NeuroAIreh@b: an artificial intelligence-based methodology for personalized and adaptive neurorehabilitation

Cognitive impairments are a prevalent consequence of acquired brain injury, dementia, and age-related cognitive decline, hampering individuals' daily functioning and independence, with significant societal and economic implications. While neurorehabilitation represents a promising avenue for addressing these deficits, traditional rehabilitation approaches face notable limitations. First, they lack adaptability, offering one-size-fits-all solutions that may not effectively meet each patient's unique needs. Furthermore, the resource-intensive nature of these interventions, often confined to clinical settings, poses barriers to widespread, cost-effective, and sustained implementation, resulting in suboptimal outcomes in terms of intervention adaptability, intensity, and duration. In response to these challenges, this paper introduces NeuroAIreh@b, an innovative cognitive profiling and training methodology that uses an AI-driven framework to optimize neurorehabilitation prescription. NeuroAIreh@b effectively bridges the gap between neuropsychological assessment and computational modeling, thereby affording highly personalized and adaptive neurorehabilitation sessions. This approach also leverages virtual reality-based simulations of daily living activities to enhance ecological validity and efficacy. The feasibility of NeuroAIreh@b has already been demonstrated through a clinical study with stroke patients employing a tablet-based intervention. The NeuroAIreh@b methodology holds the potential for efficacy studies in large randomized controlled trials in the future.

Stafne's bone defect: a systematic review

BACKGROUND

This systematic review integrated the available data published in the literature on Stafne's bone defect (SBD), considering the clinical, imaging and histopathological results.

MATERIAL AND METHODS

An electronic search was undertaken in six databases. Eligibility criteria were: articles in English, Spanish, and Portuguese describing case reports or case series of SBD, reported up to September/2021. Risk of bias was assessed using the Joanna Briggs Institute tool.

RESULTS

A total of 98 articles were retrieved, involving 465 individuals with SBD and were included for quantitative analysis. Mean age was 52.78 years (range: 11-89 years), with male predilection (n=374/80.85%). Radiographs were the most frequent imagiological exams (n=298/64.09%), followed by computed tomography (n=98/21.08%). SBD was more prevalent in the posterior mandible (n=361/93.77%) as a hypodense radiolucent lesion (n=250/77.40%). Mean size was 1.58 cm (range: 0.3-.8.0 cm). Two-hundred-and-two lesions (97.37%) were unilocular and 126 (91.97%) were classified as well-defined. Clinical symptoms were reported in 73 cases, while 68 cases (93.15%) were asymptomatic. Only 34 cases (12.32%) were submitted to histopathological examination. Mean follow-up time was 26.42 ±25.39 months.

CONCLUSIONS

SBD is more frequent in male patients in the fifth and sixth decade of life. Classic SBD is radiographically characterized as a single, unilocular and well-defined lesion in the posterior region of the jaw with a radiolucent/hypodense appearance.

Chemotaxonomic differentiation of Pinus species based on n-alkane and long-chain alcohol profiles of needle cuticular waxes

n-Alkane and long-chain alcohol (LCOH) profiles of needle cuticular waxes of nine provenances of three Pinus species (P. taeda. P. pinaster and P. pinea) were determined and their chemotaxonomic importance was studied. n-Alkanes concentrations were very low in all Pinus spp. A lack of ability of these compounds to differentiate Pinus spp. and their provenances was observed. LCOH concentrations were much higher, being nonacosan-10-ol (10-C29-OH) the most abundant one in all Pinus spp. Total LCOH concentrations varied (P<0.001) between Pinus spp. with P. taeda presenting the highest (P<0.05) value and P. pinea the lowest one. Differences in LCOH profiles were large (P<0.001) and allowed separation of Pinus spp. in the Principal Component Analysis (PCA). Although a noticeable separation of individuals was not observed. cluster analysis on LCOH concentrations allowed a clear distinction between species. indicating their potential to be used as chemotaxonomic markers to differentiate provenances of different Pinus spp.

The influence of simultaneous pancreas-kidney transplantation on the evolution of diabetic foot lesions and peripheral arterial disease

PURPOSE

Simultaneous pancreas-kidney transplantation (SPKT) remains the best treatment option in patients with type 1 diabetes and chronic kidney failure. There are only a few studies addressing the potential ischemic deterioration of peripheral arterial disease (PAD) due to blood diverting from the iliac artery to the kidney graft. We aimed to evaluate diabetic foot lesions and PAD evolution in SPKT recipients and investigate if they are more frequent in ipsilateral lower limb of kidney graft.

METHODS

We developed a retrospective cohort, including patients submitted to SPKT in our tertiary center, between 2000 and 2017. Diabetic foot lesions and PAD frequencies were compared in the period before and after transplantation.

RESULTS

Two hundred and eleven patients were included, 50.2% (n = 106) female, with a median age at transplantation of 35 years (IQR 9). After a median follow-up period of 10 years (IQR 7), patient, kidney, and pancreatic graft survival were 90.5% (n = 191), 83.4% (n = 176), and 74.9% (n = 158), respectively. Before transplant, 2.8% (n = 6) had PAD and 5.3% (n = 11) had history of foot lesions. In post-transplant period, 17.1% (n = 36) patients presented PAD and 25.6% (n = 54) developed diabetic foot ulcers, 47.6% (n = 35) of which in the ipsilateral and 53.3% (n = 40) in the contralateral lower limb of the kidney graft (p = 0.48). Nine patients (4.3%) underwent major lower limb amputation, 3 (30%) ipsilateral and 7 (70%) contralateral to the kidney graft (p = 0.29).

CONCLUSIONS

Diabetic foot lesions were not more frequent in the ipsilateral lower limb of the kidney graft, therefore downgrading the 'steal syndrome' role in these patients.

Hydropriming and Nutripriming of Bread Wheat Seeds Improved the Flour's Nutritional Value of the First Unprimed Offspring

Seed hydropriming or nutripriming has been used for wheat biofortification. Previously, the untreated S1 offspring of bread wheat S0 seeds hydro- and nutriprimed with FeSO₄.7H₂O and/or ZnSO₄.7H₂O showed improved yield relative to the offspring of untreated S0 seeds. We hypothesize that such improvement would have its origin in the higher quality of S1 seeds resulting from plants whose seeds were primed. In this work, we characterised biochemically the whole-wheat flour of unprimed S1 offspring whose S0 seeds were hydro- and nutriprimed with Fe and/or Zn and compared it to the offspring of untreated S0 seeds (control). We identified and quantified 16 free amino acids and five soluble sugars per offspring using high-performance liquid chromatography and the Association of Official Analytical Chemists (AOAC) methods. The most abundant amino acids were glutamic acid and glutamine, proline, and glycine, presenting their highest contents in the offspring of seeds nutriprimed with 8 ppm Zn (0.351 mmol∙g^-1), 8 ppm Fe + 8 ppm Zn (0.199 mmol∙g^-1), and (0.135 mmol∙g^-1), respectively. The highest contents of glucose (1.91 mg∙g^-1 sample), ash (24.90 g∙kg^-1 dry matter, DM), and crude protein (209.70 g∙kg^-1 DM) were presented by the offspring resulting from 4 ppm Fe + 4 ppm Zn, 8 ppm Zn, and 8 ppm Fe + 8 ppm Zn, respectively. The highest total starch content (630.10 g∙kg^-1 DM) was detected in the offspring of seeds soaked in 8 ppm Fe. The nutritional value of the flour of the S1 offspring resulting from nutripriming was significantly higher than the control. Overall, the novelty of our research is that seed priming can improve the quality of the wheat grain and flour, at least till the first offspring, without the need to repeat the presowing treatment. Beyond the study of subsequent generations, the unravelling of transgenerational mechanisms underlying the biochemical improvement of the offspring is approached.

