Film as a pedagogical tool for climate change and mental health nursing education

The relationship between climate change and worsening mental health is of increasing concern globally. Climate change is ubiquitous, yet marginalized populations bear a disproportionate burden of the physical and mental health impacts, while youth are more likely to report mental health concerns related to climate change than older generations. Mental health nurses will inevitably see these impacts play out in their practice, thus it is important to explore innovative tools for teaching about and responding to the emotional and psychological impacts of climate change. This perspective paper presents an educational project that utilized film and structured reflection to engage with the intersecting topics of planetary and mental health. The authors created a documentary film that presents the relationship between mental health and climate change as well as an accompanying reflective toolkit. Both the film and toolkit were integrated into an undergraduate course about the health impacts of climate change. This paper explores the relevance of climate change to mental health nursing education and practice, describes the process of creating and integrating the film and toolkit into a course and advances the position that film is an innovative way to engage individuals and communities (such as student or community groups) with the emotional and psychological concerns that arise in response to complex challenges of climate change. More research is needed to better understand the mental health impacts of climate change and to explore novel approaches to education and advocacy about this topic. We hope that sharing our project and experiences will inspire additional discussion and research related to these emerging issues that are of great relevance to mental health nursing.

P10.22.A Prognostic role ofTCF7L2 in glioblastoma

Background

Glioblastoma is the most common and devastating brain cancer and despite maximal surgical resection, chemotherapy and radiotherapy, the five-year survival rate is less than 7%. The TCF7L2 gene encodes transcription factor 7-like 2, a main effector of Wnt/β-Catenin signaling pathway involved in cancer development and progression. Aberrant activation of the TCF7L2 gene is one of the primary events in tumorigenesis by maintaining stem-cell characteristics, however its role in glioblastoma is poorly studied.

Material and Methods

The expression of TCF7L2 was analyzed by qRT-PCR in a series of consecutive glioblastoma samples from patients that underwent surgical resection. Secondary or recurrent glioblastomas were excluded from the analysis. All patients underwent radio- and chemotherapy according to the protocol. Housekeeping gene RPL13 was used as reference gene. The 2-ΔCT method was used to calculate the relative expression of TCF7L2 to the reference gene.

Results

A total of 49 glioblastoma samples were included in the study. The mean survival period was 58.2 weeks. The median value of TCF7L2 expression was used as a cut-off point for the survival analysis. There were no statistically significant differences regarding the clinical and histopathological factors between the groups with low and high expression of TCF7L2. By using the Kaplan-Meier analysis, we observed that patients with overexpression of TCF7L2 had a decreased survival rate compared to patients with low levels of TCF7L2 (38.8 weeks vs. 77.34 weeks, p = 0.001).

Conclusion

These results demonstrate that glioblastoma patients with high levels of TCF7L2 have a poorer survival rate and TCF7L2 might be a useful prognostic factor for these patients. However, further studies are needed to elucidate the mechanisms through which TCF7L2 affects the prognosis and its implication as a possible therapeutic target.

This work was supported by an ERA PerMed grant - ERAPERMED2018-270 (PerProGlio).

P07.02 Robot-assisted stereotactic brain biopsy combined with cortical mapping using navigated transcranial magnetic stimulation

BACKGROUND

Frame-based stereotactic biopsy has been for decades the gold-standard method for taking samples of brain tumors for the histopathological diagnostic in cases when surgery was contraindicated. However, novel frameless techniques have been developed in order to facilitate the procedure for the neurosurgeon, and for the patient as well. Preoperative cortical mapping techniques enable the planning of the trajectory with the sparing of eloquent areas.

MATERIAL AND METHODS

A preoperative cortical mapping using navigated transcranial magnetic stimulation was performed in the case of a 37-year-old male that presented with headache. The MRI scan revealed multiple lesions located frontal lobe and temporal lobe on the right hemisphere and frontal and occipital lobes on the left hemisphere. The results of the preoperative cortical mapping were integrated into the neuronavigation system and used for the planning of the frameless based stereotactic brain biopsy. A biopsy procedure was performed using a robotic arm according to the planned trajectory.

