The empty pelvis syndrome: a core data set from the PelvEx collaborative

BACKGROUND

Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of radicality of PE are inconsistent; therefore, the best approaches for prevention are unknown. To facilitate future research into EPS, the aim of this study is to define a measurable core outcome set, core descriptor set and written definition for EPS. Consensus on strategies to mitigate EPS was also explored.

METHOD

Three-stage consensus methodology was used: longlisting with systematic review, healthcare professional event, patient engagement, and Delphi-piloting; shortlisting with two rounds of modified Delphi; and a confirmatory stage using a modified nominal group technique. This included a selection of measurement instruments, and iterative generation of a written EPS definition.

RESULTS

One hundred and three and 119 participants took part in the modified Delphi and consensus meetings, respectively. This encompassed international patient and healthcare professional representation with multidisciplinary input. Seventy statements were longlisted, seven core outcomes (bowel obstruction, enteroperineal fistula, chronic perineal sinus, infected pelvic collection, bowel obstruction, morbidity from reconstruction, re-intervention, and quality of life), and four core descriptors (magnitude of surgery, radiotherapy-induced damage, methods of reconstruction, and changes in volume of pelvic dead space) reached consensus-where applicable, measurement of these outcomes and descriptors was defined. A written definition for EPS was agreed.

CONCLUSIONS

EPS is an area of unmet research and clinical need. This study provides an agreed definition and core data set for EPS to facilitate further research.

Towards optimal use of antithrombotic therapy of people with cancer at the end of life: A research protocol for the development and implementation of the SERENITY shared decision support tool

BACKGROUND

Even though antithrombotic therapy has probably little or even negative effects on the well-being of people with cancer during their last year of life, deprescribing antithrombotic therapy at the end of life is rare in practice. It is often continued until death, possibly resulting in excess bleeding, an increased disease burden and higher healthcare costs.

METHODS

The SERENITY consortium comprises researchers and clinicians from eight European countries with specialties in different clinical fields, epidemiology and psychology. SERENITY will use a comprehensive approach combining a realist review, flash mob research, epidemiological studies, and qualitative interviews. The results of these studies will be used in a Delphi process to reach a consensus on the optimal design of the shared decision support tool. Next, the shared decision support tool will be tested in a randomised controlled trial. A targeted implementation and dissemination plan will be developed to enable the use of the SERENITY tool across Europe, as well as its incorporation in clinical guidelines and policies. The entire project is funded by Horizon Europe.

RESULTS

SERENITY will develop an information-driven shared decision support tool that will facilitate treatment decisions regarding the appropriate use of antithrombotic therapy in people with cancer at the end of life.

CONCLUSIONS

We aim to develop an intervention that guides the appropriate use of antithrombotic therapy, prevents bleeding complications, and saves healthcare costs. Hopefully, usage of the tool leads to enhanced empowerment and improved quality of life and treatment satisfaction of people with advanced cancer and their care givers.

Minimum standards of pelvic exenterative practice: PelvEx Collaborative guideline

This document outlines the important aspects of caring for patients who have been diagnosed with advanced pelvic cancer. It is primarily aimed at those who are establishing a service that adequately caters to this patient group. The relevant literature has been summarized and an attempt made to simplify the approach to management of these complex cases.

AB1455 VERY LOW FREQUENCY ANAS/DFS70 PATTERN POSITIVITY IN A LARGE COHORT OF AUTOIMMUNE/AUTOINFLAMMATORY AND CONTROLS IN A SINGLE HOSPITAL FROM COLOMBIA

Background

Antinuclear antibodies (ANA) have diagnostic significance in rheumatology. Anti-DFS70 (Dense Fine Speckle-70 kd) antibodies may be an exclusionary marker for systemic autoimmune rheumatic disease (SARD). Low frequency of this pattern has previously been described in healthy populations.

Objectives

To evaluate ANAS/DFS70 positivity and autoantibody profile in a large Colombian population with rheumatoid arthritis (RA), psoriasis (PsO), as well as, undifferentiated connective tissue diseases (UCTD), first degree relatives (FDR), and healthy controls (HC).

