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Tuberous sclerosis complex is a rare genetic disorder leading to the growth of hamartomas in multiple organs, including cardiac rhabdomyomas. Children with symptomatic cardiac rhabdomyoma require frequent admissions to intensive care units, have major complications, namely, arrhythmias, cardiac outflow tract obstruction and heart failure, affecting the quality of life and taking on high healthcare cost. Currently, there is no standard pharmacological treatment for this condition, and the management includes a conservative approach and supportive care. Everolimus has shown positive effects on subependymal giant cell astrocytomas, renal angiomyolipoma and refractory seizures associated with tuberous sclerosis complex. However, evidence supporting efficacy in symptomatic cardiac rhabdomyoma is limited to case reports. The ORACLE trial is the first randomised clinical trial assessing the efficacy of everolimus as a specific therapy for symptomatic cardiac rhabdomyoma.
ORACLE is a phase II, prospective, randomised, placebo-controlled, double-blind, multicentre protocol trial. A total of 40 children with symptomatic cardiac rhabdomyoma secondary to tuberous sclerosis complex will be randomised to receive oral everolimus or placebo for 3 months. The primary outcome is 50% or more reduction in the tumour size related to baseline. As secondary outcomes we include the presence of arrhythmias, pericardial effusion, intracardiac obstruction, adverse events, progression of tumour reduction and effect on heart failure.
ORACLE protocol addresses a relevant unmet need in children with tuberous sclerosis complex and cardiac rhabdomyoma. The results of the trial will potentially support the first evidence-based therapy for this condition.
Although many mental health care systems provide care interventions that are not related to direct health care, little is known about the interfaces between the latter and core health care. ‘Core health care’ refers to services whose explicit aim is direct clinical treatment which is usually provided by health professionals, i.e., physicians, nurses, psychologists. ‘Other care’ is typically provided by other staff and includes accommodation, training, promotion of independence, employment support and social skills. In such a definition, ‘other care’ does not necessarily mean being funded or governed differently. The aims of the study were: (1) using a standard classification system (Description and Evaluation of Services and Directories in Europe for Long Term Care, DESDE-LTC) to identify ‘core health’ and ‘other care’ services provided to adults with mental health problems; and (2) to investigate the balance of care by analysing the types and characteristics of core health and other care services.
The study was conducted in eight selected local areas in eight European countries with different mental health systems. All publicly funded mental health services, regardless of the funding agency, for people over 18 years old were identified and coded. The availability, capacity and the workforce of the local mental health services were described using their functional main activity or ‘Main Types of Care’ (MTC) as the standard for international comparison, following the DESDE-LTC system.
In these European study areas, 822 MTCs were identified as providing core health care and 448 provided other types of care. Even though one-third of mental health services in the selected study areas provided interventions that were coded as ‘other care’, significant variation was found in the typology and characteristics of these services across the eight study areas.
The functional distinction between core health and other care overcomes the traditional division between ‘health’ and ‘social’ sectors based on governance and funding. The overall balance between core health and other care services varied significantly across the European sites. Mental health systems cannot be understood or planned without taking into account the availability and capacity of all services specifically available for this target population, including those outside the health sector.
Perovskites solar cells have reached impressive efficiencies (22%) in recent years. Because certain environmental concerns are raised by the use of lead halides, there is an interest to seek out lead-free alternatives, featuring bismuth or antimony. Alongside, one of the major drawbacks displayed by MAPbI3 is their low stability at ambient conditions. In this work, (RP4)xBiyIz were synthesized, using different types of tetra-alkylphosphoniums (R4PI) were R = ethyl, butyl, hexyl, and octyl, to assess their stability. Afterwards, they were characterized to study their morphology and crystal structure, as well as their optical properties.