Application of Fourier transform infrared spectroscopy (FTIR) techniques in the mid-IR (MIR) and near-IR (NIR) spectroscopy to determine n-alkane and long-chain alcohol contents in plant species and faecal samples

n-Alkanes and long-chain alcohols (LCOH) have been used as faecal markers to assess the feeding behaviour of both wild and domestic herbivore species. However, their chemical analysis is time-consuming and expensive, making it necessary to develop more expeditious methodologies to evaluate concentrations of these markers. This work aimed to evaluate the use of Fourier Transform Infrared Spectroscopy (FTIR) technology in the near infrared (NIR) and mid infrared (MIR) intervals, for the determination of n-alkane and LCOH concentrations of different plant species and faecal samples of domestic herbivores. Spectra of 33 feed samples, namely L. perenne, T. repens, U. gallii, short heathers (mixture of Erica spp. and Calluna vulgaris), improved pasture grasses (mixture of L. perenne and A. capillaris), heath grasses (mixture of P. longifolium and A. curtissii), improved pasture species (mixture of L. perenne, T. repens and A. capillaris) and herbaceous species (mixture of all herbaceous species found in the plot)) and 181 faecal samples (cattle and horses) were recorded. In order to develop calibrations for the prediction of n-alkanes and LCOH concentrations, partial least squares (PLS) regression was used. Regarding the models developed for plant species, the best results were observed for the calibrations using NIR. The best external validation coefficients of determination (R²v) obtained were 0.90 and 0.79 for LCOH and n-alkanes, respectively. For faecal samples, in the NIR interval, results indicate similar external validation predictions (R²v) for both animal species (0.64). On the contrary, in the MIR interval, differences between cattle (0.70) and horses (0.57) faecal samples in R²v were observed. Regarding the models created for both animal species faeces, LCOH (C₂₆-OH and C₃₀-OH concentrations ranging from 713.3 to 4451.9 mg/kg DM, respectively; R²v values ranging from 0.72 to 0.95) and n-alkanes (C31 and C33 concentrations ranging from 112.8 to 643.2 mg/kg DM, respectively; R²v values ranging from 0.19 to 0.90) present in higher concentrations tended to be those with better estimates. Results obtained suggest that the selection of the technique to be used may depend on the type of matrix, being the homogeneity of the matrices one of the most important factors for its success. In order to improve the accuracy and robustness of the models created for the estimation of the concentrations of these markers using these methodologies, the database (greater variability) used for the calibrations of these models must be increased.

The influence of overweight and obesity in the oral health of a sample of portuguese adults

Background

Overweight and obesity may lead to different problems in various body systems and in the oral cavity. Dental caries and periodontal disease have been related with overweight. The aim of this study was to assess how overweight and obesity have impact on the lifestyle, oral habits and oral pathologies.

Methods

We conducted an observational cross-sectional study where we applied a questionnaire to 140 individuals from Lisbon and Viseu, Portugal., which 70 had a normal Body Mass Index (BMI) (control group) and 70 had an excessive BMI. We also made an oral observation in each individual to record the permanent teeth decayed, missing and filled index (DMFT), the Community Periodontal Index and the oral hygiene status.

Results

From the final sample, 30% of the subjects with overweight brushed their teeth once a day or less, while the majority (62.9%) of the control group brushed twice a day. In the oral examination, 70% had calculus, while in the control group only 22.5% presented calcified plaque. The DMFT was higher among the obesity group in comparison with the control group. Regarding periodontal disease, the participants with overweight need more dental intervention (81.4%) in contrast with the control group (14%).

Conclusions

Most overweight and obese individuals present precarious oral hygiene habits, higher prevalence of dental caries, and worse periods of periodontal health. They are not aware of the repercussions of the association between their cariogenic diet, oral health and overweight.

Key messages

• Oral health behaviors are related with other health conditions, namely obesity and this is a fundamental public health issue.

• Primary preventive strategies should be established having in consideration the oral health status of adults in treatment for obesity and in weight control programs.

PSVII-16 Evaluation of the Population Profile of Methanogenic Microorganisms in Animals Treated with the Additive Fator P

The effects caused by climatic variations in the world, have been attributed to the increase in the emission of greenhouse gases and as a consequence of worsening global warming. The improper handling of animals can contribute to the emission of gases of enteric origin, which are harmful to the environment. The use of additives in the diet of animals tends to be more advantageous as it will equilibrate the ruminal microbial flora, modulate the ruminal metabolism, and reduce the emission of greenhouse gases to environment. Fator P is a natural additive that was developed to attend the current needs of the livestock market, and make the management system more productive and sustainable, and reduce impacts on the environment. The aim of this work was to evaluate the profile of methanogenic microorganisms by the method of relative quantification by qPCR in animals treated with the natural additive Fator P. The experiment was carried out in triplicate, with a total of six animals, in pasture, receiving 6 gr of the Fator P additive and control. Over 28 days of experiment, the ruminal liquid was collected in days 0, 2, 4, 7, 10, 14, 21, 28, and the DNA was extracted using the Qiagem 51604 kit. The reaction of qPCR was realized using a primers sequence of total bacteria and methanogenic bacteria. The population profile of microorganisms over the days, Factor P showed a statistically significant reduction (p &lt; 0,05) on days 2 (55,7%; p = 0,0188), 7 (72,08%; p = 0,0445), 14 (56,31%, p = 0,0123), 21 (46,62%, p = 0,0049), 28 (53,28%, p = 0,0499). The result indicates that the reduction in the population of methanogens can reduce the emission of gases of enteric origin and shows the efficiency of the additive in management system more productive and sustainable.

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Chronic obstructive pulmonary disease exacerbations' management in Portuguese hospitals - EvaluateCOPDpt, a multicentre, observational, prospective study

INTRODUCTION AND OBJECTIVES

In order to improve the quality of chronic obstructive pulmonary disease (COPD) patients' care, better knowledge of clinical practice and the factors associated with patient outcomes are needed. This study aimed to evaluate the relation between clinical practice and the outcomes of patients admitted for COPD exacerbations in Portuguese hospitals.