RESULTS

The targeted lesion was the right frontal one. The planned trajectory took into account the results from the cortical mapping using nTMS, and the eloquent areas were avoided. The robotic arm guided the procedure and aligned to the entry point and trajectory. According to the histopathological result the lesion was a grade II diffuse astrocytoma. There were no perioperative complications.

CONCLUSION

To our knowledge, this is the first report that describes the use of a robot-guided frameless brain biopsy system combined with the preoperative mapping of the eloquent cortical areas using navigated transcranial magnetic stimulation. This approach is a safe one and carries less burden for the patient as well as for the surgeon.

P1243 Nonbacterial thrombotic endocarditis (NBTE) of the aortic valve: incidental finding in hospitalized patients with advanced heart failure

Background

The presence of small mobile masses on the ventricular side of the aortic valves in the absence of valvular regurgitation and signs of systemic inflammation has been previously described as marantic endocarditis and is now referred to as nonbacterial thrombotic endocarditis (NBTE). It is thought to be associated with endothelial dysfunction and procoagulative status, as is the case of acute decompensated heart failure (HF).

Case description

We present a series of three male patients, with similar clinical characteristics, who were admitted for acute decompensated HF. All three patients had chronic HF, due to non-ischemic dilated cardiomyopathy with severe biventricular dysfunction, with resynchronization therapy, with elevated natriuretic peptides and previous HF hospitalizations in the past year requiring prolonged intravenous treatments. Other clinical, biological criteria for the definition of advanced HF were also met. All patients were under chronic anticoagulation treatment using a direct oral anticoagulant because of persistent atrial fibrillation. Thorough echocardiographic evaluation (both transthoracic and transoesophageal ultrasound) identified small mobile masses on the ventricular side of the aortic valves, centrally, on the line of cusp coaptation, with only minor central regurgitation. The lack of progression of valve lesion and the absence of gross signs of inflammation (no fever, normal hemoleucogram, normal CRP, repeated negative blood cultures) on serial examinations during several weeks follow-up allowed for the exclusion of infective endocarditis. In one case we also identified a left atrial appendage thrombus and presumably thrombotic masses attached to right side pacing leads. No clinically systemic embolic events were identified.

Conclusion

We consider this to be an incidental finding in the given subclinical prothrombotic and inflammatory predisposing milieu of advanced chronic HF and the increasing high quality echocardiography imaging. Its clinical significance is still unknown, while differential diagnosis from subacute or chronic endocarditis relies largely on clinical judgment.

45 Severe secondary mitral regurgitation due to left ventricular non- compactation cardiomyopathy- a rare cause of heart failure

Introduction

Left ventricular non-compaction is a rare form of cardiomyopathy charactherized by the presence of a two layered ventricular wall- a thinner epicardial layer and an inner, non-compacted layer with prominent trabeculations associated with deep, intratrabecular recesses that communicate with left ventricle cavity. Clinical manifestations vary in severity, including symptoms of heart failure, thromboembolic events or arrhythmias. Left ventricular (LV) dysfunction leads to tethering of the mitral apparatus and is a cause for secondary significant mitral regurgitation.

Case presentation

We report the case of a 57 year-old female patient, diagnosed with severe mitral regurgitation one year before presentation, with severe heart failure (HF) symptoms, referred to our clinic for the surgical replacement of the mitral valve. Clinical examination revealed no signs of pulmonary or systemic congestion and systolic apical murmur. Blood tests were normal, except for the elevated BNP (552 pg/ml). Electrocardiogram showed sinus rhythm and left ventricular hypertrophy. Coronary angiogram did not identify any coronary artery lesions. Echocardiography revealed mildly dilated left ventricle, but wih proeminent trabeculations and two distinct myocardial layers with a non-compacted/compacted ratio of 2:1 in the anterior and lateral walls, diagnostic for left ventricular non-compaction cardiomyopathy. LV ejection fraction was 40% , with severe secondary mitral regurgitation due to significant antero-posterior dilation of the mitral ring, with intact mitral leaflets; mild pulmonary hypertension was present.

