Using a food web model to predict the effects of Hazardous and Noxious Substances (HNS) accidental spills on deep-sea hydrothermal vents from the Mid-Atlantic Ridge (MAR) region

Deep-sea hydrothermal vents host unique ecosystems but face risks of incidents with Hazardous and Noxious Substances (HNS) along busy shipping lanes such as the transatlantic route. We developed an Ecopath with Ecosim (EwE) model of the Menez Gwen (MG) vent field (MG-EwE) (Mid-Atlantic Ridge) to simulate ecosystem effects of potential accidental spills of four different HNS, using a semi-Lagrangian Dispersion Model (sLDM) coupled with the Regional Ocean Modelling System (ROMS) calibrated for the study area. Food web modelling revealed a simplified trophic structure with low energy efficiency. The MG ecosystem was vulnerable to disruptions caused by all tested HNS, yet it revealed some long-term resilience. Understanding these impacts is vital for enhancing Spill Prevention, Control, and Countermeasure plans (SPCC) in remote marine areas and developing tools to assess stressors effects on these invaluable habitats.

Roles and activities of nurses in cancer prevention and early detection in low- and middle-income countries: A scoping review

Objective

Nurses play a crucial role in cancer control. Prior reviews presented the effectiveness of nursing interventions such as tobacco cessation counseling and cervical cancer screening but did not focus on low- and middle-income countries (LMICs). This scoping review addresses a gap in the literature by describing the roles and activities of nurses in cancer prevention and early detection in LMICs.

Methods

Following Arksey and O'Malley's scoping review framework, we searched seven databases using subject headings and keywords from 1990 to January 2021 and updated in April 2022. The reference lists of relevant studies were also searched. Two reviewers independently screened the relevance of studies through Rayyan, assessed full text articles, and extracted data using a Google Form. Conflicts were resolved by a third reviewer.

Results

A total of 180 studies were included, representing all six World Health Organization regions and 48 LMICs. The largest number of studies were from the African region (n ​= ​72), the Americas (n ​= ​49), and South-East Asia region (n ​= ​29). The main nursing roles featured were patient/community education (n ​= ​113), history taking and cancer risk assessment (n ​= ​63), performing screening exams (n ​= ​136), care coordination (n ​= ​57), and training other healthcare professionals (n ​= ​9).

Conclusions

This scoping review provides a comprehensive picture of nurses' role in cancer prevention and early detection in LMICs, across all six World Health Organization regions. Additional cancer workforce data sources at the country level are needed to fully understand the activities of nurses in cancer prevention. Future research is also needed to measure the impact of nursing educational and other interventions in both primary and secondary cancer prevention.

P04.02.A Integrated diagnosis and therapeutic decision of pediatric nervous system tumors using a comprehensive genomic profiling test

Background

Nervous system tumors (NST) are one of the leading causes of cancer-related death in children. Next-generation sequencing has enabled the identification of an increasing number of genetic markers, allowing for a more accurate diagnosis, and may help guide clinicians towards a more specific therapeutic approach.

Material and Methods

Retrospective cohort study of pediatric and young adult patients with NST analyzed with FoundationOneHeme® (FOH) panel from March 2020 to April 2021. This panel was requested, in addition to previously performed pathological reviews and routine genetic tests, in order to obtain more accurate diagnoses and/or possible therapeutic targets.

Results

Fifty NST were analyzed with FOH panel, corresponding to 49 patients. Median age at NST diagnosis was 13 years (range 0-23 years); 50% were females. Initial diagnoses were: 10 pilocytic astrocytomas, 10 diffuse gliomas, 5 ependymomas, 6 mixed neuronal-glial tumors, 7 embryonal tumors, 3 meningeal tumors, 5 peripheral nervous system tumors (PNST) and 4 other types of tumors. There was a change in the final integrated diagnosis after performing the FOH panel in 10 patients (1 pilocytic astrocytoma, 3 diffuse gliomas, 4 mixed neuronal-glial tumors and 1 PNST). In thirty patients, at least one possible therapeutic target was identified: in 5 patients the target therapies are approved for the patients’ tumor type; in 20 patients, target therapies are approved for the same mutations in other tumor types; and in 30 patients target therapies are still being evaluated in ongoing clinical trials. After the results of the FOH panel were known, the previous therapeutic approach was changed in 15 patients, but in only 4 this was attributed to the new genomic findings.

Conclusion

Comprehensive genomic profiling tests can improve diagnostic accuracy and allow for a more reliable approach to the management of pediatric patients with nervous system tumors. Although in most patients there was no immediate therapeutic application of the potential targets found, the genomic data obtained could be very useful to patients who may have tumor progressions in the future.

