The effect of a home-based, gamified stability skills intervention on 4-5-year-old children's physical and cognitive outcomes: A pilot study

BACKGROUND

Stability skills (e.g., static/dynamic balance) are a precursor for other movement skill development (e.g., jumping, catching). However, young children consistently demonstrate low stability and movement skill ability. There is therefore a need to develop effective strategies to improve stability skills in early childhood.

AIM

To pilot the effect of a home-based gamified stability skills intervention on 4-5-year-old children's physical skills, self-perceptions and cognitions.

METHODS

One-hundred-and-eleven 4-5-year-old children participated from three schools. Two schools were allocated into the intervention group (n = 66 children, 33 boys) and one to the control group (n = 45 children, 25 boys). Stability, fundamental movement skills, perceived motor competence, and cognition were assessed at baseline and at post-intervention. The intervention group was given a booklet detailing the 12-week gamified stability skill intervention. The control group participated in their usual weekly activities.

RESULTS

A series of ANCOVAs controlling for baseline values demonstrated significantly higher stability skills (F(1,93) = 24.79, p < 0.001, partial η2 = 0.212), fundamental movement skills (F(1,94) = 15.5, p = < 0.001, partial η2 = 0.139), perceived motor competence (F(1,96) = 5.48, p = 0.021, partial η2 = 0.054) and cognition (F(1,96) = 15.5, p = < 0.001, partial η2 = 0.139) at post-test for the intervention versus control groups.

DISCUSSION

This study demonstrates that a home-based, gamified, stability skills intervention enhances stability skills, fundamental movement skills, perceived motor competence and cognition in children aged 4-5-years old.

Alpha 1-acid glycoprotein is upregulated in severe COVID-19 patients and decreases neutrophil NETs in SARS-CoV-2 infection

Orosomucoid, or alpha-1 acid glycoprotein (AGP), is a major acute-phase protein expressed in response to systemic injury and inflammation. AGP has been described as an inhibitor of neutrophil migration on sepsis, particularly its immunomodulation effects. AGP's biological functions in coronavirus disease 2019 (COVID-19) are not understood. We sought to investigate the role of AGP in severe COVID-19 infection patients and neutrophils infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Epidemiological data, AGP levels, and other laboratory parameters were measured in blood samples from 56 subjects hospitalized in the ICU with SARS-CoV-2 infection. To evaluate the role of AGP in NETosis in neutrophils, blood samples from health patients were collected, and neutrophils were separated and infected with SARS-CoV-2. Those neutrophils were treated with AGP or vehicle, and NETosis was analyzed by flow cytometry. AGP was upregulated in severe COVID-19 patients (p<0.05). AGP level was positively correlated with IL-6 and C-reactive protein (respectively, p=0.005, p=0.002) and negatively correlated with lactate (p=0.004). AGP treatment downregulated early and late NETosis (respectively, 35.7% and 43.5%) in neutrophils infected with SARS-CoV-2 and up-regulated IL-6 supernatant culture expression (p<0.0001). Our data showed increased AGP in COVID-19 infection and contributed to NETosis regulation and increased IL-6 production, possibly related to the Cytokine storm in COVID-19.

Neutrophil virucidal activity against SARS-CoV-2 is mediated by NETs

BACKGROUND

The inflammation in the lungs and other vital organs in COVID-19 are characterized by the presence of neutrophils and high concentration of neutrophil extracellular traps (NETs), which also seems to mediate host tissue damage. However, it is not known whether NETs could have virucidal activity against SARS-CoV-2.

METHODS

We investigated whether NETs could prevent SARS-CoV-2 replication in neutrophils and epithelial cells, and what the consequence of NETs degradation in K18-humanized ACE2 transgenic mice infected with SARS-CoV-2.

RESULTS

Here, by immunofluorescence microscopy we observed that viral particles co-localize with NETs in neutrophils isolated from COVID-19 patients or from healthy individuals and infected in vitro. The inhibition of NETs production increased virus replication in neutrophils. In parallel, we observed that NETs inhibited virus abilities to infect and replicate in epithelial cells after 24 h of infection. Degradation of NETs with DNase I prevented their virucidal effect in vitro. Using K18-humanized ACE2 transgenic mice we observed a higher viral load in animals treated with DNase I. On the other hand, the virucidal effect of NETs was not dependent on neutrophil elastase or myeloperoxidase activity.

CONCLUSION

Our results provide evidence of the role of NETosis as a mechanism of SARS-CoV-2 viral capture and inhibition.

Immune-mediated hematological disease in dogs is associated with alterations of the fecal microbiota: a pilot study

BACKGROUND

The dog is the most popular companion animal and is a valuable large animal model for several human diseases. Canine immune-mediated hematological diseases, including immune-mediated hemolytic anemia (IMHA) and immune thrombocytopenia (ITP), share many features in common with autoimmune hematological diseases of humans. The gut microbiome has been linked to systemic illness, but few studies have evaluated its association with immune-mediated hematological disease. To address this knowledge gap, 16S rRNA gene sequencing was used to profile the fecal microbiota of dogs with spontaneous IMHA and ITP at presentation and following successful treatment. In total, 21 affected and 13 healthy control dogs were included in the study.

RESULTS

IMHA/ITP is associated with remodeling of fecal microbiota, marked by decreased relative abundance of the spirochete Treponema spp., increased relative abundance of the pathobionts Clostridium septicum and Escherichia coli, and increased overall microbial diversity. Logistic regression analysis demonstrated that Treponema spp. were associated with decreased risk of IMHA/ITP (odds ratio [OR] 0.24-0.34), while Ruminococcaceae UCG-009 and Christensenellaceae R-7 group were associated with increased risk of disease (OR = 6.84 [95% CI 2-32.74] and 8.36 [95% CI 1.85-71.88] respectively).

CONCLUSIONS

This study demonstrates an association of immune-mediated hematological diseases in dogs with fecal dysbiosis, and points to specific bacterial genera as biomarkers of disease. Microbes identified as positive or negative risk factors for IMHA/ITP represent an area for future research as potential targets for new diagnostic assays and/or therapeutic applications.

Sub-Bandgap Sensitization of Perovskite Semiconductors via Colloidal Quantum Dots Incorporation

By taking advantage of the outstanding intrinsic optoelectronic properties of perovskite-based photovoltaic materials, together with the strong near-infrared (NIR) absorption and electronic confinement in PbS quantum dots (QDs), sub-bandgap photocurrent generation is possible, opening the way for solar cell efficiencies surpassing the classical limits. The present study shows an effective methodology for the inclusion of high densities of colloidal PbS QDs in a MAPbI3 (methylammonium lead iodide) perovskite matrix as a means to enhance the spectral window of photon absorption of the perovskite host film and allow photocurrent production below its bandgap. The QDs were introduced in the perovskite matrix in different sizes and concentrations to study the formation of quantum-confined levels within the host bandgap and the potential formation of a delocalized intermediate mini-band (IB). Pronounced sub-bandgap (in NIR) absorption was optically confirmed with the introduction of QDs in the perovskite. The consequent photocurrent generation was demonstrated via photoconductivity measurements, which indicated IB establishment in the films. Despite verifying the reduced crystallinity of the MAPbI3 matrix with a higher concentration and size of the embedded QDs, the nanostructured films showed pronounced enhancement (above 10-fold) in NIR absorption and consequent photocurrent generation at photon energies below the perovskite bandgap.

