short-term experiments. However, the use of SP in high pipeline milking machines led to higher vacuum fluctuations, which, in the long term, may entail a potential risk factor for the mammary gland health status. The aim of this work was to study how AP and SP affect the milk yield, mammary gland health status, and milk composition of goats in the long term, during a complete lactation period, in a high pipeline milking machine. With this objective, 100 Murciano-Granadina goats with similar parturition dates (4 ± 1 postpartum weeks) were divided into 2 similar groups (50 goats per group) according their parity, milk yield, mammary gland health status, and milking duration (after a 15-d pre-experimental period). Throughout the experimental period (7 mo), one group was milked using SP and the other group using AP. Every month, samplings were carried out of the variables related to sanitary status of the mammary gland, milk fractioning, milking duration, average and maximum milk flows, milk composition, teat end status, vacuum fluctuations at the short milk tube during milking, and pulsation tests. Results showed that the use of SP in a high pipeline milking machine showed higher vacuum fluctuations without involving any difference in the other variables studied. We concluded that the use of AP in the milking of Murciano-Granadina goats offers little improvement of the milking performance and increases the investment required for installation and maintenance of the milking machines.

Incoherent-mediator for quantum state transfer in the ultrastrong coupling regime

We study quantum state transfer between two qubits coupled to a common quantum bus that is constituted by an ultrastrong coupled light-matter system. By tuning both qubit frequencies on resonance with a forbidden transition in the mediating system, we demonstrate a high-fidelity swap operation even though the quantum bus is thermally populated. We discuss a possible physical implementation in a realistic circuit QED scheme that leads to the multimode Dicke model. This proposal may have applications on hot quantum information processing within the context of ultrastrong coupling regime of light-matter interaction.

Day-care unit for rigid panendoscopy of the upper aerodigestive tract: A study of 436 procedures

OBJECTIVES

To assess the role of day-care management of upper aerodigestive tract (UADT) panendoscopy and to study criteria for conventional hospital admission and reasons for conversion.

PATIENTS AND METHODS

Retrospective study, from January 2011 to May 2013. Inclusion criteria UADT panendoscopy for carcinoma assessment. Study variables, age, gender, tumor location, reason for panendoscopy, TNM stage, previous external radiotherapy, home-to-hospital distance and Apfel, Detsky and ASA scores. A day-care and a conventional admission group were compared using Fisher's test for ASA score, student's test for age and Pearson's chi² test for the other variables.

RESULTS

Four hundred and thirty-six panendoscopies were performed: 252 in day-care, including 4 cases of conversion and 184 with conventional admission. There were no significant differences between groups for age, gender, tumor location, TNM stage, reason for panendoscopy, previous external radiotherapy, home-to-hospital distance or Apfel score. A significant difference was observed for ASA score (P<0.0001) and Detsky score (P=0.03). In 39% of cases, the reason for hospital admission without criteria defined by the French Society of Anesthesia and Intensive Care Medicine (SFAR) and French Health Authority (HAS) was the patient's refusal of day care. In 10% of conventional admissions, day-care was not implemented because of psychosocial factors.

CONCLUSION

Day-care management is appropriate for UADT panendoscopy in selected patients. The reasons for the high rate of patient refusal should be studied.

Monitoring CD27+ memory B-cells in neuromyelitis optica spectrum disorders patients treated with rituximab: Results from a bicentric study

BACKGROUND

Rituximab (RTX) is increasingly used in the treatment of neuromyelitis optica spectrum disorder (NMO-SD). Administration regimen is not consensual as there is no reliable biomarker of RTX efficacy. In most cases, after induction, RTX is administered systematically every 6months.

OBJECTIVE

To assess efficacy and safety of a maintenance regimen based on CD19+ CD27+ memory B-cell (mBc) detection.

METHODS

We conducted a study in two French centers, including patients with NMO-SD who received an induction therapy with RTX. We compared the number of administered infusions, relapses and EDSS depending on two maintenance schemes (S1: administration of 1g RTX infusion every 6months or S2: a scheme based on regular mBc detection. 1g RTX was administered if mBc was >0.05%) RESULTS: 40 patients were included (mean age: 40.2years, F/M sex ratio: 5/1). Aquaporin-4 antibodies were positive in 75% patients. Under S1 regimen, all patients received 2 infusions per year, whereas under S2, they received 1.62 infusion per year. The mean interval between infusions under S2 was 7.4months, without decrease of clinical efficacy.