Acute and subchronic effects of petroleum on the freshwater fish Hoplias aff. malabaricus

Abstract Petroleum water soluble fraction (WSF) impairs organisms, but damages may vary among cell and tissue levels. The aim of the present study was to evaluate the acute (24 h, 48 h, 72 h) and subchronic effects (36 days) of WSF (0%, 25% and 100%) in juveniles of the Neotropical top predator fish Hoplias aff. malabaricus. The effects of WSF were evaluated at a molecular level using the comet assay and micronucleus test for genome damage; and at a morphological level through histological identification of liver pathologic lesions. In both acute and subchronic exposure we found low levels of DNA damage (< 10% of comet tail) and non-significant frequency of micronucleus in WSF exposed fish. The most significant liver lesions in WSF exposed fish were fatty vacuolization, hypertrophy and focal necrosis. Since these tissue injuries were progressive and persistent, their irreversibility may negatively affect fish recruitment, even in a such resistant top predator.

Vocal universals and geographic variations in the acoustic repertoire of the common bottlenose dolphin

Acoustical geographic variation is common in widely distributed species and it is already described for several taxa, at various scales. In cetaceans, intraspecific variation in acoustic repertoires has been linked to ecological factors, geographical barriers, and social processes. For the common bottlenose dolphin (Tursiops truncatus), studies on acoustic variability are scarce, focus on a single signal type-whistles and on the influence of environmental variables. Here, we analyze the acoustic emissions of nine bottlenose dolphin populations across the Atlantic Ocean and the Mediterranean Sea, and identify common signal types and acoustic variants to assess repertoires' (dis)similarity. Overall, these dolphins present a rich acoustic repertoire, with 24 distinct signal sub-types including: whistles, burst-pulsed sounds, brays and bangs. Acoustic divergence was observed only in social signals, suggesting the relevance of cultural transmission in geographic variation. The repertoire dissimilarity values were remarkably low (from 0.08 to 0.4) and do not reflect the geographic distances among populations. Our findings suggest that acoustic ecology may play an important role in the occurrence of intraspecific variability, as proposed by the 'environmental adaptation hypothesis'. Further work may clarify the boundaries between neighboring populations, and shed light into vocal learning and cultural transmission in bottlenose dolphin societies.

Removal of flocculated TiO2 nanoparticles by settling or dissolved air flotation

Engineered nanoparticles of TiO₂ (TiO₂-NPs) are used in the industry for a great number of applications. After their usage, the particles end up in aquatic environments, contaminating supply waters and watercourses. Bench-scale studies report removal of TiO₂-NPs (450 nm, the mean volumetric diameter) by flocculation followed by settling or by dissolved air flotation (4 bar saturation pressure and 30% recycling ratio). Floc formation was conducted after heterocoagulation with iron hydroxide (30-40 mg L^-1Fe³⁺⁾ and gelatinized corn starch (10-20 mgL^-1) as flocculant, at pH 7. Particle size distribution and zeta potential, removal efficiencies as a function of time and microphotography of flocs were analyzed. Mechanisms involve ferric hydroxide precipitation, heterocoagulation with the nanoparticles and flocculation of the loaded carrier precipitates with gelatinized starch. Best results showed removals between 95-100% of TiO₂-NPs, either by settling or flotation after 5 min. Clear treated waters with low turbidity < 3 nephelometric turbidity units (NTU) and TiO₂-NPs concentrations <1 mg L^-1 were obtained. A practical advantage in DAF was the higher solids content (1.9% w/w) of the sludge, when compared to settling (0.7% w/w). This would facilitate the sludge dewatering and disposal, but DAF has the disadvantage of the poor efficiency at high concentration of the nanoparticles of titanium oxide (>100 mg L^-1). Conversely, the removal by settling of the flocs increased at high dosages. It is believed that both processes are sustainable in terms of reagents and the removal efficiencies of TiO₂ nanoparticles from water.

Tisseel® versus Hemopatch® for dural sealing in neurosurgery. A prospective study in a tertiary center

BACKGROUND

Dural repair is a potential source of complications in neurosurgery. We make a comparison in pseudomeningocele and CSF leak incidence with the sealants Tisseel® and Hemopatch®.

METHODS

We collected 147 patients from September 2017 to December 2018 in a prospective observational study. Inclusion criteria were adult patients with an intradural cranial or spinal surgery whose dura was closed with a fibrin sealant. Primary endpoints were the incidence of pseudo meningocele and CSF leak. Secondary endpoints were the surgical-site infection, epidural hematoma, and the influence of previous surgery.

RESULTS

In 65 and 82 patients Tisseel® and Hemopatch® were used as sealants respectively. The incidence of CSF leak presented a significant statistical relation with the use of Tisseel® in a univariate and multivariate analysis. Infratentorial surgery presented a higher incidence of pseudomeningocele and CSF leak, but the approach used was not a significant factor in multivariate analysis. Patients who were operated previously had a higher risk present a postoperative complication.