COVID-19-related hyperglycemia is associated with infection of hepatocytes and stimulation of gluconeogenesis

Occurrence of hyperglycemia upon infection is associated with worse clinical outcome in COVID-19 patients. However, it is still unknown whether SARS-CoV-2 directly triggers hyperglycemia. Herein, we interrogated whether and how SARS-CoV-2 causes hyperglycemia by infecting hepatocytes and increasing glucose production. We performed a retrospective cohort study including patients that were admitted at a hospital with suspicion of COVID-19. Clinical and laboratory data were collected from the chart records and daily blood glucose values were analyzed to test the hypothesis on whether COVID-19 was independently associated with hyperglycemia. Blood glucose was collected from a subgroup of nondiabetic patients to assess pancreatic hormones. Postmortem liver biopsies were collected to assess the presence of SARS-CoV-2 and its transporters in hepatocytes. In human hepatocytes, we studied the mechanistic bases of SARS-CoV-2 entrance and its gluconeogenic effect. SARS-CoV-2 infection was independently associated with hyperglycemia, regardless of diabetic history and beta cell function. We detected replicating viruses in human hepatocytes from postmortem liver biopsies and in primary hepatocytes. We found that SARS-CoV-2 variants infected human hepatocytes in vitro with different susceptibility. SARS-CoV-2 infection in hepatocytes yields the release of new infectious viral particles, though not causing cell damage. We showed that infected hepatocytes increase glucose production and this is associated with induction of PEPCK activity. Furthermore, our results demonstrate that SARS-CoV-2 entry in hepatocytes occurs partially through ACE2- and GRP78-dependent mechanisms. SARS-CoV-2 infects and replicates in hepatocytes and exerts a PEPCK-dependent gluconeogenic effect in these cells that potentially is a key cause of hyperglycemia in infected patients.

C5aR1 signaling triggers lung immunopathology in COVID-19 through neutrophil extracellular traps

Patients with severe COVID-19 develop acute respiratory distress syndrome (ARDS) that may progress to cytokine storm syndrome, organ dysfunction, and death. Considering that complement component 5a (C5a), through its cellular receptor C5aR1, has potent proinflammatory actions, and plays immunopathological roles in inflammatory diseases, we investigated whether C5a/C5aR1 pathway could be involved in COVID-19 pathophysiology. C5a/C5aR1 signaling increased locally in the lung, especially in neutrophils of critically ill COVID-19 patients compared to patients with influenza infection, as well as in the lung tissue of K18-hACE2 Tg mice (Tg mice) infected with SARS-CoV-2. Genetic and pharmacological inhibition of C5aR1 signaling ameliorated lung immunopathology in Tg-infected mice. Mechanistically, we found that C5aR1 signaling drives neutrophil extracellular trap (NET)s-dependent immunopathology. These data confirm the immunopathological role of C5a/C5aR1 signaling in COVID-19 and indicate that antagonists of C5aR1 could be useful for COVID-19 treatment.

Characteristics and prognosis of the catecholamine induced QT prolongation syndrome

Background

We have recently demonstrated association of unexplained sudden cardiac arrest (SCA) with inheritance of catecholamine induced QT prolongation (CIQTP).

Objective

We here aim to describe incidence, characteristics and prognosis of this new syndrome in young patients with unexplained SCA or their relatives.

Methods

We reviewed the medical screening of all consecutive patients or their first-degree relatives explore from 2015 after the occurrence of a SCA before age 45. Structural heart disease or inherited arrhythmia diseases were excluded. A mental stress test was performed, as previously described, for each family members. All families with a positive mental stress were included in the study. Genetic screening was performed in at least one positive patient per family using targeted sequencing on a panel of 109 genes associated with inherited arrhythmias and cardiomyopathies.

Results

Among 456 patients screened (24 after SCA, 432 for familial screening) of 153 families, we identified 10 families (6.5%) with a catecholamine induced QT prolongation. No mutation was identified in these families. One hundred and ten patients were screened in CIQTP families. Thirty-four patients (30.9%) presented a CIQTP (mean age 42±20 yo, 64.7% of women). Five (14.7%) patients presented with previous symptoms (including 4 syncope and 1 SCA).

Two patients (5.9%) were implanted with an ICD and eleven (32.3%) were treated with beta blocker therapy mainly because of QT prolongation &gt;500 ms after mental stress test or previous symptoms.

After a 3.6±1.8 years of follow up, no sudden cardiac death nor syncope occurred on beta blocker therapy except for one patient implanted with an ICD after a SCA. Under beta blocker treatment the patient was asymptomatic for 5 years. After a suddenly stop of the beta blocker treatment, the patient underwent VF. For 3 years now the patient is asymptomatic under beta blocker treatment.

Conclusions

In our experience, CIQTP families represent 6.5% of cases of unexplained SCD and suggest systematic screening with a mental stress test for family screening after the occurrence of a SCA. Beta blocker therapy is very efficient to reduce the risk of SCA.

Funding Acknowledgement

Type of funding sources: None.

Can Specular Gloss Measurements Predict the Effectiveness of Finishing/Polishing Protocols in Dental Polymers? A Systematic Review and Linear Mixed-effects Prediction Model

PURPOSE

The current gold standard measure to assess polishing efficacy is surface roughness (SR) assessed in laboratory research. Specular gloss (SG) has been negatively correlated to SR, which raises the following question: Can SG be used to accurately determine the effectiveness of a finishing/polishing procedure in direct resin composites?

METHODS

A systematic approach and search strategy, following Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, was developed and conducted in five electronic databases: PubMed/Medline, Scopus, Web of Science, EMBASE (Ovid), and SciELO/LILACS to identify laboratory studies that assessed SR and SG, simultaneously, of resin composites, without date or language restriction. Risk of bias assessment was carried out by two reviewers, independently. From the extracted quantitative data of SG/SR, regression analyses were performed, and a linear mixed-effects prediction model was derived using the nimble package in R (v4.0.3).

RESULTS

A total of 928 potential studies were found, out of which, 13 were eligible after criterion screening. Experimental groups featured 31 resin composites of six different filler types, with the most common being microhybrids followed by nanohybrids. More than half of the studies initially reported a linear correlation between SR and SG, which ranged from r2 = 0.34-0.96. Taking into account the regression analysis and prediction model posteriorly performed, the corresponding SG threshold for 0.2 μm is estimated to be >55 GU. Most of the evidence was classified as moderate or high risk of bias.

CONCLUSION

SG is universally correlated to SR in polymers, and a reference value of >55 GU is proposed, above which samples are considered well polished.

Evaluation of the Fiscal Costs and Consequences of Alzheimer's Disease in Germany: Microsimulation of Patients' and Caregivers' Pathways

BACKGROUND

Alzheimer's disease is a severe condition, impacting individual's wellbeing and independence in daily activities. Informal care provision is common and of great value to societies but is not without negative externalities to households and the broader economy.

OBJECTIVES

Estimate the lifetime incremental fiscal consequences of Alzheimer's disease in community-based individuals and their informal caregivers.

SETTING

The fiscal consequences of Alzheimer's disease was modeled using the German government and social security perspective.

PARTICIPANTS

Synthetic cohort containing 1,000 pairs of people with Alzheimer's disease and their informal caregivers, compared to 1,000 demographically identical pairs from the general population.

DESIGN

Disease progression was modeled using published equations and a state-transition microsimulation framework. Labor participation, financial support and paid taxes were estimated according to cognitive decline and caregiving responsibilities using German labor statistics and tax rates. Healthcare costs were sourced from several German publications. Costs and life-years were discounted at 3% annually.

MEASUREMENTS

Results are reported as lifetime incremental differences in total tax revenue and transfer payments between the cohort affected by Alzheimer's disease and their general population analogues.

RESULTS

The Alzheimer's disease-affected pair was associated with net incremental fiscal losses of €74,288 ($85,037) to the German government and social security over the lifetime of people with Alzheimer's disease. Most costs were lost taxes on employment earnings (48.4%) due to caregivers working reduced hours. Caregivers were estimated to earn €56,967 ($65,209) less than their general population analogues. Financial support for informal and formal care accounted for 20.4%, and medical healthcare costs represented 24.0% of the incremental fiscal losses. Sensitivity analyses confirmed the robustness of the model results. In a cohort with early onset Alzheimer's disease, incremental fiscal losses were predicted to be €118,533 ($114,209) over the lifetime of people with Alzheimer's disease.

CONCLUSIONS

Alzheimer's disease externalities profoundly impact public economics for governments and should be considered to inform policy making and healthcare planning.

Modelling the Pan-European Economic Burden of Alzheimer's Disease

Background

Recent advances open the opportunity of altering the course of Alzheimer's disease (AD) through lifestyle-based modifications and novel therapies. Ensuring that society is investing limited budgets in the interventions that have the greatest potential to generate tangible impact will require tools to guide policymakers.

