Printed Digital Wax-up Model as a Blueprint for Layered Pressed-ceramic Laminate Veneers: Technique Description and Case Report

This article presents a clinical technique for transferring Digital Smile Design (DSD) information and a digital wax-up to fabricate highly personalized ceramic laminate veneers. The hybrid workflow of digitally designed wax-up and conventional hand-crafted veneers is showcased in a female adult who sought to improve her smile due to maxillary anterior incisal wear. The ceramic veneers, layered by feldspathic porcelain, followed the contours and shade blueprint planned with the digital wax-up. The DSD improved the harmony of the facial-and-smile relationship, and the ceramic restorations fulfilled the patient's esthetic and functional demands. Guides based on the printed model with the digitally designed wax-up can provide a reference for pressed lithium disilicate veneers layered with feldspathic porcelain.

Cardiovascular Magnetic Resonance Imaging in Patients With Ibrutinib-Associated Cardiotoxicity

Importance

Ibrutinib has been associated with serious cardiotoxic arrhythmias. In preclinical models, these events are paralleled or proceeded by diffuse myocardial injury (inflammation and fibrosis). Yet whether this is seen in patients or has implications for future cardiotoxic risk is unknown.

Objective

To assess the incidence and outcomes of myocardial injury among patients with ibrutinib-related cardiotoxicity.

Design, Setting, and Participants

This cohort study included consecutive patients treated with ibrutinib from 2012 to 2019, phenotyped using cardiovascular magnetic resonance (CMR) from a large US Comprehensive Cancer Center registry.

Exposures

Ibrutinib treatment for cancer control.

Main Outcomes and Measures

The primary outcome was the presence of late gadolinium enhancement (LGE) fibrosis. The secondary outcome was the occurrence of major adverse cardiac events (MACE), defined as atrial fibrillation, heart failure, symptomatic ventricular arrhythmias, and sudden death of probable or definite ibrutinib association after CMR. We also assessed parametric-mapping subclinical fibrosis (native-T1, extracellular volume fraction) and inflammation/edema (max-T2) measures. Cardiovascular magnetic resonance measures were compared with those obtained in similar consecutive patients with cancer without ibrutinib treatment (pretreatment controls). Observed measures were also compared with similar-aged broad population rates (general-population controls) and a broader pool of cardiovascular disease (CVD) risk-matched cancer controls. Multivariable regression was used to assess the association between CMR measures and MACE.

Results

Overall, 49 patients treated with ibrutinib were identified, including 33 imaged after treatment initiation (mean [SD] age, 65 [10] years, 9 [27%] with hypertension, and 23 [69.7%] with index-arrhythmias); median duration of ibrutinib-use was 14 months. The mean (SD) pretreatment native T1 was 977.0 (73.0) ms, max-T2 56.5 (4.0) ms, and 4 (13.3%) had LGE. Posttreatment initiation, mean (SD) native T1 was 1033.7 (48.2) ms, max-T2 61.5 (4.8) ms, and 17 (54.8%) had LGE (P < .001, P = .01, and P < .001, respectively, pre- vs post-ibrutinib treatment). Native T12SDs was elevated in 9 (28.6%), and max-T22SDs in 21 (63.0%), respectively. Cardiovascular magnetic resonance measures were highest in those with suspected toxic effects (P = .01 and P = .01, respectively). There was no association between traditional CVD-risk or cancer-treatment status and abnormal CMR measures. Among those without traditional CVD, 16 (58.6%) had LGE vs 38 (13.3%) in matched-controls (relative-risk, 4.8; P < .001). Over a median follow-up of 19 months, 13 (39.4%) experienced MACE. In multivariable models inclusive of traditional CVD risk factors, LGE (hazard ratio [HR], 4.9; P = .04), and native-T12SDs (HR, 3.3; P = .05) associated with higher risks of MACE.

Conclusions and Relevance

In this cohort study, myocardial injury was common in ibrutinib users, and its presence was associated with higher cardiotoxic risk.

The Heart Failure Optimization Study (HF-OPT): rationale and design

BACKGROUND

According to the current guidelines, implantable cardioverter-defibrillators (ICD) for primary prevention in patients with heart failure and reduced ejection fraction (HFrEF) should not be considered until optimal guideline-directed medical therapy (GDMT) has been achieved for a minimum of 3 months. Optimization of GDMT often needs time beyond 3 months after diagnosis. The aim of the Heart Failure Optimization Study (HF-OPT) is to evaluate the recovery of left ventricular function beyond 3 months after diagnosis of newly diagnosed HFrEF.