Methods

A cross-sectional study was conducted. We analyzed 531 individuals between 18-65 years, 101 RA patients (ACR/EULAR 2010 classification criteria), 137 relatives from RA, 60 PsO patients (Colombian classification consensus), 47 UCTD patients, and 186 HC matched by age and sex. The determination of ANAS-HEp2 antibodies, was carried out. The ANAS/DFS70 positive results used as a confirmatory test the determination by Knocked out, for the psip gen and CytoBead by indirect immunofluorescence-IFI technique. Absolute and relative frequencies were established and associations with chi square test.

Results

The distribution by diagnostic group was RA: 19%, PsO: 11,3%, UCTD: 8,9%, 25,8% RA relatives, and 35% healthy controls. RA was ANA test (+) in 42%, PsO 41,7%, UCTD 78,7%, FDR 26,3%, and HC 26,9%. The positive frequency of ANA/DFS70 in the total group was 2.3% and 1,4% in SARD (n=12; 2 FDR, 6 HC, 3 UCTD, and PsO 1), no RA patients were positive. These 12 participants were negative for rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA), one patient with UCTD were positive for Anti SSB/La, Anti Sm, Anti RNP, and anti DNAds, another was positive for anti Sm IgG and IgM B2GP, and IgG ACA. Most participants had negative acute phase reactants (erythrosedimentation rate ESR[-] 83,3% and C-reactive protein CRP[-] 66,6%). ANAS/DFS70 was associated with positivity for ANAS independently of ANAS titers, (p <0,001). None of the patients’ positives ANAS DFS70 in the UCTD group in 5 years developed definitive autoimmune disease.

Conclusion

Despite the low frequency in the group in general, it has been shown that anti-DFS70 is more prevalent in healthy individuals than in patients with SARD, which was found in this group of individuals. ANAS/DFS70 autoantibodies were present in very low frequency in Colombian patients with SARD. Thus, patients with a positive result tend to have a mild or non-progressing phenotype of autoimmune or autoinflammatory diseases. This analysis reinforce evidence of ANA/DFS70 positivity as well as autoantibody negativity described abroad as a negative predictive marker of SARD.

Table 1.

Clinical and demographical variables for ANAS/DFS70 patients n=12.

AGEGENDERANASESRCRPRFACPARoLaSmRNPDNAdsACA IgGACA IgMACA IgAB2GP IgGB2GP IgMUCTD30F1/160------+--+--++UCTD61F1/320-----++++-----UCTD42F1/160-+------+-----PsO43F1/320--------------FDR31M1/80--------------FDR32F1/160+-------------HC50F1/80--------------HC26F1/80+-------------HC27F1/160--------------HC54F1/320--------------HC32F1/160--------------HC53F1/320-+------------

Rheumatoid arthritis (RA), Psoriasis (PsO), as well as, Undifferentiated connective tissue diseases (UCTD), first degree relatives (FDR), healthy controls (HC), rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA), erythrosedimentation rate (ESR), and C-reactive protein (CRP).

Acknowledgements

Hospital Militar Central / Universidad del Bosque

Disclosure of Interests

None declared

COVID-19 impact on the health and emotional well-being of the general population

 

A tremendous number of studies describe results on the evolution of the COVID-19 impact on infected patients, hospital admissions, deaths, mental health and well-being of the population. However, there are hardly any reports on its impact and evolution since the beginning of the pandemic with clinical, contextual and individual perception information. Our work describes the research project called Health Care and Social Survey (ESSOC, Encuesta Sanitaria y SOCial). It arises from the need to provide specific, reliable, early, and timely data on the impact of COVID-19 that can be considered when making decisions to prepare and provide an effective Public Health response in the different affected populations. It is linked to official statistical operations included in the Andalusian Regional Government and has also been granted a favorable opinion by the Research Ethics Committee. The ESSOC is based on a Real-World Data design. It integrates observational data extracted from multiple sources including information based on surveys and clinical, epidemiological, population, and environmental registries. The surveys have an overlapping panel design with a total of over 22,000 effective interviews being carried out over three years from the beginning of the state of alarm in Spain. Their geographical scope is the Autonomous Region of Andalusia (8.4MM people, the fifth most populated region in Europe), and the population scopes are general population, population residing in disadvantaged areas, and population over the age of 55. The conceptual approach of this study encompasses all aspects affecting health that will contribute to an extraordinary increase in the current knowledge of the impact of the COVID-19 pandemic. Its results will be very useful for cross-disciplinary comparisons in population-based studies, and the methodology developed will serve as a model to be applied in other epidemiological studies.