CONCLUSION

In our study, mBc-based administration of RTX allowed personalizing treatment administration and in several cases to lower the cumulative dose without loss of efficacy.

Relationship of mammary gland health status and other noninfectious factors with electrical conductivity of milk in Manchega ewes

Measuring the electrical conductivity (EC) of milk during milking has been extensively studied in cattle as a low-cost mastitis detection method that can be easily automated. The aim of this work was to study the effect of the health status of the glands and several noninfectious factors (lactation stage, milking session, and lactation number) that affect the use of EC measurement of milk to detect mastitis in dairy sheep livestock. Likewise, we studied the relation between EC and milk composition (macrocomposition and mineral content) and between EC and somatic cell count (SCC). Finally, we evaluated the use of EC thresholds as a mastitis detection method. To this end, we monitored the glandular milk EC throughout 2 consecutive lactations, during which 42 and 40 ewes were controlled, respectively. We carried out 7 biweekly checks, analyzing the EC, SCC, composition, and mineral content of glandular milk at morning and evening milkings. Before the morning milking, samples were aseptically collected for bacteriological analysis, and the results along with the SCC were used to classify the glands according to their sanitary status (healthy, latently infected, or infected). Lactation stage, parity, milking (morning or evening), health status, and the interactions of parity with health status, lactation stage with health status, and parity with lactation stage all had a significant effect on SCC and EC of the milk. The correlation between EC and SCC was only significant when all the data were analyzed jointly (r = 0.33) and for SCC ≥ 600.000 cells/mL (r = 0.25). The changes in milk composition, mainly in fat content, largely explained the variation in EC (R² = 0.69). For the same EC threshold, the specificity and sensitivity varied depending on the parity or the milking, with the negative predictive value obtained being higher than the positive predictive value at all times. We concluded that developing methods of detecting mastitis in sheep by milk EC readings would require consideration of noninfectious factors that also affect the gauging of EC. One option to consider would be individualized daily monitoring of the glands, as demonstrated in other species such as cattle and goat.

Spontaneous Regression of Intracranial Arteriovenous Malformations

Spontaneous and complete regression of cerebral arteriovenous malformations has rarely been reported in the literature. We describe two new cases with a literature review.

Neuromyelitis optica: Contribution of therapeutic responses markers monitoring in patients given rituximab

Neuromyelitis optica (NMO) is a central nervous system inflammatory autoimmune disease characterized by medullary and/or optical nerve damage. It is rare but life-threatening. Concerning the treatment of NMO, many drugs have been used in background therapy. Some studies have shown efficacy of rituximab (an antiCD20 monoclonal anti-body) either on the reduction of the annual number of exacerbation or the mean score EDSS. In 2013, a Korean team reported a new protocol during which they administered rituximab only when memory B lymphocytes CD27+ were detectable in the bloodstream. In our patient, institution of this protocol led to clinical benefit with a major decrease in the EDSS score over time (7 in August 2012 vs. 1 in October 2015), a reduction of the total administered dose (4g in 2013 vs. 1.375g in 2014 vs. 0g in 2015) and side effects. Compared with the rate of theoretical administration, health expenditure savings reached 1700 Euros per month over the 11-month treatment. Monitoring therapeutic response markers with memory B lymphocyte counts appear to be an efficient cost-effective way to measure clinical efficiency, reduce total doses, and limit side effects.