METHODS

The HF-OPT multicenter study is comprised of two non-randomized phases (registry and study). During the first 90 days a wearable cardioverter-defibrillator (WCD) is prescribed and patients are enrolled in an observational pre-study registry. Registry subjects meeting inclusion criteria for the study portion at day 90 have ongoing left ventricular ejection fraction (LVEF) reassessment at 90, 180 and 360 days after the index hospital discharge, regardless of continued WCD use. Approximately 600 subjects will be enrolled in the study portion. Of those, one-third are anticipated to start the study phase at day 90 with reduced LVEF. The primary objective of this study is to observe the rate of recovery of LVEF > 35% between 90 and 180 days, while key secondary endpoints include mortality and WCD recorded arrhythmias and shocks.

DISCUSSION

The HF-OPT study will provide important information on the rate of additional recovery of LVEF > 35%, between 90 and 180 days, in newly diagnosed HF with reduced LVEF patients being titrated with GDMT. The results of the study may impact indications for primary prophylactic ICD implantation.

Hypertensive events after the initiation of contemporary cancer therapies for breast cancer control

BACKGROUND

Contemporary therapies improve breast cancer (BC) outcomes. Yet, many of these therapies have been increasingly linked with serious cardiotoxicity, including reports of profound hypertension. Yet, the incidence, predictors, and impacts of these events are largely unknown.

METHODS

Leveraging two large U.S.-based registries, the National Inpatient Sample (NIS) and the Food and Drug Administration Adverse Event Reporting System (FAERS) databases, we assessed the incidence, factors, and outcomes of hypertensive events among BC patients from 2007 to 2015. Differences in baseline characteristics, hypertension-related discharges, and complications were examined over time. Further, we performed a disproportionality analysis using reporting-odds-ratios (ROR) to determine the association between individual BC drugs and hypertensive events. Utilizing an ROR cutoff of >1.0, we quantified associations by drug-class, and individual drugs with the likelihood of excess hypertension.

RESULTS

Overall, there were 5,464,401 BC-admissions, of which 46,989 (0.8%) presented with hypertension. Hypertensive BC patients were older, and saw initially increased in-hospital mortality, which equilibrated over time. The mean incidence of hypertension-related admissions was 732 per 100,000 among BC patients, versus 96 per 100,000 among non-cancer patients (RR 7.71, p < 0.001). Moreover, in FAERS, those with hypertension versus other BC-treatment side-effects were more frequently hospitalized (40.1% vs. 36.7%, p < 0.001), and were most commonly associated with chemotherapy (45.9%). Outside of Eribulin (ROR 3.36; 95% CI 1.37-8.22), no specific drug was associated with a higher reporting of hypertension; however, collectively BC drugs were associated with a higher odds of hypertension (ROR 1.66; 95% CI 1.09-2.53).

CONCLUSIONS

BC therapies are associated with a substantial increase in limiting hypertension.

Aortic and vascular involvement in Loeys-Dietz Syndrome. Results from the REPAG registry (Spanish network of genetic aortic diseases)

Background

LDS is a rare disease due to genetic variants in the TGFB pathway. Limited information is available regarding the overall aortic and vascular outcome of these patients

Purpose

To evaluate aortic and vascular complications of patients with mutations in the TGFB pathway.

Methods

Retrospective longitudinal study including patients with (likely) pathogenic (LP/P) variants in the TGFbeta pathway from 10 tertiary centers. Clinical and imaging data were reviewed and data on aortic and vascular outcome included.

Results

A total of 163 patients were included (47.9% women, 38.6% index cases), mean age at first evaluation 32.3±20.4 years, 27.0% with age &lt;16 years. 70 TGFBR1, 43 TGFBR2, 29 SMAD3, 9 TGFB2 and 12 TGFB3 (Table1)