Objectives

To build on previous studies to develop an economic model that estimates the societal burden of AD and evaluates the potential impact of novel interventions in six large European countries.

Design

AD progression was modelled using a published Markov structure with a 40-year time horizon to estimate lifetime costs and life years in a cohort aged 65 years and above diagnosed with mild cognitive impairment due to AD (MCI-AD) in 2020. Demographic projections were utilized to estimate the prevalence of MCI-AD up to 2100, total corresponding costs and life years. The model allows a comparison of costs associated with the introduction of a hypothetical new disease-modifying therapy that slows disease progression between MCI-AD and all AD-Dementia stages as well as a 'delayed onset' scenario where disease progression is halted at the MCI-AD stage, potentially occurring, for example, through lifestyle-based modifications.

Results

The 2022 present value of total lifetime costs for this cohort moving through all disease stages is ~€1.2T. Approximately 80% of the present value of lifetime costs in our model are driven by informal care and non-medical direct costs. Our model suggests that a 25% and 50% reduction in disease progression compared to natural history could translate into a present value of cost savings of €33.7B and €72.7B. Halting MCI-AD progression for 3 years with no therapeutic effect thereafter resulted in a present value cost savings of €84.7B in savings.

Conclusions

Our data further suggest that early intervention via disease-modifying therapies or lifestyle-based modifications in AD could result in cost savings for society. Additionally, our findings reinforce the importance of accounting for the full value of innovative interventions, management and care paradigms, including their potential impact on direct, indirect and intangible costs impacting patients, their care partners and health and social care systems.

Light management with quantum nanostructured dots-in-host semiconductors

Insightful knowledge on quantum nanostructured materials is paramount to engineer and exploit their vast gamut of applications. Here, a formalism based on the single-band effective mass equation was developed to determine the light absorption of colloidal quantum dots (CQDs) embedded in a wider bandgap semiconductor host, employing only three parameters (dots/host potential barrier, effective mass, and QD size). It was ascertained how to tune such parameters to design the energy level structure and consequent optical response. Our findings show that the CQD size has the biggest effect on the number and energy of the confined levels, while the potential barrier causes a linear shift of their values. While smaller QDs allow wider energetic separation between levels (as desired for most quantum-based technologies), the larger dots with higher number of levels are those that exhibit the strongest absorption. Nevertheless, it was unprecedently shown that such quantum-enabled absorption coefficients can reach the levels (10⁴-10⁵cm^-1) of bulk semiconductors.

Developing a social prescribing local system in a European Mediterranean country: a feasibility study to promote active and healthy aging

BACKGROUND

Social Prescribing (SP) is an innovative strategy to respond to the non-clinical health needs of the population. A Social Prescribing Local System (SPLS) can be defined as a set of joined community, health, and social organizations to foster SP-oriented activities. This study aimed to develop and assess the feasibility of an SPLS implemented in a Mediterranean country, to promote health and wellbeing and contribute to active and healthy aging.

METHODS

A mixed-methods approach was followed, including three sequential components: 1) Cross-sectional online survey targeting health professionals (HP) working in a primary health care cluster, Portugal's southern region; 2) Pilot study implementing an on-the-job training program for HP, designed to meet identified training needs in the survey; 3) Focus group (FG) with the HP who participated in the pilot study, two individual interviews, with an elderly patient and a community provider for assessing the satisfaction with the pilot test.

RESULTS

Sixty-five HP completed the survey; of these, 13 completed the theoretical part of the on-the-job training program; and six (out of these 13) completed the full program. Five HP participated in the FG, one patient and one community provider were interviewed. The surveyed HP perceived as facilitators to implement SP: an automatic system of notifications to prompt the use of SP, contribute to patient satisfaction, human and community resources' stability. The survey also highlighted barriers to SP implementation: length of appointments, shortage of human resources, data records confidentiality, low patient adherence rates, bureaucratic issues, time constraints, and financial costs. Participants were satisfied with the training. Identified SPLS implementation benefits were grouped into four dimensions (from the qualitative approach): gains for patients' health and wellbeing, support for the health services, sustainability of the community resources, and HP' professional satisfaction.

CONCLUSIONS

Our study took the first steps towards the implementation of an SPLS. Findings reinforce that training HP in SP and on-the-job training seems feasible. This approach was well received and appears to represent a suitable and sustainable strategy. It can promote professional satisfaction, support health services, contribute to the stability of community resources, improve health and promote active and healthy aging.

Enhanced solar photocatalysis of TiO2 nanoparticles and nanostructured thin films grown on paper

Titanium dioxide nanoparticles and nanostructured thin films were simultaneously synthesized using a microwave-assisted hydrothermal method. The synthesis formed very fine particles, appearing as nanospheres in the 11 nm size range. As for the nanostructured films, they have displayed similar structural characteristics to the nanoparticles, with thickness of 130 nm. These films covered uniformly and homogenously the Whatman paper, while maintaining its flexibility. The materials processed had their photocatalytic activity assessed from rhodamine B degradation under solar radiation (91% degradation after 40 min for the powder material and 68% after 6 h for the nanostructured thin films). Reusability experiments were also carried out, revealing superior performance concerning the Degussa P25, the most common photocatalyst used. The results of the present work can be thought as an option for the existing photocatalysts activated under solar light, namely for water purification, as it simultaneously produces enhanced photocatalytic powders and photocatalytic papers fully disposable and that can be easily recycled.

COVID-19 Dashboard for the Lisbon Region - an advisory tool for policy

Issue/problem

At the time of arrival of the COVID-19 pandemic to Portugal, the Public Health Department of Lisbon and Tagus Valley Regional Health Administration was confronted with its obsolete information system, which could not provide the information that Public Health Authorities needed to bring the pandemic under control. In order to tackle this issue, our goal was to aggregate all the relevant epidemiological data for the region in an accessible and user-friendly dashboard.

Methods

Starting from March 2020 we created a dashboard, which compiled and analyzed COVID-19 data, such as: confirmed and active cases, deaths, hospitalizations (including ICU beds), high/low risk contacts, mandatory confinements, tests, and clusters. This dashboard had anonymized data and was updated daily as well as constantly upgraded by taking into consideration new incoming data and feedback provided by users, serving its purpose as an advisory tool for policy.

Results

The dashboard was available to Local, Regional, and National Public Health Authorities and made possible to monitor trends and predict epidemiological changes that, prior to its existence, were dispersed in several datasets. Most importantly, it allowed for a better allocation of human resources for contact tracing and case management activities, to easily identify basic social needs for the most vulnerable citizens. It also provided for policy measures adjusted to the smallest administrative division in Portugal, the parish, that ultimately allowed for a better epidemiological control in Lisbon Metropolitan Area in 2020.

Lessons

The regional dashboard is far from perfect, but it highlights the constant need for robust information and epidemiological surveillance systems, serving both National, Regional and Local Public Health Authorities. It appeared out of necessity during a pandemic and it proved once more the importance of data analytics for guiding public health action based on evidence.

Key messages

Data analytics can serve both as an advisory tool for policy as well as to guide public health interventions. The COVID-19 Dashboard for the Lisbon Region aggregates relevant epidemiological data that helped Public Health authorities better understand and control the Pandemic in the region.

Elderly: Coping with sleep disorders

Introduction

Sleep problems are a common presenting symptom of elderly patients to Primary care physicians and Psychiatrists. Almost half of seniors over age 65 who live at home are dissatisfied with their sleep, and nearly two-thirds of those residing in nursing home facilities suffer from sleep disorders. Chronic and pervasive sleep complaints and disturbances are frequently associated with excessive daytime sleepiness and may result in impaired cognition, diminished intellect, poor memory, confusion, and psychomotor retardation.

Objectives

The aim of this article is to sumarize and explore the facts envolving sleep disorders, discusses approaches to treatment and highlights new research in the area of geriatric sleep disorders.

Methods

An online bibliographic search was carried out on PubMed and Medline using the keywords “Elderly”, “sleep” and “Psychiatry”.