Effect of puerperal metritis on reproductive and productive performance in dairy cows in Argentina

The objectives of this study were to evaluate the reproductive and productive performance of dairy cows with and without puerperal metritis and to evaluate the effectiveness of using a long-acting ceftiofur preparation. Dairy cows in one dairy farm, calving from July 2009 to January 2010, were examined between 3 and 14 days postpartum and classified on the basis of vaginal discharge into three groups: cows with normal discharge (control; C); cows with a bloody mucus purulent or pathologic nonfetid discharge (PnFD), and cows with bloody mucopurulent or purulent fetid discharge (PFD). Cows in C and PnFD groups were not treated, whereas those in the PFD group were randomly allocated to receive 2.2 mg/kg of ceftiofur subcutaneously behind the ear (PFD-T) or remain untreated (PFD-No T). From the 640 cows examined, 58.2% formed the C group, 13.4% formed the PnFD group, and 28.4% formed the PFD group. Survival curves differed between cows in the C group and PFD-No T group (P = 0.0013) and between PFD-No T versus PFD-T group (P = 0.0006). Survival curves of PnFD were intermediate and did not differ from those in the C group (P = 0.2) and PFD-T group (P = 0.1) but tended to be different from the PFD-No T group (P = 0.056). The postpartum interval to achieve a 25% pregnancy rate was 72 days for cows in the C group, 73 days for the PFD-T group, 83 days for PnFD group, and 95 days for the PFD-No T group. The chance of pregnancy in a cow in the C group was 1.98 times higher (95% confidence interval = 1.33, 3.08) and in cows in the PFD-T group was 2.16 times higher (95% confidence interval = 1.37, 3.50) than that in the PFD-No T group. Finally, the chance of pregnancy in cows in the PnFD group tended to be higher (P = 0.08) than that in the PFD-No T group but did not differ from the other two groups. Cumulative 305-day milk production was higher (P < 0.0001) in C group than those with vaginal discharge, regardless of fetidness and regardless of treatment. It is concluded that puerperal metritis affects the reproductive and productive performance of dairy cows and the treatment with ceftiofur was effective in reducing the adverse effects on reproductive performance but not on milk production.

Quantum Rabi Model with Trapped Ions

We propose the quantum simulation of the quantum Rabi model in all parameter regimes by means of detuned bichromatic sideband excitations of a single trapped ion. We show that current setups can reproduce, in particular, the ultrastrong and deep strong coupling regimes of such a paradigmatic light-matter interaction. Furthermore, associated with these extreme dipolar regimes, we study the controlled generation and detection of their entangled ground states by means of adiabatic methods. Ion traps have arguably performed the first quantum simulation of the Jaynes-Cummings model, a restricted regime of the quantum Rabi model where the rotating-wave approximation holds. We show that one can go beyond and experimentally investigate the quantum simulation of coupling regimes of the quantum Rabi model that are difficult to achieve with natural dipolar interactions.

Scalable quantum memory in the ultrastrong coupling regime

Circuit quantum electrodynamics, consisting of superconducting artificial atoms coupled to on-chip resonators, represents a prime candidate to implement the scalable quantum computing architecture because of the presence of good tunability and controllability. Furthermore, recent advances have pushed the technology towards the ultrastrong coupling regime of light-matter interaction, where the qubit-resonator coupling strength reaches a considerable fraction of the resonator frequency. Here, we propose a qubit-resonator system operating in that regime, as a quantum memory device and study the storage and retrieval of quantum information in and from the Z2 parity-protected quantum memory, within experimentally feasible schemes. We are also convinced that our proposal might pave a way to realize a scalable quantum random-access memory due to its fast storage and readout performances.

Fermion-fermion scattering in quantum field theory with superconducting circuits

We propose an analog-digital quantum simulation of fermion-fermion scattering mediated by a continuum of bosonic modes within a circuit quantum electrodynamics scenario. This quantum technology naturally provides strong coupling of superconducting qubits with a continuum of electromagnetic modes in an open transmission line. In this way, we propose qubits to efficiently simulate fermionic modes via digital techniques, while we consider the continuum complexity of an open transmission line to simulate the continuum complexity of bosonic modes in quantum field theories. Therefore, we believe that the complexity-simulating-complexity concept should become a leading paradigm in any effort towards scalable quantum simulations.