Key messages

It is needed to provide specific, reliable, early, and timely data on the impact of COVID-19 that can be considered when making decisions to prepare and provide an effective Public Health response. Our research project integrates observational data extracted from multiple sources including information based on surveys and clinical, epidemiological, population, and environmental registries.

A pre-registered short-term forecasting study of COVID-19 in Germany and Poland during the second wave

Disease modelling has had considerable policy impact during the ongoing COVID-19 pandemic, and it is increasingly acknowledged that combining multiple models can improve the reliability of outputs. Here we report insights from ten weeks of collaborative short-term forecasting of COVID-19 in Germany and Poland (12 October-19 December 2020). The study period covers the onset of the second wave in both countries, with tightening non-pharmaceutical interventions (NPIs) and subsequently a decay (Poland) or plateau and renewed increase (Germany) in reported cases. Thirteen independent teams provided probabilistic real-time forecasts of COVID-19 cases and deaths. These were reported for lead times of one to four weeks, with evaluation focused on one- and two-week horizons, which are less affected by changing NPIs. Heterogeneity between forecasts was considerable both in terms of point predictions and forecast spread. Ensemble forecasts showed good relative performance, in particular in terms of coverage, but did not clearly dominate single-model predictions. The study was preregistered and will be followed up in future phases of the pandemic.

Original and minimally invasive approach to a left-lung refractory atelectasis after reparation of an aortic recoarctation in a lactant: Selective endobronchial CPAP

Atelectasis is one of the most common respiratory complications in pediatric patients after open-heart surgery, and may lead to weaning failure and increased morbidity. We report the use of an original, minimally invasive approach to refractory left lung atelectasis after repair of an aortic coarctation in a 2 month-old infant, in which a CPAP system connected to a flexible endobronchial tube resolved the atelectasis.

Original and minimally invasive approach to a left-lung refractary atelectasis after reparation of an aortic recoarctation in a lactant: Selective endobronchial CPAP

Atelectasis is one of the most common respiratory complications in pediatric patients after open-heart surgery, and may lead to weaning failure and increased morbidity. We report the use of an original, minimally invasive approach to refractory left lung atelectasis after repair of an aortic coarctation in a 2 month-old infant, in which a CPAP system connected to a flexible endobronchial tube resolved the atelectasis.

Suicide postvention in psychiatry

Introduction

During their career and sometimes during their training psychiatrists have to deal with the suicide of patients and have also to help other colleagues and families to cope with the situation. Suicide postvention should be integrated in psychiatric training and better implemented in both psychiatric and community contexts.

Objectives

To discuss the concept of suicide postvention in Psychiatry. To discuss the importance of addressing suicide postvention in psychiatric settings including during specialized training of Psychiatry residents.

Methods

MEDLINE and PubMed databases searches for peer-reviewed studies, published in the last ten years, using combinations of the key-words suicide postvention and psychiatry. Selection of the relevant studies according to the study aims.

Results

The literature search retrieved a total of 44 papers. All the articles that didn´t refer to the studied topic were excluded. Relevant articles discussing suicide postvention were selected, comprising a total of 22 articles. The reviewed papers discuss different contexts and strategies of suicide postvention that will be explored and critically discussed.

Conclusions

Addressing the topic of suicide postvention and implementing support programs and training in this field is crucial to psychiatry trainees, psychiatrists and other mental health professionals that integrate multidisciplinary teams, patients and their families and also to the community as a whole. Future research in this field can help to improve suicide postvention across different settings.

Disclosure

No significant relationships.

Scoping Review of Healthcare Literature on Mobile, Wearable, and Textile Sensing Technology for Continuous Monitoring

Remote monitoring of health can reduce frequent hospitalisations, diminishing the burden on the healthcare system and cost to the community. Patient monitoring helps identify symptoms associated with diseases or disease-driven disorders, which makes it an essential element of medical diagnoses, clinical interventions, and rehabilitation treatments for severe medical conditions. This monitoring can be expensive and time-consuming and provide an incomplete picture of the state of the patient. In the last decade, there has been a significant increase in the adoption of mobile and wearable devices, along with the introduction of smart textile solutions that offer the possibility of continuous monitoring. These alternatives fuel a technology shift in healthcare, one that involves the continuous tracking and monitoring of individuals. This scoping review examines how mobile, wearable, and textile sensing technology have been permeating healthcare by offering alternate solutions to challenging issues, such as personalised prescriptions or home-based secondary prevention. To do so, we have selected 222 healthcare literature articles published from 2007 to 2019 and reviewed them following the PRISMA process under the schema of a scoping review framework. Overall, our findings show a recent increase in research on mobile sensing technology to address patient monitoring, reflected by 128 articles published in journals and 19 articles in conference proceedings between 2014 and 2019, which represents 57.65% and 8.55% respectively of all included articles.

