Acculturation, coping, and PTSD in Hispanic 9/11 rescue and recovery workers

Objective: Research examining the responders of the World Trade Center terrorist attacks of 9/11 has found that Hispanic responders are at greater risk for posttraumatic stress disorder (PTSD) than non-Hispanic White responders. However, no studies have examined how acculturation may influence the relationship between coping and PTSD in Hispanic 9/11 responders. This novel study is the first to examine differences in coping and PTSD among Hispanic responders by level of acculturation. Methods: The sample is composed of 845 Hispanic 9/11 responders who were seen at the World Trade Center Health Program and participated in a web-based survey. Using logistic and multiple linear regression, we examined how acculturation is related to their coping strategies and risk for PTSD. We also tested for interaction to examine whether level of acculturation moderated the relationship between coping and PTSD symptom severity. Results: Key findings revealed that higher acculturation is associated with the use of substances, venting, and humor to cope, while lower acculturation is associated with the use of active coping and self-distraction in this sample. We also found that less acculturated responders were more likely to experience more severe PTSD. Lastly, our findings revealed that Hispanics who are more acculturated and used substances to cope had more severe PTSD than less acculturated responders. Conclusion: These findings highlight the need to consider the role of acculturation in Hispanic responders' coping and PTSD. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Latent-transforming growth factor beta-binding protein-2 (LTBP-2) is required for longevity but not for development of zonular fibers

Latent-transforming growth factor beta-binding protein 2 (LTBP-2) is a major component of arterial and lung tissue and of the ciliary zonule, the system of extracellular fibers that centers and suspends the lens in the eye. LTBP-2 has been implicated previously in the development of extracellular microfibrils, although its exact role remains unclear. Here, we analyzed the three-dimensional structure of the ciliary zonule in wild type mice and used a knockout model to test the contribution of LTBP-2 to zonule structure and mechanical properties. In wild types, zonular fibers had diameters of 0.5-1.0 micrometers, with an outer layer of fibrillin-1-rich microfibrils and a core of fibrillin-2-rich microfibrils. LTBP-2 was present in both layers. The absence of LTBP-2 did not affect the number of fibers, their diameters, nor their coaxial organization. However, by two months of age, LTBP-2-depleted fibers began to rupture, and by six months, a fully penetrant ectopia lentis phenotype was present, as confirmed by in vivo imaging. To determine whether the seemingly normal fibers of young mice were compromised mechanically, we compared zonule stress/strain relationships of wild type and LTBP-2-deficient mice and developed a quasi-linear viscoelastic engineering model to analyze the resulting data. In the absence of LTBP-2, the ultimate tensile strength of the zonule was reduced by about 50%, and the viscoelastic behavior of the fibers was altered significantly. We developed a harmonic oscillator model to calculate the forces generated during saccadic eye movement. Model simulations suggested that mutant fibers are prone to failure during rapid rotation of the eyeball. Together, these data indicate that LTBP-2 is necessary for the strength and longevity of zonular fibers, but not necessarily for their formation.

Autogenous transfer of intracytoplasmic sperm injection-produced equine embryos into the uterus of the oocyte donor during the same oestrous cycle

The clinical use of intracytoplasmic sperm injection (ICSI) in horses usually involves the transfer of embryos into recipient mares, resulting in substantial cost increases. This is essential when subfertile mares are oocyte donors; but some donors are fertile, with ICSI compensating for limited or poor-quality spermatozoa. Fertile oocyte donors could carry pregnancies, eliminating the need for a recipient. We assessed the potential of using oocyte donors as recipients for their own ICSI-produced embryos during the same cycle. Donors in oestrus and with large dominant follicles were administered ovulation-inducing compounds to cause follicle and oocyte maturation. Maturing oocytes were collected, cultured and fertilised using ICSI. At 6 or 7 days after ICSI, developing blastocysts were transferred into respective donors' uteri, and pregnancy rates were determined. Twenty follicles were aspirated from nine mares and 12 oocytes were collected. After ICSI, 10 of the 12 oocytes (83%) cleaved, and eight (67% of injected oocytes) developed into blastocysts for transfer. Five pregnancies resulted from the eight transferred embryos (pregnancy rate 62% per embryo and 42% per sperm-injected oocyte). Following this synchronisation regime, ICSI-produced embryos can be transferred into oocyte donors' uteri during the same cycle, allowing donors to carry pregnancies after assisted fertilisation.

AB0594 EFFECTIVENESS OF RITUXIMAB IN CSDMARDS-RESISTANT ACTIVE MIXED CONNECTIVE TISSUE DISEASE

Background:

Objectives:

To evaluate rituximab (RTX) effectiveness and safety in treating patients with refractory mixed connective tissue disease (MCTD).