Within-day variation and effect of acute stress on plasma and milk cortisol in lactating goats

An experiment was carried out to study the effect of acute stress on cortisol concentration in goat milk (milk cortisol; MC) and its suitability for stress assessment. Additional variables studied were plasma cortisol (PC), blood glucose (BG), and somatic cell count (SCC). Ten goats free of mastitis at 2 mo of lactation were divided into 2 groups. One group of animals was exposed to acute stress (visual and auditory, but not physical, contact with a barking dog for 3 min) immediately before the 1000 h sampling (STR), and the other group was considered as the control group, not exposed to acute stress (CON). The animals were gradually accustomed to the sampling schedule for 1 wk before the stress treatment (pre-experimental period). The variables PC, MC, BG, SCC, and milk composition (fat, lactose, whey protein, true protein, and casein) were recorded at 0600, 1000, 1130, 1400, 1800, 2200, and 0200 h. Milk variables were recorded in both glands separately. The right gland (n=10) was completely milked and the left gland (n=10) was milked to 30 mL at every sampling except at 1000 h, when complete milking was carried out on both glands. Variables were analyzed by using a linear mixed model. Both PC and MC concentrations varied throughout the day, with values being highest in the morning. Higher PC levels were recorded in the STR group immediately after treatment compared with CON (36.9 vs 16.3 ng/mL). For MC, differences between treatments were noted 1.5h after STR treatment (1.27 vs 0.25 ng/mL). Blood glucose increased immediately after treatment in STR animals, being different from CON until 1.5h after treatment sampling (101 vs. 58 mg/dL). The SCC was not increased by STR treatment, showing higher values in the morning and afternoon compared with evening and night (5.6±0.13 to 5.87±0.13 log10 SCC). The STR treatment had no significant effect on milk composition, and overall milk yield of a complete day after stress stimulus of both groups was similar (STR: 2,067±280 g/d; CON: 2,134±427 g/d). We conclude that plasma and milk cortisol concentrations in control dairy goats varied throughout the day; MC showed significant differences in the STR group if samples were taken 1.5h after the stressing stimulus, whereas PC showed significant differences in samples taken immediately after the stressing stimulus. Additionally, MC sampling has the advantage of being noninvasive compared with blood sampling.

Dynamical Casimir effect entangles artificial atoms

We show that the physics underlying the dynamical Casimir effect may generate multipartite quantum correlations. To achieve it, we propose a circuit quantum electrodynamics scenario involving superconducting quantum interference devices, cavities, and superconducting qubits, also called artificial atoms. Our results predict the generation of highly entangled states for two and three superconducting qubits in different geometric configurations with realistic parameters. This proposal paves the way for a scalable method of multipartite entanglement generation in cavity networks through dynamical Casimir physics.

Short communication: effects of milk removal on teat tissue and recovery in Murciano-Granadina goats

The aim of this work was to study how machine milking (MM) carried out in appropriate conditions affects teat wall thickness and canal length and their return after milking to premilking conditions compared with other milk removal methods considered biological referents: kid suckling (KS), catheter removal (CATH), and hand milking (HM). Three Latin square experiments were designed, each divided into 2 periods. In the first period, the left glands of each animal were machine milked and the KS, CATH, and HM treatments were applied to the right glands in experiments 1, 2, and 3, respectively. Subsequently, in the second period, the removal methods were interchanged. Teat wall thickness, teat wall area, teat end wall area, and teat canal length were measured from the ultrasound images. Milk removal using the reference methods (KS, CATH, and HM) and by MM caused increases in teat wall thickness and teat canal length, which were greater with MM. The time needed for the teat walls and canal to return to their physiological conditions before milk removal was greater than 10h in the reference methods and following machine milking.

[Gastric cancer risk estimate in patients with chronic gastritis associated with Helicobacter pylori infection in a clinical setting]

BACKGROUND/AIM

Severity of chronic gastritis associated with Helicobacter pylori infection (CGAHpI) could play a role in evaluating the potential risk to develop gastric cancer. Our aim was to estimate the risk for gastric cancer in a clinical setting, according to histopathologic criteria, by applying the gastric cancer risk index (GCRI) METHODS: Histopathologic study of the gastric biopsies (corpus-antrum) from consecutive adult patients that underwent gastroesophageal duodenoscopy was carried out, and the GCRI was applied in patients presenting with CGAHpI.

