Long-term multidisciplinary follow-up programs in pediatric cardiac arrest survivors

Long-term outcome studies after pediatric cardiac arrest (CA) are few. They require a CA registry and dedicated outcome teams. Learning about the long-term outcomes is very important for developing prognostication guidelines, improving post-cardiac care, counseling caregivers about the future of their child, and creating opportunities for therapeutic intervention studies to improve outcomes. Few PICUs worldwide provide a multidisciplinary follow-up program as routine practice at an outpatient clinic with standardized measurements, using validated instruments including neuropsychological assessments by psychologists. The primary goal of such a follow-up program should be to provide excellent care to children and their caregivers, thereby resulting in a high attendance. Pediatric psychologists, neurologists and pediatricians/pediatric intensivists should ideally be involved to screen for delayed development and psychosocial problems and offer appropriate care at the same time. Preferably, outcomes should consist of evaluation of morbidity (physical and neuropsychological), functional health and Health Related Quality Of Life (QoL) of the patient and their caregivers.

Upward trends in eating disorders, self-harm, and suicide attempt emergency admissions in female adolescents after COVID-19 lockdown

INTRODUCTION

Increased mental health problems have been reported in children and adolescents related to the COVID-19 lockdown and its immediate aftermath, especially among adolescent females. However, the longer-term impact of persistent quarantine measures and social restrictions on this population is yet to be further explored.

MATERIALS AND METHODS

We compared the number of children/adolescents admissions to the psychiatric emergency department (ED) of Hospital Clínic de Barcelona during the COVID-19 lockdown and the following year with the numbers of admissions the year before lockdown, adjusting for variations in the population. We also conducted separate analyses by gender, age group, and diagnostic categories. Finally, we also repeated the analyses considering the cumulated deficit/excess since the start of the lockdown. Statistical significance was estimated using binomial tests with Bonferroni correction.

RESULTS

A total of 2425 admissions were recorded. Globally, admission rates decreased during the lockdown (46%) and progressively increased during the one-year aftermath (43% by spring 2021). This increase was particularly high in adolescent females (85%) while unclear in children and/or males. The main diagnostic categories involved were anxiety, depressive, and eating disorders, as well as self-harm behavior, suicidal ideation, and suicide attempts. The increase in eating disorders, self-harm behavior, and suicide attempts admissions in female adolescents remained statistically significant when considering the cumulated deficit/excess.

CONCLUSIONS

We found increased ED admissions during the aftermath of the COVID-19 lockdown among adolescent females. We recommend strengthening the attention to this population to provide adequate specialized care and prevention strategies.

The impact of the Catalonia Suicide Risk Code (CSRC) in a tertiary hospital: Reduction in hospitalizations and emergency room visits for any reason but not for suicide attempt

INTRODUCTION

Suicide attempts represent a public health concern. The objective of this study is to describe the clinical characteristics of patients visiting an emergency room for a suicide attempt and included in a suicide prevention program, the Catalonia Suicide Risk Code (CSRC), particularly focusing on the follow-up evaluations.

MATERIALS AND METHODS

The CSRC program is divided in 3 phases: (1) alert and activation, (2) proactive telephone and face-to-face follow-up and (3) comprehensive preventive health monitoring. This is the analysis of the sample of patients attempting or intending suicide who were seen at a tertiary hospital in Barcelona, and their 1-year follow-up outcome.

RESULTS

Three hundred and sixty-five patients were included. In 15% of the cases, there was no previous psychiatric history but in the majority of cases, a previous psychiatric diagnosis was present. The most common type of suicide attempt was by drug overdose (84%). Up to 66.6% of the patients attended the scheduled follow-up visit in the CSRC program. A significant reduction in the proportion of patients visiting the emergency room for any reason (but not specifically for a suicide attempt) and being hospitalized in the first semester in comparison with the second six months after the CSRC activation (30.1% versus 19.9%, p=0.006; 14.1% versus 5.8%, p=0.002) was observed.

CONCLUSIONS

The clinical risk factors and the findings of the CSRC helped in the characterization of suicide attempters. The CSRC may contribute to reduce hospitalizations and the use of mental health care resources, at least in the short-term.

Emergency Psychiatry before and during COVID-19 pandemia

Introduction

The COVID-19 pandemic had a significant impact worldwide. Consultations in the Emergency Service of the Hospital Clínic of Barcelona varied in terms of reasons for consultations, psychopathology, and other aspects, before and after the pandemic.

Objectives

To examine changes in the profile of patients admitted before and during the COVID-19 pandemic to our Psychiatric Emergency Service.

Methods

All children, adolescent and adult psychiatric inpatients admitted from December 4th 2019 to March 31st 2021 to the Psychiatric Emergency Service of Hospital Clínic of Barcelona, Spain, were retrospectively included for analysis and divided into two groups –groups 1 or 2- including the first one all patients who attended before lockdown and the second group those who attended during the pandemic.

Results

A total of 1991 patients were included -1224 in the first group and 767 in the second group. The majority of patients were male (52.08%), with a mean age of 41.21 years (SD 16.53). A proportion significantly higher of men was found in the second group (p<0.05). The proportion of patients consulting with substance use disorders was significantly higher in the second group (p<0.05). Patients from the second group presented a significantly higher proportion of admissions in an acute psychiatric ward (p<0.05), and also a significantly higher proportion of consultations of patients with dementia (p<0.05).