Bovine leukaemia virus (BLV) is the causative agent of enzootic bovine leucosis, which has been reported worldwide. BLV has been found recently in human tissue and it could have a significant impact on human health. A possible hypothesis regarding viral entry to humans is through the consumption of infected foodstuffs. This study was aimed at detecting the presence of BLV DNA in raw beef and fresh milk for human consumption. Nested PCR directed at the BLV gag gene (272 bp) was used as a diagnostic test. PCR products were confirmed by Sanger sequencing. Forty-nine per cent of the samples proved positive for the presence of proviral DNA. This is the first study highlighting the presence of the BLV gag gene in meat products for human consumption and confirms the presence of the viral DNA in raw milk, as in previous reports. The presence of viral DNA in food products could suggest that viral particles may also be found. Further studies are needed to confirm the presence of infected viral particles, even though the present findings could represent a first approach to BLV transmission to humans through foodstuff consumption.
There is a need of more quantitative standardised data to compare local Mental Health Systems (MHSs) across international jurisdictions. Problems related to terminological variability and commensurability in the evaluation of services hamper like-with-like comparisons and hinder the development of work in this area. This study was aimed to provide standard assessment and comparison of MHS in selected local areas in Europe, contributing to a better understanding of MHS and related allocation of resources at local level and to lessen the scarcity in standard service comparison in Europe. This study is part of the Seventh Framework programme REFINEMENT (Research on Financing Systems’ Effect on the Quality of Mental Health Care in Europe) project.
A total of eight study areas from European countries with different systems of care (Austria, England, Finland, France, Italy, Norway, Romania, Spain) were analysed using a standard open-access classification system (Description and Evaluation of Services for Long Term Care in Europe, DESDE-LTC). All publicly funded services universally accessible to adults (≥18 years) with a psychiatric disorder were coded. Care availability, diversity and capacity were compared across these eight local MHS.
The comparison of MHS revealed more community-oriented delivery systems in the areas of England (Hampshire) and Southern European countries (Verona – Italy and Girona – Spain). Community-oriented systems with a higher proportion of hospital care were identified in Austria (Industrieviertel) and Scandinavian countries (Sør-Trøndelag in Norway and Helsinki-Uusimaa in Finland), while Loiret (France) was considered as a predominantly hospital-based system. The MHS in Suceava (Romania) was still in transition to community care.
There is a significant variation in care availability and capacity across MHS of local areas in Europe. This information is relevant for understanding the process of implementation of community-oriented mental health care in local areas. Standard comparison of care provision in local areas is important for context analysis and policy planning.
The major depression is associated with decreased cognitive functions in a range of areas, including attention, memory and executive functions. The cognitive symptoms of depression can have a profound effect on the ability of patients to keep out the tasks of daily living, and are significant factors that affect the ability to function both interpersonal and occupational level.
Vortioxetina have a multimodal action acting on various serotonin receptors in addition to inhibiting serotonin reuptake. Vortioxetina, is a new therapeutic tool seems to have shown efficacy in the treatment of cognitive symptoms of depression.
To evaluate this action we have evaluated the cognitive decline in patients with major depression before receiving treatment vortioxetina (whether state or not previously treated with other antidepressants) and at 2, 6 and 12 months after starting treatment with the drug. For that, we’ve used the Verbal Hearing Test King (RAVLT), which evaluates the auditory verbal short-term memory, the learning rate, the retention of information, and the differences between learning and recovery, and testing Digit substitution by symbols (DSST) that perform quick detection of brain dysfunctions by a conventional task.
The results of this study are still under analysis.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
I deficiency is still a worldwide public health problem, with children being especially vulnerable. No nationwide study had been conducted to assess the I status of Spanish children, and thus an observational, multicentre and cross-sectional study was conducted in Spain to assess the I status and thyroid function in schoolchildren aged 6–7 years. The median urinary I (UI) and thyroid-stimulating hormone (TSH) levels in whole blood were used to assess the I status and thyroid function, respectively. A FFQ was used to determine the consumption of I-rich foods. A total of 1981 schoolchildren (52 % male) were included. The median UI was 173 μg/l, and 17·9 % of children showed UI<100 μg/l. The median UI was higher in males (180·8 v. 153·6 μg/l; P<0·001). Iodised salt (IS) intake at home was 69·8 %. IS consumption and intakes of ≥2 glasses of milk or 1 cup of yogurt/d were associated with significantly higher median UI. Median TSH was 0·90 mU/l and was higher in females (0·98 v. 0·83; P<0·001). In total, 0·5 % of children had known hypothyroidism (derived from the questionnaire) and 7·6 % had TSH levels above reference values. Median TSH was higher in schoolchildren with family history of hypothyroidism. I intake was adequate in Spanish schoolchildren. However, no correlation was found between TSH and median UI in any geographical area. The prevalence of TSH above reference values was high and its association with thyroid autoimmunity should be determined. Further assessment of thyroid autoimmunity in Spanish schoolchildren is desirable.