RESULTS

One hundred eleven patients (77% female) with a mean age of 38.6±13.1 years were included. Active Helicobacter pylori infection (aHpi) was diagnosed in 77 cases (69.40%). In 45% of the cases with aHpi, pangastritis (23%) or corpus-predominant gastritis (22%) was diagnosed. Nine cases were diagnosed with intestinal metaplasia (8%), 7 of which (77.70%) were in the aHpi group. Twenty one percent of the patients with aHpi had a GCRI of 2 (18.10%) or 3 (2.50%) points (high risk index), while 79.10% accumulated a GCRI of 0 or 1 points (low risk index). Of the patients with no aHpi, none of them had 3 points (p=0.001). Of the 18 patients that accumulated 2 or 3 points, 6 (33.30%) presented with intestinal metaplasia (all with pangastritis and corpus-predominant gastritis), of which 4 cases (66.60%) had aHpi.

CONCLUSIONS

The estimated gastric cancer risk in patients with CGAHpI in the clinical setting studied was relatively low and 5% of the patients had a histopathologic phenotype associated with an elevated risk for developing gastric cancer.

18 PREGNANCY RATES IN LACTATING DAIRY COWS TREATED WITH GONADOTROPIN-RELEASING HORMONE-BASED SYNCHRONIZATION PROGRAMS AND INSEMINATED AT A FIXED TIME

An experiment was designed to compare pregnancy rates in lactating dairy cows synchronized with a 7-day CIDR-Synch or a 5-day CIDR-Synch program and to determine if the addition of a second prostaglandin F2α (PGF) injection to the 7-day CIDR-Synch program would improve pregnancy rates following fixed-time AI (FTAI). The experiments were performed on 2 dairy farms in Argentina, with year-round calving and a mixed feeding system (35% grazing plus 65% corn silage and grain). Cows (n = 621) were 39.3 ± 6.5 days in milk (DIM, mean ± SD) when they were enrolled in the program, had 2.4 ± 1.5 lactations and a body condition score (BCS) of 3.1 ± 0.2 (range: 2.7 to 4.0). All cows received a pre-synchronization treatment with 2 doses of prostaglandin (PGF, 25 mg of dinoprost, Lutalyse, Pfizer Animal Health, Argentina) 14 days apart, and 11 days after the second PGF (Day 0) received 10 µg of Buserelin (GnRH, Receptal, MSD-Intervet, Argentina) and a CIDR device (1.9 g of progesterone, Pfizer Animal Health). Cows were randomly allocated to 1 of 3 groups. The CIDR devices were removed and PGF was administered to cows in Groups 1 and 2 on Day 7. A second GnRH was given 56 h later and cows experienced FTAI 16 h after gonadotropin-releasing hormone (GnRH) injection (i.e. 72 h after CIDR removal). Cows in Group 2 also received a second PGF injection on the afternoon of Day 7. Cows in Group 3 had the CIDR removed and received 2 PGF injections 12 h apart on Day 5. A second dose of GnRH was given and FTAI was performed at the same time, on Day 8 (i.e. 72 h after CIDR removal). All cows were examined by ultrasonography (Aloka 500V, Aloka, Tokyo, Japan) on the day of the first PGF injection and at CIDR removal to determine the presence and number of corpora lutea (CL), and 30 days after FTAI to determine pregnancy status. Data were analyzed by logistic regression to determine the effects of treatment, parity, days postpartum, milk production, BCS, presence of a CL at enrollment, and number of CL at the time of CIDR removal on pregnancy rates. Overall pregnancy rates did not differ among groups: 32.9% (68/207), 38.2% (78/204), and 38.3% (80/209) for Groups 1, 2, and 3, respectively (P = 0.2). Although the number of CL present at CIDR removal did not significantly affect pregnancy rates (P = 0.4), pregnancy rates in cows with 1 CL in Groups 1 and 2 tended to differ [29.0% (11/38) v. 48.9% (21/43); P < 0.07], but neither differed from that in Group 3 [37.2% (16/43)]. No differences were detected among groups in cows without a CL at CIDR removal [overall pregnancy rate: 29.4% (5/17)] and those with ≥2 CL [overall pregnancy rate: 36.1% (173/479)]. Among the other variables evaluated, first-parity cows had 1.96 (1.38–2.78) times more chance of getting pregnant than second-or-more-parity cows (P = 0.002) and cows with BCS >3 had 1.63 (1.16–2.28) times more chance of getting pregnant than those with BCS <3 (P = 0.003). Finally, herd, days postpartum, milk production, and presence of a CL at enrollment did not significantly affect pregnancy rates. We concluded that the 3 treatments resulted in similar pregnancy rates for lactating dairy cows and that the benefit of adding a second PGF injection to the 7-day protocol was only marginal in cows with 1 CL at CIDR removal.