During a mean follow-up of 4.7±3.7 years, 54 (33.1%) patients had at least 1 aortic surgery (max 6). Mean age at first aortic surgery was 37.2±16.8 years (Range 1.2–72.9). First surgery was elective in 42 (77.8%), and included aortic root or ascending aorta in 40 (95.2%) and isolated descending aorta in 2 (4.8%). Emergent surgery included aortic root or ascending aorta in 11 (92.7%). Ascending aorta-root diameter previous to elective surgery was 48.9±4.9mm (range 41–65). 7 patients died during follow-up (2 intracranial bleeding, 1 SD, 2 aortic ruptures, 1post aortic surgery, 1 non-CV). Furthermore, 19 acute aortic syndromes (AAS) were reported (17 dissections, 2 haematomas) in 18 patients, 10 type A (52.6%). Mean age at first AAS was 42.3±11.1 years (min 19.7 years to 62.9 years)

Median survival free of intervention, dissection or death was 57.1 years, being worst for men than women (44.7 yrs vs 69.1 years, p&lt;0.001) (Figure 1), these gender-difference only remained significant in the TGFBR1 and SMAD3 groups (p=0.005 and p=0.008) Regarding aortic branch and intracranial aneurysms, a total of 383 imaging studies of aortic branches and 223 cranial imaging studies were performed during the clinical follow-up. 21 cranial aneurysms and 73 aortic branch aneurisms were reported. 14 (11.5%) patients suffered 19 aneurysms-related events (3 dissections, 3 ruptures, 13 interventions).

Conclusions

In patients with Loeys-Dietz Syndrome, there's a high prevalence of aortic surgeries and acute aortic events, with high numbers of peripheral and intracranial aneurysms. A worst prognosis in men than in women is observed in TGFBR1 and SMAD3 variants. Thus, specialized clinical and imaging follow-up is crucial in the management of these patients

Funding Acknowledgement

Type of funding sources: None.

Profile and prognosis of patients with heart failure with recovered ejection fraction

Background

Patients with heart failure (HF) and reduced ejection fraction (rEF) have a poor prognosis. Nevertheless, in the subgroup of patients with recovered ejection fraction (recEF) prognosis is unknown.

Purpose

To analyze characteristics and prognosis in patients with HFrEF (initial EF and at one year &lt;40%) and HFrecEF (initial EF &lt;40% and at one year ≥40% with ≥10% absolute improvement from the initial value).

Methods

Retrospective observational study of outpatients referred to the HF unit within March/2006 and November/2021. Baseline characteristics, ecocardiographic data and follow-up were collected, discerning between patients with HFrEF and HFrecEF.

Results

A total of 346 patients (76.0% men) were analyzed with a mean of age 66.3 (IQR 57.8–74.4) years, of which 50.6% remained with rEF and 49.4% recEF. Median follow-up was 4.6 (2.8–7.9) years. Both groups had a similar risk profile albeit less prevalence of dyslipidemia in the group with recEF (43.5% vs 56.7%, p=0.015). Ischemic etiology predominated in those with rEF (41.7% vs 25.7%, p=0.002) and enolic in recEF (10.5% vs 3.4%, p=0.009). The incidence of combined event (readmission for HF or death) was lower in HFrecEF (33.6% vs 66.4%, p&lt;0.001), as well as death (33.9% vs 66.1%, p&lt;0.001) and readmission for HF (24.4% vs 75.6%, p&lt;0.001). Prevalence of cardiovascular death was lower in the group with recEF (37.8% vs 61.1%, p=0.021). In the multivariate analysis, rEF was an independent predictor for the combined event (HR 2.17; 95% IC [1.45–3.25], p&lt;0.001), as well as for global mortality and readmission for HF.

Conclusion

Patients with HFrecEF have a similar risk profile than patients with HFrEF although with better long-term prognosis.

Funding Acknowledgement

Type of funding sources: None.

Clinical Correlates of Cardiac Conduction in Bipolar Disorder

Introduction

Patients with bipolar disorder (BD) have an increased risk for cardiovascular morbimortality. Clinical risk factors, specifically for arrhythmias and sudden cardiac death remain understudied.

Objectives

This study was conducted to assess differences in cardiac conduction among BD patients.

Methods

We included patients with BD in a cross-sectional design, confirmed by structured interview, age 18 through 80. Clinical characteristics were obtained using a structured questionnaire or medical records review. ECG intervals duration and morphology were manually assessed by cardiologists and compared among clinical subgroups using Chi-square, Mann-Whitney, and Kruskall-Wallis tests. Exploratory multivariable linear and logistic regression models were fitted to adjust for potential confounders.