MATERIALS AND METHODS

Observational, multicentre, prospective study with a 60-days follow-up period, in 11 hospitals, including patients aged ≥ 30 years, admitted to hospital for at least 24 hours due to an acute exacerbation of COPD. Demographic and clinical data were collected, including sex, age, smoking habits, hospitalisations, pulmonary function, comorbidities, COPD symptoms, and treatment. Sixty days after discharge, COPD exacerbations management, outcome measures, and readmission data were evaluated through a structured phone follow-up interview.

RESULTS

196 patients were included (85.7% male, mean age 71.2 years), the majority admitted through the emergency service. Ex-smokers and current smokers accounted for 51% and 36%, respectively. On admission, 72.4% were on LAMA, 54.6% on LABA, and 45.5% were on LABA/LAMA. Inhaled corticosteroids (ICS) were used in 37.3% and systemic steroids (SCS) in 10.3%. 35.7 % had had at least one exacerbation, with hospitalisation, in the previous year. There was no spirometry data for 23.2%. On hospitalisation, 98.5% of patients were treated with oxygen and 38.3% with non-invasive ventilation. Additionally, 93.4% used SCS and 60.2% ICS. Antibiotics were administered to 85.2%. 95.4% of patients were discharged; 9 died, 5 of whom had a COPD-related death. The median length of stay was 12 days for discharged patients and 33 days for patients who died. At discharge, 79.1% were prescribed with LAMA, 63.6% SCS, 61.5% LABA and 55.6% LAMA+LABA. 26,2% were prescribed with ICS+LABA+LAMA. At follow-up, 44.4% had a scheduled medical appointment within the 60 days after being discharged, and 28.3% were later readmitted due to exacerbation, of whom 52.8% were hospitalised.

CONCLUSIONS

The severity of COPD, particularly in exacerbations, is directly related to impaired lung function and quality of life, mortality, and significant health system costs. Knowledge about COPD exacerbations' management in acute hospital admissions in Portugal may help stimulate a national discussion and review of existing data to engage clinicians, policymakers, managers, and patients, raising awareness and promoting action on COPD.

Ultrasound training simulator using augmented reality glasses: an accuracy and precision assessment study

Ultrasound (US) imaging despite being safe, cost-effective, and radiation-free, presents poor quality and artifacts, requiring specific medical training in US probe handling and image evaluation. The use of simulators to train physicians has proven its effectiveness, but most of them require specific facilities and hardware. In the last few years, augmented reality has gained relevance to simulate real scenarios which can avoid large setups and broaden medical training to more physicians. This work proposes a new framework for the training of US images acquisition. It consists of a custom-made application that runs on AR glasses (Microsoft HoloLens 2) and interacts with a US simulator application. The AR glasses track the orientation of a QR code mounted on a US probe, communicating its orientation with the US simulator application. This allows the physician to interact with a US probe seeing in real-time the US image in the physician's field of view. The QR code tracking assessment of the AR glasses was conducted by measuring the orientation accuracy and precision when compared with the measures of an electromagnetic tracking device (i.e., NDI Aurora). The proposed solution presented a good performance, rendering the US image in AR glasses with real-time feedback. Moreover, it can track the QR code on the US probe with an accuracy of 0.755°, and a precision of 0.018°. Overall, the proposed framework presents promising results and the use of AR glasses as a tracking device reached a good performance. Clinical Relevance- Simulation is a relevant tool to train physicians, especially in US imaging. AR glasses can broaden the training to less trained physicians by reducing the need for complex setups. This technology allows the implementation of a more natural user interface, which can be relevant in scenarios where good coordination between the eyes and hands of the physician is necessary (i.e., Biopsies).

Pharmacological Targeting of Senescence with ABT-263 in Experimental Heart Failure with Preserved Ejection Fraction

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Fundação Ciência e Tecnlogia

HFpEF is the most common form of heart disease in the elderly and is associated with high morbidity and mortality. Our understanding of HFpEF pathophysiology is limited and development of efficient therapies that alter the clinical course of the disease has proved greatly challenging. Although aging is a risk factor of HFpEF1, the involvement of aging hallmarks such as cell senescent and immunosenescence is unclear. Recently, a link between endothelial senescence and HFpEF development was demonstrated in mice with accelerated aging [1], endorsing anti-aging pharmacologic as potential new therapeutic alternatives for HFpEF. In fact, the senolytic (drugs that selectively promote apoptosis of senescent cells) ABT-263 has already proven efficacy in the context of cardiovascular diseases. Further studies are needed to clarify the relevance of aging and of anti-aging therapies in the context of HFpEF.

Using ZSF1 obese rats (ZSF1-Ob) as model of HFpEF we showed from 18 weeks signs of immunosenescence compared to ZSF1-Ln, namely an increased frequency of circulating myeloid cells and decreased frequency of T and B cells. Concomitantly, expression of pro-inflammatory factors (IL-6, IL-1, TGF-β, TNF-α) was upregulated in peripheral blood mononuclear cells (PBMCs) of ZSF1-Ob which also displayed characteristic features of cell senescence (p21 expression, lysosomal endogenous Beta-galactosidase (SA-B-Gal) senescence-associated secretory phenotype (SASP) and up-regulation of BCL-XL. Importantly, no signs of cellular senescence (SA-B-gal, pH2AX and senescence associated pathways) were found in the main hematopoietic organs (spleen and bone marrow). Alongside, these systemic alterations, an upsurge of cellular senescence was observed in myocardium of ZSF1-Ob rats, particularly in endothelial and hematopoietic cells. Serum of ZSF1-Ob rat was able to induce activation and cellular senescence of cardiac microvascular endothelial cells, indicating that systemic circulating factors may be the upstream mechanism of cellular senescence and dysfunction in HFpEF. Analysis of HFpEF patients and a control cohort adjusted to main co-morbidities further demonstrated accumulation of senescent monocytes in HFpEF patients. In these patients, the senescence marker SA-B-Gal correlated with plasmatic brain natriuretic peptide (BNP) levels and pulmonary artery systolic pressure. Targeting aging hallmarks through the treatment of ZSF1-Ob rat with ABT-263 resulted in a reduction in circulating senescent cells, decreased systemic and local inflammation, re-established immune proportions, restore the levels of circulating BNP and attenuated myocardial remodeling, particularly endothelial dysfunction and fibrosis.

Collectively these findings support that premature cellular senescence contributes to the establishment of a deleterious pro-inflammatory environment in HFpEF and that senolytic agents hold promise for the treatment of this syndrome.

Portuguese translation, cross-cultural adaptation and reliability of Young Spine Questionnaire

OBJECTIVE

To translate and perform the cross-cultural adaptation of the Young Spine Questionnaire (YSQ) into Portuguese, and to assess its reliability.