Results

Management of sleep disorders is complicated by the risk of side effects of pharmacologic treatment approaches, and thus nonpharmacologic strategies are preferred when possible. Additionally, many of the pharmacologic strategies used in treating younger adults have not been studied adequately in the geriatric population, and more specifically in patients with underlying cognitive disorders, making treatment choices difficult.

Conclusions

This review has provided insights into the biopsychosocial impact of sleep disorders in the elderly, as this group pose unique challenges for diagnosis and treatment. Sleep changes in the elderly may have a far broader impact on geriatric health than originally thought, with implications for AD and delirium, and further research is needed in these areas as well.

Genome-wide association study and pathway analysis for carcass fatness in Nellore cattle measured by ultrasound

Identifying genes or genomic regions influencing carcass-quality traits such as fatness (FTN) is essential to optimize the genetic selection processes in beef cattle. The aim of this study was to identify genomic regions associated with FTN in Nellore cattle as well as to elucidate the metabolic pathways related to the phenotypic expression. Ultrasound-based measurements of FTN were collected in 11 750 animals, with 39 903 animals in the pedigree file. Additionally, 1440 animals were genotyped using the GGP-indicus 35K SNP panel, which contained 33 623 SNPs after quality control. Twenty genes related to FTN were found on 11 chromosomes, explaining 12.96% of the total additive genetic variance. Gene ontology revealed seven genes: NR1L2, PKD2, GSK3β, EXT1, RAD51B, SORCS1 and DPH6, associated with important processes related to FTN. In addition, novel candidate genes (MAATS1, LYPD1, CDK5RAP2, RAD51B, c13H2Oorf96 and TRAPPC11) were detected and could provide further knowledge to uncover genetic regions associated to carcass fatness in beef cattle.

Impact of pulmonary valve replacement on ventricular arrhythmias in patients with tetralogy of Fallot

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): INSERM - French Society of Cardiology

OnBehalf

DAIT4F Investigators

Background

Sudden cardiac death is a major cause of death in tetralogy of Fallot (TOF) and right ventricular overload is commonly considered as a potential trigger for ventricular arrhythmias.

Purpose

We aimed to assess the impact of pulmonary valve replacement (PVR) on ventricular arrhythmias burden using a population of TOF patients with continuous cardiac monitoring by implantable cardioverter defibrillator (ICD).

Methods

Nationwide French registry including all TOF patients with an ICD. Survival data with recurrent events were used to compare the burden of appropriate ICD therapies before and after PVR in patients who underwent PVR over the study period.

Results

A total of 165 patients (mean age 42.2 ± 13.3 years, 70.1% males) were included from 40 centers. Over a median (IQR) follow-up period of 6.8 (2.5-11.4) years, 26 (15.8%) patients underwent PVR. Among those patients, 18 (69.2%) experienced at least one appropriate ICD therapy. When considering all ICD therapies delivered before (n = 62) and after (n = 16) PVR, the burden of ICD appropriate therapies was significantly lower after PVR (HR 0.21, 95%CI 0.08-0.56, p = 0.002). In the overall cohort, PVR before ICD implantation was also independently associated with a lower risk of appropriate ICD therapy in primary prevention patients (HR 0.29, 95%CI 0.10-0.89, p = 0.031).

Conclusions

In this cohort of high-risk TOF patients implanted with an ICD, the burden of appropriate ICD therapies was significantly reduced after PVR. While optimal indications and timing for PVR are debated, these findings suggest the importance of considering ventricular arrhythmias in the overall making-decision process. Abstract Figure.

A closer look to apathy

Introduction

Apathy is a neuropsychiatry syndrome, conceptualised as a loss of motivation free of altered consciousness, cognitive impairment or emotional distress, associated with a wide range of brain disorders such as Dementia, Major depression and schizophrenia. Even though under-recognized and under-diagnosed, apathy hardly appears uncommon. Its reported frequency in various neurologic and psychiatric conditions varies widely, from less than 10 to over 80%, reflecting differences in population characteristics and assessment procedures.

Objectives

The aim of this article is to review the concept of Apathy and clarify its nosology, pathopshysiology and treatment.

Methods

An online bibliographic search was carried out on PubMed and Medline using “Apathy” as a term.

Results

The literature reviewed shows that apathy is a multi-dimensional clinical construct with a current definition and validated diagnostic criteria. Analysis reveals that apathy is strongly associated with disruption particularly of anterior cingulate cortex (ACC), ventral striatum (VS) and nucleus accumbens (N acc). Remarkably, these changes are consistent across clinical disorders and imaging modalities, playing a crucial role in normal motivated behaviour.

Conclusions

The neuromodulator dopamine is heavily implicated in ACC and VS. Therapeutically, numerous small studies suggest that psychostimulants, dopaminergics, and cholinesterase inhibitors may benefit those manifesting this syndrome. However, no adequately powered, randomized controlled trials have reported success and no medication have ever been approved for this disorder Further research is needed to help understand the functional neuroanatomy, neuromodulators involved and possible treatment options of this clinical construct.

Left atrial functional assessment and mortality in patients with severe aortic stenosis

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction: Aortic valve stenosis (AS) is the most common primary valvular heart disease leading to surgical or percutaneous aortic valve replacement (AVR) in Europe. Both symptoms and systolic dysfunction can appear late in the course of the disease, being often synonym of irreversible damage to the myocardium when found. Thus, there is a necessity to find other sensitive markers present at an earlier stage of the disease. 

Purpose

Our primary aim is to clarify the relationship between LA function measured at severe AS diagnosis (evaluated by means of volumetric assessment) and all-cause mortality during follow-up.

Methods

We retrospectively evaluated patients diagnosed with severe AS for the first time at our echocardiography laboratory. We evaluated all 3 left atrial (LA) functional phases (reservoir, conduit and pump) by measuring LA volumes at different timings of cardiac cycle. Treatment strategy was decided according to heart team consensus and own patient decision. We divided patients into groups according to terciles of LA reservoir, conduit and pump function. Primary outcome was defined by the occurrence of all-cause mortality during follow-up.

Results

After exclusion criteria, a total of 451 patients were included in the analysis (aged 74 ±11years, 54% male) and were followed during a median period of 73 months (interquartile range 44.5). A total of 55.8% of patients underwent AVR and 45,5% of patients registered the primary outcome. Left atrial emptying fraction (LAEF) was the best LA functional parameter in discriminating primary outcome (AUC 0.840, p &lt; 0.001), even when compared to left ventricular ejection fraction, aortic valve area, aortic mean pressure gradient and aortic Vmax. Patients in the lower tercile of LAEF were older, had greater comorbidities, had greater AS severity, with greater degree of diastolic disfunction. After adjustment for clinical and demographic variables, cumulative survival of patients with LAEF &lt;37% and LAEF 37 to 53% relative to patients with LAEF ≥54% remained significantly lower (adjusted HR 19.04, 95% CI 8.30-43.67, P &lt; 0.001 and adjusted HR 4.09, 95% CI 1.85-9.06, P = 0.001). Survival was also higher in patients with LAEF 37 to 53% when compared to patients with LAEF &lt;37% (adjusted HR 0.22, 95% CI 0.13-0.37, P &lt; 0.001). All associations remained true after adjustment for AVR (LAEF &lt;37% versus LAEF 37 to 53% and LAEF ≥54%, respectively, adjusted HR 3.97, 95% CI 1.80-8.78, P = 0.001 and adjusted HR 13.95, 95% CI 5.98-32.54, P &lt; 0.001, respectively)

Conclusion(s) In patients with a first diagnosis of severe AS in hospital setting, LA function assessed by volumetric parameters is an independent predictor of all-cause mortality. Compared to classical severity parameters, different LA functional parameters were found to be more potent predictors of death. These data can be useful in clinical practice for risk stratification and therefore for decision of timing for AVR.