Results

We included 117 patients (60.7% women, 76.9% bipolar I, 50% history of psychosis, 22.6% suicide attempts). We found a significantly longer QTc interval in BD patients with hypertension (difference: 9.5 ms, p=0.006), obesity (difference: 25 ms, p=0.001), and metabolic syndrome (difference: 13 ms, p=0.007). Hypertension remained a significant predictor of longer QTc after adjusting for age, gender, and antipsychotic use (estimate 17.718, p=0.018). We observed a significantly shorter PR interval in women (difference: 6 ms, p=0.029), early age of onset (difference 6 ms, p=0.025), non-users of lithium (difference 4 ms, p=0.002), and early trauma (difference 4 ms, p=0.038). Finally, we identified significant correlations between symptom severity, blood glucose and PR interval (r=0.298, p=0.001; r=0.278, p=0.003; respectively).

Conclusions

Patients with BD and hypertension may have an increased risk for QTc prolongation. Careful cardiovascular monitoring may be warranted.

Disclosure

No significant relationships.

Prognostic value of myocardial injury and chronic kidney disease in an emergency unit

Background

Cardiac troponin is independently associated with cardiovascular events and mortality in patients with chronic kidney disease (CKD). Their joint effect is yet to be clarified.

Purpose

This study aims to evaluate the prognostic implication of myocardial injury and CKD in patients attended in an emergency room.

Methods

Retrospective study carried out between January 2012 and December 2013 with consecutive patients attended in an emergency room with troponin determination, who were distributed into four cohorts according to positive troponin and/or glomerular filtration rate (GFR) &lt;45ml/min/ 1.7. We analysed their baseline characteristics and the four-year prognosis.

Results

3622 patients were included (median age 68.5 years [IQR 55.5–79.5]; 43% were women). Compared to subjects with normal GFR, the 565 subjects with CKD were significantly older (80.5 vs 66.5 years), with worse cardiovascular profile (arterial hypertension: 87% vs 56%; diabetes mellitus: 46% vs 22%) and greater comorbidity (history of myocardial infarction: 29% vs 18%; heart failure: 17% vs 5%; peripheral vascular disease: 16% vs 5%; cerebrovascular disease: 13% vs 7%%). Myocardial injury was also related to elderly and worse cardiovascular profile and comorbidity, especially in normal GFR subjects. 23.5% (718 subjects) of normal GFR subjects presented with myocardial injury. This percentage was much higher in the presence of renal impairment (331 subjects, 58.6%). Troponin was associated with a higher risk of death (both in-hospital and during follow-up) and of readmission due to infarction or heart failure, regardless of GFR. The reference cohort in the multivariate competing risk mode was that with subjects without myocardial injury or kidney disease. This analysis showed the worst MACE (all-cause death, non-fatal myocardial infarction and heart failure admission) in four-year follow-up in patients with renal impairment and positive troponin (HR 3.94, 95% CI 3.317–4.682), second worst MACE in those with myocardial injury and with normal GFR (HR 2.408, 95% CI 2.064–2.811), and then abnormal GFR patients with negative troponin (HR 1.532, 95% CI 1.220–1.923). Patients with both myocardial injury and renal impairment had the highest mortality (HR 4.633, 95% CI 3.829–5.604) and more readmissions for heart failure (HR 2.163, 95% CI 1.647–2.841). The myocardial-injury-and-normal-GFR cohort showed significantly higher mortality than the renal-impairment-with-negative-troponin cohort (HR 2.669 vs HR 1.794), more heart failure (HR 1.951 vs 1.067) and more myocardial infarctions (HR 2.439 vs 1.235) in the follow-up.

Conclusion

The results suggest that myocardial injury has better predictive power than chronic kidney disease for MACE events and also for individually mortality, readmission for heart failure or myocardial infarction.

Funding Acknowledgement

Type of funding sources: None.

Accuracy of gradient diffusion method for susceptibility testing of dalbavancin and comparators

OBJECTIVES

This multicenter study aimed to assess the performances of gradient diffusion (GD) method in comparison to broth microdilution (BMD) method for susceptibility testing of dalbavancin, daptomycin, vancomycin, and teicoplanin.

METHODS

Minimum Inhibitory Concentrations (MICs) were retrospectively determined concomitantly by BMD and GD methods, for 93 staphylococci and enterococci isolated from clinical samples. BMD was considered as the gold standard. Essential (EA) and categorical agreements (CA) were calculated. Discordant categorical results were categorized as major (ME) and very major errors (VME).