CONCLUSIONS

The incidence of pseudomeningocele and CSF leak was higher with Tisseel® compared with Hemopatch® with a statistic significant relation in case of CSF fistulae. The procedure done may be a confusion factor in our study. There was no report of adverse effects or a higher incidence of complications. However, it is recommended to plan randomized trials with larger samples to get stronger evidence.

A cost-utility analysis of increasing percutaneous coronary intervention use in elderly patients with acute coronary syndromes in six European countries

AIMS

Percutaneous coronary intervention reduces mortality in acute coronary syndrome patients but the cost-utility of increasing its use in elderly acute coronary syndrome patients is unknown.

METHODS

We assessed the efficiency of increased percutaneous coronary intervention use compared to current practice in patients aged ≥75 years admitted for acute coronary syndrome in France, Germany, Greece, Italy, Portugal and Spain with a semi-Markov state transition model. In-hospital mortality reduction estimates by percutaneous coronary intervention use and costs were derived from the EUROpean Treatment & Reduction of Acute Coronary Syndromes cost analysis EU project (n = 28,600). Risk of recurrence and out-of-hospital all-cause mortality were obtained from the Information System for the Development of Research in Primary Care (SIDIAP) database from North-Eastern Spain (n = 55,564). In-hospital mortality was modelled using stratified propensity score analysis. The 8-year acute coronary syndrome recurrence risk and out-of-hospital mortality were estimated with a multistate survival model. The scenarios analysed were to increase percutaneous coronary intervention use among patients with the highest, moderate and lowest probability of receiving percutaneous coronary intervention based on the propensity score analysis.

RESULTS

France, Greece and Portugal showed similar total costs/1000 individuals (7.29-11.05 m €); while in Germany, Italy and Spain, costs were higher (13.53-22.57 m €). Incremental cost-utility ratios of providing percutaneous coronary intervention to all patients ranged from 2262.8 €/quality adjusted life year gained for German males to 6324.3 €/quality adjusted life year gained for Italian females. Increasing percutaneous coronary intervention use was cost-effective at a willingness-to-pay threshold of 10,000 €/quality adjusted life year gained for all scenarios in the six countries, in males and females.

CONCLUSION

Compared to current clinical practice, broadening percutaneous coronary intervention use in elderly acute coronary syndrome patients would be cost-effective across different healthcare systems in Europe, regardless of the selected strategy.

Epidermolysis Bullosa Pruriginosa successfully treated with concomitant topical and systemic agents

Epidermolysis bullosa pruriginosa, a genetic mechanobullous disease, manifests at birth or late in life and is characterised by intense pruritus, resulting in lichenified or nodular prurigo-like lesions and scarring most prominent on the shins. Treatment is unsatisfactory. We report a patient treated with success using a combination of topical and systemic agents.

AB0968 DIAGNOSIS OF INFLAMMATORY BACK PAIN (IBP) IN A LOW-INCOME POPULATION USING ASAS IBP DEFINITION

Background:

Inflammatory back pain (IBP) is an important entry criterion for identifying patients with axial spondyloarthritis. Due to the very frequent prevalence of chronic non-inflammatory back pain (CBP), IBP is difficult to differentiate and recognize in many clinical practices. CBP is a frequent diagnosis in populations with low socioeconomic status.

Objectives:

To investigate whether IBP ASAS definition help discriminate from CBP in a low-income population.

Methods:

A total of 202 consecutive individuals were directly interviewed in Fortaleza/Brazil, for the prevalence of IBP (ASAS definition), monthly family income (US$), school education [>/≤ 8 school-years(SY)], and smoking habit (present/absent). People from all social levels were included.

Results:

Mean age was 38.9±12.9 years, 100 (49.5%) were male and 36 (17.8%) were smokers; 135 (66.8%) declared less than 730US$ family earnings per month and 71 (35.1%) had less than 8 SY. Although 122 (60.3%) declared lumbar pain, in comparison, 29 (14.3%), 22 (10.9%) and 59 (29.2%) fulfilled ASAS, Berlin, and Calin’s IBP criteria, respectively. There were 39 (58.02%) vs. 83 (61.5%) with vs. without CBP and 9 (13.4%) vs. 20 (14.8%) fulfilling vs. not fulfilling the ASAS IBP definition among those with more or less than 730US$ earnings (P>0.05), respectively.

Conclusion:

This is the first report on the prevalence of IBP in a very low-income population. Over one-third had less than 8SY, revealing very low literacy. Smoking prevalence was also low if compared to 28% smoking prevalence WHO estimates across Europe*. These IBP prevalence data are similar to those reported in wealthier populations, living in higher latitude. Data suggest that ASAS IBP definition may be used to discriminate patients with IBP from those with CBP, regardless of income and literacy.