Conclusions

The COVID-19 pandemic lead to a significant reduction in the overall consultations, with a higher proportion of severe cases. The lack of availability of caregivers and telework might have influenced the increase in consultations of patients with dementia.

Disclosure

AG has received travel and financial support from Janssen, Otsuka-Lundbeck and Angelini, and research support from Instituto de Salud Carlos III, and declares no support related with the subject of this presentation.

The COVID-19 policy response in Spain and Portugal: a study of measures to slow down infection rate

Background

The COVID-19 global pandemic triggered massive policy responses worldwide. Measures taken during the pandemic differed across countries and time. Governance systems may influence the capacity of countries to respond promptly and mobilize the necessary resources in time. Identifying measures and when they appeared are critical questions to assess emergency response strategies. The objective of this study was to analyze the policy response to slow down the infection rate of COVID-19 cases in Portugal and Spain according to timing (related to death rates) and stringency.

Methods

A descriptive comparative study of non-pharmaceutical interventions was conducted through a content analysis of policies and records review of official government sources. Portugal and Spain were selected considering the similarities between national health systems, but different government organization and epidemic impact. The Autonomous Community of Madrid was also included as example of subnational systems. Death rates were retrieved from daily statistics of open secondary sources.

Results

Results show that countries responded with a complex mix of measures across policy sectors, following dynamic patterns established by the epidemic evolution and governance systems. Policies aimed to reduce the spread of the virus, enable individuals and businesses to comply with restrictions, and reinforce National Health System's capacity. The declaration of state of emergency was a critical tool to organize actions under clear leadership, especially in devolved contexts.

Conclusions

Our findings suggest that, in early epidemic phases, a centralized command can be more effective at timely enacting nationwide stringent measures. Evidence from this study contributes to the argument that a fast, robust, and early response might have been more effective at containing spread at the initial stages of the pandemic.

Key messages

The policy response included measured to reduce spread of infection, enhance adherence and strengthen health systems capacity to deal with the pandemic.

The declaration of state of emergency was essential to ensure an organized, coherent, timely, and robust response, especially in devolved contexts.

POS0623 CYTOKINE PRODUCTION BY BLOOD LYMPHOCYTES DEFINES A PROFILE ASSOCIATED WITH NON-REMISSION IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH TNF INHIBITORS

Background:

In clinical practice no more than 50% of the patients treated with TNF inhibitors (TNFi) achieve remission (REM). Previous investigations suggested that peripheral blood mononuclear cells (PBMC) may be markers associated with the TNFi treatment success1.

Objectives:

This study aims to analyse the intracellular cytokine production by PBMC and its association with REM achievement after 6 months (m) of TNFi treatment in patients with RA.

Methods:

This was a prospective study including 62 patients with RA starting the 1st TNFi. PBMC were isolated from patients at baseline and after 6m of treatment with TNFi and cryopreserved until studied. In vitro stimulation and intracellular cytokine production by PBMC was performed as follow: in the presence of 2µg/mL brefeldin and 2µmol/L monensin monocytes were stimulated with 20ng/mL LPS during 4h whereas lymphocytes were stimulated with 50ng/mL phorbol 12-myristate 13-acetate and 750ng/mL ionomycin for 4h at 37°C. To identify IL10-producing B cells, PBMC were pre-incubated with 3µg/mL of CpG oligonucleotide during 20h at 37°C prior to stimulation. Intracellular cytokine production (TNFα, IL6, GM-CSF, IL10) by the different cell subsets (monocytes, CD4+ and CD8+ T cells, naïve and memory B cells) was analysed by flow-cytometry. Clinical activity at baseline and after 6m was assessed by DAS28-ESR. REM was defined as DAS28≤2.6 at 6m. The association between cytokine production by each PBMC subset and REM was analysed through univariable and multivariable logistic regression models. Receiving operating curve (ROC) analysis was used to select the optimal ratio of cytokine production associated with REM status.

Results:

After 6m of TNFi treatment, 30 (48%) patients achieved REM. No significant differences between REM and non-REM groups were observed for patients’ characteristics at baseline except for DAS28, which was lower in the REM group (non-REM: 5.4±0.9; REM: 4.3±0.9; p<0.0001) (Table 1). Therefore, further analyses were adjusted by baseline DAS28. A lower ratio between calculated with the IL10 and TNFα production by B cells and by CD4+ T cells (IL10 B/TNF CD4) at 6m was found for non-REM patients (non-REM: 0.31 vs REM: 0.54; p=0.007). Based on a ROC analysis, we found that a (IL10 B/TNF CD4)<0.54 at 6 m was significantly associated with a higher probability of non-REM at 6 months (OR: 5.0; 95% CI: 1.1-21.7) (Figure 1).

Table 1.

Baseline predictors of reduction of disease activity at 12 months from start of abatacept. Linear regression.

