Robust multiferroicity and magnetic modulation of the ferroelectric imprint field in heterostructures comprising epitaxial Hf0.5Zr0.5O2 and Co

Magnetoelectric multiferroics, either single-phase or composites comprising ferroelectric/ferromagnetic coupled films, are promising candidates for energy efficient memory computing. However, most of the multiferroic magnetoelectric systems studied so far are based on materials that are not compatible with industrial processes. Doped hafnia is emerging as one of the few CMOS-compatible ferroelectric materials. Thus, it is highly relevant to study the integration of ferroelectric hafnia into multiferroic systems. In particular, ferroelectricity in hafnia, and the eventual magnetoelectric coupling when ferromagnetic layers are grown atop of it, are very much dependent on quality of interfaces. Since magnetic metals frequently exhibit noticeable reactivity when grown onto oxides, it is expected that ferroelectricity and magnetoelectricity might be reduced in multiferroic hafnia-based structures. In this article, we present excellent ferroelectric endurance and retention in epitaxial Hf0.5Zr0.5O2 films grown on buffered silicon using Co as the top electrode. The crucial influence of a thin Pt capping layer grown on top of Co on the ferroelectric functional characteristics is revealed by contrasting the utilization of Pt-capped Co, non-capped Co and Pt. Magnetic control of the imprint electric field (up to 40% modulation) is achieved in Pt-capped Co/Hf0.5Zr0.5O2 structures, although this does not lead to appreciable tuning of the ferroelectric polarization, as a result of its high stability. Computation of piezoelectric and flexoelectric strain-mediated mechanisms of the observed magnetoelectric coupling reveal that flexoelectric contributions are likely to be at the origin of the large imprint electric field variation.

Exploiting Leishmania-Primed Dendritic Cells as Potential Immunomodulators of Canine Immune Response

Dendritic cells (DCs) capture pathogens and process antigens, playing a crucial role in activating naïve T cells, bridging the gap between innate and acquired immunity. However, little is known about DC activation when facing Leishmania parasites. Thus, this study investigates in vitro activity of canine peripheral blood-derived DCs (moDCs) exposed to L. infantum and L. amazonensis parasites and their extracellular vesicles (EVs). L. infantum increased toll-like receptor 4 gene expression in synergy with nuclear factor κB activation and the generation of pro-inflammatory cytokines. This parasite also induced the expression of class II molecules of major histocompatibility complex (MHC) and upregulated co-stimulatory molecule CD86, which, together with the release of chemokine CXCL16, can attract and help in T lymphocyte activation. In contrast, L. amazonensis induced moDCs to generate a mix of pro- and anti-inflammatory cytokines, indicating that this parasite can establish a different immune relationship with DCs. EVs promoted moDCs to express class I MHC associated with the upregulation of co-stimulatory molecules and the release of CXCL16, suggesting that EVs can modulate moDCs to attract cytotoxic CD8+ T cells. Thus, these parasites and their EVs can shape DC activation. A detailed understanding of DC activation may open new avenues for the development of advanced leishmaniasis control strategies.

Mal-positioning of a dialysis catheter: One lumen with arterial blood and the other with venous blood?

Partial anomalous pulmonary vein drainage is a rare congenital defect, where the pulmonary vein drains into a systemic vein instead of draining into the left atrium. We present a case of a 63-year-old woman on hemodialysis who was found to have a right pulmonary vein with anomalous drainage to the superior vena cava after mal-positioning of a dialysis catheter, which demonstrated unexpected blood results from the different lumina of the catheter. Multiple imaging techniques were used to deal with this rare clinical situation. This is the first case reporting a mal-positioning of a left-side internal jugular vein tunneled catheter into a right-side pulmonary vein.

High-performance and self-powered visible light photodetector using multiple coupled synergetic effects

In this work, we demonstrate, for the first time, that coupling together the pyroelectric effect, the photovoltaic effect and the plasmonic effect is a novel method to significantly enhance the performance of self-powered photodetectors in the visible region. Photodetectors based on tri-layered heterojunction of n-Si/p-SnO/n-ZnO through the inclusion of silver (Ag) nanoparticles (NPs) at the SnO/ZnO interface were fabricated. The photo-response of the device, with excitation from a chopped 650 nm wavelength laser, was carefully investigated, and it was shown that the photodetector performance is enhanced the most with the inclusion of spheroidal Ag NPs with ∼70 nm diameter. The Al/Si/SnO/Ag NPs/ZnO/ITO device exhibited an optimum responsivity, detectivity and sensitivity of 210.2 mA W-1, 5.47 × 109 Jones and 15.0 × 104, respectively, together with a rise and fall time of 2.3 and 51.3 μs, respectively, at a laser power density of 317 mW cm-2 and at a chopper frequency of 10 Hz. The present photodetectors are more than twice as responsive as the current best-performing ZnO-based pyro-phototronic photodetectors and they also exhibit other competitive features, such as detectivity, and fall and rise times. Therefore, by exploiting the plasmonic effect of the Ag NPs together with the pyroelectric effect in a ZnO film, and the photovoltaic effect at a Si/SnO junction, all in a single device, photodetectors were developed with state-of-the-art performance for the visible region.

Childhood-Onset Lupus Nephritis in the Childhood Arthritis and Rheumatology Research Alliance Registry: Short-Term Kidney Status and Variation in Care

OBJECTIVE

The goal was to characterize short-term kidney status and describe variation in early care utilization in a multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE) and nephritis.

METHODS

We analyzed previously collected prospective data from North American patients with cSLE with kidney biopsy-proven nephritis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from March 2017 through December 2019. We determined the proportion of patients with abnormal kidney status at the most recent registry visit and applied generalized linear mixed models to identify associated factors. We also calculated frequency of medication use, both during induction and ever recorded.