Capgras syndrome is the most frequent delusional misidentification syndrome (DMS) which was first described in 1923 by Capgras and Reboul-Lachaux as ‘L’illusion des sosies’. Consists of believe that close relatives have been replaced by nearly identical impostors. It can occur in the context of psychiatric disorders (schizophrenia, major depression) such organic, in which onset of delirium is usually later coinciding with neurological damage or neurodegenerative disease.
Woman 73-year-old diagnosed of schizophrenia since more than thirty years ago. Her family talk about general impairment of the patient in the last two years. She needed a couple of psychiatric hospitalizations because of her psychiatric disease, and probably onset of cognitive impairment. In this context, we objectified the presence of a Capgras syndrome.
To review the literature available about Capgras syndrome in elderly and illustrate it with a clinical case.
Review of literature about Capgras syndrome in elderly by searching of articles in the PubMed database of the last five years to illustrate the exposure of a single case report.
The etiology of this syndrome is not yet well understood. Advanced age is frequently found Capgras syndrome with or without the concomitant presence of an obvious cognitive impairment.
Since it is a complex process an etiological model that combines cognitive and perceptual deficits, organic impairment and psychodynamic factors should be proposed. And it is important to make a correct differential diagnosis that allows us to carry out the best possible treatment.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Delusional of parasitosis or Ekbom's syndrome (ES) is a psychiatric disorder in which the patient has a fixed and false belief that small organisms infest the body. The belief is often accompanied by hallucinations. It is an uncommon condition that was initially studied by dermatologists, more prevalent in the elderly and typically observed in women older than 50 years although isolated cases among men have been reported.
To review current knowledge about delusional of parasitosis in elderly patients through literature systematic review and the analysis of a case report.
We performed a literature search using electronic manuscripts available in PubMed database published during the last five years, following the description and discussion of a clinical case. We report a case of an 85-year-old man who presented a delusional parasitosis as a primary disorder.
The literature on ES consists mostly of case reports and limited series. In this paper, we analyze the etiology, demographic characteristics, clinical features and treatment in geriatric patients with delusional parasitosis.
International classifications have included this syndrome in non-schizophrenic delusions. However, it has also been reported in schizophrenia, affective disorders, and organic or induced psychosis. Treatment is based on antipsychotic agents, psychotherapy and cooperation between dermatologists and psychiatrists.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Development of polymers with antimicrobial characteristics can avoid deterioration and assist in containing spread of pathogens harmful to human health. This study aimed to compare the antimicrobial and mechanical properties of polymeric matrices containing organic antimicrobial additives. Silver organomodified bentonite (Ag_bentonite) and organochlorine molecule in a masterbatch based polyethylene (Cl_PE) were tested in proportion of 2% in a thermoplastic elastomeric formulation. The polymeric matrices were prepared by melt mixing and evaluated in tensile and antimicrobial properties against Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) strains. The additives were characterized by thermogravimetric analysis (TGA) and scanning electron microscopy (SEM). The nanoscale of Ag_bentonite was verified by SEM. TGA assay showed that Cl_PE is more sensitive to heat than Ag_bentonite. As a result of this lower thermal stability, the addition of Cl_PE reduced the tensile properties of the compound. The sample with Cl_PE was effective against both bacterial strains, reducing the populations of S. aureus and E. coli in 99 and 96%, respectively. The addition of Ag_bentonite did not affect the tensile strength and decreased in 97 and 40% S. aureus and E. coli populations, respectively. The results indicate that the use of organic additives is promissory, but further modifications in processing must be necessary.