References:

This is the first report on the prevalence of IBP in a very low-income population. Over one-third had less than 8SY, revealing very low literacy. Smoking prevalence (17.8%) was also low if compared to 28% smoking prevalence WHO estimates across Europe*. These IBP prevalence data are similar to those reported in wealthier populations, living in higher latitude. Data suggest that ASAS IBP definition may be used to discriminate patients with IBP from those with CBP, regardless of income and literacy.

Disclosure of Interests:

Jobson Oliveira: None declared, Rodolfo Nunes: None declared, Guilherme da Silva: None declared, Igor Nogueira: None declared, Artur Azevedo: None declared, Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Airton Rocha Speakers bureau: Not related to the present work

Maternal and paternal preconception exposure to phenols and preterm birth

BACKGROUND

Phenol exposure during pregnancy has been associated with preterm birth, but the potential effect of preconception exposure in either parent is unknown. There is a growing body of evidence to suggest that the preconception period is a critical window of vulnerability for adverse pregnancy outcomes.

OBJECTIVE

We examined whether maternal and paternal preconception urinary concentrations of select phenols were associated with the risk of preterm birth among couples attending fertility care.

METHODS

The analysis included 417 female and 229 male participants of the Environment and Reproductive Health (EARTH) Study who gave birth to 418 singleton infants between 2005 and 2018 and for whom we had phenol biomarkers quantified in at least one urine sample collected before conception. Mothers and fathers provided an average of 4 and 3 urine samples during the preconception period, respectively. We calculated the geometric mean of bisphenol A (BPA), bisphenol S (BPS), benzophenone-3, triclosan, and the molar sum of parabens (ΣParabens) urinary concentrations to estimate each participant's preconception exposure. Risk ratios (RRs) of preterm birth (live birth before 37 completed weeks' gestation) were estimated using modified Poisson regression models adjusted for covariates.

RESULTS

The mean (SD) gestational age among singletons was 39.3 (1.7) weeks with 8% born preterm. A natural log-unit increase in maternal preconception BPA (RR 1.94; 95% CI: 1.20, 3.14) and BPS (RR 2.42; 95% CI: 1.01, 5.77) concentration was associated with an increased risk of preterm birth. These associations remained after further adjustment for maternal prenatal and paternal preconception biomarker concentrations. Paternal preconception ΣParabens concentrations showed a possible elevated risk of preterm birth (RR 1.36; 95% CI: 0.94, 1.96). No consistent pattern of association was observed for benzophenone-3 or triclosan biomarkers in either parent.

DISCUSSION

Maternal preconception urinary BPA and BPS concentrations, as well as paternal preconception urinary parabens concentrations were prospectively associated with a higher risk of preterm birth. Subfertile couples' exposure to select phenols during the preconception period may be an unrecognized risk factor for adverse pregnancy outcomes.

Management of psoriasis in pregnancy - a review of the evidence to date

The onset of psoriasis collides with women’s reproductive timeframe, and pregnancy brings challenges to its treatment. Indeed, the health of both mother and foetus must be considered. When choosing to treat pregnant women affected by psoriasis with pharmacological therapy, it is important to be aware of all possible options and their repercussions. Although there are several pharmacological therapies available, pregnancy brings ethical concerns and any pharmacological approach must be well thought out. The data available in humans are limited, and further investigation on this matter is needed. Within biological therapies, certolizumab pegol has recently been identified as a promising approach during pregnancy because it has been shown to have no late active placental transfer and no clear signs of foetal harm. This article aims to review the impact of psoriasis during pregnancy, how the disease can be managed pharmacologically during this period according to the available armamentarium, and the possible effects of the therapeutic options for the mother and the foetus.

P03.13 Evaluation of PIK3CA mutational status in glioma molecular subgroups

BACKGROUND

Gliomas are the most common and lethal malignant tumors of central nervous system. In 2016, World Health Organization (WHO) classification included IDH mutations and 1p/19q codeletion as diagnostic criteria to define glioma entities. However, new biomarkers for diagnosis, prognosis and response to therapy are needed. In this context, PIK3CA mutations have been described as constitutive mutations, which highlights their relevance in gliomas. Here we clarified the clinical relevance of PIK3CA mutations according to the 2016 WHO classification, the potential impact on diagnosis, prognosis, response to therapy, as well as their correlation with EGFR amplification and PTEN deletion.

MATERIAL AND METHODS

A cohort of 444 adult diffuse glioma samples from Instituto Português de Oncologia Lisboa Francisco Gentil (IPOLFG) was classified according to the 2016 WHO Classification. The mutational status of exon 9 and 20 of PIK3CA was evaluated in molecular subgroups of gliomas by Sanger sequencing. PTEN deletion and EGFR amplification were identified by Fluorescent in situ hybridization (FISH).