Abstract Figure. Survival of patients stratified by group

Major Cost Drivers in Assessing the Economic Burden of Alzheimer’s Disease: A Structured, Rapid Review

Background: Alzheimer’s Disease is the most common cause of dementia, affecting memory, thinking and behavior. Symptoms eventually grow severe enough to interfere with daily tasks. AD is predicted to increase healthcare spending and costs associated with formal and informal caregiving. The aim of this study was to identify and quantify the contribution of the different cost components associated with AD. Methods: A structured literature review was conducted to identify studies reporting the economic burden of Alzheimer`s Disease beyond the healthcare setting. The search was conducted in Medline, Embase and EconLit and limited to studies published in the last 10 years. For each identified cost component, frequency weighted mean costs were calculated across countries to estimate the percentage contribution of each component by care setting and disease severity. Results obtained by each costing approach were also compared. Results: For community-dwelling adults, the percentage of healthcare, social care and indirect costs to total costs were 13.9%, 17.4% and 68.7%, respectively. The percentage of costs varied by disease severity with 26.0% and 10.4% of costs spent on healthcare for mild and severe disease, respectively. The proportion of total spending on indirect costs changed from 60.7% to 72.5% as disease progressed. For those in residential care, the contribution of each cost component was similar between moderate and severe disease. Social care accounted on average for 85.9% of total costs. Conclusion: The contribution of healthcare costs to the overall burden was not negligible; but was generally exceeded by social and informal care costs.

SARS-CoV-2-triggered neutrophil extracellular traps mediate COVID-19 pathology

Severe COVID-19 patients develop acute respiratory distress syndrome that may progress to cytokine storm syndrome, organ dysfunction, and death. Considering that neutrophil extracellular traps (NETs) have been described as important mediators of tissue damage in inflammatory diseases, we investigated whether NETs would be involved in COVID-19 pathophysiology. A cohort of 32 hospitalized patients with a confirmed diagnosis of COVID-19 and healthy controls were enrolled. The concentration of NETs was augmented in plasma, tracheal aspirate, and lung autopsies tissues from COVID-19 patients, and their neutrophils released higher levels of NETs. Notably, we found that viable SARS-CoV-2 can directly induce the release of NETs by healthy neutrophils. Mechanistically, NETs triggered by SARS-CoV-2 depend on angiotensin-converting enzyme 2, serine protease, virus replication, and PAD-4. Finally, NETs released by SARS-CoV-2-activated neutrophils promote lung epithelial cell death in vitro. These results unravel a possible detrimental role of NETs in the pathophysiology of COVID-19. Therefore, the inhibition of NETs represents a potential therapeutic target for COVID-19.

Epicardial fat tissue: a new tool for identification of coronary artery disease patients?

Introduction

Epicardial fat (EF), the true visceral fat depot of the heart, has been strongly correlated with both coronary artery disease (CAD) incidence and severity. However, the methods for its measurement were not always affordable. Its measurement by echocardiography is fast, accessible and easily reproducible, turning it into a promising clinical tool for assessing cardiovascular risk to predict the incidence of CAD.

Purpose

To determine the correlation between EF tissue dimensions measured by transthoracic echocardiography and the presence of CAD.

Methods

We prospectively analysed data from 196 consecutive patients admitted for acute coronary syndrome in our coronary care unit. All patients underwent diagnostic coronary angiography and echocardiogram during stay. EF dimensions were obtained with transthoracic echocardiography by measuring maximum EF diameter (mm) at the basal right ventricular free wall (PLAXB) level and mid-right ventricular free wall (PLAXM) level [in paraesternal long-axis view (PLAX)] and maximum right-ventricle free wall EF diameter at basal (PSAXB) level and papillary-muscle (PSAXM) level [in paraesternal short-axis view (PSAX)]. All measures were taken at end-systole. Patients were divided in 2 groups according to the presence of significant CAD (sCAD) or not (nCAD), defined as having at least 1 diseased epicardial vessel with a stenosis &gt;50%.

Results

One-hundred and sixty-three (83.2%) had significant CAD. 22 patients (11.2%) were admitted for unstable angina, 60 patients (30.6%) for non-ST elevation myocardial infarction and 93 patients (47,4%) for ST-elevation myocardial infarction. Mean EF diameters were as follows: PLAXB (19,3±5.1 mm), PLAXM (11.3±2.6), PSAXB (10,6±2.8), PSAXM (10.5±2.8). We found a direct correlation between number of diseased epicardial coronary vessels and epicardial fat thickness in PLAXB (r=0.506, p&lt;0.001), PLAXM (r=0.372, p&lt;0.001), PSAXB (r=0.445, p&lt;0.001) and PSAXM (r=0.372, p&lt;0.001). EF was significantly different between groups: PLAXB (20,6±4.4 vs. 13.8±3,8, p&lt;0.001), PLAXM (11.8±2.5 vs. 9.0±1.9, p&lt;0.001), PSAXB (11.1±2.7 vs. 8.3±2.3, p&lt;0.001) and PSAXM (11.0±2.6 vs. 8.2±4, p&lt;0.001). Receiver operating characteristic curve analysis showed that the predictive value of mean right ventricular EF [(PLAXB+PSAXB)/2] for significant CAD was 0.895 (AUC=0.895, CI 95% 0.818–0,972, p&lt;0.001). For a [(PLAXB+PLAXM)/2] value of 12.57 mm, sensitivity was 86.3% and specificity was 79.3%.

Conclusions

In a population of high suspicion of acute coronary syndromes, echocardiographic EF is a sensitive and specific marker of the presence of significant coronary disease and could become an important tool for coronary risk prediction.

Figure 1

Funding Acknowledgement

Type of funding source: None

Right atrial mechanics by strain echocardiography in chronic thromboembolic pulmonary hypertension

Introduction

Chronic thromboembolic pulmonary hypertension (CPTEH) is the result of thromboemboli leading not only to mechanical obstruction but also pulmonary vascular remodelling and progressive increase in right heart afterload. Prognostic assessment in CPTEH is complex and multifactorial.

Purpose

We used two-dimensional strain echocardiography (2D-STE) to quantify right atrial (RA) mechanics and its correlation with invasive hemodynamics, load-dependent biomarkers and well-known prognostic markers in patients with CTEPH.

Methods

A total of 44 patients (24 females, mean age 61±15.6 years) with CTEPH were recruited. 2D-STE was used to measure right atrial reservoir strain (RASr) (Figure 1) which was then compared to conventional ultrasound measurements, right heart catheterisation (RHC) measurements, the percentage of obstruction in ventilation-perfusion pulmonary single-photon emission computed tomography (V/Q SPECT), B-type natriuretic peptide (BNP) values and 6-minute walk test (6MWT) performance. All patients underwent transthoracic echocardiographic evaluation with a maximal time distance of three months to RHC.

Results

There was a significant positive correlation of RASr with RV longitudinal function determined by tricuspid annular plane systolic excursion (TAPSE) (r=0.488, p=0.003), tricuspid annular peak systolic velocity (S') (r=0.490, p=0.002), right ventricular outflow tract velocity time integral (RVOT VTI) (r=0.457, p=0.005), as well as with 6MWT (r=0.491, p=0.004). There was a significant negative correlation of RASr with mean pulmonary artery pressure (r=−0.513, p=0.002), pulmonary vascular resistance (r=−0.439, p=0.011) and right atrial pressure (RAP) (r=−0.513, p=0.002). RASr was also correlated with Log-transformed BNP values (r=−0.552, p&lt;0,001), and in a multivariate linear regression model, RASr was an independent predictor of Log-transformed BNP values (β=−0.448, 95% CI: −0.046 to −0.009; p=0.005). There was no correlation between RASr and the percentage of obstruction in V/Q SPECT (r=0.164, p=0.388).

Conclusion

2D-STE-derived RA mechanics demonstrated to be a useful, non-invasive, surrogate measurement of RHC parameters. It also predicted important clinical/laboratory prognostic measurements, such as BNP and 6MWT performance. The absence of correlation between 2D-STE values and the percentage of vessel obstruction determined by SPECT may suggest that RV maladaptive response to the obstruction, rather than the degree of obstruction, dictates right heart failure in CTEPH.

Right atrial strain components

Funding Acknowledgement

Type of funding source: None

Incidence, timing, predictors, and impact of sustained ventricular arrhythmia complicating st-segment elevation myocardial infarction

Aims

To describe the incidence, predictors, and in-hospital impact of early SVA (eSVA, occurring &lt; day 2 post-STEMI) and late SVA (lSVA, occurring ≥ day 2 post-STEMI) in STEMI patients. To derive and internally validate a risk score to identify patients at high-risk of lSVA.