METHOD

Translation and cross-cultural adaptations were conducted according to accepted international standards. A preliminary version underwent pilot-testing with 32 children (11-14 years), equally divided by gender and age. Children were asked to rate each question in terms of clarity and comprehensibility, and to provide general feedback regarding the questionnaire. The final version of the questionnaire was approved by a committee consisting of experts from various fields. Test-retest reliability was assessed on 58 children using Cohen's and Fleiss' Kappa.

RESULTS

Translation and cross-cultural adaptation of the YSQ only resulted in minor changes and the children rated all questions as "clear and understandable" in the pilot test, without gender or age differences being detected. Test-retest data was collected with a mean interval of 13 days. Reliability scores ranged from 0.56-0.97, equivalent to "moderate" to "almost perfect" agreement. Most questions (84%) had "substantial" or "almost perfect" agreement.

CONCLUSION

The translation and cross-cultural adaptation of YSQ into Portuguese was successfully performed. This questionnaire was also shown to be reliable, supporting its future use in research projects.

Intercellular transfer of miR-200c-3p impairs the angiogenic capacity of cardiac endothelial cells

As mediators of intercellular communication, extracellular vesicles containing molecular cargo such as microRNAs, are secreted by cells and taken up by recipient cells to influence their cellular phenotype and function. Here, we report that cardiac stress-induced differential microRNA content, with miR-200c-3p being one of the most enriched, in cardiomyocyte-derived extracellular vesicles mediates functional crosstalk with endothelial cells. Silencing of miR-200c-3p in mice subjected to chronic increased cardiac pressure overload resulted in attenuated hypertrophy, smaller fibrotic areas, higher capillary density and preserved cardiac ejection fraction. Interestingly, we were able to maximal rescue microvascular and cardiac function with very low doses of antagomir, which specifically silences miR-200c-3p expression in the non-myocyte cells. Our results reveal vesicle transfer of miR-200c-3p from cardiomyocytes to cardiac endothelial cells, underlining the importance of cardiac intercellular communication in the pathophysiology of heart failure.

Overtaking risk modeling in two-lane two-way highway with heterogeneous traffic environment of a low-income country using naturalistic driving dataset

INTRODUCTION

Driver behavior related to overtaking maneuvers, which are considered a major safety risk determinant on two-lane two-way highway in low- and middle-income countries (LMIC), are an important subject of further analysis. This study evaluates safety risk in terms of nature and severity of probable conflicts during overtaking maneuvers on a bi-directional undivided two-lane highway in a heterogeneous traffic environment of a low-income country. Nature and severity of probable conflicts were defined with the application of surrogate safety proximity indicators in real-world naturalistic driving environment.

METHOD

A risk severity model for overtaking maneuver was developed to better understand the significant factors associated with the probability of conflict and its severity during overtaking maneuver using discrete choice modeling approaches. The relevance of three alternate discrete outcome frameworks, namely multinomial logit (ML), ordered probit (OP), and mixed logit (MXL) models are addressed. The best fitted model is identified and estimated. The impact of the significant attributes was also evaluated. The study collected data from a section of two-lane highway in Bangladesh using naturalistic driving from both observational and computer vision techniques. A total of 46 explanatory variables related to overtaking maneuver are assessed.

RESULTS

Speed differential between overtaking and overtaken vehicles have a significant impact on the probability of severe conflicts. Moreover, the presence of a bus as an overtaking vehicle was found to contribute significantly to the severity of conflicts.

CONCLUSIONS

The study makes substantial research contributions related to overtaking behavior and safety risk evaluation during overtaking in mixed traffic environment in low-income countries. The results can be used as a proactive tool for the evaluation of overtaking maneuvers and associated safety risk, and making policy decisions reducing safety risk during overtaking maneuver as well as overall safety, while acknowledging the limited resources and facilities in low-income countries.

Extracorporeal CO2 removal in acute exacerbation of COPD unresponsive to non-invasive ventilation

Background

The gold-standard treatment for acute exacerbation of chronic obstructive pulmonary disease (ae-COPD) is non-invasive ventilation (NIV). However, NIV failures may be observed, and invasive mechanical ventilation (IMV) is required. Extracorporeal CO₂ removal (ECCO₂R) devices can be an alternative to intubation. The aim of the study was to assess ECCO₂R effectiveness and safety.

Methods

Patients with consecutive ae-COPD who experienced NIV failure were retrospectively assessed over two periods of time: before and after ECCO₂R device implementation in our ICU in 2015 (Xenios AG).

Results

Both groups (ECCO₂R: n=26, control group: n=25) were comparable at baseline, except for BMI, which was significantly higher in the ECCO₂R group (30 kg/m² vs 25 kg/m²). pH and PaCO₂ significantly improved in both groups. The mean time on ECCO₂R was 5.4 days versus 27 days for IMV in the control group. Four patients required IMV in the ECCO₂R group, of whom three received IMV after ECCO₂R weaning. Seven major bleeding events were observed with ECCO₂R, but only three led to premature discontinuation of ECCO₂R. Eight cases of ventilator-associated pneumonia were observed in the control group. Mean time spent in the ICU and mean hospital stay in the ECCO₂R and control groups were, respectively, 18 vs 30 days, 29 vs 49 days, and the 90-day mortality rates were 15% vs 28%.

Conclusions

ECCO₂R was associated with significant improvement of pH and PaCO₂ in patients with ae-COPD failing NIV therapy. It also led to avoiding intubation in 85% of cases, with low complication rates.

Trial registration number

ClinicalTrials.gov, NCT04882410. Date of registration 12 May 2021, retrospectively registered.

https://www.clinicaltrials.gov/ct2/show/NCT04882410.

Hydrostatic pressure mimicking diurnal spinal movements maintains anabolic turnover in bovine nucleus pulposus cells in vitro

Treatment strategies for progressive intervertebral-disc degeneration often alleviate pain and other symptoms. With the goal of developing strategies to promote the regeneration of the nucleus pulposus (NP), the present study tried to identify the biological effects of hydrostatic (HP) and osmotic pressures on NP cells. The study hypothesis was that a repetitive regimen of cyclic HP followed by constant HP in high-osmolality medium would increase anabolic molecules in NP cells. Bovine NP cells/clusters were enclosed within semi-permeable membrane pouches and incubated under a regimen of cyclic HP for 2 d followed by constant HP for 1 d, repeated 6 times over 18 d. NP cells showed a significantly increased expression of anabolic genes over time: aggrecan, chondroitin sulfate N-acetylgalactosaminyltransferase 1, hyaluronan synthase 2, collagen type 2 (p < 0.05). In addition, the expression of catabolic or degenerative genes (matrix metalloproteinase 13, collagen type 1) and cellular characteristic genes (proliferating cell nucleic antigen, E-cadherin) was suppressed. The amount of sulfated glycosaminoglycan increased significantly at day 18 compared to day 3 (p < 0.01). Immunostaining revealed deposition of extracellular-matrix molecules and localization of other specific molecules corresponding to their genetic expression. An improved understanding of how cells respond to physicochemical stresses will help to better treat the degenerating disc using either cell- or gene-based therapies as well as other potential matrix-enhancing therapies. Efforts to apply these tissue-engineering and regenerative-medicine strategies will need to consider these important physicochemical stresses that may have a major impact on the survivability of such treatments.