RESULTS

We identified 222 patients with kidney biopsy-proven nephritis, with 64% class III/IV nephritis on initial biopsy. At the most recent registry visit at median (interquartile range) of 17 (8-29) months from initial kidney biopsy, 58 of 106 patients (55%) with available data had abnormal kidney status. This finding was associated with male sex (odds ratio [OR] 3.88, 95% confidence interval [95% CI] 1.21-12.46) and age at cSLE diagnosis (OR 1.23, 95% CI 1.01-1.49). Patients with class IV nephritis were more likely than class III to receive cyclophosphamide and rituximab during induction. There was substantial variation in mycophenolate, cyclophosphamide, and rituximab ever use patterns across rheumatology centers.

CONCLUSION

In this cohort with predominately class III/IV nephritis, male sex and older age at cSLE diagnosis were associated with abnormal short-term kidney status. We also observed substantial variation in contemporary medication use for pediatric lupus nephritis between pediatric rheumatology centers. Additional studies are needed to better understand the impact of this variation on long-term kidney outcomes.

Ferroelectric Orthorhombic ZrO2 Thin Films Achieved Through Nanosecond Laser Annealing

A new approach for the stabilization of the ferroelectric orthorhombic ZrO₂ films is demonstrated through nanosecond laser annealing (NLA) of as-deposited Si/SiO_x /W(14 nm)/ZrO₂ (8 nm)/W(22 nm), grown by ion beam sputtering at low temperatures. The NLA process optimization is guided by COMSOL multiphysics simulations. The films annealed under the optimized conditions reveal the presence of the orthorhombic phase, as confirmed by X-ray diffraction, electron backscatter diffraction, and transmission electron microscopy. Macroscopic polarization-electric field hysteresis loops show ferroelectric behavior, with saturation polarization of 12.8 µC cm^-2 , remnant polarization of 12.7 µC cm^-2 and coercive field of 1.2 MV cm^-1 . The films exhibit a wake-up effect that is attributed to the migration of point defects, such as oxygen vacancies, and/or a transition from nonferroelectric (monoclinic and tetragonal phase) to the ferroelectric orthorhombic phase. The capacitors demonstrate a stable polarization with an endurance of 6.0 × 10⁵ cycles, demonstrating the potential of the NLA process for the fabrication of ferroelectric memory devices with high polarization, low coercive field, and high cycling stability.

Molecular Dynamics Simulation of Ti Metal Cutting Using a TiN:Ag Self-Lubricating Coated Tool

Silver-ceramic nanocomposite coatings, such as TiN:Ag, are among the most interesting solutions to improve the machining and cutting process of hard-to-cut Ti alloys, since they combine the TiN matrix hardness with the lubricating and protective action of Ag nanoparticles. Therefore, it is important to understand how, when present, Ag distributes at the tool-workpiece interface and how it affects the tribolayer formation and the tool wear. Molecular dynamics simulation results, obtained using a MEAM-based force field, are presented here for the cutting process of a Ti workpiece with a TiN tool, with and without the presence of Ag at the interface, for different cutting speeds. Ag is shown to form a thin protective layer at the workpiece-tool interface that prevents a direct contact between the parts and greatly reduces the tool degradation. Our simulations confirm the importance of Ag in self-lubricating nanocomposite coatings to realize the machining of otherwise hard-to-cut materials.

Oxygen Adsorption on Polar and Non-Polar Zn:ZnO Heterostructures from First Principles

Zn:ZnO nanostructures have been studied extensively due to their potential use in many applications, such as oxygen scavengers for food packaging applications. Under atmospheric conditions, ZnO grows on the surface of Zn via an oxidation process. The mechanisms governing Zn oxidation are still not fully understood, with classical oxidation models, such as the Cabrera Mott, underestimating the oxide thickness of Zn:ZnO core-shell structures. In this work, Ab initio DFT calculations were performed to assess the adsorption properties of oxygen molecules on Zn:ZnO heterostructures to help elucidate the mechanisms involved in the growth of a ZnO film on a Zn substrate. Results suggest that the charge transfer mechanism from the Zn:ZnO heterostructures to the adsorbed oxygen layer can be promoted by two different processes: the electronic doping of ZnO due to the formation of the Zn:ZnO interface and the excess surface charge due to the presence of dangling bonds on the as cleaved ZnO.

Neutron and Gamma-Ray Detection System Coupled to a Multirotor for Screening of Shipping Container Cargo

In order to detect special nuclear materials and other radioactive materials in Security and Defense scenarios, normally, a combination of neutron and gamma-ray detection systems is used. In particular, to avoid illicit traffic of special nuclear materials and radioactive sources/materials, radiation portal monitors are placed at seaports to inspect shipping-container cargo. Despite their large volume (high efficiency), these detection systems are expensive, and therefore only a fraction of these containers are inspected. In this work, a novel mobile radiation detection system is presented, based on an EJ-200 plastic scintillator for the detection of gamma rays and beta particles, and a neutron detector EJ-426HD plastic scintillator (with ⁶Li) embedded in a compact and modular moderator. The use of silicon photomultipliers in both detectors presented advantages such as lightweight, compactness, and low power consumption. The developed detection system was integrated in a highly maneuverable multirotor. Monte Carlo simulations were validated by laboratory measurements and field tests were performed using real gamma-ray and neutron sources. The detection and localization within one meter was achieved using a maximum likelihood estimation algorithm for ¹³⁷Cs sources (4 MBq), as well as the detection of ²⁴¹Am-beryllium (1.45 GBq) source placed inside the shipping container.

Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry

BACKGROUND

Children with juvenile idiopathic arthritis (JIA) who achieve a drug free remission often experience a flare of their disease requiring either intraarticular steroids (IAS) or systemic treatment with disease modifying anti-rheumatic drugs (DMARDs). IAS offer an opportunity to recapture disease control and avoid exposure to side effects from systemic immunosuppression. We examined a cohort of patients treated with IAS after drug free remission and report the probability of restarting systemic treatment within 12 months.

METHODS

We analyzed a cohort of patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry who received IAS for a flare after a period of drug free remission. Historical factors and clinical characteristics and of the patients including data obtained at the time of treatment were analyzed.

RESULTS

We identified 46 patients who met the inclusion criteria. Of those with follow up data available 49% had restarted systemic treatment 6 months after IAS injection and 70% had restarted systemic treatment at 12 months. The proportion of patients with prior use of a biologic DMARD was the only factor that differed between patients who restarted systemic treatment those who did not, both at 6 months (79% vs 35%, p < 0.01) and 12 months (81% vs 33%, p < 0.05).

CONCLUSION

While IAS are an option for all patients who flare after drug free remission, it may not prevent the need to restart systemic treatment. Prior use of a biologic DMARD may predict lack of success for IAS. Those who previously received methotrexate only, on the other hand, are excellent candidates for IAS.

Extraction of Polyphenols and Vitamins Using Biodegradable ATPS Based on Ethyl Lactate

The growing human population, together with the inefficient use of natural resources, has been dramatically increasing the production of food waste, which poses serious economic, environmental, and social problems. Being so, it is necessary to increase the efficiency of food consumption so as to reduce its waste and to convert the remaining residues into societal benefits. Since this biowaste is rich in polyphenols and vitamins, it could become the feedstock for the production of important value-added compounds for the pharmaceutical (e.g., food supplements) and cosmetic (e.g., creams and shampoos) industries. In this work, partition studies of one polyphenol (epicatechin) and two B-complex vitamins (cyanocobalamin and nicotinic acid) were performed in biodegradable Aqueous Two-Phase Systems (ATPS) based on ethyl lactate and on organic salts (disodium tartrate, tripotassium citrate, and trisodium citrate) at 298.15 K and 0.1 MPa. The largest partition coefficient (K) and extraction efficiency (E) were obtained for vitamin B12 (K=78.56, E=97.5%) for the longest tie line TLL=77.66% in the ATPS {ethyl lactate (1) + tripotassium citrate (2) + water (3)}. All the extractions were obtained with low biomolecule mass losses in quantification (<5%) and after a thorough study of pH influence in the UV−Vis absorbance spectra.

Electrocardiographic imaging a valid tool or an inaccurate toy?

Funding Acknowledgements

Type of funding sources: Private hospital(s). Main funding source(s): Learning Health

Background and aim

Electrocardiographic imaging (ECGI) is capable of performing an activation map with a single beat. However, previous studies using the epicardial-only system, have suggested a bad accuracy for the assessment of the epicardial breakthrough. Recent systems using endo-epicardial analysis have shown promising results. The aim of this study was to assess the accuracy and reproducibility of two endo-epicardial ECGI systems using different cardiac sources one based on the extracellular-potential, and the other on the equivalent double layer model, respectively the AMYCARD (EP Solutions SA, Switzerland) and VIVO (Catheter Precision, NJ USA) systems.

Methods

We studied 11 consecutive patients referred for ablation of frequent idiopathic premature ventricular contractions at our center that had an ECGI performed using both systems on the same day. The AMYCARD system uses a dense array of body-surface electrocardiograms with up to 224 leads and VIVO uses just the 12-leads ECG. Both systems use a patient-specific heart torso geometry obtained with a CT-scan or cardiac magnetic resonance. The localisation of the PVCs based on ECGI was done using a segmental model with 22 segments on the left ventricle, to include the classical 17 segment model plus the aortic cusps and the papillary muscles, and 12 segments on the right ventricle including 4 on the right ventricular outflow tract (RVOT): (anterior, lateral, right septum and left septum). A perfect match was defined as a predicted location within the same anatomic segment, whereas a near match as a predicted location within the same segment or a contiguous one.

Results

The median (Q1-Q3) number of leads used for the AMYCARD was 131 (118-144). Seven patients underwent ablation and in 4 ablation is pending. The predicted locations and the ablation site are depicted on the Table. We found a perfect match between both systems in 73% (Figure) and near match in 91% of cases. In patients that underwent ablation the systems localised the site of origin of the PVCs within the same segment or the contiguous segment in all patients with VIVO and in six out of seven with AMYCARD.

Conclusions

ECGI is an accurate diagnostic tool with reproducible results regardless the cardiac source used for analysis.

Assessment of activation duration across the right ventricular outflow tract in patients with premature ventricular contractions using noninvasive electrocardiographic mapping: a validation study

Funding Acknowledgements

Type of funding sources: Private hospital(s). Main funding source(s): Learning Health

Introduction

Previous studies have reported that wavefront propagation speed across the right ventricular outflow tract (RVOT) can distinguish premature ventricular contractions (PVCs) with a RVOT origin from PVCs with a left ventricular outflow tract (LVOT) origin.

Aim

Validate the non-invasive electrocardiographic mapping (ECGI) for assessment of RVOT activation duration (AD) during PVCs and assess its value as a predictor of the origin of the PVCs.

Methods

We studied 18 consecutive patients, 8 males, median age 55 (35-63) years that underwent ablation of frequent (&gt; 10.000 per 24 h) idiopathic PVCs with inferior axis, that had and an ECGI performed before ablation and the RVOT mapped in PVC. The ECGI was performed with the Amycard system, and invasive mapping was performed with the Carto or Ensite system. Isochronal activation maps of the RVOT in PVC were obtained with the activation direction method (ADM) of the ECGI, and with the Carto and Ensite systems. Total RVOT AD was measured as the time interval between the earliest and the latest activated region. Agreement between the two methods was performed using a Bland-Altman plot and linear regression . The cutoff value of AD to predict PVC origin was calculated with ROC curve.