Baseline patients’ characteristicsTotal patients (n=62)DAS28>2.6(n=32; 52%)DAS28≤2.6(n=30; 48%)p-valueAge (years)53±1253±1352±100.8Female55 (89)30 (94)25 (83)0.2Disease duration (years)8 (4-11)8 (4-12)7 (3-11)0.7RF positive49 (79)23 (72)26 (87)0.1ACPA positive54 (87)26 (81)28 (93)0.2Smoking habit (n=55)0.2Non-smokers26 (47)16 (55)10 (38) Smoker29 (53)13 (45)16 (51)Body mass index (kg/m2)25.9±5.625.8±5.726.0±5.60.9DAS284.9±1.05.4±0.94.3±0.9<0.0001Concomitant csDMARDs60 (97)32 (100)28 (93)0.3MTX [±OD]46 (74)26 (81)20 (67)0.3Only OD14 (23)6 (19)8 (26)0.3Prednisone36 (58)19 (59)17 (57)0.9

Conclusion:

Our results show that the proinflammatory IL10 B/TNF CD4 ratio is associated with non-REM status. It could be useful to analyse the success of TNFi treatment in patients with RA.

References:

[1]Rodríguez-Martín E, et al. Front Immunol. 2020; 11: 1913.

Acknowledgements:

ISCIII (PI16/00474; PI16/01092)

Disclosure of Interests:

Borja Hernández-Breijo: None declared, Eulalia Rodríguez-Martín: None declared, Carlota García-Hoz: None declared, Victoria Navarro-Compán Speakers bureau: Abbvie, Janssen, Lilly, MSD, Novartis, Pfizer and UCB, Grant/research support from: Abbvie, Janssen, Lilly, MSD, Novartis, Pfizer and UCB, Cristina Sobrino: None declared, ANA MARTÍNEZ-FEITO: None declared, Israel Nieto-Gañán: None declared, Javier Bachiller-Corral Speakers bureau: Abbvie, MSD, BMS and Roche, Grant/research support from: Pfizer, Paloma Lapuente-Suanzes: None declared, Gemma Bonilla: None declared, Cristina Pijoán-Moratalla: None declared, Mónica Vázquez: None declared, Alejandro Balsa Speakers bureau: Abbvie, BMS, Nordic, Novartis, Pfizer, Sandoz, Sanofi, Roche and UCB, DORA PASCUAL-SALCEDO: None declared, Luisa María Villar: None declared, Chamaida Plasencia Speakers bureau: AbbVie, Lilly, Novartis, Pfizer, Sanofi, Biogen and UCB

Changing trends in psychiatric emergency service admissions during the COVID-19 outbreak: Report from a worldwide epicentre

BACKGROUND

During the COVID-19 pandemic, a structural reorganization was imposed on public health systems. Psychiatry services were also affected with the imposed reduction of non-urgent consultations. We aim to explore the effect of these changes on a Psychiatry Emergency Service during COVID-19 lockdown in Spain.

METHODS

A retrospective analysis was performed on all patients admitted to our Psychiatric Emergency Service 90 days before and after March 14^th, 2020, the first day of lockdown in Spain. Extracted data were compared between the two periods. Poisson regression analysis was performed to analyze changes in admission rates.

RESULTS

1,958 psychiatric emergency admissions were analyzed. Although the number of admissions decreased by 37.9%, we observed a significant increase in the percentage of acute psychiatric hospitalization during the lockdown. Anxiety spectrum disorders accumulated the greatest significant decrease in admission rates during the lockdown. On the other hand, a significant increase in admissions rates was found in patients with dementia, autism spectrum disorders, and substance use disorders during the lockdown.

LIMITATIONS

This study was conducted in a single psychiatric emergency service, preventing a generalization of our results. The comparison time period might have biased our results due to the influence of external factors.

CONCLUSION

Mental health consequences of COVID-19 are becoming apparent. A reduction of admission rates for anxiety disorders might be related telepsychiatry implementation during the lockdown. Other conditions particularly vulnerable to the routine changes and lack of social support have suffered the most, and efforts should be placed to treat these situations.

Computational modelling of nasal respiratory flow

CFD has emerged as a promising diagnostic tool for clinical trials, with tremendous potential. However, for real clinical applications to be useful, overall statistical findings from large population samples (e.g., multiple cases and models) are needed. Fully resolved solutions are not a priority, but rather rapid solutions with fast turn-around times are desired. This leads to the issue of what are the minimum modelling criteria for achieving adequate accuracy in respiratory flows for large-scale clinical applications, with a view to rapid turnaround times. This study simulated a highly-resolved solution using the large eddy simulation (LES) method as a reference case for comparison with lower resolution models that included larger time steps and no turbulence modelling. Differences in solutions were quantified by pressure loss, flow resistance, unsteadiness, turbulence intensity, and hysteresis effects from multiple cycles. The results demonstrated that sufficient accuracy could be achieved with lower resolution models if the mean flow was considered. Furthermore, to achieve an established transient result unaffected by the initial start-up quiescent effects, the results need to be taken from at least the second respiration cycle. It was also found that the exhalation phase exhibited strong turbulence. The results are expected to provide guidance for future modelling efforts for clinical and engineering applications requiring large numbers of cases using simplified modelling approaches.