RESULTS

PIK3CA mutations showed a higher frequency in the subgroup of gliomas with IDH mutations and 1p/19q codeletion - oligodendrogliomas (10%). In Glioblastoma (GBM) IDH-mutant and IDH-wildtype these oncogenic mutations were observed in 9% and 3% of cases, respectively. Similar results were obtained using The Cancer Genome Atlas (TCGA) data, which was 8% and 2%, respectively. H1047R and E542K were the most frequent mutations identified in the glioma molecular subgroups. Importantly, we found 3 unreported pathogenic variants in exon 20 of PIK3CA (c.3112T>C, c.2988T>C, c.3040C>T) and one polymorphic variant (c.3210A>G). In addition, PIK3CA mutations, PTEN deletion and EGFR amplification were not mutually exclusive alterations in glioma molecular subgroups. For the first time in gliomas, it was identified the rs45455192 polymorphism at a frequency of 16% in astrocytomas IDH-mutant, 24% in oligodendrogliomas and 18% in both molecular subgroups of GBM, although this polymorphism did not have prognostic value. The analysis of PIK3CA mutations in glioma recurrences showed that these mutations are maintained during glioma progression.

CONCLUSION

In two independent cohorts (IPOLFG and TCGA), it was obtained similar frequencies of PIK3CA mutations in GBM molecular subgroups. In addition, these mutations are more relevant in less aggressive gliomas (IDH-mutated and 1p/19q codeleted). These alterations seem to be important in tumor maintenance and progression, which makes this gene a potential therapeutic target. In the future, we will investigate the effect of the in vitro pharmacological inhibition of PIK3CA in GBM mutant cell lines.

Bulk nanobubbles in the mineral and environmental areas: Updating research and applications

In the last decade, the research with bulk nanobubbles (ultrafine bubbles with a diameter <1 μm, according to ISO 20480-1:2017) has been rapidly increasing in the academic and industrial environments. Nowadays, there are many applications reported in the literature, with several patents, procedures, and techniques on nanobubbles generation and an evergrowing research and many applications. Yet, most of those publications reporting bulk nanobubbles generation devices, do not bring information on measurements of size distribution or bubbles concentration (if nanobubbles). Further, there is a problem of scale and many of these products are small bench discontinuous rigs difficult to scale up, which might serve small scale purposes, but are not able for treating high flow-rate wastewaters or minerals pulps at industrial scale. These nanometric bubbles present interesting and peculiar properties such as high surface area per volume unit, high stability and longevity, surface charge in water and the ability to aggregate hydrophobic particles. These findings demonstrate their high potential for applications in many technological areas, which occur not only as isolated bubbles but also jointly with micro (~ 1-100 μm diameter) and/or macrobubbles (~100 μm - 2 mm diameter). This paper reviews the evolution of basic research on nanobubbles, the challenges concerning generation and stability and their applications in the mineral (flotation) and environmental areas (treatment of water and wastewaters or remediation of contaminated environments). Herein, because the importance in engineering, as a whole, most of the studies are based on the nanobubbles generated by depressurisation/hydrodynamic cavitation of the air-saturated water in flow constrictors (venturi, needle valves). In the mineral area, they appear to be responsible for increasing the recovery and flotation kinetics of fine (<74 μm) and ultrafine (<13 μm) particles at lower frother and collector dosages. In the environmental area, nanobubbles have been reported to enhance the removal of a variety of pollutants (emulsified oil, colloidal solids, organic/inorganic precipitates, ions) by flotation associated with bigger bubbles. More, the application of isolated nanobubbles on the removal of residual pollutants, such as amine and oil (both as flocs) were reported. Also, the use of ozone and oxygen nanobubbles has been studied for the remediation/decontamination of soil and aquatic ecosystems and for the oxidation of emerging pollutants in water and wastewater treatment. The future of nanobubbles in flotation separation research is highly promising; operating costs of the different forms of nanobubbles generation and bench studies should be validated through pilot and real scale with the continuous injection of these bubbles.

Metformin and Breast Cancer: Molecular Targets

Metformin has been the first-line drug for the treatment of type II diabetes mellitus for decades, being presently the most widely prescribed antihyperglycemic drug. Retrospective studies associate the use of metformin with a reduction in cancer incidence and cancer-related death. However, despite extensive research about the molecular effects of metformin in cancer cells, its mode of action remains controversial. The major molecular targets of metformin include complex I of the mitochondrial electron transport chain, adenosine monophosphate (AMP)-activated protein kinase (AMPK), and mechanistic target of rapamycin complex 1 (mTORC1), but AMPK-independent effects of metformin have also been described. Breast cancer is one of the leading causes of cancer-related morbidity and mortality among women worldwide. Several studies have reinforced a link between breast cancer risk and diabetes. Moreover, metformin significantly reduces breast cancer risk, compared to patients who are not using metformin and is independent of diabetes status. In this review, we summarize the current molecular evidence to elucidate metformin's mode of action against breast cancer cells.