A Liver's Iliad: Liver Graft Retransplant to a Second Recipient After Brain Death in a First Recipient

With the current increased incidence of cirrhosis, the demand for liver transplant continues to grow. Here, we performed a systematic review to assess the feasibility, safety, and long-term outcomes of reused liver grafts for expansion of the donor pool. Our search identified 19 studies, including 36 patients plus 1 patient from our own institution. Ten studies were single case reports, 4 were case series, 4 were letters to the editor, and 1 was a literature review and also included a case report. Our patient presented with intentional acetaminophen overdose, received a transplant from a brain dead donor, and was confirmed brain dead 12 days posttransplant. The second recipient, who had alcoholrelated liver disease cirrhosis, underwent orthotopic liver transplant with the reused liver and was discharged from the hospital after an uneventful postoperative course. Among the 19 studies, all donors had confirmed brain death and all transplants included the whole liver, except for 2 cases of auxiliary liver grafts (reduced liver transplant) and 1 case of extended right living-donor liver graft (donor and recipient being related sisters). Overall, among first recipients, the most frequent cause of liver disease was acetaminophen overdose followed by alcohol-related liver disease cirrhosis. There were 2 cases of retransplant. Among second recipients, hepatocellular carcinoma was the most frequent cause of liver disease followed by alcohol-related liver disease cirrhosis. We found that functional outcomes with these grafts were comparable to outcomes with grafts from conventional donors; in the absence of other contraindications, we suggest that, not only for liver transplant but for other organs, these reused grafts can be used for those awaiting transplantation. Because the ability to reuse grafts is an infrequent condition, it would be difficult to generally recommend this technique; however, on a case-by-case basis, this source could expand the donor pool.

Implementación de un sistema de detección de flavivirus en mosquitos

Los Flavivirus constituyen virus transmitidos por artrópodos, principalmente mosquitos. Pueden producir enfermedades en humanos y animales, también incluyen virus específicos de insectos que solo infectan y se replican en los insectos, no así en vertebrados. En Paraguay los virus dengue, fiebre amarilla y Zika fueron detectados en infecciones humanas, pero los estudios de flavivirus en mosquitos son aún escasos. Por ello, el objetivo del presente estudio fue implementar un sistema de detección de flavivirus en mosquitos en el IICS-UNA. Primero, se organizaron capacitaciones en colecta, preparación de pools y procesamiento por técnicas de RT-PCRs convencionales realizadas por expertos internacionales a profesionales locales (bioquímicos y biólogos). Además, se implementaron planillas de registro de datos y de control de transporte de muestras de los lugares de colectas hasta el IICS-UNA. Se prepararon en total 201 pools de 1 a 35 mosquitos cada uno agrupados por especie, localidad, entre otros criterios. Para asegurar la integridad del RNA extraído se realizó la detección de un control interno (Actina-1), siendo todos los pools positivos para el mismo, 91/201 pools fueron positivos para flavivirus. Se realizó la secuenciación de 19/91 pools positivos para flavivirus identificándose flavivirus de insectos (detectándose principalmente Culex Flavivirus, cell fusing agents Flavivirus y Kamiti river virus), evidenciando la elevada distribución de estos virus. Estos resultados demuestran que fue factible implementar el sistema de detección de flavivirus en mosquitos, lo cual podría contribuir a fortalecer la vigilancia y control de estas virosis, así como el conocimiento sobre la importancia ecológica de flavivirus de insectos.

The impact of experiences of violence on the physical and mental health of a portuguese sample

Introduction

Violent Experiences result in economic and social costs for society, impacting on emotions in families, on health (both physical and mental), and overall quality of life, causing potential damages. Thus, it becomes relevant to do research on this impact, aiming at raising awareness and promoting prevention.

Objectives

The purpose of the study is to estimate the impact of experiences of violence on both physical and mental health taking into account variables such as age, gender, and marital status.

Methods

This is a cross-sectional study sampling 1407 Portuguese speaking adults, with an age average of 42 years old (DP=17.28). The measures used were: The SF-36 questionnaire to assess quality of life, physical and mental health, and the Experiences of Violence Questionnaire.

Results

The sample was divided into two groups (victims and non-victims). The group of participants that were not subjected to violence presents more positive results. In relation to the comparison between genders, it was verified that males present more positive results having into account all dimensions SF-36 when compared to women. Also, older participants (53 years old or more) presents lower results of general health.

Conclusions

Violence and health, increasingly related due to the impact it has on the subjects’ physical and mental health and quality of life.

Disclosure

No significant relationships.

PSXII-15 The organic additives in tropical pasture: effects in vitro

Currently the inclusion of organic additives in the diet of cattle on pasture is being considered as an advantageous option for livestock, increasing the productivity of the animals, being more profitable for the breeder, and making management practices safer and more sustainable for the environment. The present work was to evaluate in vitro metabolic effects of Fator P® in potential and degradability rate of dry matter (DM) of forage of the Urochloa brizantha (syn. Brachiaria brizantha). The Fator P® is the organic additive elaborate by a blend of the compounds like aminoacids (lysine, methionine, and tyrosine), the choline, minerals, probiotics and essential fatty acids (omega 3 and omega 6). The additive was evaluated in dosage of 6 gr / 8 kg DM in compared to control, during 72 hours of the experiment (0, 12, 24, 48, 72). The calculations of ruminal kinetics rate were performed based on mathematical model developed by Orskov e Mcdonald (1979) and France et al. (1993). In the table were expressed all the results obtained after by analyses of results by the method One-Way ANOVA. The soluble fraction was the same, as it was the same forage. There was a difference in the potentially fermentable insoluble fraction and non-degradable fraction (P &lt; 0.001). No difference in the degradation rate (P = 0.54). The results showed that the additive was able to improve de efficient of potential degradation in 22.1% (P &lt; 0,001). In this condition, the data show that can improve ruminal utilization of ingested forage. The animals can better enjoy the diet consumed, increasing weight gains and carcass quality. Besides that, the organic additive can improve sustainability, reducing de enteric gas production for the environment, and the risks of evolution of microbial resistance, for being composed of organic and natural substances.