Management and valorization of waste from a non-centrifugal cane sugar mill via anaerobic co-digestion: Technical and economic potential

The main sugarcane wastes from the non-centrifugal cane sugar (NCS) agro-industry, agricultural crop residue (ACR) and sugarcane scum (SCS), were used to produce biogas in a bench-scale semi-continuous anaerobic tubular digester. A two-stage strategy was proposed to achieve the appropriate operability and stability of the digester. In the first stage, the operability of the digester was achieved with ACR mono-digestion. In the second stage, the digester feed was changed until it reached an ACR:SCS ratio (co-digestion) of 75:25, based on volatile solids, and until stability was achieved. The strategy was successful, and specific biogas production of 0.132 m³ kg^-1VS with a methane content of 50.4% was achieved, confirming the technical feasibility of the process. Economic viability was established through a case study at a typical NCS mill. Therefore, anaerobic co-digestion can be consolidated as a technological alternative for the treatment of ACR + SCS and the sustainable benefit of the NCS agro-industry.

Simultaneous pelvic exenteration and liver resection for primary rectal cancer with synchronous liver metastases: results from the PelvEx Collaborative

AIM

At presentation, 15-20% of patients with rectal cancer already have synchronous liver metastases. The aim of this study was to determine the surgical and survival outcomes in patients with advanced rectal cancer who underwent combined pelvic exenteration and liver (oligometastatic) resection.

METHOD

Data from 20 international institutions that performed simultaneous pelvic exenteration and liver resection between 2007 and 2017 were accumulated. Primarily, we examined perioperative outcomes, morbidity and mortality. We also assessed the impact that margin status had on survival.

RESULTS

Of 128 patients, 72 (56.2%) were men with a median age of 60 years [interquartile range (IQR) 15 years]. The median size of the liver oligometastatic deposits was 2 cm (IQR 1.8 cm). The median duration of surgery was 406 min (IQR 240 min), with a median blood loss of 1090 ml (IQR 2010 ml). A negative resection margin (R0 resection) was achieved in 73.5% of pelvic exenterations and 66.4% of liver resections. The 30-day mortality rate was 1.6%, and 32% of patients had a major postoperative complication. The 5-year overall survival for patients in whom an R0 resection of both primary and metastatic disease was achieved was 54.6% compared with 20% for those with an R1/R2 resection (P = 0.006).

CONCLUSION

Simultaneous pelvic exenteration and liver resection is feasible, with acceptable morbidity and mortality. Simultaneous resection should only be performed where an R0 resection of both pelvic and hepatic disease is anticipated.

The phase angle as a marker of health and body composition in soccer players in Bogotá – Colombia

Background

Body composition is a parameter that is evaluated to predict the nutritional status of the population. This is assessed by bioelectric impedance analysis, which reports BMI, fat percentage, skeletal muscle mass, phase angle (AP), among others. The latter, in recent years has become important because it is a direct electrical measurement in the body, used for the clinical prognosis of diseases such as cancer, anorexy nervous, sarcopenia and chronic liver disease. AP is an index of vitality and integrality of the cell membrane and an indicator of muscle strength and endurance; likewise, it is inversely related to BMI, age and gender, normal values in healthy populations range between 5.5° to 9°, it is believed that physical activity and sport can also modify AP values. Therefore, the purpose of the study was to determine the relationship between body composition and AP in soccer players in Bogotá, Colombia.

Methods

Quantitative, cross-sectional, correlational approach. The sample was 84 soccer players (age: 18.67 + 2.9 years; height: 1.73 + 0.07 m; weight: 66.58 + 9.94 Kg), who were assessed using the Bioimpedance method through InBody 770®.