Carbon nanotubes (CNTs) were synthesized by Chemical Vapor Deposition (CVD) from diethyl ether, butanol, hexane and ethyl acetate. A quartz tube with a stainless steel tube catalyst core with 0.019 m diameter and 0.6 m large formed the reactor. To avoid combustion, argon was used as the carrier gas. Time process ranged 30 to 60 min. The range of CNTs synthesis temperature was 680-850 °C for different precursors. Scanning Electron Microscopy micrographs have demonstrated tangled CNTs growth in all samples, thus presenting difficult length measurement. The CNTs diameters from diethyl ether are 45-200 nm, butanol diameter range from 55-230 nm, hexane diameter range is 50-130 nm and ethyl acetate range from 100 to 300 nm. Carbon content for all samples was higher than 93 %, CNTs from butanol showed carbon concentration up to 99%. FTIR, Raman and X-Ray Spectroscopies spectra for all samples demonstrated the characteristics signals present in carbon nanotubes. This research proposes a simple, effective and innovative method to synthesize CNTs by CVD on iron stainless steel catalyst in combination with diethyl ether, ethyl acetate, butanol and hexane as precursors by applying the principles of green chemistry, sustainability and its ease to be scaled.
Gold nanoparticles can be used as ultimate electrical materials for storing electrons or controlling their flow for the next generation nano-electronic devices. These particles are the core element of assemblies where the electrical current is reduced to the smallest possible since electrons are controlled one by one by using the Coulomb blockade phenomenon. We prepared colloidal gold nanoparticles beteween 4 and 15 nm and grafted them on a grafted organic monolayer (GOM) on silicon. GOM are highly ordered monolayers prepared by hydrosilylation of alkene molecules and subsequently modified with an amine group so that gold nanoparticles can be firmly immobilized on top of the layer. We discuss several electrical properties at a single electron level. Using the conductive tip of KPFM, we were also able to reveal the spontaneous charging behavior of the gold nanoparticles so that the local work function of a 10 nm gold nanoparticle is only 3.7 eV. By placing an STM tip above a nanoparticle, Coulomb blockade allows controlling the number of electrons simultaneously injected in the nanoparticle. This opens the way for new kinds of single electron memories or single electron transistors.
A nanoporous carbon (C) material, functionalized with Cobalt-Oxide/Cobalt
(CoO/Co) core-shell nanoparticles (NPs), was structurally and chemically
characterized with transmission electron microcopy (TEM) while its
electrochemical response for Lithium ion battery (LIB) applications was
evaluated as well. The results herein show that the nanoporous C material was
uniformly functionalized with the CoO/Co core-shell NPs. Further the NPs were
crystalline with fcc-type lattice on the Co2+ oxide shell
and hcp-type core of metallic Co0. The electrochemical study was
carried out by using galvanostatic charge/discharge cycling at a current density
of 1000 mA g−1. The potential of this hybrid material for
LIB applications was confirmed and it is attributed to the successful dispersion
of the Co2+/ Co0 NPs in the C support.
Gravity wave turbulence is investigated experimentally in a large wave basin in which irregular waves are generated unidirectionally. The roles of the basin boundary conditions (absorbing or reflecting) and of the forcing properties are investigated. To that purpose, an absorbing sloping beach opposite the wavemaker can be replaced by a reflecting vertical wall. We observe that the wave field properties depend strongly on these boundary conditions. A quasi-one-dimensional field of nonlinear waves propagates towards the beach, where they are damped whereas a more multidirectional wave field is observed with the wall. In both cases, the wave spectrum scales as a frequency power law with an exponent that increases continuously with the forcing amplitude up to a value close to
. The physical mechanisms involved most likely differ with the boundary condition used, but cannot be easily discriminated with only temporal measurements. We also studied freely decaying gravity wave turbulence in the closed basin. No self-similar decay of the spectrum is observed, whereas its Fourier modes decay first as a time power law due to nonlinear mechanisms, and then exponentially due to linear viscous damping. We estimate the linear, nonlinear and dissipative time scales to test the time scale separation that highlights the important role of a large-scale Fourier mode. By estimation of the mean energy flux from the initial decay of wave energy, the Kolmogorov–Zakharov constant of the weak turbulence theory is evaluated and found to be compatible with a recently obtained theoretical value.