RESULTS

EA and CA were 95.7% and 96.8%, 82.8% and 100%, 97.8% and 96.8%, and 94.6% and 95.7% for dalbavancin, daptomycin, vancomycin, and teicoplanin respectively. Concerning dalbavancin, 3 ME without any VME were observed and discrepancies were low (≤ to 2 two-fold dilutions) between both methods. VME were noted in 1 and 3 cases for vancomycin and teicoplanin, respectively, and resulted from 1 two-fold dilution discrepancy in each case. EA was lower for daptomycin. When they were discrepant, BMD MICs were systematically higher than GD ones. Nevertheless, no categorical discrepancy was noted.

CONCLUSIONS

GD appears as an acceptable and convenient alternative for dalbavancin, vancomycin, and teicoplanin MICs determination. Our study also emphasizes how achieving accurate daptomycin MICs remains challenging.

Incidence of pacing-induced cardiomyopathy in pacemaker-dependent patients is lower with leadless pacemakers compared to transvenous pacemakers

Introduction

Frequent right AQ4ventricular pacing (≥40%) with a transvenous pacemaker (TVP) is associated with the risk of pacing‐induced cardiomyopathy (PICM). Leadless pacemakers (LPs) have distinct physical and mechanical differences from TVP. The risk of PICM with LP is not known. To identify incidence, predictors, and long‐term outcomes of PICM in LP and TVP patients.

Methods

The study comprised all pacemaker‐dependent patients with LP or TVP who had left ventricular ejection fraction (LVEF) of ≥50 from 2014 to 2019. The incidence of PICM (≥10% LVEF drop) was assessed with an echocardiogram. Predictors for PICM were identified using multivariate analysis. Long‐term outcomes after cardiac resynchronization (CRT) were assessed in both groups.

Results

A total of 131 patients with TVP and 67 with LP comprised the study. All patients in the TVP group and the majority in the LP group underwent atrioventricular node ablation. The mean follow‐up duration in TVP and LP groups was 592 ± 549 and 817 ± 600 days, respectively. A total of 18 (13.7%) patients in TVP and 2 (3%) in LP developed PICM after a median duration of 254 (interquartile range: 470) days. The incidence of PICM was significantly higher with TVP compared with LP (p = .02). TVP as pacing modality was a positive (odds ratio [OR]: 1.07) while age was negative (OR: 0.94) predictor for PICM on multivariable analysis. Both patients in LP and all except two in the TVP group responded to CRT.

Conclusion

Incidence of PICM is significantly lower with LP compared with TVP in pacemaker‐dependent patients. Age and TVP as pacing modality were predictors for PICM.

Change in health-related quality of life among patients with a reduced ejection fraction initiating guideline-directed medical therapy

Background

Management of patients with heart failure (HF) should include patient reported outcomes (PROs). The Kansas City Cardiomyopathy Questionnaire is self-administered with subscales to evaluate HF symptom burden, physical limitations, social limitations (recreational participation), and quality of life (QoL). Change in PROs among newly diagnosed patients with HF and reduced ejection fraction (HFrEF) prescribed a wearable cardioverter defibrillator (WCD) and initiating guideline-directed medical therapy (GDMT) has not been assessed.

Purpose

Examine PROs over 180 days of receiving GDMT for newly diagnosed HFrEF.

Methods

Patients (n=93, 75.3% male) were enrolled ≤10 days post-hospitalization for new onset HF; all patients had an EF ≤35% and were prescribed a WCD. Health status, as measured by PRO was assessed at baseline, day 90, and day 180. Controlling for age and EF at baseline, changes in PROs over the 180-day study period were evaluated using repeated measures modeling. Pairwise comparisons with Bonferroni adjustments were used to compare adjacent timepoints. Higher scores reflect better health status.

Results

After controlling for age (mean 56±13.4) and baseline EF (mean 22±7.7) improvements in health status were observed. From baseline to day 90, physical limitation, symptom frequency, QoL, and the summary score all increased (Δ: 17.8, 23.7, 28.4, 23.7, respectively; all p's &lt;0.05). From day 90 to day 180, only QoL continued to improve (Δ 7.5, p=0.001). Change in social limitations over time was not significant (p=0.42).

Conclusion

Patients report improved health status in the months following a new diagnosis of HFrEF when prescribed a WCD and GDMT.