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PSVI-16 Essential fatty acids and bio-surfactants can improve de bovine production in tropical pasture

Improving the efficiency of production of beef cattle on tropical pasture is a challenge. So, new technologies need be tested. Essential fatty acids (EFA) are essential for cell structure, regulation and can improve the immune response. Bio-surfactants (BS) can increase the interaction between microorganisms and substrates in the rumen (Liu et al., 2013). The aim of this work was to test a blend of EFA and BS in the performance of beef cattle in tropical pasture. This study was conducted in the Premix’s Research Center, Patrocínio Paulista, São Paulo State, Brazil. The area used had 6 hectares of pasture of Urochloa brizantha (syn. Brachiaria brizantha). Twenty-four Nellore steers were evaluated for 313 days. The initial weight was 253 ±10.9 kg. The diet was pasture and protein-energy supplements (0.4% of live weight) with (test) or not (control) additives. The additive was the blend of EFA (14.02g/kg-linolenic) and BS (57.5g/kg-phosphatidylcholine) including 0.3% in the supplement. The parameters used were daily average gain, carcass yield and carcass daily gain. The rumen degradability of dry matter of the forage was analyzed with cannulated animals (72, 48, 36, 24, 12, 6, 0 hours; Orskov & McDonald,1979). The analysis of variance was used with 5% significance. The daily average gain was 680 g/day for the control and 735 g/day for the test (P = 0.02). The carcass yield is not different (mean=55.48). The carcass daily gain was 429 g/day for the control and 456 g/day for the test (P = 0.06). The degradation potential of dry matter was 54.25% for the control and 56.71% for the test (P = 0.03). This is 4.5% more degradation of dry matter for the test. It can explain the 8% more of daily average gain and 8.45 kg of carcass in the period. The blend of EFA and BS can take additive effect improving the bovine production on tropical pasture and can be an environmentally friendly alternative.

Detection and characterization of Plasmodium spp. by semi-nested multiplex PCR both in mosquito vectors and in humans residing in historically endemic areas of Paraguay

In Paraguay, no cases of Malaria have been recorded since 2011. Microscopy and the SnM-PCR technique were implemented to detect and characterize Plasmodium spp. both in mosquitoes and in humans residing in historically endemic areas of Paraguay, to evaluate the possibility of finding asymptomatic cases and/or Plasmodium parasites circulating in anophelines. Between 2013 and 2015, 361 human blood samples were collected on filter paper, and between 2016 and 2017, 938 female Anopheles mosquitoes were captured in 15 Paraguayan localities. All the diagnostic techniques showed negative results. We observed no asymptomatic case or Plasmodium circulating in vectors.

Metabolically healthy obesity in a young population assisted by the Family Health Strategy in Brazil

Background

Obesity is increasing in younger populations, and is associated with a high cardiovascular (CV) risk, however, it is not clear whether metabolically healthy obesity (MHO) may have a lower CV risk or if it is just an earlier stage of the disease.

Objective

To evaluate the prevalence and CV risk factors associated with MHO in a young population assisted by a Family Health Care unit in a large urban center in Brazil.

Methods

A cross-sectional population study for CV risk assessment in adults aged 20-50 years old from a FHC unit in Rio de Janeiro. Demographic, anthropometric data and CV risk factors were recorded. All underwent office blood pressure (OBP) measurements, laboratory evaluation (lipid and glycidic profile). Obesity was defined as a BMI ≥ 30 kg/m2 and MHO are those who have less than 3 of the following criteria: hypertension, diabetes, total cholesterol ≥ 200 mg/dL, HDL&lt;40 mg/dL (men) and 50 mg/dL (women), triglycerides&gt;150 mg/dL and increased waist circumference.

Results

A total of 632 individuals were evaluated (60% female; mean age 37 ± 9 years). The prevalence of obesity was 26%, of which 73% were classified as MHO. Obeses are older, with a higher prevalence of physical inactivity (51% vs 41%, p = 0.03), hypertension (44% vs 19%, p &lt; 0.001), dyslipidemia (50% vs 36%, p = 0.002) and diabetes (7% vs 2%, p = 0.001) with higher systolic OBP. MHO compared to unhealthy ones are significantly younger and smoke less. Despite being obese, they have lower BMI (33.6 vs 35.2 kg/m2, p = 0.02) and abdominal circumference (102 vs 110 cm, p = 0.03), with lower diastolic BP.

Conclusions

MHO was more prevalent in this young population and seems to have a lower CV risk, however it is not clear whether these younger and less obese individuals are only at an earlier stage of the disease. Perhaps the CV diseases onset is postponed for a few years. Even so, these individuals should not be excluded from public health policies as a form of primary prevention.

Key messages

In this young population, MHO was more prevalent and presented a lower CV risk. The follow-up of MHO will show if they are really healthy or if they are at an early stage of the disease.

Cardiovascular risk factors and social determinants in a population study in Rio de Janeiro, Brazil

Background

The association of cardiovascular (CV) diseases and their risk factors with socioeconomic status has been well described, but its influence is often underestimated in epidemiological studies in Brazil.

Objective

To evaluate the relationship between the main CV risk factors and socioeconomic indicators in a population of adults registered in a Family Health Care (FHC) unit in a great urban center - Rio de Janeiro, Brazil.

Methods

Cross-sectional population study that included adults aged between 20 and 50 years living in the area covered by the FHC unit in Rio de Janeiro. Demographic data (gender and age), socioeconomic data (education level, profession, employment), CV risk factors (smoking, sedentary lifestyle, obesity, hypertension, diabetes, dyslipidemia) were recorded. The metabolic profile is evaluated through laboratory tests. Those who studied up to high school were considered poorly educated.

Results

604 individuals were enrolled [39% male, mean age: 38.8 ± 8,9 years] The median of schooling was 12 years. 288 individuals had high schooling, 44.5% were male. A total of 130 individuals did not study or work. Women with low education had a higher risk of smoking, obesity and hypertension with no difference regarding labor or study activities. Otherwise, men with low education had a higher risk of sedentary lifestyle and hypertension. Among men, not working or studying increased the risk of smoking and hypertension.

Conclusions

We found an inverse association between socioeconomic conditions and the prevalence of CV risk factors. Women are more affected by low schooling, while men are more affected by their working occupation. The study suggests that socioeconomic factors influence the CV risk, affecting men and women differently, pointing to the need for more comprehensive public health policies that effectively reverse this situation.

Key messages

We found an inverse association between socioeconomic conditions and the prevalence of CV risk factors. Socioeconomic factors influence cardiovascular risk differently according to gender.

She Has The Blues: An Unusual Case of Copper Sulphate Intoxication

BACKGROUND

Copper is an essential trace element of the human body. However, it is related to many diseases. Copper intoxication is not common in Western countries, but needs to be rapidly recognised because of its high lethality.

CASE PRESENTATION

We report the case of a 40-year-old woman who presented to the emergency department after performing intrarectal administration of a blue powder sent from Cameroon by her family, in the belief that this would help her to get pregnant. Her evolution was complicated by multiorgan failure and the unusual circumstances. The diagnosis was suspected on the basis of the clinical presentation and the colour of the powder, and confirmed by blood dosage and toxicological analysis of the powder. She underwent symptomatic treatment, and the outcome was progressively favourable, apart from persistent chronic renal failure with dependence on dialysis.

CONCLUSION

Copper intoxications are rare but severe. Laboratory diagnosis of the condition is not an issue; the difficulty is suspecting it and quickly initiating chelation treatment associated with symptomatic treatments.