Methods

Data of 13523 patients enrolled in the ORBI registry were analysed. Logistic regression was performed to identify predictors of eSVA, lSVA, and in-hospital all-cause mortality. Predictors of lSVA were used to build a risk score.

Results

eSVA occurred in 678 patients (5%) whereas 120 patients (0.9%) experienced lSVA at a median timing of 3 days post-STEMI. eSVA associated with a significantly higher risk of all-cause mortality (adjusted OR:1.90, 95% CI: 1.39–2.61, p&lt;0.001) whereas only a trend was observed with lSVA (adjusted OR: 1.69, 95% CI:0.91–3.13, p=0.09). Multivariable predictors of eSVA are listed in Table 1. Multivariable predictors of lSVA are listed in the Figure. The score derived from these variables allowed the classification of patients into four risk categories: low (0–21), low-to- intermediate (22–34), intermediate-to-high (35–44), and high (≥45). Observed lSVA rates were 0.2%, 0.4%, 0.8%, and 2.5%, across the four risk categories, respectively. The model demonstrated good discrimination (20-fold cross-validated c-statistic of 0.76) and adequate calibration (Hosmer-Lemeshow p=0.40).

Conclusion

eSVA are 5-fold more common than lSVA in the setting of STEMI, mainly associate with other early complications, and portends a 2-fold higher risk of in-hospital mortality. Moreover, we developed a risk score identifying patients at high risk of lSVA for whom early ICU discharge may not be suitable.

Funding Acknowledgement

Type of funding source: None

Left atrial emptying fraction: a powerful predictor of events in severe aortic stenosis

Background

Increasing evidence suggests that left atrial (LA) structural and functional changes have an important role in risk stratification and prediction of clinical outcomes. We know from multiple data that left atrial maximum volume (LAVI), measured at end-systole, is a powerful prognostic marker in multiple patient groups. However, recent studies have suggested that this marker may not be the best representative of diastolic function as it does not image the full spectrum of atrial mechanics. Another measure of LA function is the left atrial emptying fraction (LAEF), which has proved to be a significant prognostic marker in many patient groups. Less known is its role in event prediction in severe aortic stenosis patients, a disease with a very important burden in modern societies.

Purpose

The authors hypothesised that LAEF is a powerful predictor of clinical outcomes at 1 year in patients with severe aortic stenosis.

Methods

We retrospectively evaluated 151 patients referred to our echocardiography laboratory with the diagnosis of severe aortic stenosis. All patients underwent transthoracic echocardiography. LA maximum volume was indexed to body surface area. LAEF was calculated as LAVI-LA minimum volume divided by LAVI. Patients were followed for 1 year regarding clinical outcomes. Clinical outcome was defined as a composite of hospital admission for a cardiovascular (CV) cause, emergency department recurrence for a CV cause or CV death. Logistic binary regression was used to evaluate associations of LAEF with the outcome.

Results

A total of 51.7% of patients (n=78) were males. Mean patient age was 76.6±8.0 years. A total of 38.4% of patients were diabetics (n=56), 96% had dyslipidaemia (n=145) and 25% (n=37) had atrial fibrillation. Mean left ventricular ejection fraction (LVEF) was 60.6±7.3, and mean LAVI was 41.4±12.1. In a multivariable regression model including clinical and echocardiographic markers, higher LAVI and pulmonary artery systolic pressure (PASP) were associated with lower LAEF. Receiver operating characteristic curve analysis showed that the predictive value of LAEF for outcomes at 1 year was 0.693 (AUC=0.693, CI 95% 0.578–0.809, p=0.002), performing better than other echocardiographic markers such as LAVI (AUC=0.567, CI 95% 0.440–0.694, p=0.286), PASP (AUC=0.582, CI 95% 0.451–0.714, p=0.191) and LVEF (AUC=0.590, CI 95% 0.464–0.716, p=0.153). After adjustment of baseline characteristics, a LAEF less than 41.3% remained a good predictor of clinical outcomes at 1 year (OR 2.615, CI 95% 1.085–6.305, p=0.32).

Conclusions

In this cohort of severe aortic stenosis patients, a reduced LAEF was associated with greater incidence of cardiovascular events, being a stronger predictor than LAVI, PASP or LVEF. This study suggests that LA dysfunction over LA volumes correlates better with clinical outcomes.

Funding Acknowledgement

Type of funding source: None

Efficacy of deep sedation for patients with intractable electrical storm refractory to anti-arrhythmic drugs

Background

Sympathetic overactivity is implicated in the initiation and maintenance of electrical storm (ES). Deep sedation has empirically been considered as an efficient therapeutic option to blunt sympathetic tone and control ES.

Purpose

The aim of this multicenter study was to determine the efficacy of deep sedation in patients presenting intractable ES refractory to anti-arrhythmic drugs.

Methods

Patients requiring deep sedation for refractory ES from January 1st 2007 to July 31st 2018 were retrospectively included in 13 centers. The primary endpoint was the rate of acute response to sedation, defined as ES termination within 15 minutes after deep sedation.

Results

Among the 116 patients, 55 (47.4%) had ES termination within 15 minutes and were considered “acute responders” to deep sedation. Clinical signs of congestive heart failure before deep sedation (OR=3.31, 95% CI:1.001–10.97, p=0.049) was the only independent predictor of non-acute response. Twenty-one non-acute responders (34.4%) had an extracorporeal membrane oxygenation (ECMO) implanted. Non-acute responders had a significantly lower in-hospital survival (Log-rank, p=0.010). ECMO implantation did not influence survival in non-acute responders to sedation. Acute response to deep sedation was an independent protector of in-hospital mortality, decreasing by 73% the risk of death (OR 0.27; 95% CI:0.10–0.70, p=0.008).

Conclusion

To the best of our knowledge, this multicenter study is the first analysis of the efficacy of deep sedation in patients with intractable ES refractory to anti-arrhythmic drugs, and demonstrating the positive impact of “acute response” on in-hospital survival.

Funding Acknowledgement

Type of funding source: None

SARS-CoV-2-triggered neutrophil extracellular traps mediate COVID-19 pathology

Severe COVID-19 patients develop acute respiratory distress syndrome that may progress to cytokine storm syndrome, organ dysfunction, and death. Considering that neutrophil extracellular traps (NETs) have been described as important mediators of tissue damage in inflammatory diseases, we investigated whether NETs would be involved in COVID-19 pathophysiology. A cohort of 32 hospitalized patients with a confirmed diagnosis of COVID-19 and healthy controls were enrolled. The concentration of NETs was augmented in plasma, tracheal aspirate, and lung autopsies tissues from COVID-19 patients, and their neutrophils released higher levels of NETs. Notably, we found that viable SARS-CoV-2 can directly induce the release of NETs by healthy neutrophils. Mechanistically, NETs triggered by SARS-CoV-2 depend on angiotensin-converting enzyme 2, serine protease, virus replication, and PAD-4. Finally, NETs released by SARS-CoV-2–activated neutrophils promote lung epithelial cell death in vitro. These results unravel a possible detrimental role of NETs in the pathophysiology of COVID-19. Therefore, the inhibition of NETs represents a potential therapeutic target for COVID-19.

Environmental behaviour and ecotoxicity of cationic surfactants towards marine organisms

Cationic surfactants are surface-active compounds that can be found in many products, including household and cleaning agents. As a consequence, they tend to be discarded into water streams, ultimately ending up in the aquatic environment. In spite of this environmental issue, studies describing their effects towards marine species are lacking. The aim of this study was therefore to evaluate the short-term exposure effects of two commercial cationic surfactants and three novel gemini surfactants on four marine species, the green microalgae Nannochloropsis gaditana and Tetraselmis chuii, the diatom Phaeodactylum tricornutum, and the crustacean Artemia salina. Furthermore, biodegradation and size distribution of the cationic surfactants in artificial seawater were also studied by UV-vis spectrophotometry and dynamic light scattering, respectively. Ecotoxicity tests revealed that the commercial cationic surfactant N-cetyl-N,N,N-trimethylammonium bromide is toxic to all tested marine species while N-dodecyl-N,N,N-trimethylammonium chloride and 1,4-bis-[N-(1-dodecyl)-N,N-dimethylammoniummethyl]benzene dibromide showed the lowest toxicity among the tested cationic surfactants. Besides the novel insights regarding the effects caused by these five cationic surfactants, this work opens prospects for the replacement of commercially available surfactants by more environmentally friendly alternatives.