Unravelling potential severe psychiatric repercussions on healthcare professionals during the COVID-19 crisis

The coronavirus disease 2019 (COVID-19) outbreak is putting healthcare professionals, especially those in the frontline, under extreme pressures, with a high risk of experiencing physical exhaustion, psychological disturbances, stigmatization, insomnia, depression and anxiety. We report the case of a general practitioner, without relevant somatic or psychiatric history that experienced a "brief reactive psychosis (298.8)" under stressful circumstances derived from COVID-19. She presented with delusional ideas of catastrophe regarding the current pandemic situation, delusions of self-reference, surveillance and persecution, with high affective and behavioural involvement. Physical examination and all further additional investigations did not reveal any secondary causes. She was administered olanzapine 10 mg with significant psychopathological improvement being later discharged with indications to maintain the treatment. To our knowledge this is the first reported case of severe mental illness in a healthcare professional without previous psychiatric history due to COVID-19 outbreak. Around 85% of patients presenting a brief psychotic disorder will develop a potentially disabling serious psychotic illness in the long-term. This case represents the potentially serious mental health consequences on healthcare professionals throughout the COVID-19 crisis and emphasizes the need to implement urgent measures to maintain staff mental health during the current pandemic.

[Detection and registration of alcohol use in the emergency department]

OBJECTIVE

Due to the high economic and morbimortality burden associated to alcohol use, in the last decades, public health services have developed several programs to detect and to intervene on at risk drinkers in primary care settings and emergency departments (ED). The aim of this study is to determine the proportion of detected and registered risky drinkers in an ED of Hospital Clínic de Barcelona.

METHODS

All patients over 18 years old, presenting to the ED and reporting risky drinking, were asked to participate. We did a descriptive analysis of the data after revising clinical records.

RESULTS

We detected 247 risky drinkers after assessing more than 2,047 patients with AUDIT-C scale. From these, 200 accepted to participate. Only 65 (32.5%) of these patients were properly detected and registered as risky drinkers, while the majority of them (122, 61%) had no record about their alcohol use in their clinical records.

CONCLUSIONS

Risky drinkers are properly detected and registered in less than 35% of the patients. It is necessary to evaluate which barriers are restricting the implementation of screening programs to detect at risk drinkers.

Sensitivity analysis of a strongly-coupled human-based electromechanical cardiac model: Effect of mechanical parameters on physiologically relevant biomarkers

The human heart beats as a result of multiscale nonlinear dynamics coupling subcellular to whole organ processes, achieving electrophysiologically-driven mechanical contraction. Computational cardiac modelling and simulation have achieved a great degree of maturity, both in terms of mathematical models of underlying biophysical processes and the development of simulation software. In this study, we present the detailed description of a human-based physiologically-based, and fully-coupled ventricular electromechanical modelling and simulation framework, and a sensitivity analysis focused on its mechanical properties. The biophysical detail of the model, from ionic to whole-organ, is crucial to enable future simulations of disease and drug action. Key novelties include the coupling of state-of-the-art human-based electrophysiology membrane kinetics, excitation-contraction and active contraction models, and the incorporation of a pre-stress model to allow for pre-stressing and pre-loading the ventricles in a dynamical regime. Through high performance computing simulations, we demonstrate that 50% to 200% - 1000% variations in key parameters result in changes in clinically-relevant mechanical biomarkers ranging from diseased to healthy values in clinical studies. Furthermore mechanical biomarkers are primarily affected by only one or two parameters. Specifically, ejection fraction is dominated by the scaling parameter of the active tension model and its scaling parameter in the normal direction ( k ort 2 ); the end systolic pressure is dominated by the pressure at which the ejection phase is triggered ( P ej ) and the compliance of the Windkessel fluid model ( C ); and the longitudinal fractional shortening is dominated by the fibre angle ( ϕ ) and k ort 2 . The wall thickening does not seem to be clearly dominated by any of the considered input parameters. In summary, this study presents in detail the description and implementation of a human-based coupled electromechanical modelling and simulation framework, and a high performance computing study on the sensitivity of mechanical biomarkers to key model parameters. The tools and knowledge generated enable future investigations into disease and drug action on human ventricles.

Plasmonic coupling in closed-packed ordered gallium nanoparticles

Plasmonic gallium (Ga) nanoparticles (NPs) are well known to exhibit good performance in numerous applications such as surface enhanced fluorescence and Raman spectroscopy or biosensing. However, to reach the optimal optical performance, the strength of the localized surface plasmon resonances (LSPRs) must be enhanced particularly by suitable narrowing the NP size distribution among other factors. With this purpose, our last work demonstrated the production of hexagonal ordered arrays of Ga NPs by using templates of aluminium (Al) shallow pit arrays, whose LSPRs were observed in the VIS region. The quantitative analysis of the optical properties by spectroscopic ellipsometry confirmed an outstanding improvement of the LSPR intensity and full width at half maximum (FWHM) due to the imposed ordering. Here, by engineering the template dimensions, and therefore by tuning Ga NPs size, we expand the LSPRs of the Ga NPs to cover a wider range of the electromagnetic spectrum from the UV to the IR regions. More interestingly, the factors that cause this optical performance improvement are studied with the universal plasmon ruler equation, supported with discrete dipole approximation simulations. The results allow us to conclude that the plasmonic coupling between NPs originated in the ordered systems is the main cause for the optimized optical response.