Results

PVCs originated from the RVOT in 11 (61%) patients. The median (Q1-Q3) RVOT AD measured with ECGI was 54 (39-68) ms and with invasive map 57 (36-70) ms. The agreement between both methods was good with an R2 of 0.747, p&lt;0.0001. Figure displays the Bland-Altman plot (panel A), the linear regression plot (panel B). and two examples of the ECGI isochronal map (panel C). The AD was significantly higher in PVCs from the RVOT vs LVOT, both with ECGI and Carto, respectively 62 (58-73) vs 37 (33-40) ms, p&lt;0.0001 and 68 (60-75) vs 34 (30-40) ms, p&lt;0.0001. The cutoff value of 43 ms for AD measured with ECGI, predicted the origin of the PVCs with a sensitivity and specificity of 100%.

Conclusions

We found good agreement between ECGI and Carto. The AD obtained with ECGI was accurate to predict the origin of the PVCs.

A Method to Measure the Damage Caused by Cell-Sucking Herbivores

The damage that herbivores inflict on plants is a key component of their interaction. Several methods have been proposed to quantify the damage caused by chewing insects, but such methods are not very successful when the damage is inflicted by a cell-sucking organism. Here, we present a protocol that allows a non-destructive quantification of the damage inflicted by cell-sucking arthropods, robustly filtering out leaf vascular structures that might be mistakenly classified as damage in many plant species. The protocol is set for the laboratory environment and uses Fiji and ilastik, two free software packages.

Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis

BACKGROUND

Social determinants of health (SDH) greatly influence outcomes during the first year of treatment in rheumatoid arthritis, a disease similar to polyarticular juvenile idiopathic arthritis (pJIA). We investigated the correlation of community poverty level and other SDH with the persistence of moderate to severe disease activity and functional disability over the first year of treatment in pJIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry.

METHODS

In this cohort study, unadjusted and adjusted generalized linear mixed effects models analyzed the effect of community poverty and other SDH on disease activity, using the clinical Juvenile Arthritis Disease Activity Score-10, and disability, using the Child Health Assessment Questionnaire, measured at baseline, 6, and 12 months.

RESULTS

One thousand six hundred eighty-four patients were identified. High community poverty (≥20% living below the federal poverty level) was associated with increased odds of functional disability (OR 1.82, 95% CI 1.28-2.60) but was not statistically significant after adjustment (aOR 1.23, 95% CI 0.81-1.86) and was not associated with increased disease activity. Non-white race/ethnicity was associated with higher disease activity (aOR 2.48, 95% CI: 1.41-4.36). Lower self-reported household income was associated with higher disease activity and persistent functional disability. Public insurance (aOR 1.56, 95% CI 1.06-2.29) and low family education (aOR 1.89, 95% CI 1.14-3.12) was associated with persistent functional disability.

CONCLUSION

High community poverty level was associated with persistent functional disability in unadjusted analysis but not with persistent moderate to high disease activity. Race/ethnicity and other SDH were associated with persistent disease activity and functional disability.

A Fast and Precise Tool for Multi-Layer Planar Coil Self-Inductance Calculation

An open-source tool that allows for a fast and precise analytical calculation of multi-layer planar coils self-inductance, without any geometry limitation is proposed here. The process of designing and simulating planar coils to achieve reliable results is commonly limited on accuracy and or geometry, or are too time-consuming and expensive, thus a tool to speed up this design process is desired. The model is based on Grover equations, valid for any geometry. The validation of the tool was performed through the comparison with experimental measurements, Finite Element Model (FEM) simulations, and the main analytical methods usually used in literature, with errors registered to be below 2.5%, when compared to standard FEM simulations, and when compared to experimental measurements they are below 10% in the case of the 1-layer coils, and below 5% in the 2-layer coils (without taking into consideration the coil connectors). The proposed model offers a new approach to the calculation of the self-inductance of planar coils of several layers that combines precision, speed, independence of geometry, easy interaction, and no need for extra resources.

A new approach to atrial flutter ablation using functional substrate mapping with wavefront discontinuity during sinus rhythm

Funding Acknowledgements

Type of funding sources: None.

Background

Ultra high-density (UHD) mapping allows accurate identification of local abnormal electrograms and low voltage within a small area range, allowing precise identification of reentry circuits. Areas with high isochronal density in a small area known as deceleration zones (DZ) are responsible for reentry.

Purpose

Identify the DZ and areas of low voltage in sinus rhythm (SR) and evaluate the feasibility of performing atrial flutter (AFL) ablation by targeting those zones.

Methods

We prospectively enrolled patients in SR referred for AFL ablation (either typical or atypical). An isochronal late activation mapping (ILAM) during SR with UHD catheter was performed, annotating latest deflection of local electrograms. DZ were defined as areas with &gt;3 isochrones within 1cm radius, prioritizing zones with maximal density. Atrial flutter was then induced and ILAM during flutter was performed for comparison. Voltage mapping was also assessed (0.1-0.5mV). Ablation targeted DZ in SR that displayed the higher voltage. DZ in SR were compared to DZ in AFL. Number of radiofrequency (RF) applications needed to terminate AFL were assessed. After AFL termination, complete line of the slow conduction zone was completed, and pulmonary vein isolation (PVI) was done in case of left AFL. Categorical variables are presented in absolute and relative values and median and interquartile range were used for numerical variables, as well t-student test for correlation of numerical variables.