Change in Quality of Life

Funding Acknowledgement

Type of funding source: None

Contemporary Understandings of Cardiovascular Disease After Cancer Radiotherapy: a Focus on Ischemic Heart Disease

PURPOSE OF REVIEW

Radiation-induced cardiovascular disease, including coronary artery disease, is a well-known sequela of radiation therapy and represents a significant source of morbidity and mortality for cancer survivors. This review examines current literature and guidelines to care for this growing population of cancer survivors.

RECENT FINDINGS

The development of radiation-induced ischemic heart disease following radiation can lead even to early cardiotoxicities, inclusive of coronary artery disease, which limit cancer treatment outcomes. These coronary lesions tend to be diffuse, complex, and proximal. Early detection with multimodality imaging and targeted intervention is required to minimize these risks. Early awareness, detection, and management of radiation-induced cardiovascular disease are paramount as cancer survivorship continues to grow.

Efficacy of adjunctive aripiprazole to lithium or valproate in the long-term treatment of mania in subjects with bipolar i disorder (CN138–189)

Objectives

To evaluate the long-term safety and efficacy of adjunctive aripiprazole (ARI) to lithium (LI) or valproate (VAL) in delaying time to relapse in bipolar I disorder.

Methods

Bipolar I disorder subjects with a current manic or mixed episode received LI or VAL for at least 2 weeks; inadequate responders (YMRS score ≥ 16 and ≤35% decrease from baseline at 2 weeks) received adjunctive ARI. Subjects maintaining mood stability (YMRS and MADRS ≤ 12 for 12 consecutive weeks) were randomised 1:1 to double-blind ARI (10 to 30 mg/day) or placebo (PBO) plus LI or VAL. Relapse was monitored up to 52 weeks.

Results

337 subjects were randomised to continuation of mood stabiliser plus adjunctive ARI or PBO; 61.3% and 52.7%, respectively, completed the study. Adjunctive ARI significantly delayed the time to any relapse, hazard ratio = 0.544 (95% CI: 0.33, 0.89, log-rank p = 0.014). Overall relapse rates at 52 weeks were 14.9% and 25.4% in ARI vs PBO subjects. A superior reduction in CGI-BP Mania Severity of Illness from baseline at 52 weeks was also observed (0.3 vs. 0.0, respectively, p = 0.01). Adverse events generally were as expected per known drug and illness profiles with no significant difference in mean change in body weight between adjunctive PBO (0.60 kg) and adjunctive ARI (1.07 kg) (p = 0.49 Week 52, LOCF).

Conclusion

Continuation of aripiprazole treatment increased time to relapse to any mood episode compared with placebo plus LI/VAL over 1 year, indicating a long-term benefit in continuing adjunctive aripiprazole to a mood stabiliser after sustained remission is achieved.

Personality dimensions and drug of choice: A descriptive study using Cloninger's temperament and character inventory revised

Personality dimensions related with drug use are novelty seeking, impulsivity and harm avoidance. Studies predicting drug of choice over personality variables are controversial.

Objective

To describe personality profile of drug users in relation to substance of choice.

Aims

To know personality dimension differences according to drug used.

Methods

Cloninger's TCI-R was administered to 218 patients in a dual diagnosis unit.

SPSS was applied.

Results

Of the patients, 33.94% had personality disorder. Principal substances used were alcohol, cocaine and cannabis.

Most of drug users had normal scores in each dimension. No high scores were found in reward dependence, self-directedness and cooperativeness with any drug.

High scores were observed for novelty seeking in 42.9% of timulants users; for arm avoidance in a quarter of cocaine, alcohol and methadone users and for persistence in 18.2% of hypnotics users.

Low scores were observed for reward dependence in 45% of heroine and hypnotics users; for persistence in 50% of methadone and 32% of cocaine users; for self-directedness in most of types of drug users and for cooperativeness in up to 50% in heroine, hypnotics, stimulants and cocaine users.

Statistical significant differences were observed for cocaine use and high novelty seeking and low cooperation; for non cannabis use and high harm avoidance; for non anfetamine use and low scores in reward dependence; for opiate use and low self-directedness.

Conclusions

Most of patients had normal scores in the different dimensions.