Perturbative measurement of magnetoresistance

In this paper, we report the development of a novel technique in which the magnetoresistance of nanostructures is perturbatively measured by transversally modulating the DC magnetic field. It measures the electrical transport counterpart of the transverse magnetic AC-susceptibility. The technique was developed in a conventional four-probe configuration in which a small DC current flows through the sample and a small transverse AC-field perturbates the equilibrium position of the sample magnetization. Lock-in detection, in-phase with the AC-perturbation, is used to measure the voltage signal between the two inner electrodes of the four-probe station. We successfully demonstrated that this signal is proportional to the product of the first derivative of sample resistance with respect to the equilibrium position of the magnetization times the second derivative of the energy with respect to the equilibrium position of the magnetization. These dependences add new features to the technique investigated here that were not captured by the investigations previously reported on the same subject. To show the effective use of the technique, we discuss its application in measuring magnetic properties of thin magnetic films in the non-saturated regime.

Biosimilar Agents for Psoriasis Treatment: The Perspective of Portuguese Patients

INTRODUCTION

Biosimilars are highly similar copies of previously approved original biologic medicines. Their introduction on the market may yield cost reduction. The aim of this study was to evaluate the perspectives of psoriasis patients on biosimilar medications.

MATERIALS AND METHODS

We conducted a 14 questions survey of psoriasis patients receiving biological therapy and followed-up in a dermatology department of a Portuguese tertiary care hospital.

RESULTS

From a total of 108 patients included, 70.4% of patients did not know the definition of biosimilar agent and 76.6% of patients showed partial or total interest in using a biosimilar drug. Nearly 80% of patients partially or totally agreed in using a biosimilar drug in order to reduce healthcare costs with psoriasis treatment. However, the lack of studies in the European population and in psoriatic patients led most of the patients (72.2% and 75.0%, respectively) to somewhat or completely oppose to the use of biosimilars. Demographic variables, household income and type of current biologic therapy did not affect patient preferences.

DISCUSSION

Despite of the unfamiliarity of the respondents with biosimilars, most patients seem receptive to their use. Nevertheless, there are two issues of concern: i) the use of biosimilars that are not tested in a European population, and ii) its approval for psoriasis without trials in this disease. Thus, an immediate need exists for patient education about biosimilars.

CONCLUSION

Biosimilars may increase patient access to biologic therapies. Improved communication and the involvement of patients in decision-making regarding biosimilars may increase their acceptance in future.

The successful treatment with ixekizumab in a multi-failure psoriasis patient

We report a patient with severe psoriasis who failed to respond to phototherapy, conventional systemic treatment and four biologic agents (etanercept, ustekinumab, adalimumab and secukinumab). Combination of a higher-dose secukinumab regimen with phototherapy had no success. Remarkably, ixekizumab, an IL-17A inhibitor, provided almost complete psoriasis clearance after 24 weeks of treatment. The reason for the success of ixekizumab after the failure to respond to a biologic with same mechanism of action is still unknown. Interestingly, failure of secukinumab does not preclude future therapeutic success with a second IL-17A-inhibitor.

Predicting prognosis in patients with advanced cancer: A prospective study

BACKGROUND

Prognosis is one of the most challenging questions with which physicians are confronted. Accuracy in the prediction of survival is necessary for clinical, ethical, and organizational reasons.

AIM

Evaluate young doctors' clinical prediction of survival and the aids they could get: expert opinion, Palliative Prognostic score, and Palliative Prognostic Index.

DESIGN

Prospective, observational study.

SETTING/PARTICIPANTS

Advanced cancer patients under observation of an inhospital palliative care team, from April to July 2014. A total of 38 patients were included, mostly male (65.8%), average age 68.5 years. Average survival time was 24 days. Follow-up concluded with death or after 90 days.

RESULTS

Young doctors' clinical prediction of survival was adequate at 10.5%, with 55.3% severe errors in an optimistic direction. Palliative care experts were more adequate (23.7%) and made less severe errors (42.1%). Palliative Prognostic score and Palliative Prognostic Index were even more adequate (47% and 55%, respectively) and made even less severe errors (0% and 11%, respectively). The best correlation with observed survival was achieved when palliative care experts used palliative prognostic score ( r_s = -0.629; p < 0.01).

CONCLUSION

Young doctors' clinical prediction of survival is often inadequate. Palliative Prognostic score, which includes clinical prediction of survival, calculated by palliative care experts had the best performance. Our results support the recommendation of using clinical prediction of survival together with prognostic scores.