Results

The averages obtained were: AP 6.46°+0.58; muscle mass 32.25 + 5.06 Kg, percentage of fat mass 15.90 + 3.97. There was a direct relationship between AP, skeletal muscle mass and lean mass in the right, left arm, trunk and right leg (p &lt; 0.01), while with the percentage of body fat mass of the right and left arm the relationship was inverse.

Conclusions

Body composition with high values of musculoskeletal mass and AP favor the functionality and development of strength, which in turn are protective factors for the presence of diseases such as sarcopenia.

Key messages

The Phase Angle is constituted as an easily accessible marker of nutritional health and morphofunctional profile in athletes. The Phase Angle and body composition as determinants of the profile in athletes.

Aerobic capacity as a protective factor for hypertension in Bogota’s soccer players

Background

In Colombia between 1998-2011 the 23.5% of deaths that were reported were from CardioVascular Disease (CVD), 12.4% were caused by hypertensive disease; well now physical activity has been reported as a protective factor for CVD and Hypertension (HT), those people who perform high levels of physical activity have a relative decrease in developing HT by 19%, however what happens when this physical activity takes place with a duration greater than 4 hours a day, with moderate and high intensities, becoming a sports practice, the same benefits or opposite effects would be had, so the objective of the study was to determine the relationship between aerobic capacity and blood pressure in soccer players in the city of Bogotá.

Methods

Quantitative cross-sectional research; blood pressure of 64 players and the aerobic capacity was assessed using the Legger test (VO2 Max).

Results

It was evidenced that 4.6% of the players have hypotension, 50.8% normotension, 30.8% prehypertension and 12.3% stage I hypertension; As regards for VO2 max, 7.7% had an excellent capacity, 73.8% good and 12.3% favorable, there was no relationship between the variables.

Conclusions

Soccer players, although they have good levels of VO2 max, they do not present a decrease in blood pressure data, being mostly within a normal range.

Key messages

Although physical activity is a protective factor for HT. Soccer training does not show a decrease in blood pressure, possibly could be a risk factor for HT and CVD.

SAT0580 ANALYSIS OF ANAS/DFS70 PATTERN IN A LARGE COHORT OF AUTOIMMUNE/AUTOINFLAMMATORY DISEASES COMPARED WITH FIRST DEGREE RELATIVES AND HEALTHY CONTROLS EVALUATED IN A SINGLE HOSPITAL FROM COLOMBIA

Background:

Autoimmune diseases have a broad phenotypic spectrum, with great variability in clinical manifestations. Anti-DFS70/LEDGFp75 (ANAS/DFS70) antibodies have attracted interest as a positive result in patients without clinical evidence of autoimmune systemic rheumatic disease (SARD). It has been proven in non-rheumatic inflammatory diseases and in “apparently healthy” individuals.

Objectives:

To assess ANAS/DFS70 performance in a large population with autoimmune/autoinflammatory diseases compared with first degree relatives and healthy controls.

Methods:

A cross-sectional study was conducted. We analysed 531 individuals between 18-65 years old, 101 rheumatoid arthritis (RA) patients (ACR/EULAR 2010 classification criteria), 137 relatives from RA, 60 psoriasis (Ps) patients (Colombian classification consensus), 47 Undifferentiated connective tissue diseases(UCTD) patients and 186 healthy controls matched by age and sex. The healthy control group were individuals who lived and work similarly like those patients those criteria of exclusion criteria were to present autoimmune or auto-inflammatory disease, infectious, neoplasms, diabetes, antibiotic treatment, pregnancy or lactation, consanguinity with autoimmune entities. Ethical Committee approved.

The determination of ANAS-HEp2 antibodies (ANA-Hep-2 AESKU.Dignostic®, Autoantiboy test SYSTEM IMCO DIAGNOSTICS REF 1103® and ANA-Hep-2 AESKU.Dignostic®) was carried out. The positive results (standard AC-2) are used as a confirmatory test the determination of ANAS / DFS70: AUTOANTIBOY TEST SYSTEM IMMCO DIAGNOSTICS (Knocked out, for the psip gene) REF 1108® and CytoBead ANA Generic Assays ref 8065 ® by indirect immunofluorescence-IFI technique. In addition, serum levels of C-reactive protein (PCR), erythrocyte sedimentation rate (ESR), IgG/IgA antibodies against citrullinated peptide (ACPA), and rheumatoid factor (RF). Absolute and relative frequencies were established.