Presence of comorbid personality disorder led us to consider the results with caution.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Cardiovascular and other risk factors among people who live in slums in Buenos Aires, Argentina

OBJECTIVES

Effective planning of health policies requires the availability of accurate data, representing the burden of disease and risks to the diverse components of society. In Argentina, health information comes from the national risk factors survey (NRFS), which characterises the distribution of different risk factors. However, the NRFS has never collected information from residents living in slums, despite slums representing 10% of the population. The objective of this survey was to characterise the prevalence of cardiovascular and other risk factors among the inhabitants of one of the largest slums in Buenos Aires (Villa 31) and compare it to data from the NRFS.

STUDY DESIGN

This was a cross-sectional study.

METHODS

A cross-sectional study was carried out in 400 slum households, using the same data structure as the NRFS. The survey obtained information about economic aspects, reproductive health, addictions and risk factors. All participants had their blood pressure, weight and height measured. A total of 406 people were interviewed and their data were compared with data from 32,365 people in the NRFS. All comparisons were made on the basis of age group.

RESULTS

A fair/poor self-perceived level of health (odds ratio [OR] 3.19, 95% confidence interval [CI]: 2.60-3.91), anxiety and moderate to severe depression (OR 5.44, 95% CI: 4.43-6.69), problem drinking (OR 10.01, 95% CI 8.08-12.40), self-reported hypertension (OR 1.26, 95% CI: 1.01-1.57), overweight (OR 1.26, 95% CI: 1.03-1.55) and obesity (OR 1.72, 95% CI: 1.38-2.15) were significantly higher in the slum population. In people aged 18-24 years, the prevalence of diabetes was triple the national average (OR 3.17, 95% CI: 1.26-7.98). For all evaluated conditions in this study, the inhabitants of the slum received significantly less treatment compared with participants from the NRFS.

CONCLUSIONS

The prevalence of cardiovascular and other risk factors in the slum population has a different distribution to that reported in the NRFS. These data suggest the need to establish specific policies for slum populations.

Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

99 Effect of application of seminal plasma on Day 0, 5, or 7 postmating on pregnancy rate and embryonic survival in alpacas (Lama pacos)

Alpacas, similar to other camelids, are classified as induced ovulators, as an external stimulus is required for the occurrence of ovulation. A protein identified as β-nerve growth factor, present in the seminal plasma (SP), has the capacity to induce ovulation and corpus luteum formation. Alpacas exhibit poor reproductive efficiency, with birth rates below 50% due in part to high embryo mortality before 35 days post-mating. A study was carried out to evaluate the effect of the application of SP on Day 0, 5, or 7 post-mating on pregnancy rate and embryo survival, defined as the difference in the numbers of pregnant females between Day 35 and 25. Nonpregnant adult alpaca females (n=124) between 5 to 6 years old were evaluated by transrectal ultrasonography to determine presence of a follicle ≥7mm, and then 2 days later to confirm permanence of the follicle. Alpacas were then bred by natural mating and assigned randomly to 1 of 4 treatments: 1mL of SP IM at mating; 1mL of SP IM Day 5 post-mating; 1mL of SP IM Day 7 post-mating; and control. Semen was collected from adults male and ejaculates were diluted 1:1 with PBS and then centrifuged for 30min at 3000 rpm. Supernatant was separated and a drop evaluated to determine absence of spermatozoa and SP-free sperm was stored at −20°C. Twenty adult males with optimal reproductive performance were used for mating with females assigned to the different treatments. Animals were evaluated by ultrasound with an Aloka SSD 500 (Aloka, Tokyo, Japan) and 5.0-MHz linear transducer on Day 25 and 35 to determine pregnancy rate and embryonic survival. Data were analysed by chi-square. Results are present in Table 1. The results differ from our initial hypothesis and a possible explanations may be that additional application of SP IM could saturate receptors and block the action of the seminal plasma present in the ejaculate of males. Table 1.Pregnancy rate and embryonic survival in alpacas with application of seminal plasma on Day 0, 5, or 7 Study was supported by project no. 405-PNICP-PIAP-UNMSM.

Impact of the introduction of a nucleic acid amplification test for Clostridium difficile diagnosis on stool rejection policies

Background

The change from non-molecular to nucleic acid amplification tests (NAATs) is known to increase the detection of Clostridium difficile infection (CDI); however, the impact on stool rejection policies in clinical laboratories is unclear. The current guidelines have reinforced the importance of respecting strict conditions for performing tests on stool samples for CDI diagnosis. The purpose of this study was to estimate whether the implementation of molecular tests has resulted in changes in stool rejection policies between clinical laboratories that introduced NAATs and those that did not.