Results

We studied 6 AFL (4 atypical, 66.7%) in 5 patients, 2 male (40%), median age 70 (64- 72). UHD ILAM in SR with 2195 points (1212-2865) and 2197 points (1356-3102) in AFL (p = 0.62).  The UHD ILAM identified a median of (QR) DZ in SR, that colocalized with AFL isthmus and DZ in AFL in 100%. DZ were not always located in low voltage areas. Aiming at the higher voltage in the DZ terminated the AFL in all cases, with a median RF time of 38 (25-58) seconds and AFL was no longer inducible. However, according to protocol, the complete line of slow conduction zone was done, with a median RF time of 1049.5 (274-1194) seconds (p = 0,009).

Conclusions

Isochronal mapping in sinus rhythm with UHD catheters can display the functional substrate for reentry in AFL, allowing a substrate guided ablation in case of non-inducible AFL. Targeting the areas of high isochronal density, is effective in terminating AFL, obviating the need for extensive ablation. Abstract Figure.

State-of-the-Art Mobile Radiation Detection Systems for Different Scenarios

In the last decade, the development of more compact and lightweight radiation detection systems led to their application in handheld and small unmanned systems, particularly air-based platforms. Examples of improvements are: the use of silicon photomultiplier-based scintillators, new scintillating crystals, compact dual-mode detectors (gamma/neutron), data fusion, mobile sensor networks, cooperative detection and search. Gamma cameras and dual-particle cameras are increasingly being used for source location. This study reviews and discusses the research advancements in the field of gamma-ray and neutron measurements using mobile radiation detection systems since the Fukushima nuclear accident. Four scenarios are considered: radiological and nuclear accidents and emergencies; illicit traffic of special nuclear materials and radioactive materials; nuclear, accelerator, targets, and irradiation facilities; and naturally occurring radioactive materials monitoring-related activities. The work presented in this paper aims to: compile and review information on the radiation detection systems, contextual sensors and platforms used for each scenario; assess their advantages and limitations, looking prospectively to new research and challenges in the field; and support the decision making of national radioprotection agencies and response teams in respect to adequate detection system for each scenario. For that, an extensive literature review was conducted.

Cuffless systolic and diastolic blood pressure estimation at the wrist via an optical device: comparison to intra-arterial measurements

 

The diagnosis and management of hypertension usually requires the estimation of blood pressure (BP) by means of an inflatable cuff. This procedure generates discomfort and limits patient compliance. Cuffless devices capture BP readings without performing any arterial occlusion. We believe that comfortable and cuffless BP monitoring devices can significantly aid in the fight against hypertension and support the expansion of ambulatory and remote patient monitoring programs, provided that these devices provide reliable BP readings.

The purpose of this study was to compare the systolic (S) and diastolic (D) blood pressure (BP) estimations from a new optical device at the wrist (figure) against invasive measurements performed on patients scheduled for radial arterial catheterization. The first results from this study were recently published and demonstrated good agreement for the overall study population. Here we report expanded statistical analyses for different population subgroups such as gender, age, body mass index (BMI) and skin color.

The study protocol consisted of the simultaneous recording of reflective photo-plethysmographic signals (PPG) from the optical device, and BP values recorded by a contralateral radial arterial catheter. The PPG signals were processed to generate estimates of SBP and DBP. Agreement of paired BP estimations was further calculated in terms of standard deviation (SD) of differences. The mean of differences were systematically zero because BP estimations from the optical device were calibrated for each patient.

The table shows that, for the overall population, both SBP and DBP differences SDs were smaller than 8 mmHg (as already published). Furthermore, across different population groups, both genders, all BMIs and all skin colors also resulted in SDs smaller than 8 mmHg. Only patients whose age was above 65 years were associated with a higher SD.

For the overall population and most subgroups the new optical technique appears to be capable of replacing more traditional methods of BP estimation. Only the SBP differences for the subgroup of older patients were larger. Additional studies are needed to confirm and expand these very encouraging results.

Table 1. SD of measured BP differences Population N SD of SBP differences SD of DBP differences (mmHg) (mmHg) All 16 7.1 2.9 Gender Male 10 6.4 2.8 Female 6 8.0 3.1 Age (years) &lt;65 7 4.0 2.3 &gt;65 9 *9.3 3.4 BMI (kg/m2) &lt;26 10 7.9 2.9 &gt;26 6 5.7 2.8 Skin Color (Fitzpatrick) 2 13 7.7 3.0 3 3 4.5 2.6 *Only subgroup with a SD larger than 8mmHg.

Figure 1. The investigational device

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Aktiia SA

Substrate guided ablation of idiopathic right ventricular outflow tract premature ventricular contractions in patients with low arrhythmia burden during the procedure

Background

Ablation of premature ventricular contractions (PVCs) is currently based on activation mapping. This strategy is impaired by the absence or paucity of PVCs on the day of the procedure. Frequently, isolated diastolic potentials (DP) are present at the successful ablation site in sinus rhythm (SR), although their meaning is still a matter of debate.

Objective

Evaluate the feasibility and results of a substrate-based approach for ablation of idiopathic right ventricular outflow tract (RVOT) PVCs, in patients that present with a low PVC burden during the procedure.

Methods

We included 12 consecutive patients referred for ablation of frequent (&gt;10000/24 hours) idiopathic PVCs from the RVOT that present with less than 2 PVCs/min in the beginning of the procedure. The ablation was based on fast mapping of the RVOT in SR looking for DPs, defined as isolated small amplitude potentials occurring after the T wave of the surface ECG in SR (Figure). The area with DPs was marked and a reduced activation mapping of the PVCs was done in that area. We evaluated the procedure time, mapping, fluoroscopy and radiofrequency (RF) application times. The number of points used for the maps, the area of DPs, local activation time and success rate. Values are presented as median (Q1-Q3). Electroanatomical mapping of the RVOT in SR was also performed in a control group of 10 subjects that underwent ablation of supraventricular arrhythmias, to evaluate the prevalence of DPs in subjects without PVCs.