Raw water clarification by flotation with microbubbles and nanobubbles generated with a multiphase pump

Raw water clarification by flotation was studied by injecting air into a centrifugal multiphase pump to generate microbubbles (MBs) and nanobubbles (NBs). Measurements of gas dispersion parameters were performed and optimal conditions were obtained using a pump pressure of 4 bar. Values showed a bubble Sauter diameter of 75 μm, an air holdup of 1.2%, a bubble surface area flux of 34 s^-1 and an NB concentration of 1 × 10⁸ NBs mL^-1 (measuring 220 nm). Then, a study compared flotation with bubbles formed with the multiphase pump (F-MP) to lamellar settling at the clarification stage of a water treatment plant (WTP), in Brazil. The F-MP showed a higher separation efficiency at high hydraulic loads (9-15 m h^-1), even without the use of a polymer, reaching 2 NTU (10-25 NTU raw water feed), which was much lower than the technical goal of the WTP (5 NTU). The results and the technical aspects are discussed, and it is concluded that the employment of MBs and NBs with pumps widens new research lines and applications in modern flotation.

Satisfaction with a therapeutic sleeve for arm lymphedema secondary to breast cancer treatment: Controlled crossover trial

Highlights

Secondary lymphedema is a late iatrogenic side effect of breast cancer treatment.Despite multimodal decongestive therapy in their daily life breast cancer survivors with lymphedema have few alternatives but to use a compressive sleeve.Concerned with the well-known low compliance to the daily use of traditional sleeves, we conducted a comparative study to evaluate the subjective assessment of an innovative class 1 compression sleeve.We concluded that the PRADEX^® sleeve, not being worse in its compressive efficacy, is much better with regard to patient comfort.

Abstract

Secondary arm lymphedema is a feared late iatrogenic side effect of breast cancer survivors with a negative impact on patient's self-image and quality of life. Its reported incidence is extremely variable, from 6% to 80%, as well as the effectiveness of the multimodal decongestive lymphedema therapy.In their daily life breast cancer survivors with lymphedema have few alternatives but to use a compressive sleeve. Concerned with the well-known low compliance to the daily use of traditional sleeves, we conducted a comparative study in a subgroup of our patients with lymphedema secondary to breast cancer treatment for the subjective assessment of PRADEX^®, an innovative class 1 compression sleeve. Secondarily, we aimed to assess the non-inferiority of PRADEX^® regarding subjective and objective measures of the severity of lymphedema.We studied 46 women with grade 1 secondary arm lymphedema, who used their usual sleeve and PRADEX^® daily for 2 weeks each, in a crossover design.The new therapeutic sleeve was classified as having a better design and a better usability and comfort (more comfortable, thinner, fresher, softer, more flexible, comfortable, resistant to dirt and easier to dress and to wear). Women's subjective opinion about the severity of lymphedema favored their usual sleeve in detriment of PRADEX^®, but this subjective feeling was contradicted by objective measurements of different perimeters of the arm at the beginning and at the end of the study.We concluded that the PRADEX^® sleeve, not being worse in its compressive therapeutic efficacy, is much better with regard to patient comfort.

Mid-regional proadrenomedullin: An early marker of response in critically ill patients with severe community-acquired pneumonia?

BACKGROUND

Mid-regional proadrenomedullin (MR-proADM) is a novel biomarker with potential prognostic utility in patients with community-acquired pneumonia (CAP).

PURPOSE

To evaluate the value of MR-proADM levels at ICU admission for further severity stratification and outcome prediction, and its kinetics as an early predictor of response in severe CAP (SCAP).

MATERIALS AND METHODS

Prospective, single-center, cohort study of 19 SCAP patients admitted to the ICU within 12h after the first antibiotic dose.

RESULTS

At ICU admission median MR-proADM was 3.58nmol/l (IQR: 2.83-10.00). No significant association was found between its serum levels at admission and severity assessed by SAPS II (Spearman's correlation=0.24, p=0.31) or SOFA score (SOFA<10: <3.45nmol/l vs. SOFA≥10: 3.90nmol/l, p=0.74). Hospital and one-year mortality were 26% and 32%, respectively. No significant difference in median MR-proADM serum levels was found between survivors and non-survivors and its accuracy to predict hospital mortality was bad (aROC 0.53). After 48h of antibiotic therapy, MR-proADM decreased in all but 5 patients (median -20%; IQR -56% to +0.1%). Its kinetics measured by the percent change from baseline was a good predictor of clinical response (aROC 0.80). The best discrimination was achieved by classifying patients according to whether MR-proADM decreased or not within 48h. No decrease in MR-proADM serum levels significantly increased the chances of dying independently of general severity (SAPS II-adjusted OR 174; 95% CI 2-15,422; p=0.024).

CONCLUSIONS

In SCAP patients, a decrease in MR-proADM serum levels in the first 48h after ICU admission was a good predictor of clinical response and better outcome.