Results:

531 participants were included: RA 19%, 25,8% RA relatives, Ps 11,3%, UCTD 8,9%, and 35% healthy controls. RA mean age was 41,8±12,2 years, female 82,2%, with ANA test(+) result 42%. In Ps mean age 49,1±15,7 years, female 53,3%, ANA test(+) 41,7%. UCTD mean age 41,3±15,2 years, female 85,1%, and ANA test(+) 78,7%. Relatives of RA mean age 38,7±12,2 years, female 73%, ANA test(+) 26,3%. And healthy controls mean age 41,3±12,2 years, female 74,7%, and ANA test(+) 26,9%.

ANA/DFS70 was positive in a 6,4% in UCTD, 3,2% in healthy controls, 1,7% in Ps, 1,5% in Relatives of RA, no RA had positive results. These 12 participants were negative for acute phase reactants (ESR[-] 83,3% and CRP[-] 66,6%), as well as they were all negative for RF and two were positive for APCA from UCTD.

Conclusion:

ANAS/DFS70 autoantibodies were present in very low frequency in patients with SARD. Thus, patients with a positive result tend to have a mild or non-progressing phenotype of autoimmune/inflammatory diseases, as UTCD. This is the first time ANA/DFS70 are tested in a large population cohort in Latin American countries which coincide with previous results in RA and RA relatives.

Acknowledgments:

Hospital Militar Central-Universidad El Bosque-Immco diagnosis-Dizar Ltda and Generic Assay-Medipan.

Disclosure of Interests:

Consuelo Romero-Sánchez: None declared, Omar-Javier Calixto Employee of: Worked in Janssen Cilag as medical manager from 2016 to 2018, V Romero-A: None declared, A Vargas: None declared, Luis Castro: None declared, Julio Amador: None declared, Pedro Lopez-Mojica: None declared, Daniela Marin: None declared, Diana Acero-M: None declared, M Acevedo: None declared, Diana Rincón-Riaño: None declared, Juan Manuel Bello-Gualtero: None declared

Synergistic effect of sugarcane scum as an accelerant co-substrate on anaerobic co-digestion with agricultural crop residues from non-centrifugal cane sugar agribusiness sector

Anaerobic co-digestion (AcoD) of the main residues from the non-centrifugal cane sugar (NCS) making process, agricultural crop residues (ACR) and sugarcane scum (SCS), was evaluated using biochemical methane potential tests. Substrates were pretreated: ACR through particle size reduction, and SCS with dilution. The maximum methane yield of 0.276 Nm³ CH₄ kg^-1 VS_added occurred at an ACR of 2 mm and at 12.5% dilution of SCS, at a ratio of 75:25 based on volatile solids, which was 30.2% and 5.9% higher compared to SCS and ACR in mono-digestion, respectively. ACR was a substrate of adequate buffer capacity for the AcoD stability, while the SCS, in addition to helping accelerate the process, also helped improve the inoculum's methanogenic and hydrolytic activity. The first-order kinetic and dual-pool two-step models were suitable to describe methane yield. AcoD of ACR with SCS is a good option for the treatment of streams in the NCS agribusiness sector.

Sugarcane scum as a novel substrate for rapid biogas production from the non-centrifugal cane sugar agribusiness sector in developing countries

Sugarcane scum (SCS) is a waste from the non-centrifugal cane sugar making process. Due to its physicochemical characteristics, it has a high-energy potential to produce biomethane via anaerobic digestion (AD). However, (i) the total solids concentration in the SCS exceeds the limit for wet digestion and (ii) the SCS has a low pH. The aim of this research was to evaluate the utilization capacity of the SCS for methane production through a biochemical methane potential test and extent of disintegration, using dilution pretreatment. The highest methane yield, 0.227 N m³ CH₄ kg^-1 VS, was achieved at a 12.5% SCS dilution, with an organic matter removal greater than 70% and an extent of disintegration of 34.5%. This is evidence that the AD process is a feasible alternative for SCS treatment.

P182 Bleeding complications in a rendu-osler-weber syndrome patient with atrial fibrillation - challenging serial transoesophageal echocardiography

Rendu-Osler-Weber (ROW) syndrome or hereditary hemorrhagic telangiectasia is a rare autossomic dominant disease characterized by vascular dysplasia involving multiple systems and associated with an increased bleeding risk. The presence of atrial fibrillation in this population becomes a challenge, regarding the evaluation of bleeding and thrombotic risks and the best approach for the patient management.