Results

The number of PVCs during the procedure was 1 (0.1–1.6)/min. Both groups did not differ in relation to age or gender. Median age 45 (34–65) years, 6 males in the PVC group and 40 (33–65) years, 6 males in the control group, p=0.821 and p=0.231 respectively. The number of points sampled per RVOT map in SR was 400 (193–500) in the PVC group and 330 (277–425) in the control group, p=0.539. All patients in the study group had DPs in the RVOT. None of the control group subjects had DPs in the RVOT. Ablation data is presented in the Table. The acute success rate was 100%. After a median follow-up time of 4 (3–6) months one patient had recurrence.

Conclusion

In these group of patients with very low PVC burden during the procedure, this approach partially based on substrate mapping, made ablation of the PVCs feasible, in a fast and efficient way.

Funding Acknowledgement

Type of funding source: None

A pilot study augmenting cognitive behavioral therapy for panic disorder with attention bias modification: Clinical and psychophysiological outcomes

BACKGROUND AND OBJECTIVES

Studies show that attentional bias towards threat is a key maintenance factor for panic disorder (PD). Attentional bias may be an important mechanism of symptom reduction, and thus, a useful target for optimizing outcomes. The current study examined whether an attention bias modification (ABM) task enhanced CBT outcomes. Multiple methods for assessing PD were used, including physiological measurement and clinician-rated assessment.

METHODS

Adults with panic disorder (N = 24) received seven sessions of CBT with either ABM or sham attention tasks. Psychophysiological reaction to a loud tones startle paradigm was assessed before and after treatment.

RESULTS

Across both groups, panic symptom severity decreased with CBT. The ABM group showed greater reductions in PD symptoms compared to the placebo group. Notably, however, changes in attentional bias were not associated with symptom reductions across groups. No significant group differences on psychophysiological assessment were observed.

LIMITATIONS

This study is limited by the small sample size, which rendered our power to investigate mediators and moderators insufficient. More research is needed to validate the effect of attention bias modification on attentional bias to threat.

CONCLUSIONS

This pilot study suggests that future research should investigate attentional bias in conjunction with CBT. A larger sample would provide opportunity to further investigate the mechanisms through which ABM works, along with potential moderating factors and the use of psychophysiological measurements in panic disorder.

Transposition of Superior Cerebellar Artery for Microvascular Decompression in Trigeminal Neuralgia Using an In Situ Superior Petrosal Vein Sling Technique

BACKGROUND

Several microvascular decompression technical variations for the treatment of medically refractory trigeminal neuralgia have been proposed that can be categorized generally as interposition and transposition techniques. These latter approaches, so-called slinging techniques, have been increasing in popularity, because they can possibly reduce the long-term recurrence rates by preventing the formation of fibrosis and granulomas at the decompression site. We have reported a technique for transposition of the superior cerebellar artery for microvascular decompression in trigeminal neuralgia using the superior petrosal vein as an in situ sling to anchor and reroute the artery away from the nerve.

METHODS

We have presented a technical report with illustrative intraoperative images and video from 2 cases of trigeminal neuralgia in which the superior petrosal vein was used as a simple and straightforward in situ sling for transposition of the superior cerebellar artery.

RESULTS

The technique was applied successfully in 2 patients with complete and immediate remission of trigeminal neuralgia, without surgical morbidity.

CONCLUSION

The most frequent neurovascular conflict in trigeminal neuralgia involves the superior cerebellar artery, and the strategic location of the superior petrosal vein relative to this neurovascular complex allows for its use as a natural in situ sling that reroutes the artery and prevents its recoil against the nerve. This technique can be added to the increasing armamentarium of transposition techniques for microvascular decompression, with the advantage of simplicity and no requirement for a complex prosthesis to secure the transposition.

Developing an Electronic Record Tool Representative of Primary Health Care in the Public Health Care System of Buenos Aires City

The Primary Health Care strategy is based on organization of interdisciplinary teams and comprehensive approach to health, disease and health care processes. To strengthen information systems so that they represent primary health care complexities, participatory meetings were held with primary care practitioners from the public health care system of Buenos Aires City. Terms for the record tool and its components were chosen using consensus methodologies. This process involved 300 practitioners from 49 centers, and submission of 21 proposals. It was decided to change the term "Electronic Medical Record" with "Comprehensive Health Record." It was also agreed that, apart from "Reason for Consultation," the field "Problem Situation" would be added, that "Care Service" would be replaced with "Care Act," and that a new module "Health Team Management and Education Activities" would be included to document practitioners team activities.

Variation of a Persistent Primitive Hypoglossal Artery (PPHA) as Incidental Finding in the Diagnostic Clarification of Cerebral Vasculopathy Associated with Intracranial Vasculitis

We present a very rare variation of a persistent primitive hypoglossal artery (PPHA) arising from the internal carotid artery, detected during a diagnostic angiography. A 50-year-old female patient was admitted with an atypical intracranial hematoma in the left frontal lobe. Catheter angiography revealed intracranial vasculopathy with segmental stenoses, a small aneurysm of the right internal carotid artery bifurcation and a "string of beads" appearance of the left carotid artery, consistent with fibromuscular disease. On the left side, a vertebral artery ending in the posterior inferior cerebellar artery (PICA) was detected, whereas on the right side the vertebral artery was aplastic. During selective angiography of the right common carotid artery, a persistent hypoglossal artery was seen supplying the basilar artery. The literature of persistent embryonal carotid-vertebrobasilar anastomosis and their anatomical variations is discussed with respect to clinical importance for ischemia, interventional procedures, and surgery.