Fluid-structure interaction simulations outperform computational fluid dynamics in the description of thoracic aorta haemodynamics and in the differentiation of progressive dilation in Marfan syndrome patients

Abnormal fluid dynamics at the ascending aorta may be at the origin of aortic aneurysms. This study was aimed at comparing the performance of computational fluid dynamics (CFD) and fluid-structure interaction (FSI) simulations against four-dimensional (4D) flow magnetic resonance imaging (MRI) data; and to assess the capacity of advanced fluid dynamics markers to stratify aneurysm progression risk. Eight Marfan syndrome (MFS) patients, four with stable and four with dilating aneurysms of the proximal aorta, and four healthy controls were studied. FSI and CFD simulations were performed with MRI-derived geometry, inlet velocity field and Young's modulus. Flow displacement, jet angle and maximum velocity evaluated from FSI and CFD simulations were compared to 4D flow MRI data. A dimensionless parameter, the shear stress ratio (SSR), was evaluated from FSI and CFD simulations and assessed as potential correlate of aneurysm progression. FSI simulations successfully matched MRI data regarding descending to ascending aorta flow rates (R 2 = 0.92) and pulse wave velocity (R 2 = 0.99). Compared to CFD, FSI simulations showed significantly lower percentage errors in ascending and descending aorta in flow displacement (-46% ascending, -41% descending), jet angle (-28% ascending, -50% descending) and maximum velocity (-37% ascending, -34% descending) with respect to 4D flow MRI. FSI- but not CFD-derived SSR differentiated between stable and dilating MFS patients. Fluid dynamic simulations of the thoracic aorta require fluid-solid interaction to properly reproduce complex haemodynamics. FSI- but not CFD-derived SSR could help stratifying MFS patients.

Increased prevalence of asymptomatic vertebral fractures in HIV-infected patients over 50 years of age

The prevalence of asymptomatic vertebral fracture in HIV-infected patients over 50 was 20%, associated with older age, male sex, longer time since HIV diagnosis, and tubular renal alterations. Vertebral fractures were independent of osteoporosis at lumbar spine, and were not predicted by the use of the FRAX equation.

PURPOSE

Vertebral fractures (VF) are the hallmark of osteoporotic fractures. Our objective was to determine the prevalence of asymptomatic VF and associated factors in HIV-infected patients over 50 years, and the role of FRAX equation.

METHODS

In a cross-sectional study, a diagnosis of VF was established by the semiquantitative method of Genant in thoracic and lumbar radiographs. Simultaneously, a dual X-ray absorptiometry (DXA), bone and kidney-related analytical, calcium intake, physical exercise, HIV-related factors, and FRAX estimation were evaluated.

RESULTS

Overall, 128 patients (35 women, 27%) were included. Mean age was 57 years. Hypophosphatemia and tubular renal dysfunction were observed in 13 and 21%. DXA scan showed osteopenia and osteoporosis at hip in 65 and 7% of patients, and in spine in 39 and 34%, respectively. VF were observed in 26 patients (20%), with a trend to be associated with lower serum phosphate, increased alkaline phosphatase, and with lower daily calcium intake. In a multivariate analysis, older age (OR 1.2 per year; 14% of VF at 50-55; 44% at 65-70), male sex (26 vs 6%), longer time since HIV diagnosis, and renal and tubular dysfunction were the associated factors. VF were not related with osteoporosis at lumbar spine, and could not be predicted by the FRAX equation.

CONCLUSIONS

The prevalence of asymptomatic vertebral fractures is high in HIV-infected patients older than 50 years, and is not identified by the presence of osteoporosis in spine neither predicted by the FRAX equation. Spine and lumbar X-rays should be routinely performed in this aging population.

Influence of the Histopathological Features of the Lesion on the Diagnostic Yield of Fine-Needle Aspiration Cytology of Pancreatic Solid Lesions

OBJECTIVE

The rate of pancreatic lesions has increased in recent decades due to the widespread use of advanced imaging techniques. Nowadays, a significant proportion of cases are incidentally discovered in asymptomatic patients and cytology is an important tool for the diagnosis and multidisciplinary management of these cases.

STUDY DESIGN

In this study we retrospectively review the experience with pancreatic fine-needle aspiration cytology in the last 17 years at a single large tertiary hospital in Madrid, Spain.

RESULTS

Our results indicate that more than 60% of pancreatic malignant lesions are cytologically confirmed before surgery and 30% of the patients are asymptomatic. Despite this, we have noted that the total number of malignant lesions surgically resected in our hospital has basically remained unchanged over the years, because incidental diagnosis is not always synonymous with resectability and a substantial number of patients are already metastatic at the time of diagnosis. Our series also shows an increase in the number of neuroendocrine tumors, which now represent almost 20% of all cytological diagnoses at our hospital. The sensitivity in our series is 70% and the false negative rate remains 30%, despite sample quality control by experienced cytologists and standardized technical conditions. Fibrosis and necrosis are the 2 features of the primary tumor that significantly and negatively influence the accuracy of cytologic diagnosis.