LEARNING POINTS

Copper sulphate is a rare but severe condition that must be promptly diagnosed. Diagnosis may be based on clinical presentation, characterised by multiple organ failure, and suspected in the case of ingestion of a blue chemical product.In the presence of saturation gap on pulse oximetry, the clinician must consider the possibility of methemoglobinaemia, and look for toxic causes.Treatment of copper sulphate poisoning requires mainly symptomatic treatment and chelation of copper by oral or IV drugs.

P1256 Salvage mitraclip implantation for postmyocardial infarction mitral regurgitation: 2 case reports

Introduction

Acute mitral regurgitation (MR) secondary to AMI is associated with a poor clinical outcome. The role of MitraClip implantation (MCI) in this population is still not well established. We report two successful cases of salvage MCI in acute ischaemic MR.

Case Report 1: A 66-year-old diabetic woman was admitted to our institution due to extensive anterior STEMI with cardiogenic shock. Urgent cardiac catheterization (CC) revealed 100% occlusion of the left anterior descending and critical stenosis of the obtuse marginal artery, with successful PCI of both vessels and implantation of an intra-aortic balloon pump. Early transthoracic echocardiogram (TTE) revealed a dilated left ventricle with severe systolic dysfunction (LVEF – 35%), apical and anterior wall akinesia and functional grade IV MR (EROA - 40mm2 and regurgitant volume - 45mL), that was later confirmed by transesophageal echocardiography (TEE). 48h after AMI, the patient developed an arrhythmic storm requiring multiple shocks and a prolonged period of mechanical ventilation. Due to an extremely slow clinical improvement, with the need for prolonged inotropic support and refractory pulmonary congestion (NYHA IV), she was submitted to MCI, resulting in post-procedural grade I MR (EROA 7mm2 and regurgitant volume 11mL) and a marked clinical and hemodynamic improvement. An ICD for secondary prevention was implanted. At the 3 month follow-up the patient presented in NYHA II functional class without congestive symptoms.

Case Report 2: An 82-year old female patient was admitted with an inferior STEMI, with CC documenting severe 3 vessel disease with a calcified occlusion of the right coronary artery, not amenable to PCI, so the patient was submitted to emergent CABG. There was a prolonged period of post-operatory mechanical ventilation with an extremely difficult weaning process, including the need for re-intubation due to acute pulmonary edema. TTE revealed LVEF of 39% with a large inferobasal aneurysm and severe eccentric MR due to tendinous cord rupture. The patient was submitted to MCI with immediate significant improvement of the MR, allowing successful extubation 36 hours after the procedure. In the end of first month of follow-up, the TTE revealed a well-positioned clip with mild-to-moderate MR (EROA – 21.5mm2 and regurgitant volume – 38mL) with the patient being completely asymptomatic.

Conclusion

Treatment of acute MR following AMI with MCI may be a safe and effective approach in critically ill patients. In our experience, it can lead to a rapid clinical recovery and resolution of cardiogenic shock.

P229 Primary cardiac angiosarcoma of the right atrium: a rare entity presenting with an atrial arrhythmia

Introduction

Primary cardiac tumors are rare entities and 75% are benign. Angiosarcoma is the most common malignant primary cardiac tumor.

We report the case of cardiac angiosarcoma presenting with an atrial arrhythmia.

Clinical case

A 39-year-old female patient with no past medical history presented to the emergency department with heart palpitations and atypical chest pain.

Electrocardiogram on admission showed atrial flutter with a heart rate of 153 beats per minute.

Laboratory analysis were performed showing elevated D-dimer levels (2210 ug/L).

A thoracic CT scan was performed, which ruled out pulmonary embolism, but showed multiple pulmonary nodules and a right atrial (RA) mass measuring 48 mm that could correspond to a thrombus or neoplasia.

The patient was admitted in the Cardiology ICU of our hospital and was started on beta-blocker and amiodarone with conversion to sinus rhythm. Additional exams were performed:

- Transthoracic echocardiogram (TTE) revealed an heterogenous 32,6 x 17,7 mm mass in the lateral wall of the RA with an adherent mobile mass near the tricuspid valve with 28 mm diameter (possible adherent thrombus).

- Cardiac magnetic resonance imaging confirmed a RA tumor with invasion of the atrial free wall and compression of the superior vena cava.

Due to the unclear etiology of the RA mass, ultrasound-guided intracardiac biopsy was performed. Pathological examination revealed spindle cell proliferation, consistent with the diagnosis of angiosarcoma. Immunohistochemical staining was positive for Vimentin, CD34 and CD31, with 70% Ki67 expression.

Later on, the patient developed melena with significant drop of hemoglobin levels, requiring daily red blood cell transfusions and anticoagulation had to be stopped.

The patient was transferred to the Internal Medicine ward and thoracic-abdomen-pelvis staging computed tomography (CT) scan showed a significant increase in the number of pulmonary nodules, bilateral ovarian masses, 4 hepatic nodules and ileum metastization.

During hospitalization, the patient developed right leg deep venous thrombosis and thoracic CT scan revealed bilateral pulmonary embolism.

After improvement of the clinical status, palliative chemotherapy was started and the patient was discharged, maintaining regular outpatient follow-up in the Oncology Department for 1 month.

Cardiac angiosarcoma generally presents in a late stage of the disease with metastatic involvement. When surgical treatment is not possible, despite agressive chemotherapy, the prognosis remains poor.

Abstract P229 Figure. Echocardiogram: right atrium mass

Micro-level safety risk assessment model for a two-lane heterogeneous traffic environment in a developing country: A comparative crash probability modeling approach

INTRODUCTION

There have been a number of studies that have led to the development of safety risk assessment models to quantify the probability of crash frequencies on roadway facilities (both at micro- and macro-levels), over a specified time period. However, past research has rarely focused on heterogeneous traffic conditions in developing countries.

METHOD

This paper puts forward several models related to the traditional count approach to estimate crash frequency at a micro-level in a non-lane based bi-directional heterogeneous traffic environment. The paper shows the results of dispersion, zero-inflation, and random heterogeneity effects of different exogenous factors by comparing Poisson (P); Negative Binomial (NB); random and fixed parameter Zero-Inflated Poisson (ZIP); and Latent Class Models (LCM). The empirical analysis is based on data from a section of a major national highway in Bangladesh. The performance of the models was validated using different statistical goodness-of-fit measures that compared the estimated and observed average crash frequencies at individual locations. With the identification of the most significant influencing factors, the paper discusses the practical policy implications using partial effects analysis and spatial distribution.

RESULTS

It was found that the Zero-Inflated Random Parameter model gives a slightly better statistical fit when compared to alternative approaches. Practical applications: This micro-level modeling approach would be useful to identify significant crash risk factors; to prioritize road sections according to their safety level; to select site-specific appropriate counter-measures; and devise proactive target oriented safety management strategies. Thus, the results shown here could be a point of reference in the planning, designing, maintaining, and managing two-lane highway sections in developing countries.