Transsphenoidal meningoencephalocele protruding into the nasal cavity

Spontaneous transsphenoidal meningoencephalcele is a rare entity, even rarer through the Sternberg’s canal, a congenital defect on the lateral wall of the sphenoid sinus. We report such a case in an obese 52-year-old female with spontaneous cerebrospinal fluid (CSF) rhinorrhoea and recurrent meningitis. Brain CT, MRI and CT cisternography were performed. Surgical correction and short-term follow-up were recorded. CT scan showed a defect on the lateral wall of the right sphenoid sinus filled with a soft tissue mass extending to the nasal cavity. MRI scan revealed brain parenchyma from the right temporal lobe herniated through the sphenoid bone defect. CT cisternography showed 270 mmH₂O opening pressure and confirmed the CSF leakage. Surgical correction was performed with resolution of the symptoms. MRI and CT are complementary modalities for evaluating this entity, the first being the method of choice for meningoencephalcele diagnosis although bone defects are best depicted on CT scan. CT cisternography identifies the specific site of leak and confirms benign intracranial hypertension, consistently reported in meningoencephaloceles. Obesity and benign intracranial hypertension have been reported as a combined mechanism allegedly contributing to meningoencephaloceles through congenital skull base defects, by increasing intraabdominal pressure thus decreasing venous return, with augmented intracranial pressure and subsequent reduced absorption of the CSF.

Neuro-Behçet's psychiatric symptoms

Neuro-Behçet (NB) results from inflammatory peri-vasculitis affecting the central nervous system. Non-specific neurological and psychiatric symptoms are rarely the first presentation and may difficult or delay diagnosis and treatment.

We review, based on a case study and published literature, the psychiatric symptoms of NB when no clear evidence of neurologic disease activity is present.

We present the case of a female patient, who was diagnosed NB at age 23 for recurrent meningo-encephalitis, that showed progressive behavioral changes, with increased impulsivity, disinhibition, hostility and self-neglect.

Raised in a dysfunctional family, she ran away from home at 16, abandoned her studies, started abusing cannabinoids and showed an erratic life course.

In 2015, because of increasing psychiatric symptoms, she was admitted to hospital and a complete neuropsychological evaluation showed that she had a significant decline from an above average premorbid cognitive function, specifically related to memory deficits. CT and MRI didn’t show typical signs of active disease. However, a SPECT scan showed hypo-perfusion of the frontal cortex compatible with the patient's symptoms.

It is difficult to assess NB's activity as brain inflammation is only observed after structural changes are present. In this case the SPECT correlated well with psychiatric symptoms. The differential diagnosis includes organic pathology with psychiatric symptoms, psychiatric disease, personality disorders and substance abuse.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Correction of a Cystic Fibrosis Splicing Mutation by Antisense Oligonucleotides

Cystic fibrosis (CF), the most common life-threatening genetic disease in Caucasians, is caused by ∼2,000 different mutations in the CF transmembrane conductance regulator (CFTR) gene. A significant fraction of these (∼13%) affect pre-mRNA splicing for which novel therapies have been somewhat neglected. We have previously described the effect of the CFTR splicing mutation c.2657+5G>A in IVS16, showing that it originates transcripts lacking exon 16 as well as wild-type transcripts. Here, we tested an RNA-based antisense oligonucleotide (AON) strategy to correct the aberrant splicing caused by this mutation. Two AONs (AON1/2) complementary to the pre-mRNA IVS16 mutant region were designed and their effect on splicing was assessed at the RNA and protein levels, on intracellular protein localization and function. To this end, we used the 2657+5G>A mutant CFTR minigene stably expressed in HEK293 Flp-In cells that express a single copy of the transgene. RNA data from AON1-treated mutant cells show that exon 16 inclusion was almost completely restored (to 95%), also resulting in increased levels of correctly localized CFTR protein at the plasma membrane (PM) and with increased function. A novel two-color CFTR splicing reporter minigene developed here allowed the quantitative monitoring of splicing by automated microscopy localization of CFTR at the PM. The AON strategy is thus a promising therapeutic approach for the specific correction of alternative splicing.

A influência das conceções sobre a literacia científica no desenvolvimento da cidadania

As questões relacionadas com a literacia científica são objeto de grande atenção por parte dos responsáveis de muitos países e de diversos estudos. Ao mesmo tempo, os dados relativos aos jovens em idade escolar que não têm interesse pelo estudo das ciências e em prosseguir uma carreira nesta área mostram que a qualidade da investigação e a capacidade de inovar podem vir a estar em causa. Por outro lado, as caraterísticas da sociedade contemporânea obrigam a uma preocupação com a educação científica, de modo a preparar cidadãos participantes, críticos e responsáveis. No presente trabalho pretende-se discutir alguns dos resultados de um estudo no âmbito da educação em Geociências, diagnosticando a importância atribuída por alunos do ensino secundário à literacia científica. Foi escolhida uma abordagem metodológica mista, orientada pelo paradigma socio-crítico. Aplicou-se um questionário a uma amostra de 1604 alunos do ensino secundário das regiões Norte e Centro de Portugal (a margem de erro foi de 3,21%, com um nível de confiança de 99%). Da análise em componentes principais da informação recolhida destacaram-se três aspetos: a consciência dos assuntos ambientais; a perspetiva sobre as questões ambientais (otimismo ambiental); e a motivação para o envolvimento com a ciência. Os resultados do estudo realizado mostram que os alunos consideram conhecer bem os problemas ambientais que lhes são apresentados. Os resultados indicam também que a consciência dos assuntos ambientais é influenciada pela frequência da disciplina de Biologia e Geologia e pela qualificação académica mais elevada (ao nível do ensino superior) das mães. As expectativas sobre a possibilidade de os problemas ambientais serem solucionados nos próximos vinte anos são superiores no sexo feminino e nos alunos do 10.º ano sem a disciplina de Biologia e Geologia. Relativamente à motivação para o envolvimento com a ciência, os resultados apontam que o interesse pelas áreas e processos científicos é superior nos indivíduos do sexo feminino, nos alunos com a disciplina de Biologia e Geologia e nos filhos de pais com qualificação académica ao nível do ensino superior. Verifica-se ainda que a importância atribuída à ciência é maior nas raparigas, nos alunos que frequentam durante mais tempo as aulas de Biologia e Geologia e nos filhos de pais com qualificações académicas superiores. O conhecimento das conceções dos alunos sobre a importância da literacia científica pode, assim, fundamentar uma atuação da escola e da sociedade que contribua favoravelmente para o desenvolvimento e valorização da cidadania.