Effects of endurance and strength exercises associated with whey protein supplementation on quality of life (SF36) in community-dwelling seniors

Introduction Ageing is a natural, physiological and markedly heterogeneous process; however, it is possible to modify the functional decline and to promote healthy ageing. The practise of physical exercise and nutrition have shown benefits in the promotion of a better quality of life (QoL).

Objectives To verify whether protein supplementation associated with physical exercise contributes to the QoL of seniors living in the community.

Methodology A clinical prospective, blind, randomized, placebo-controlled study with a control group was conducted. The sample was probabilistic and randomly assigned. They were distributed through the 4 arms of the study with 19 participants each:1-physical exercise (strength and endurance) + whey protein supplement (20g); 2-physical exercise (strength and endurance) + placebo; 3-only whey protein supplement (20g); 4-control (without intervention). Each group was assessed at baseline and past 12 weeks. QoL was evaluated through SF36, before and after the intervention. Descriptive and inferential statistics were used.

Results The sample consisted of 79 individuals, 55 women and 25 men, with a mean age of 68.54±5.72, mean height 1.57±0.09m, mean weight 72.7±14.3kg, being homogeneous with respect to age by sex and the anthropometric characteristics (body mass index, arm and leg circumferences). The comparison between the pre and post-intervention results showed that groups 1 and 2 significantly improved their QoL (p &lt; 0.05); patients in groups 1 and 3 improved substantially more than in groups 2 and 4 (p &lt; 0.05). Subjects in group 4 worsened their outcomes in all domains of QoL assessed.

Conclusion Protein supplementation showed a positive influence on the quality of life, primarily when associated with physical exercise. In fact, seniors who were not submitted to supplementation or a prescribed exercise showed a worsening of their quality of life throughout the study.

SAFIIRA: A heavy-ion multi-purpose irradiation facility in Brazil

This work describes the new facility for applied nuclear physics at the University of Sao Paulo, mainly for irradiation of electronic devices. It is a setup composed of a quadrupole doublet for beam focusing/defocusing plus multiple scattering through gold foils to produce low intensity, large-area, and high-uniformity heavy-ion beams from ¹H to ¹⁰⁷Ag. Beam intensities can be easily adjusted from 10² particles cm²/s to hundreds of nA for an area as large as 2.0 cm² and uniformity better than 90%. Its irradiation chamber has a high-precision motorized stage, and the system is controlled by a LabView^TM environment, allowing measurement automation. Design considerations and examples of use are presented.

Elevated soluble TNFα levels and upregulated TNFα mRNA expression in purified peripheral blood monocyte subsets associated with high-grade hepatocellular carcinoma

BACKGROUND

Chronic inflammation is involved in the initiation and progression of various cancers, including liver cancer. The current study focuses on the characterization of the peripheral immune response in hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) patients, before and after surgical procedure, in order to assess the effect of tumor resection in the immune system homeostasis and to determine possible prognostic factors associated with high-grade tumors. We developed a whole-blood assay to monitor immune alterations and functional competence of peripheral monocytes in a group of 10 healthy individuals (HG), in 20 HCC patients and 8 CCA patients, by multi-color flow cytometry, qRT-PCR, and ELISA techniques.

RESULTS

The qRT-PCR analysis showed an upregulation of TNFα expression by classical and intermediate monocytes purified from HCC patients presenting tumors in grade G3-G4 as compared to G1-G2 HCC patients. Moreover, ELISA assay confirmed elevated serum levels of TNFα in G3-G4 compared to G1-G2 HCC patients. A significant decrease of circulating non-classical monocytes was detected in both CCA and HCC patients before and after surgical procedure. In addition, a functional defect in circulating classical and intermediate monocytes was observed in both groups of cancer patients when compared to the HG, with partial recovery after the surgical intervention.

CONCLUSIONS

This integrated analysis permitted the identification of altered functional competence of monocyte subsets in CCA and HCC patients. In addition, our results point to a potential role of TNFα as a prognostic peripheral biomarker in HCC patients, indicating the presence of high-grade tumors that should be further validated.

P794 Treadmill exercise stress echocardiography in children; our experience

Background

Exercise stress echocardiography (ESE) is routinely used in adults but its role in children (C) is less established

Purpose

To assess the feasibility and clinical value of ESE in outpatient children

Methods

We enrolled 309 consecutive C (mean age = 14,1 ± 2,6 years, range 6-17 yrs) who underwent treadmill ESE between 2002 and 2019: One group (Group I) of 258 C including: 237 with exercise related symptoms (chest pain and/or dyspnea and/ or lypotimia-syncope), 15 with resting ECG alterations, 6 with positive ECG stress test and other group of C (Group II) including: 10 asymptomatic for screening requested by parents, 11 with symptoms unrelated to exercise, 12 with antecedents of sudden death in the family, and 17 with known pathology - 10 with hypertrophic cardiomyopathy, 2 with aortic coarctation, 1 each with Cortriatriatum sinister, pulmonary stenosis, subaortic stenosis, bicuspid aortic valve, left ventricular hypertrophy related to arterial hypertension, aortic switch operation. Regional wall motion abnormalities (RWMA) by 2-D and continuous wave Doppler (transvalvular or transaortic or intraventricular (IVG) gradients were assessed in all.

Results

The success rate was 309/309 (100%). Only one complication (allowing asthma diagnosis by serendipity) occurred: a severe asthmatic crisis in one girl studied because of chest pain with exercise (with ESE negativity), Stress-induced RWMA occurred in 2 pts (one with HCM, the other with normal coronary arteries). A significant orthostatic exercise induced IVG (&gt; 30 mmHg) was present in 101 of the 258 C (39%) studied due to symptoms, ECG alterations or positive stress ECG.

In group II the C with induced IVG attained

greater heart rate (HR) 184 ± 12 vs 174 ± 16 (p &lt; 0,001); greater blood pressure (BP) 150 ± 19 mmHg vs 136 ± 23 mmHg (p &lt; 0,001). The OR to the reproduced symptoms that motivated the exam during the SE comparing the 101 C with IVG with the 158 without IVG was 8,22 (4,83-13,99) p &lt; 0,001 (95% CI).

Conclusions

Treadmill ESE is feasible and safe in young people. RWMA are of limited usefulness in our outpatient C group. Doppler often documents significant exercise induced IVG, occult at rest that associate with symptoms.

Abstract P794 Figure. ESE Induced IVG in a C with chest pain

162 Right ventricular function: is longitudinal strain by speckle-tracking an option?

Introduction

Estimation of right ventricular (RV) performance by echocardiography is challenging due to its anatomical and functional distinctiveness. RV longitudinal strain (RVLS) by speckle-tracking (STE) is an innovative tool and recent studies show that it can be used with prognostic significance, although it isn’t yet standardized.

Purpose

In this study, we aimed to evaluate global (G) and free wall (FW) RVLS-STE and its correlation with common RV evaluation methods.

Methods

We conducted a prospective observational study including 65 patients and 20 healthy controls. G and FW RVLS-STE were correlated to tricuspid annular plane systolic excursion (TAPSE), Doppler tissue tricuspid lateral annular systolic velocity (S`) and left ventricle ejection fraction (LVEF). Following current guidelines, a TAPSE higher than 17mm, a peak S` wave velocity higher than 9.5cm/s and a RVLS-STE inferior to -20% was considered normal.