A 72 years-old female with ROW syndrome, atrial fibrillation and a CHA2DS2-VASc risk score of four, was admitted to our hospital for left atrial appendage (LAA) closure after a period of novel oral anticoagulation crowed with multiple haemorrhagic events and blood transfusions. After the implantation of a Watchman LAA number 33 closure device (Image 1A), and because of the concomitant diagnose of chronic pulmonary embolism, she was restarted on anticoagulation therapy in lower doses, with initial tolerance. For evaluation of LAA closure device during follow-up, after an unsuccessful attempt of transoesophageal echocardiography (TEE) because of severe epistaxis subsequent to oropharyngeal anaesthesia, the patient underwent a Cardiac Computed Tomography (CT) that showed a moderate peri-device leak (4.4x11mm, 0.73cm2) – (Image 1B). For better characterization, the patient underwent a new attempt of TEE with the support of an anaesthesiologist and the need of local vasoconstrictor agents and tranexamic acid for epistaxis and oropharyngeal bleeding control. TEE confirmed a moderate posterior device-leak (7.1mm) with absence of cavitary thrombus (Image 1C). After a year of anticoagulation with new significant bleeding events, TEE was repeated with the anaesthetic and pharmacologic preparation. This TEE showed a decrease in peri-device leak (&lt;5mm wide – Image 1D), which was fundamental for supporting the multidisciplinary team decision of interruption of anticoagulation therapy. With this case we want to highlight the challenging decisions regarding patients with ROW syndrome and atrial fibrillation. Specifically, we must be alert about possible complications in trying to perform TEE in this population, once the frequent occurrence of telangiectasias in the oropharynges that may occur, as in this patient.

Abstract P182 Figure. Image 1

Could polymorphisms in ABCB1 gene represent a genetic risk factor for the development of mammary tumors in dogs?

The ABCB1 gene encodes the P-glycoprotein (P-gp) which regulates distribution and bioavailability of many endogenous and exogenous substrates, acting as a cellular mechanism of protection against these substances. Some studies have shown evidence that P-gp is related to carcinogenesis. In this study, we performed PCR and direct sequencing of ABCB1 exons 9 and 26 in 47 tissue DNA samples from canine mammary tumors. A statistically significant correlation between distinct canine breeds and the frequency of ABCB1 polymorphisms (c.985T > A and c.3442A > G SNP in ABCB1exons 9 and 26, respectively) was observed (P = 0.0015). In contrast, the TNM clinical staging, age, histological type and grade, as well as other histopathological characteristics, did not present statistically significant difference in relation to one or both SNP found in exons 9 and 26. These findings raise questions about the role of the canine ABCB1 polymorphisms in the development of mammary tumors, since the Poodle breed, which is the most common dog breed affected by mammary tumors in Brazil, presented the highest frequency of these variants. Notwithstanding, additional studies comprising a number of samples expressing the ABCB1 gene from healthy dogs, with advanced age and from different breeds, will be necessary to confirm the association of ABCB1polymorphisms and the development of mammary tumors.

Novedades en el conocimiento del género <em>Symmorphus</em> Wesmael, 1836 (Hymenoptera: Vespidae: Eumeninae) en la India, con dos primeras citas de especies

Se citan de la India por primera vez dos especies del género Symmorphus Wesmael, 1836, Symmorphus (Symmorphus) alkimus alkimus Cumming & van der Vecht, 1986 y S. (S.) ambotretus Cumming, 1989. Se incluyen una clave para las especies indias del género y una lista actualizada de las especies de Symmorphus del subcontinente indio.

[Long-term results of the early endoscopic treatment of acquired tracheal-subglottic stenosis: 10 years of experience]

INTRODUCTION

Acquired stenosis of the airway is a common complication after endotracheal intubation. Endoscopic dilation has been accepted as the treatment of choice in cases detected precociously. Our goal is to know the current status of the patients treated in our hospital with endoscopic dilation in the last 10 years.

MATERIAL AND METHODS

Retrospective cohort study of patients with subglottic and tracheal acquired stenosis (STAS) early treated endoscopically with balloon dilation at our center in the last 10 years. Bronchoscopy control at 2 weeks, a month, 3 and 6 months post-dilation were performed and later on depending on the symptoms.