Magnetic resonance imaging (MRI) identified a two layer antero-lateral myocardium and confirmed the echo diagnosis; there was no evidence of scarring as there was absent late gadolinium enhacement. In the absence of fibrosis on MRI or any arrhythmic events on repeated Holter ECG monitoring, the implantation of a cardiac defibrillator was deferred.

Given the secondary cause for mitral regurgitation (LV dysfunction), specific HF medication with beta blocker and renin-angiotensin-aldosterone blockade was initiated and titrated to optimal doses. With medical treatment the evolution was favourable. Currently, 3 years after the initial diagnosis, 6 minutes walk test revealed good functional capacity (510 m), a BNP value of 104 pg/l, without any worsening of LV systolic function nor progression of pulmonary hypertension.

Conclusion

Left ventricular non-compaction cardiomyopathy is a rare cause of heart failure, but due to advances in imaging modalities and increasing awareness, its prevalence is growing. Its pathogenesis and prognosis largely remain unknown, but early and adequate initiation of neurohormonal medication may be just as essential in order to prevent complications and improve long term prognosis, as for other forms of cardiomiopathy, even in the presence of severe secondary mitral regurgitation.

Prebiotics and probiotics in atopic dermatitis

Recent years have brought additional data on the benefits of prebiotics and probiotics treatment in patients with atopic dermatitis. This review includes all the articles published in PubMed, Scopus, Embase and Cochrane databases until 05.06.2018. The terms used for the search were 'prebiotic', 'probiotic', 'atopic dermatitis', 'Severity Scoring of Atopic Dermatitis', and 'SCORAD'. There was an increase of the intestinal permeability reported in patients with atopic dermatitis and a reduction of the cutaneous microbiome diversity. Probiotics modulate the general microbiome and immune status by improving the intestinal barrier; these effects can be responsible for reducing allergic phenomenon and atopic dermatitis severity. We have structured the results by age groups as infants, 1-18 years, adults, and also pregnancy and lactation. Literature does not offer yet answers on the issues such as the optimal dosing, duration needed to see beneficial effects, the optimal time to start the treatment; the personalized use of probiotics according to colonic dysbiosis may be associated with better results. However, most randomized controlled trials and meta-analyzes support the administration of probiotics for at least 8 weeks in order to obtain beneficial effects in improving severity scoring of atopic dermatitis.

Current Surgical Approach in the Pathology of the Arteriopathic Predominant Diabetic Foot

Introduction: The diabetic foot is a complex pathologic entity characterized by the totality of modifications appearing on the foot during the evolution of the diabetic disease. This survey aims to elaborate an algorithm of treatment for patients with arteriopathic predominant diabetic foot lesions, with the purpose of reducing the number of debilitating interventions and improving the quality of life. Material and Method: There were analysed a number of 188 patients admitted to the Surgery Clinic I of the Dr.I.Cantacuzino Clinical Hospital, in the year 2017, suffering from arteriopathic predominant diabetic foot lesions, based on several inclusion/exclusion criteria. Results: According to the type of foot lesion, most patients had the diagnosis of wet gangrene of the toe/toes (51.06%), followed by ischaemic gangrene of the toe/toes (40.4%); the surgical interventions performed on these types of lesions in 73.9% of the cases consisted of minor amputations (transmetatarsal amputation of the toe/toes/foot). Conclusions: The treatment algorithm developed as a result of this survey represents a feasible treatment solution for the pathology of the arteriopathic predominant diabetic foot and failure to comply with this treatment may lead to treatment errors in a sense in which disproportional surgery can be performed in correlation with an inexact diagnosis.