In vitro gas production studies are routinely used to assess the metabolic capacity of intestinal microbiota to ferment dietary fibre sources. The faecal inocula used during the in vitro gas production procedure are most often obtained from animals adapted to a certain diet. The present study was designed to assess whether 19 days of adaptation to a diet are sufficient for faecal inocula of pigs to reach a stable microbial composition and activity as determined by in vitro gas production. Eighteen multiparous sows were allotted to one of two treatments for three weeks: a diet high in fibre (H) or a diet low in fibre (L). After this 3-week period, the H group was transferred to the low fibre diet (HL-treatment) while the L group was transferred to the diet high in fibre (LH-treatment). Faecal samples were collected from each sow at 1, 4, 7, 10, 13, 16 and 19 days after the diet change and prepared as inoculum used for incubation with three contrasting fermentable substrates: oligofructose, soya pectin and cellulose. In addition, inocula were characterised using a phylogenetic microarray targeting the pig gastrointestinal tract microbiota. Time after diet change had an effect (P<0.05) on total gas production for the medium–fast fermentable substrates; soya pectin and oligofructose. For the more slowly fermentable cellulose, all measured fermentation parameters were consistently higher (P<0.05) for animals in the HL-treatment. Diet changes led to significant changes in relative abundance of specific bacteria, especially for members of the Bacteroidetes and Bacilli, which, respectively, increased or decreased for the LH-treatment, while changes were opposite for the HL-treatment. Changing the diet of sows led to changes in fermentation activity of the faecal microbiota and in composition of the microbiota over time. Adaptation of the microbiota as assessed by gas production occurred faster for LH-animals for fast fermentable substrates compared with HL-animals. Overall, adaptation of the large intestinal microbiota of sows as a result of ingestion of low and high fibre diets seems to take longer than 19 days, especially for the ability to ferment slowly fermentable substrates.
Blood vessel expansion and reduction in the corpus luteum (CL) is regulated by the vascular endothelial growth factor (VEGF) system and linked to the maintenance of the CL. The VEGF system has both angiogenic and antiangiogenic ligands and receptors. Our objective was to evaluate the relationship between the mRNA expression of angiogenic and antiangiogenic members of the VEGF system in the CL, throughout the luteal phase of the oestrous cycle in cows. The CL of 18 cows were collected by transvaginal surgery on days 4, 6, 9, 12, 15 and 18 of the oestrous cycle and the mRNA expression of VEGF system components was evaluated by quantitative real-time PCR. The mRNA expression of VEGF ligands and receptors increased (P<0.05) from the early- and mid-luteal phase (days 4 to 12) reaching its maximum expression on day 15 of the cycle. We found no expression of VEGF164b throughout the cycle. Expression of sVEGFR1 did not change during the oestrous cycle and exceeded that of the VEGFR1 by 100 times. Nonetheless, as VEGFR1 increased, the relationship between the soluble and membrane receptor decreased (P<0.01). In contrast, the expression of VEGFR2 was higher than that of its soluble isoform for all days studied, however, the ratio between the membrane-bound and its soluble counterpart decreased continuously throughout the cycle (P<0.01). Our results show that the expression levels for VEGF ligands, receptors and their antagonistic counterparts are adjusted during CL development and regression, to upregulate angiogenesis early in the oestrous cycle and restrict it at the time of luteolysis.
The in vitro leishmanicidal activity and cytotoxicity of pyrazole-containing macrocyclic polyamines 1–4 was assayed on Leishmania infantum and Leishmania braziliensis species. Compounds 1–4 were more active and less toxic than glucantime and both infection rates and ultrastructural alterations confirmed that 1 and 2 were highly leishmanicidal and induced extensive parasite cell damage. Modifications in the excretion products of parasites treated with 1–3 were also consistent with substantial cytoplasm alterations. Compound 2 was highlighted as a potent inhibitor of Fe-SOD in both species, whereas its effect on human CuZn-SOD was poor. Molecular modelling suggested that 2 could deactivate Fe-SOD due to a sterically favoured enhanced ability to interact with the H-bonding net that supports the enzyme`s antioxidant features.