CONCLUSION

We herein report our experience with cytologic diagnosis of pancreatic lesions in a single tertiary hospital. Our results confirm that cytology is a safe, reliable, and important tool for pancreatic lesion diagnosis and management.

Antidot patterned single and bilayer thin films based on ferrimagnetic Tb-Co alloy with perpendicular magnetic anisotropy

Hysteresis properties and magnetization reversal in TbCo(30 nm) and FeNi(10 nm)/TbCo(30 nm) films with nanoscale antidot lattices are investigated to test the effect of nanoholes on the perpendicular anisotropy in the TbCo layer and the induced exchange bias in the FeNi layer. The antidots are introduced by depositing the films on top of hexagonally ordered porous anodic alumina substrates with pore diameter and interpore distance fixed to 75 nm and 105 nm, respectively. The analysis of combined vibrating sample magnetometry, Kerr microscopy and magnetic force microscopy imaging measurements has allowed us to link macroscopic and local magnetization reversal processes. For magnetically hard TbCo films, we demonstrate the tunability of magnetic anisotropy and coercive field (i.e., it increases from 0.2 T for the continuous film to 0.5 T for the antidot film). For the antidot FeNi/TbCo film, magnetization of FeNi is confirmed to be in plane. Although an exchange bias has been locally detected in the FeNi layer, the integrated hysteresis loop has increased coercivity and zero shift along the field axis due to the significantly decreased magnetic anisotropy of TbCo layer.

Investigation of split CoFeB/Ta/CoFeB/MgO stacks for magnetic memories applications

We report on the static and dynamic magnetic properties of W/CoFeB/Ta/CoFeB/MgO stacks, where the CoFeB layer is split in two by a 0.3 nm-thick Ta "dusting" layer. A total CoFeB thickness between 1.2 and 2.4 nm is studied. Perpendicular magnetic anisotropy is obtained for thickness below 1.8 nm even at the as-deposited stacks, and it is enhanced after annealing. Saturation magnetization is 1520 (1440) kA/m before (after) annealing, increased compared to non-split CoFeB layers. Ferromagnetic resonance measurements show that high magnetic anisotropy energy may be achieved (effective anisotropy field 0.571 ± 0.003 T), combined to a moderate Gilbert damping (0.030 ± 0.001). We argue that the above characteristics make the split-CoFeB system advantageous for spintronics applications.

Multisegmented Nanowires: a Step towards the Control of the Domain Wall Configuration

Cylindrical nanowires synthesized by controlled electrodeposition constitute excellent strategic candidates to engineer magnetic domain configurations. In this work, multisegmented CoNi/Ni nanowires are synthesized for tailoring a periodic magnetic structure determined by the balance between magnetocrystalline and magnetostatic energies. High-resolution Transmission Electron Microscopy confirms the segmented growth and the sharp transition between layers. Although both CoNi and Ni segments have similar fcc cubic crystal symmetry, their magnetic configuration is quite different as experimentally revealed by Magnetic Force Microscopy (MFM) imaging. While the Ni segments are single domain with axial magnetization direction, the CoNi segments present two main configurations: a single vortex state or a complex multivortex magnetic configuration, which is further interpreted with the help of micromagnetic simulations. This original outcome is ascribed to the tight competition between anisotropies. The almost monocrystalline fcc structure of the CoNi segments, as revealed by the electron diffraction patterns, which is atypical for its composition, contributes to balance the magnetocrystalline and shape anisotropies. The results of MFM measurements performed under in-plane magnetic field demonstrate that it is possible to switch from the multivortex configuration to a single vortex configuration with low magnetic fields.

Nanoparticle functionalized laser patterned substrate: an innovative route towards low cost biomimetic platforms

Integration of nanotechnology and advanced manufacturing processes presents an attractive route to produce devices for adaptive biomedical device technologies.

Viral Escape in the Central Nervous System with Multidrug-Resistant Human Immunodeficiency Virus-1

In this study, we report the case of a patient infected with human immunodeficiency virus (HIV)-1 who developed ataxia and neurocognitive impairment due to viral escape within the central nervous system (CNS) with a multidrug-resistant HIV-1 despite long-term viral suppression in plasma. Antiretroviral therapy optimization with drugs with high CNS penetration led to viral suppression in the CSF, regression of ataxia, and improvement of neurocognitive symptoms.

[Soft-tissue infection with Mycobacterium abscessus subsp. abscessus after liposuction and panniculectomy in the Caribbean]

We report the case of a 36-year-old woman who presented with a surgical site infection with atypical mycobacteria several months after liposuction in the Caribbean. Postoperative wound infections with Mycobacterium abscessus present as subcutaneous nodular abscesses with partly putrid secretion. Due to the necessity of specific diagnostic measures, diagnosis is often delayed. Treatment is difficult because Mycobacterium abscessus is resistant to conventional tuberculostatics and many other antibiotics. Clarithromycin combined with amikacin is the commonly used empirical treatment. Treatment duration is several months.