163 EFFECT OF PUERPERAL METRITIS ON REPRODUCTIVE AND PRODUCTIVE PERFORMANCE IN DAIRY COWS IN ARGENTINA

The objectives of this study were to evaluate the reproductive and productive performance of dairy cows with and without puerperal metritis and to evaluate the effectiveness of using a long-acting antibiotic (200 mg mL–1 ceftiofur, Excede, Pfizer Animal Health, New York, NY, USA). Dairy cows in one dairy farm calving from July 2009 to January 2010 were examined between 3 and 14 days postpartum and classified based on vaginal discharge into 3 groups: cows with normal discharge (control); cows with purulent or red-brown vaginal discharge without foul smell, and cows with purulent or red-brown vaginal discharge with foul smell (Sheldon et al. 2006 Theriogenology 65, 1516–1530). Cows in the first 2 groups were not treated, whereas those in the third group were randomly allocated to receive 1 mL/30 kg of body weight of Excede subcutaneously behind the ear or remain untreated. From the 640 cows examined, 372 (58.2%) had normal discharge, 86 (13.4%) had a discharge without foul smell and 182 (28.4%) had a discharge with foul smell. Kaplan-Meier survival curves were obtained to compare pregnancy rates across days postpartum, and differences between curves were tested with the log rank statistic. Proportional hazards regression with PROC PHREG Cox of SAS were done to estimate the risk of pregnancy in terms of treatment, parity (first parity or ≥2 parities), type of delivery (normal or assisted), and milk production. Finally, lactation curves were modeled using SAS PROC NLMIXED to estimate the cumulative milk production at 305 days. Survival curves differed between cows in the control group and those with foul-smell discharge that were not treated (P < 0.01) and between untreated versus treated cows (P < 0.01) in the latter group. Survival curves of cows with discharge but without foul smell were intermediate and did not differ from those in the control group (P = 0.2) and those with foul smell discharge and treated (P = 0.1), but tended to be different from those with foul smell discharge and not treated (P = 0.056). The postpartum interval to achieve a 25% pregnancy rate was 72 days for cows in the control group, 73 days for cows with foul smell and treated, 83 days for cows with discharge without foul smell, and 95 days for those with foul smell and not treated. The chance of pregnancy in cows in the control group was 1.98 times higher (95% CI = 1.33, 3.08) and in cows with foul smell and treated was 2.16 times higher (95% CI = 1.37, 3.50) than those with foul smell and not treated. Finally, the chance of pregnancy in cows with discharge but without a foul smell tended to be higher (P = 0.08) than those with foul smell that were not treated, but did not differ with the other 2 groups. Parity, type of delivery, and production level did not affect pregnancy rates. Cumulative 305-day milk production was higher (P < 0.01) in control cows than those with vaginal discharge, regardless of smell and regardless of treatment. It is concluded that puerperal metritis affects the reproductive and productive performance of dairy cows, and the treatment with Excede was effective in reducing the adverse effects on reproductive performance.