Results

A survey was conducted to evaluate the change in the number of stool samples rejected and the rejection criteria among 12 hospital laboratories in southwestern France before and after the switch from non-molecular tests to NAATs using retrospective data from June 1 till September 30, 2013 and the same period 2014. Four laboratories introduced NAATs as a second or third step in the process. A total of 1378 and 1297 stools samples were collected in 2013 and 2014, respectively. The mean number of rejected stool samples significantly increased (p < 0.001, Chi square test), with a total of 99 (7.1%) and 147 (11.3%) specimens rejected in 2013 and 2014, respectively. Notably, these laboratories had more stringent criteria and were no longer testing the stool samples of patients with CDI-positive results within 7 days. In contrast, there was a significant decrease in the rate of rejected stool samples (p < 0.001, Chi square test) in the five laboratories that did not adopt NAATs and a less stringent stool rejection policy.

Conclusion

Nucleic acid amplification test implementation improved compliance with recommended stool rejection policies. Laboratories should follow the recommended laboratory algorithm for the CDI diagnosis combined with the correct stool rejection policy.

Electronic supplementary material

The online version of this article (10.1186/s13099-018-0245-x) contains supplementary material, which is available to authorized users.

A Model for Estimation of the Pulmonary Capillary Pressure

To estimate the pulmonary capillary pressure, a theory was introduced by Holloway and coworkers. Based upon this, a mathematical model describing the measured data was developed. Because the physiologic data are embedded in noise and the pulmonary capillary pressure cannot be measured directly, we simulated an extensive series of data. The noise properties of the data were as analyzed to design a signal-processing tool, that cancels the noise from the measured data. The signal processing tool developed for the current application consists of pre-processing with a moving time average filter and post-processing with a neural network. After a verification procedure the tool can be applied to measured data, hence a more reliable measurement of the pulmonary capillary pressure is achieved.

[A case of gonococcal arthritis: Diagnostic difficulties and usefulness of synovial fluid PCR]

INTRODUCTION

The incidence of Neisseria gonorrhoeae septic arthritis remains low in the general population. Its clinical and microbiological diagnostic remains difficult.

CASE REPORT

We report a 44-year-old man who presented with a monoarthritis of the right ankle. The diagnosis of gonoccocal septic arthritis was obtained by PCR from the joint fluid. Treatment with ceftriaxone was effective.

CONCLUSION

In patients with high risk of N. gonorrhoeae infection, PCR for detection of gonorrhea in synovial fluid could potentially facilitate the diagnostic of gonococcal septic arthritis.

Effect of sperm pretreatment with glutathione and membrane destabilizing agents lysolecithin and Triton X-100, on the efficiency of bovine intracytoplasmic sperm injection

Intracytoplasmic sperm injection (ICSI) is an assisted reproduction tool with several applications. Its effectiveness in bovines is lower than that in other species, mainly because of difficulties in the decondensation of the sperm nucleus after injection, and the presence of the acrosome and the plasma membrane which remain intact in this procedure. In this study, we assessed the effect of lysolecithin (LL) and Triton X-100 (TX), in combination with glutathione (GSH) as sperm pretreatments prior to ICSI. The GSH-LL and GSH-TX groups showed 0% of spermatozoa with intact membrane (SYBR 14+/PI), in comparison with the control (63.3%) and GSH (65.7%) groups. The proportions of spermatozoa with damaged acrosome membrane in the GSH-LL, GSH-TX, GSH and control groups were 46%, 35.9%, 10.5% and 7.5%, respectively. Sperm chromatin decondensation analysis showed that the groups incubated for 3 hr with GSH presented greater decondensation (p < .05). Although fertilization was improved in all treatment groups evaluated, no differences were observed in the cleavage rate 72 hr after activation in the GSH (73.7%), GSH-LL (80.2%) and GSH-TX (77.8%) groups compared to the control (66.3%), neither in the blastocyst rate on day 8 (24.0%, 26.2%, 27.1% and 28.4% for the control, GSH, GSH-LL and GSH-TX groups, respectively). No differences were also observed in the total number of cells in all groups. In conclusion, although these sperm treatments promoted nuclear decondensation and induced plasma membrane disruption, these effects were not sufficient to improve bovine embryonic development after ICSI.