Abundance and spatial-temporal distribution of the shrimp Xiphopenaeus kroyeri (Decapoda: Penaeidae): an exploited species in southeast Brazil

This study evaluated the abundance and spatial-temporal distribution of the shrimp Xiphopenaeus kroyeri in the coastal region of Macaé, state of Rio de Janeiro, southeastern Brazil. Monthly samples were obtained from March 2008 to February 2010 in six stations located in Inner (5, 10 and 15m depth) and Outer (25, 35 and 45m depth) areas. It was used a commercial fishery boat equipped with an otter-trawl net (3.5 m mouth width, mesh size 20mm and 15mm in the cod end). Water samples were taken for determination of temperature and salinity, and sediment samples for determination of texture and organic matter content. A total of 7146 shrimps were sampled. About 95% of all shrimps were caught in the shallow area, i.e., depths <20m. Greatest abundances were recorded in winter and spring. No significant correlation was observed between sediment (phi) and abundance. The distribution of X. kroyeri in the studied area was closely related to seasonal cold waterfront of the South Atlantic Central Water (SACW) and temperature was the main factor affecting the species abundance.

Evaluating Transportation by Comparing Several uses of Rotary Endodontic Files

AIM

To evaluate the frequent use of ProTaper Next (PTN; Dentsply Maillefer, Ballaigues, Switzerland) systems on shaping ability of root canal utilizing Solidworks (2014, Dassault Systemes) software.

MATERIALS AND METHODS

Thirty-six root canals in clear resin blocks (Dentsply-Maillefer) were allocated into six experimental groups (n = 36). Six new sets of PTN instruments (Dentsply Maillefer, Ballaigues, Switzerland) were used six times to shape the resin blocks. A #15 K-file was inserted to the working length (WL), followed by ProGlider (PG) to create a glide path. Sequential use of PTN instrumentation in a crown-down technique was used to reach size (30/07) apically. Macroscopic photos of the blocks were taken before and after instrumentation, layered by Paint Shop Pro 9 from JascSoftware, and then canal transportation was measured using Solidwork 2014. The data were analyzed by SPSS software version 22. Multivariate statistical analysis general linear model (GLM) was also applied. Bonferroni correction test was used in multiple comparisons and the statistical significance was set to 0.05.

RESULTS

There was no difference in canal transportation resulted from utilizing PTN files after six multiple uses; in addition, the PTN files showed ability to maintain the original canal anatomy, especially in the apical level, where lowest total mean value of canal center displacement was seen (3 mm level) (0.019 ± 0.017).

CONCLUSION

ProTaper Next files can be used to prepare single and multiple canals in a single furcated tooth.

CLINICAL SIGNIFICANCE

ProTaper Next nickel-titanium (NiTi) file system is a safe instrument that respects the canal shape, allows practitioners to treat difficult cases with good results, and low risk of separation.

Spin-Current to Charge-Current Conversion and Magnetoresistance in a Hybrid Structure of Graphene and Yttrium Iron Garnet

The use of graphene in spintronic devices depends, among other things, on its ability to convert a spin excitation into an electric charge signal, a phenomenon that requires a spin-orbit coupling (SOC). Here we report the observation of two effects that show the existence of SOC in large-area CVD grown single-layer graphene deposited on a single crystal film of the ferrimagnetic insulator yttrium iron garnet (YIG). The first is a magnetoresistance of graphene induced by the magnetic proximity effect with YIG. The second is the detection of a dc voltage along the graphene layer resulting from the conversion of the spin current generated by spin pumping from microwave driven ferromagnetic resonance into a charge current, which is attributed to the inverse Rashba-Edelstein effect.

Population biology of the commercially exploited shrimp Artemesia longinaris (Decapoda: Penaeidae) in an upwelling region in the Western Atlantic: comparisons at different latitudes

This study characterized the population biology of the dendrobranchiate penaeid shrimp Artemesia longinaris Spence Bate, 1888, focusing on population structure, sexual maturity, reproductive period and recruitment, and comparing reproductive parameters of a different populations along western South Atlantic..Samples were collected monthly from March, 2008 to February, 2010 in Macaé, northern coast of Rio de Janeiro State, Brazil, a region influenced by the Cabo Frio upwelling. There was a significantly higher percentage of females and with larger sizes than males. Both carapace length and sexual maturity in Macaé were similar to the dimensions found in populations in the South of the continent (Argentina). Reproductive females were present in all months, with main peaks during winter and summer. Recruitment was also continuous, with peaks, usually one to two months after the appearance of reproductive females, after the reduction of the bottom temperature values of water. These data suggest that November to January would be the appropriate months for legal off-season, due to the higher intensity of spawning females and juveniles during this period. A comparação latitudinal dos parâmetros reprodutivos, não confirma o paradigma de que tamanho do corpo e a maturidade sexual das fêmeas são menores em regiões tropicais e aumentam em direção às maiores latitudes, reforçando a hipótese da influência e importância da ACAS na dinâmica reprodutiva de A. longinaris na região The results of this study contribute to the understanding of the biology of A. longinaris, and could also be a reference to monitor this important fishery resource and consequent legal off-season. Furthermore, this population located at the northern limit of the species distribution is a source of highly relevant comparison for population studies in other areas.