Effect of intramammary infection on milk electrical conductivity in Murciano-Granadina goats

Measurements of electrical conductivity (EC) of milk are used in mastitis detection in cows due to the low cost, possibility of automation, and rapid diagnosis, but the literature about EC measurement in goats is scarce. In this study, we studied the effect of the establishment of intramammary infection (IMI) on EC of goat milk by gland using daily measurements. Additionally, the effects on milk yield, somatic cell count (SCC), and mineral content were analyzed. Eight primiparous and 10 multiparous Murciano-Granadina goats free from IMI were included in the study. Health conditions of the participating animals were monitored for 16 d and then various unfavorable health situations that may arise on commercial farms were simulated to increase the chances of IMI. Once the IMI was confirmed, the experiment continued for another 16 d. Statistical analysis was conducted using a linear mixed model considering several periods regarding the establishment of the infection and whether it affected one or both glands in the animal. The establishment of IMI caused a significant increase of EC, SCC, and chlorides in the infected glands, whereas the sodium:potassium ratio and the ratio of EC between collateral glands showed significant increases only in bilaterally infected animals. The microorganisms that caused greater increases of EC were Staphylococcus aureus and a gram-negative bacterium. Changes due to other isolated microorganisms (coagulase-negative staphylococci and streptococci) were small. No significant differences in milk yield were determined. The significant effect of infection on EC in the affected glands suggests that the use of a system based on daily readings of EC could be useful in IMI detection of goats.

Lipid/Polyelectrolyte coatings to control carbon nanotubes intracellular distribution

Carbon Nanotubes have been functionalized with a layer of poly (sulfopropyl methacrylate) synthesized from silane initiators attached to the walls of the Carbon nanotubes. On top of the poly sulfo propyl methacrylate, lipid vesicles composed of 75% 1,2-Dioleoyl-sn-Glycero-3-Phosphocholine and 25% 1,2-Dioleoyl-sn-Glycero-3-[Phospho-L-Serine] were assembled. The surface modification of the Carbon Nanotubes and lipid assembly were followed by TEM. Confocal Raman Microscopy was used to study the uptake and localization of the surface modified Carbon Nanotubes in the HepG2 cell line. The localization of the Carbon Nanotubes in the cells was affected by the surface coating. It was found that poly (sulfopropyl methacrylate) and lipid modified Carbon Nanotubes were present in the region of the lipid bodies in the cytoplasm.

Ultrafast quantum gates in circuit QED

We present a method to implement ultrafast two-qubit gates valid for the ultrastrong coupling and deep strong coupling regimes of light-matter interaction, considering state-of-the-art circuit quantum electrodynamics technology. Our proposal includes a suitable qubit architecture and is based on a four-step sequential displacement of the intracavity field, operating at a time proportional to the inverse of the resonator frequency. Through ab initio calculations, we show that these quantum gates can be performed at subnanosecond time scales while keeping a fidelity above 99%.

Analysis of the influence of variation factors on electrical conductivity of milk in Murciano-Granadina goats

The aim of this study was to obtain further knowledge on electrical conductivity (EC) of milk as a tool for detecting mastitis in goats. The effect of farm, parity, stage of lactation, and health status of the glands on EC, and the somatic cell count (SCC) of milk was analyzed. Additionally, relationships between EC and chemical composition and SCC were studied. Finally, characteristics of EC and SCC (sensitivity and specificity) as diagnostic tests used to detect mastitis were studied. One hundred and five Murciano-Granadina goats were enrolled in the study. Milk samples (by gland) were collected monthly for 7 mo on 3 farms in the southeastern Spain. To establish the health status, milk samples were aseptically collected before milking by gland. Foremilk (by gland) was collected to analyze EC, SCC, and chemical composition. Glands were classified according to the health status as free of mastitis, bacterial mastitis, or unspecific mastitis. The effects of farm, parity, and stage of lactation, as well as the interactions between health status and parity, parity and stage of lactation, and health status and stage of lactation were associated with EC. Changes in the milk's chemical composition (particularly of chloride ions) explained most of the variance in EC (R(2)=0.91). The strongest association between EC and SCC was found at SCC >2×10(6) cells/mL (r=0.42). The use of a single EC threshold for all animals and farms for detecting mastitis led to limited results for mastitis detection, which, in any case, favors negative predictive values over positive predictive values. This study revealed that factors, other than the health status, affecting EC hamper the use of an EC threshold for mastitis detection with sufficient specificity on all animals. Any detection system based on EC of milk should consider these factors, as well as specific variations for each of the animals.