Highly sensitive optical fibre long period grating biosensor anchored with silica core gold shell nanoparticles

An optical fibre long period grating (LPG), modified with a coating of silica core gold shell (SiO2:Au) nanoparticles (NPs) deposited using the layer-by-layer method, was employed for the development of a biosensor. The SiO2:Au NPs were electrostatically assembled onto the LPG with the aid of a poly(allylamine hydrochloride) (PAH) polycation layer. The LPG sensor operates at the phase matching turning point to provide the highest sensitivity. The SiO2:Au NPs were modified with biotin, which was used as a ligand for streptavidin (SV) detection. The sensing mechanism is based on the measurement of the refractive index change induced by the binding of the SV to the biotin. The effect on sensitivity of increasing the surface area by virtue of the SiO2:Au nanoparticles' diameter and film thickness was studied. The lowest measured concentration of SV was 2.5nM, achieved using an LPG modified with a 3 layer (PAH/SiO2:Au) thin film composed of SiO2 NPs of 300nm diameter with a binding constant of k=1.7(pM)(-1), sensitivity of 6.9nm/ng/mm(2) and limit of detection of 19pg/mm(2).

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV-1 infection 2015: optimizing health in preparation for adult life

The 2015 Paediatric European Network for Treatment of AIDS (PENTA) guidelines provide practical recommendations on the management of HIV‐1 infection in children in Europe and are an update to those published in 2009. Aims of treatment have progressed significantly over the last decade, moving far beyond limitation of short‐term morbidity and mortality to optimizing health status for adult life and minimizing the impact of chronic HIV infection on immune system development and health in general. Additionally, there is a greater need for increased awareness and minimization of long‐term drug toxicity. The main updates to the previous guidelines include: an increase in the number of indications for antiretroviral therapy (ART) at all ages (higher CD4 thresholds for consideration of ART initiation and additional clinical indications), revised guidance on first‐ and second‐line ART recommendations, including more recently available drug classes, expanded guidance on management of coinfections (including tuberculosis, hepatitis B and hepatitis C) and additional emphasis on the needs of adolescents as they approach transition to adult services. There is a new section on the current ART ‘pipeline’ of drug development, a comprehensive summary table of currently recommended ART with dosing recommendations. Differences between PENTA and current US and World Health Organization guidelines are highlighted and explained.

Cervical spine involvement as initial manifestation of rheumatoid arthritis: a case report

Rheumatoid arthritis' synovitis affects mostly small hand and feet joints, although it may compromise any joint with a synovial lining. Cervical involvement occurs usually in longstanding disease in over half of these patients. We report the case of a 35-year old male patient who was referred to our outpatient clinic for a 2-year severe and disabling inflammatory neck pain, with incomplete response to intramuscular non-steroidal anti-inflammatory drugs and unremarkable cervical imaging studies. He also mentioned self-limited episodes of symmetric polyarthralgia involving hands, wrists, elbows, knees and feet, which started after his cervical complaints. On laboratorial workup, positive rheumatoid factor and anti-citrullinated peptide antibody and negative HLA-B27 were found. Cervical spine magnetic resonance imaging revealed atlantoaxial subluxation and odontoid process inflammatory pannus and erosions. Rheumatoid arthritis with cervical spine involvement as initial manifestation of disease was the definite diagnosis. The patient was started on methotrexate and prednisone and he was referred to neurosurgery outpatient clinic for cervical spine fixation.

[X-linked agammaglobulinemia: experience in a Portuguese hospital]

INTRODUCTION

X-Linked agammaglobulinemia (XLA) is characterized by an arrest of B cell differentiation, leading to recurrent bacterial infections. Lifelong immunoglobulin replacement therapy (IRT) is indicated to prevent infections and their complications.

MATERIAL AND METHODS

A retrospective study of patients with XLA followed in a level three hospital was performed; data was collected retrospectively by review of clinical files.

RESULTS

XLA was diagnosed in 9 children. One (11%) had a positive family history with a prenatal diagnosis. Infection was the clinical presentation in all the others (89%), at an average age of 13 months; diagnosis was established at a mean age of 3.4 years. Acute otitis media (7/9) and pneumonia (5/9) were the most frequently observed. Seven (78%) presented serum immunoglobulin G (IgG) levels below 200mg/dL and all of them had CD19(+) B cells below 2%. Neutropenia was present at diagnosis in three patients (33%). Bruton tyrosine kinase (BTK) mutations were identified in all cases. Intravenous IRT was initiated, switched later to subcutaneous administration, in all. The mean time of follow-up was 10.7 years with cumulative time of 97 years. Eight children (89%) achieved IgG serum levels above 800 mg/dL. One presented lower values due to renal loss. No deaths occurred. After diagnosis the most frequent infections were acute otitis media (6/9). In spite of stable adequate IgG levels on IRT, two patients developed bronchiectasis.

CONCLUSIONS

XLA overall prognosis is good, as long as patients have an early and adequate treatment. However, bronchiectasis can occur even on adequate immunoglobulin replacement therapy.