A soft/hard magnetic nanostructure based on multisegmented CoNi nanowires

In this paper we have introduced a new soft/hard nanostructure based on multisegmented CoNi nanowire arrays having diameters of around 110 nm and made of five segments with nominal compositions of Co, Co66Ni33, Co50Ni50, Co33Ni66 and Ni, each of which has a length of 800 nm, so that the total length of the multisegmented nanowire is 4 μm. These arrays have been synthesized by means of potentiostatic electrodeposition into the pores of hard-anodic alumina templates. The morphology, chemical composition and microstructure of the multisegmented CoNi nanowires were determined by high-resolution scanning electron microscopy, energy dispersive X-ray microanalysis, and powder X-ray diffraction method, respectively. The room temperature magnetic behavior of the multisegmented nanowire arrays is also studied and compared with CoNi nanowire arrays with homogeneous composition (non-segmented nanowires), synthesized in the same templates and having the same dimensions as the segmented ones. These nanostructures could be used to control the movement of magnetic domain walls. In this way, these nanostructures can be an alternative to store information or even perform logic functions.

Magnetic microwire probes for the magnetic rod interfacial stress rheometer

The magnetic needle interfacial shear rheometer is a valuable tool for the study of the mechanical properties of thin fluid films or monolayers. However, it is difficult to differentiate the interfacial and subphase contributions to the drag on the needle. In principle, the problem can be addressed by decreasing the needle diameter, which decreases the bulk contribution while the interfacial contribution remains essentially the same. Here we show the results obtained when using a new type of needle, that of magnetic microwires with diameter approximately 10 times thinner than for commercial needles. We show that the lower inertia of the microwires calls for a new calibration procedure. We propose such a new calibration procedure based on the flow field solution around the needle introduced in refs 1 and 2. By measuring thin silicone oil films with well-controlled interfacial viscosities as well as eicosanol (C20) and pentadecanoic acid (PDA, C15) Langmuir monolayers, we show that the new calibration method works well for standard needles as well as for the microwire probes. Moreover, we show that the analysis of the force terms contributing to the force on the needle helps to ascertain whether the measurements obtained are reliable for given surface shear viscosity values. We also show that the microwire probes have at least a 10-fold-lower resolution limit, allowing one to measure interfacial viscosities as low as 10(-7) N·m/s.

Participation of b0,+and B0,+systems in the transport of mercury bound to cysteine in intestinal cells

The main source of exposure to mercury (Hg) as divalent inorganic Hg [Hg(ii)] and methylmercury (CH₃Hg) is the diet, in which complexes with the amino acid cysteine (Hg–Cys) may be found.

Crystallographically driven magnetic behaviour of arrays of monocrystalline Co nanowires

Cobalt nanowires, 40 nm in diameter and several micrometers long, have been grown by controlled electrodeposition into ordered anodic alumina templates. The hcp crystal symmetry is tuned by a suitable choice of the electrolyte pH (between 3.5 and 6.0) during growth. Systematic high resolution transmission electron microscopy imaging and analysis of the electron diffraction patterns reveals a dependence of crystal orientation from electrolyte pH. The tailored modification of the crystalline signature results in the reorientation of the magnetocrystalline anisotropy and increasing experimental coercivity and squareness with decreasing polar angle of the 'c' growth axis. Micromagnetic modeling of the demagnetization process and its angular dependence is in agreement with the experiment and allows us to establish the change in the character of the magnetization reversal: from quasi-curling to vortex domain wall propagation modes when the crystal 'c' axis tilts more than 75° in respect to the nanowire axis.

Micromagnetism of permalloy antidot arrays prepared from alumina templates

Magnetic hysteresis processes of hexagonal arrays of permalloy antidots have been studied by means of micromagnetic simulations as a function of geometrical parameters. The ideal system shows a maximum of the coercive field as a function of the antidot diameter. The simulated magnetic behavior has been compared with experimental values for antidot arrays of permalloy prepared from alumina templates with thicknesses between 2 and 60 nm, showing a monotonic increase of the coercive field as a function of the antidot diameter. We show that the introduction into simulations of the combination of variable antidot diameters from bottom to top due to the fabrication process and, more importantly, large geometrical domains, which break the sample symmetry, solves the discrepancy between the simulations and the experiment.

Characterization of the intestinal absorption of inorganic mercury in Caco-2 cells

The main form of mercury exposure in the general population is through food. Intestinal absorption is therefore a key step in the penetration of mercury into the systemic circulation, and should be considered when evaluating exposure risk. Many studies have investigated the transport of mercury species in different cell lines, though the mechanisms underlying their intestinal absorption are not clear. This study evaluates the accumulation and transport of Hg(II), one of the mercury species ingested in food, using Caco-2 cells as intestinal epithelium model with the purpose of clarifying the mechanisms involved in its absorption. Hg(II) shows moderate absorption, and its transport fundamentally takes place via a carrier-mediated transcellular mechanism. The experiments indicate the participation of an energy-dependent transport mechanism. In addition, H(+)- and Na(+)-dependent transport is also observed. These data, together with those obtained from inhibition studies using specific substrates or inhibitors of different transporter families, suggest the participation of divalent cation and amino acid transporters, and even some organic anion transporters, in Hg(II) intestinal transport. An important cellular accumulation of up to 51% is observed - a situation which in view of the toxic nature of this species could affect intestinal mucosal function. This study contributes new information on the mechanisms of transport of Hg(II) at intestinal level, and which may be responsible for penetration of this mercurial form into the systemic circulation.