RESULTS

32 patient were treated in the period considered. The median age was 4.5 (3-120) months. There were necessary 2.5 (1-5) dilations per patient. All cases were extubated in the operating room or in the following 24 hours. There were no complications during the procedure. Follow-up time was 6 (1-10) years. Only 1 of the 32 patients have had recurrence of stenosis 2 years after, it was secondary to reintubations due to new surgical interventions; which it was dilated successfully.

CONCLUSIONS

Early endoscopic dilation in the acquired airway stenosis is a safe and effective long-term procedure. The results support the use of this technique as a treatment of choice in these patients.

Anaerobic digestion of cheese whey: Energetic and nutritional potential for the dairy sector in developing countries

Cheese whey (CW) is the main waste generated in the cheesemaking process and has high organic matter content and acidity. Therefore, CW disposal is a challenge for small to medium enterprises (SMEs) in the dairy industry that do not have any type of treatment plant. Anaerobic digestion (AD) is an attractive process for solving this problem. The aim of this research was to determine the biomethane and struvite precipitation potentials of CW from four dairy SMEs. First, changes in CW properties (organic matter and pH) were evaluated. Second, biomethane and struvite potentials were assessed using cattle slurry as inoculum. The organic matter in CW varied from 40 to 65gVS/kg, 65 to 140g COD/L, and 2 to 10g/L for VFAs depending on the sampling time and type of sample. The pH of the CW samples ranged from 3 to 6.5. In the anaerobic biodegradability analysis, methane yields reached 0.51 to 0.60L CH₄/g VS_added, which represented electrical and caloric potentials of 54 and 108kWh/m³ for CW, respectively. Organic matter removal in all experiments was above 83%. Moreover, anaerobic digestates presented NH₄⁺/PO₄^3- molar ratios between 2.6 and 4.0, which are adequate for struvite precipitation with potential production of 8.5-10.4g struvite/L CW. Finally, the use of biogas as energetic supplement and struvite as soil fertilizer, represents economics saves of US$ 6.91/m³ CW and US$ 5.75/m³ CW in therms of electricity and fertilizer use, respectively. The energetic, agricultural and economic potentials, evidence that AD process is a feasible alternative for cheese whey treatment.

The wearable cardioverter defibrillator as a bridge to reimplantation in patients with ICD or CRT-D-related infections

Background

The approach to treat device infection in patients with implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) is a challenging procedure. Optimal treatment is complete extraction of the infected device. To protect these patients from sudden cardiac arrest while waiting for reimplantation and to avoid recurrent infection, a wearable cardioverter defibrillator (WCD) seems to be a valuable solution.

Therefore, we investigated the management and outcome of patients with ICD or CRT-D infections using the WCD as a bridge to re-implantation after lead extraction procedures.

Methods

We conducted a retrospective study on consecutive patients who underwent ICD or CRT-D removal due to device-related local or systemic infections. All patients were prescribed a WCD at our center between 01/2012 and 10/2015. All patients returned to our outpatient clinic for regular ICD or CRT-D monitoring initially 1 and 3 months after reimplantation followed by 6-months intervals.

Results

Twenty-one patients (mean age 65.0 ± 8.0 years, male 76.2%) were included in the study. Complete lead extraction was achieved in all patients. While waiting for reimplantation one patient experienced a symptomatic episode of sustained ventricular tachycardia. This episode was converted successfully into sinus rhythm by a single 150 J shock.

Mean follow-up time 392 ± 206 days, showing survival rate of 100% and freedom from reinfection in all patients.

Conclusion

The WCD seems to be a valuable bridging option for patients with ICD or CRT-D infections, showing no recurrent device infection.

Low cost digester monitoring under realistic conditions: Rural use of biogas and digestate quality

The purpose of this work was to assess the behaviour of anaerobic digestion of cattle manure in a rural digester under realistic conditions, and estimate the quality and properties of the digestate. The data obtained during monitoring indicated that the digester operation was stable without risk of inhibition. It produced an average of 0.85Nm³biogas/d at 65.6% methane, providing an energy savings of 76%. In addition, the digestate contained high nutrient concentrations, which is an important feature of fertilizers. However, this method requires post-treatment due to the presence of pathogens.