The impact of glycemic variability on length of stay and mortality in diabetic patients admitted with community-acquired pneumonia or chronic obstructive pulmonary disease

AIM

To investigate the influence of glycemic variability (GV) on length of stay and in-hospital mortality in non-critical diabetic patients.

METHODS

A observation retrospective study was performed. Diabetic patients admitted between January and June 2016 with the diagnosis of community-acquire pneumonia (CAP) and/or acute exacerbation of chronic obstructive pulmonary disease (COPD) were enrolled and glycemic control (persistent hyperglycemia, hypoglycemia, mean glucose level (MGL) and respective standard deviation (SD) and coefficient of variation (CV)) were evaluated. Primary outcomes were length of stay and in-hospital mortality.

RESULTS

Data from 242 patients were analyzed. Fifty-eight percent of the patients were male, with a median age of 77 years (min-max, 29-98). Patients had on average 2.1 glucose readings-day and the MGL was 193.3 mg/dl (min-max, 84.3-436.6). Hypoglycemia was documented in 13.4% of the patients and 55.4% had persistent hyperglycemia. The median length of hospital stay was 10 days (min-max, 1-66) and in-hospital mortality was 7.4%. We found a significant higher in-hospital mortality in older patients, with history of cancer and with nosocomial infections. We did not find any correlation between MGL, SD, CV, hypoglycemia or persist hyperglycemia and in-hospital mortality. A longer length of stay was observed in patients with heavy alcohol consumption and nosocomial infections. The length of stay was negatively correlated with the mean glucose level (r²-0.147; p < 0.05) and positively correlated with the coefficient of variation (p 0.162; p < 0.05).

CONCLUSION

This study confirmed the negative impact of the glycemic variability in the outcomes of diabetic patients admitted with CAP or acute exacerbation of COPD.

Assessment of diet composition of free-ranging addax antelopes (Addaxnasomaculatus) by the combination of microhistological procedures andn-alkanes and long-chain alcohols as fecal markers

Understanding herbivore foraging behaviour is crucial for adequate wildlife management decisions. This study assessed the diet composition of free-ranging addax antelope (Addax nasomaculatus (de Blainville, 1816)). Samples collected during the spring season were analyzed using microhistological procedures along with n-alkanes and long-chain alcohols as fecal markers. Twelve animals were monitored and fresh fecal samples were collected daily during a 7-day period. Diet composition estimates obtained by both methods were similar and indicate that Stipagrostis pungens (Desf.) De Winter was the main diet component followed by Fagonia glutinosa Delile, Helianthemum kahiricum Delile, and Hammada schmittiana (Pomel.) Botsch. Data showed that addax have mixed diets composed of perennial woody and herbaceous plant species depending on their availability. The four species most selected by the animals were also the most abundant species in terms of plant cover. In contrast, species that accounted for less than 5% of the plant cover were not present in the fecal samples. Results of this study represent a single grazing season, and for that reason, further studies are required to fully understand how the grazing behaviour of addax varies with seasonal changes in vegetation cover.

Characterization of the dysplastic Walch type C glenoid

Aims

The Walch Type C dysplastic glenoid is characterized by excessive retroversion. This anatomical study describes its morphology.

Patients and Methods

A total of 29 shoulders with a dysplastic glenoid were analyzed. CT was used to measure retroversion, inclination, height, width, radius-of-curvature, surface area, depth, subluxation of the humeral head and the Goutallier classification of fatty infiltration. The severity of dysplasia and deficiency of the posterior rim of the glenoid were recorded.

Results

A type C glenoid occurred in 1.8% of shoulders referred to our tertiary centres. The mean retroversion, inclination, height, width, radius-of-curvature, surface area, and depth of the glenoid were 37°, 3°, 46 mm, 30 mm, 37°, 1284 mm3, and 16 mm, respectively. The mean posterior subluxation was 90%. The Goutallier class was < 2 in 25 shoulders (86%). Glenoid dysplasia was mild in four, moderate in 14, and severe in 11 shoulders. The typical appearance of the posterior glenoid rim had a rounded or ‘lazy J’ morphology. The glenoid neck was deficient in 18 shoulders (62%).

Conclusion

A dysplastic Type C glenoid characteristically has a uniconcave retroverted morphology, a deficient posteroinferior rim and scapular neck, and a reduced depth. These findings help to define the unique anatomical variations and may aid the planning of surgery and the development of components for these patients. Cite this article: Bone Joint J 2018;100-B:1074–9.

Author Correction: Osmotic modulation of chromatin impacts on efficiency and kinetics of cell fate modulation

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has been fixed in the paper.

Effectiveness and safety of local anesthetic, semi-flexible pleuroscopy - experience from a peripheral hospital

If the seemingly less invasive semi-flexible pleuroscopes are combined with strategies of conscious sedation and local anesthesia the pleuroscopy has the potential to reach an increasing number of hospital settings. Local experiences can provide valuable information pertaining to the reproducibility of this technique in different scenarios. We performed a retrospective analysis of the clinical records of all patients that had undergone local anesthetic semi-flexible pleuroscopy in our unit between February 2015 and July 2017. Data on demographics, previous biochemical, cytological and histopathological analysis, procedure details, diagnostic and therapeutic results, complications and mortality were collected from all patients. Statistical analysis was performed using SPSS v23. A total of 30 patients were included. They were mainly male (66.7%), with a median age of 72 years (minimum 19 years, maximum 87 years). All presented with exudative pleural effusions and the exam was performed for diagnostic reasons. Pleural tissue was obtained in all patients and the overall diagnostic accuracy was 93.3%. Malignancy was the chief group of diagnosis (66.7%), followed by pleural tuberculosis (13.3%). The procedure was well tolerated and self-limited subcutaneous emphysema was the only complication registered (13.3%). No deaths were associated with the procedure. Our results globally overlap those of wider series and reinforce the perception that local anesthetic semi-flexible pleuroscopy is a well-tolerated, safe and highly accurate diagnostic and therapeutic tool which has proved to be both feasible and effective in our experience.

Osmotic modulation of chromatin impacts on efficiency and kinetics of cell fate modulation

Chromatin structure is a major regulator of transcription and gene expression. Herein we explore the use of osmotic modulation to modify the chromatin structure and reprogram gene expression. In this study we use the extracellular osmotic pressure as a chromatin structure and transcriptional modulator. Hyposmotic modulation promotes chromatin loosening and induces changes in RNA polymerase II (Pol II) activity. The chromatin decondensation opens space for higher amounts of DNA engaged RNA Pol II. Hyposmotic modulation constitutes an alternative route to manipulate cell fate decisions. This technology was tested in model protocols of induced pluripotency and transdifferentiation in cells growing in suspension and adherent to substrates, CD34⁺ umbilical-cord-blood (UCB), fibroblasts and B-cells. The efficiency and kinetics of these cell fate modulation processes were improved by transient hyposmotic modulation of the cell environment.