Advances in three-dimensional rapid prototyping of microfluidic devices for biological applications

The capability of 3D printing technologies for direct production of complex 3D structures in a single step has recently attracted an ever increasing interest within the field of microfluidics. Recently, ultrafast lasers have also allowed developing new methods for production of internal microfluidic channels within the bulk of glass and polymer materials by direct internal 3D laser writing. This review critically summarizes the latest advances in the production of microfluidic 3D structures by using 3D printing technologies and direct internal 3D laser writing fabrication methods. Current applications of these rapid prototyped microfluidic platforms in biology will be also discussed. These include imaging of cells and living organisms, electrochemical detection of viruses and neurotransmitters, and studies in drug transport and induced-release of adenosine triphosphate from erythrocytes.

Electrochemical synthesis and magnetic characterization of periodically modulated Co nanowires

The synthesis of templates with modulated pore channels by combined mild and hard anodization processes is described. The hard anodization pulses, implemented during anodization, are controlled not only in time length and amplitude, but also in shape: square and exponential signals have been applied. Electrodeposition of Co is subsequently performed to obtain uniform and modulated diameter nanowire arrays. Square and exponential modulated diameter nanowires are imaged by scanning electron microscopy and hcp hexagonal polycrystalline structure is confirmed in all Co nanowires. Magnetic behavior strongly depends on nanowire shape and is interpreted considering the modification of magnetostatic interactions between wires induced by local stray fields from magnetic charges at the ends of the wider segments in modulated wires. As a consequence, magnetization processes under parallel and perpendicular field configurations denote the contribution of both thin and wide segments.

Precooling treatments induce resistance of Anastrepha ludens eggs to quarantine treatments of high-pressure processing combined with cold

High-pressure processing (HPP) combined with heat or cold has been proposed as an alternative quarantine process for Mexican fruit fly Anastrepha ludens Loew (Diptera: Tephritidae). HPP conditions at levels higher than 100 MPa applied to destroy eggs and larvae can also affect the postharvest physiology of the fruits. HPP at pressure levels in the range of 50-100 MPa is recommended. Eggs have been reported as being more resistant to HPP than larvae. Therefore, the objective of this study was to assess the effect of a precooling treatment on the biological viability of A. ludens eggs treated by HPP at 0 degrees C. The capability of nondestroyed eggs to develop and reproduce was also evaluated. One-, 2-, 3-, and 4-d-old eggs were precooled in ice water for 0 (control) 3, 6, 12, or 24 h and then pressurized at 50, 70, or 90 MPa for 0, 3, 6, or 9 min at 0 degrees C. The hatching capability of pressurized eggs was evaluated. The most lethal effect of HPP on nonprecooled eggs (0 h) was obtained at 90 MPa for 9 min, destroying all eggs except for the 3-d-old ones, which showed an 11.8% hatch rate. Precooling treatment improved the hatch rate of eggs ranging from 4 to 50% depending on precooling conditions. The main effect was observed after 6 h. These results suggest that precooling modified the biochemistry and physiology of eggs, improving their resistance to HPP treatments.

Determination of polyphenolic compounds of red wines by UV-VIS-NIR spectroscopy and chemometrics tools

Spectral analysis is a quick and non-destructive method to analyse wine. In this work, trans-resveratrol, oenin, malvin, catechin, epicatechin, quercetin and syringic acid were determined in commercial red wines from DO Rías Baixas and DO Ribeira Sacra (Spain) by UV-VIS-NIR spectroscopy. Calibration models were developed using principal component regression (PCR) or partial least squares (PLS) regression. HPLC was used as reference method. The results showed that reliable PLS models were obtained to quantify all polyphenols for Rías Baixas wines. For Ribeira Sacra, feasible models were obtained to determine quercetin, epicatechin, oenin and syringic acid. PCR calibration models showed worst reliable of prediction than PLS models. For red wines from mencía grapes, feasible models were obtained for catechin and oenin, regardless the geographical origin. The results obtained demonstrate that UV-VIS-NIR spectroscopy can be used to determine individual polyphenolic compounds in red wines.

3DEM Loupe: Analysis of macromolecular dynamics using structures from electron microscopy

Electron microscopy (EM) provides access to structural information of macromolecular complexes in the 3-20 Å resolution range. Normal mode analysis has been extensively used with atomic resolution structures and successfully applied to EM structures. The major application of normal modes is the identification of possible conformational changes in proteins. The analysis can throw light on the mechanism following ligand binding, protein-protein interactions, channel opening and other functional macromolecular movements. In this article, we present a new web server, 3DEM Loupe, which allows normal mode analysis of any uploaded EM volume using a user-friendly interface and an intuitive workflow. Results can be fully explored in 3D through animations and movies generated by the server. The application is freely available at http://3demloupe.cnb.csic.es.