Results

Mean age was 66.34 ± 15.45 years with 61.5% males in the patient group and 31.1 ± 7 years with 50% males in the control group. Echocardiographic findings in patient group included 44.6% with reduced LVEF (EF &lt; 50%), 26.2% with moderate to severe valvular disease, 23% with an elevated systolic pulmonary pressure (&gt; 35mmHg) and 36.9% without significant structural disease. The control group had no pathological signs on echocardiography. Peak S` wave and TAPSE showed a better correlation with FW RVLS-STE (r²=0.41, p &lt; 0.001 and r²=0.46, p &lt; 0.001) than G RVLS-STE (r²=0.27, p &lt; 0.001 and r²=0.30, p &lt; 0.001). A high absolute FW RVLS-STE (&lt; -20%) was a good marker of a normal TAPSE and a normal peak S` wave velocity, with a negative predictive value of 87% and 98% respectively. Comparing to control group, patients with reduced LVEF showed a reduction in TAPSE (27.6 mm vs 18.53 mm, p &lt; 0.001), S` (14.8 cm/s vs 10.84 cm/s, p &lt; 0.001) and FW RVLS-STE (-28.7% vs -15.34%, p &lt; 0.001). Patients with moderate to severe valvular disease also showed a reduction in TAPSE (27.6 mm vs 18.4 mm, p &lt; 0.001), S` (14.8 cm/s vs 10.3 cm/s, p &lt; 0.001) and FW RVLS-STE (-28.7% vs -16.04%, p &lt; 0.001). And finally, patients with elevated systolic pulmonary pressure also showed a reduction in TAPSE (27.6 mm vs 17.94 mm, p &lt; 0.001), S` (14.8 cm/s vs 10.47 cm/s, p &lt; 0.001) and FW RVLS-STE (-28.7% vs -16.7%, p &lt; 0.001).

Conclusion

FW RVLS-STE is better than G RVLS-STE as a RV evaluation method. RVLS-STE is correlated with TAPSE and peak S` wave velocity. It was the only parameter that showed reduction to abnormal values (&gt; -20%) in pathological groups and seems to be an accurate marker of RV function particularly detecting early dysfunction

Association between Cognitive Function and Clustered Cardiovascular Risk of Metabolic Syndrome in Older Adults at Risk of Cognitive Decline

OBJECTIVES

Metabolic syndrome (MetS) represents a cluster of obesity and insulin resistance-related comorbidities. Abdominal obesity, hypertension, elevated triglyceride and glucose levels are components of MetS and may have a negative effect on cognitive function, but few cognitive studies have examined the combined risk severity. We sought to determine which specific cognitive abilities were associated with MetS in older adults at risk of cognitive decline.

DESIGN

Cross-sectional study.

PARTICIPANTS

108 AIBL Active participants with memory complaints and at least one cardiovascular risk factor.

MEASUREMENTS

Cardiovascular parameters and blood tests were obtained to assess metabolic syndrome criteria. The factors of MetS were standardized to obtain continuous z-scores. A battery of neuropsychological tests was used to evaluate cognitive function.

RESULTS

Higher MetS z-scores were associated with poorer global cognition using ADAS-cog (adjusted standardized beta=0.26, SE 0.11, p<0.05) and higher Trail Making B scores (adjusted beta=0.23, SE 0.11, p<0.05). Higher MetS risk was related to lower cognitive performance.

CONCLUSION

Combined risk due to multiple risk factors in MetS was related to lower global cognitive performance and executive function. A higher MetS risk burden may point to opportunities for cognitive testing in older adults as individuals may experience cognitive changes.

P945 Should children, with exercise induced intra-ventricular gradients, be treated with beta blockers?

Background

In our experience, treadmill exercise echocardiography (SE) is feasible and safe in children (C). Regional wall motion abnormalities (RWMA) are of limited usefulness, but Doppler often - (in 39% from 258 previously studied C) - documents significant intraventricular gradients (IVG), occult at rest, and allowing to document a possible explanation for exercise related symptoms, or abnormal resting or stress-ECG findings.

Purpose - To assess the effect of ß blockers on the occurrence of IVG, in C, with symptoms or abnormal resting or stress-ECG findings.

Methods – We repeated SE in 66 of the 101 C – (with normal echocardiogram at rest) - that developed IVG on exertion, under treatment with ß blockers. These 66 C who repeated the SE under treatment with ß blockers are the study group. 15 (23%) of them were female and the mean age of the group was 14,6 ± 1,7 years old (11 to 17).

They all underwent SE with 2D and Doppler echocardiographic evaluation of, and during treatment with ß blockers.

Results

Mean IVG in those 66 C submitted to SE was 105 ± 38 mmHg in the first SE evaluation. In SE evaluation performed under ß blockers, 37 of them didn’t develop IVG and in 29 of them IVG was significantly reduced to a mean IVG of 58 ± 32 mmHg (p&lt; 0,0001). The mean heart rate attained at peak exercise was 178 ± 15 bpm in the first SE evaluation and 157 ± 9 bpm in the evaluation performed under treatment with ß blockers (p &lt; 0, 0001). 47 of these C reproduced clinical symptoms (that were indication to SE) of beta-blockers, and only 7 reproduced the symptoms under treatment with beta blockers (p&lt; 0,0001).

Conclusions

In C with symptoms, abnormal rest or exercise ECG on medical evaluation and IVG on exertion, treatment with oral ß blockers prevented the occurrence of IVG or significantly reduced its magnitude. These changes were associated to significant clinical improvement in 85 % of the symptomatic population.

Abstract P945 Figure. SE without and with beta-blockers

P320 Left atrial mechanics in moderate mitral valve disease: earlier markers of damage

BACKGROUND

Left atrial (LA) mechanics is impaired in mitral valve disease, but it is not clear whether reservoir, conduit or contractile functions are differentially impaired in stenosis (MS) or regurgitation (MR). We aimed to study LA mechanics in patients with moderate MR or moderate MS and identify discriminators of disease.

METHODS

We conducted a prospective, observational study of 100 patients with isolated moderate MR and 100 patients with moderate MS. LA mechanics with speckle tracking echocardiography (STE) assessed LA reservoir (LA ɛsys and SRs), conduit(LAɛe, SRe), and contractile (LAɛa, SRa) functions. Left ventricle (LV) functional parameters were assessed as well, including LV ejection fraction (LVEF), LV end-diastolic diameter (LVDD) and LV global longitudinal strain (LV-GLS).

RESULTS

The mean age was 67 ± 14 years and 75% were female. Mean left ventricular ejection fraction (LVEF), LV end-diastolic diameter (LVDD), LV global longitudinal strain (LV-GLS) and systolic pulmonary artery pressure (sPAP) did not differ between MR and MS (table 1).LA indexed volume (LAVi) and LA strain did not vary between MR and MS, but strain rate did. SRs and SRe had better values in MR, whereas SRa had worse values in MR (table 1). SRe (&lt;-0.7%) had the superior discriminative power for MR, with an area under the curve of 0.85, sensitivity of 76% and specificity of 85%.

CONCLUSIONS

LA strain rate phases were the only parameters that varied between MR and MS. Contractile phase strain rate was more impaired in MR and conduit phase strain rate in MS. This highly specific data reflect the earlier hemodynamic changes occurring in LA in the setting of mitral valve disease.

mMR mMS P value LVEF (±SD,%) 57.4 ± 6.4 59.6 ± 4.6 0.145 LV-GLS (±SD, %) -17.7 ± 4.5 -17.1 ± 3.5 0.587 sPAP (±SD, mmHg) 30.3 ± 10.5 32.4 ± 8.3 0.387 LAVi (± SD, ml/m2) 46.3 ± 6.4 48.2 ± 7.4 0.281 LAɛs (± SD, %) 15.8 ± 7.3 13.3 ± 9 0.062 LAɛe (± SD, %) 8.4 ± 4.7 7.1 ± 5.4 0.074 LAɛa (± SD, %) 6.3 ± 4.8 7.4 ± 4.5 0.081 LA SRs (± SD, %) 0.8 ± 0.4 0.6 ± 0.3 0.004 LA SRe (± SD, %) -0.9 ± 0.5 -0.5 ± 0.3 &lt;0.001 LA SRa (± SD, %) -0.5 ± 0.4 -0.8 ± 0.5 0.007