Methods:

Open observational study including patients with refractory MCTD (active disease despite treatment with glucocorticoids and csDMARDs) from two third-level hospitals who had been treated with RTX (off-label use) from January 2001 to December 2019.

Results:

Thirteen patients (all women) were included, with a mean age of 32 years (SD: 10, range 17-50) and a median time of evolution of the disease of 55 months (SD: 34.3; range 5-98 months). The main indication for initiating treatment with RTX was refractory arthritis (100%), most of the times accompanied by other features of the disease including shrinking lung syndrome (2), fibrosing progressive non-specific interstitial pneumonia (FP-NSIP) (1), recurrent serositis (2), glomerulonephritis (GMN) (2), lymphadenitis (1) and immune thrombocytopenic purpura (ITP) (1). All patients were treated with RTX at rheumatoid arthritis dosage while the baseline immunosuppressive treatment (methotrexate, azathioprine, mycophenolate, leflunomide or tacrolimus) remained unchanged. Hydroxychloroquine was also associated in 8 of the patients. The follow-up time (median) after starting RTX was 118 months (range, 65-177 months, with a total of 132.6 patient-years of follow-up) and the mean number of cycles of treatment was 4.2 (range, 1-15), with a variable interval (from 6 to 12 months). After the first RTX cycle, a partial or complete response was achieved in 92% of the patients. A significant improvement in the mean DAS28-ESR was observed (initial: 4.56 ± 1.6 / final: 2.21 ± 0.85; p=0.008). In all but one patient, who had previously failed to 2 anti-TNFα DAS28-ESR clinical remission or low activity was achieved, generally from week 16 to 20, although relapses were frequent and all cases need retreatment after 6-9 months. In 4 patients, RTX retreatment dosage was optimized to 1 g/cycle. The 3 patients with pulmonary involvement showed stabilization (2 cases) or improvement (1) of the lung function(as defined by the American Thoracic Society). In patients with GMN, renal response to RTX treatment was complete in a patient and partial in the other. The patient with ITP entered remission after the first RTX cycle and no more cycles were needed. Response in patients with serositis and lymphadenitis was also complete and maintained. Moreover, the glucocorticoid doses were reduced to less than half of the initial dose in all cases. At the end of the follow-up, 7 out of the 13 patients (54%) were still being treated with RTX. For the remaining 6 patients, RTX was withdrawn because of primary failure (1), recurrent bacterial infections (2), gestational desire (2) sustained remission (1).

Conclusion:

According to our preliminary results, RTX seems to be effective and relatively safe in patients with csDMARDs-resistant active MCTD.

Disclosure of Interests:

L Montolio-Chiva: None declared, J. Narváez: None declared, Juanjo J Alegre-Sancho Consultant of: UCB, Roche, Sanofi, Boehringer, Celltrion, Paid instructor for: GSK, Speakers bureau: MSD, GSK, Lilly, Sanofi, Roche, UCB, Actelion, Pfizer, Abbvie, Novartis, J Lluch Pons: None declared, Ana V Orenes Vera: None declared, I Vázquez-Gómez: None declared, Maribel Mora: None declared, Xavier González: None declared, Carla Marco: None declared, Jesús Rodriguez: None declared, Montserrat Romera: None declared, Joan Miquel Nolla: None declared

Natural History of Perianal Fistulising Lesions in Patients With Elderly-onset Crohn's Disease: A Population-based Study

INTRODUCTION

Most studies of elderly-onset Crohn's disease [CD; diagnosed in patients aged 60 or over] have described a mild course. However, data on the natural history of perianal fistulising CD [pfCD] in this population are scarce. In a population-based cohort study, we described the prevalence, natural history, and treatment of pfCD in patients with elderly-onset CD vs patients with paediatric-onset CD.

METHOD

All patients diagnosed with CD at or after the age of 60 between 1988 and 2006, were included [n = 372]. Logistic regression, Cox models, and a nested case-control method were used to identify factors associated with pfCD.

RESULTS

A total of 34 elderly patients [9% of the 372] had pfCD at diagnosis. After a median follow-up of 6 years (interquartile range [IQR]: 3; 10), 59 patients [16%] had pfCD; the same prevalence [16%] was observed in paediatric-onset patients. At last follow-up, anal incontinence was more frequent in elderly patients with pfCD than in elderly patients without pfCD [22% vs 4%, respectively; p < 10-4]. Rectal CD at diagnosis was associated with pfCD: hazard ratio (95% confidence interval [CI] = 2.8 [1.6-5.0]). Although 37% of the patients received immunosuppressants and 17% received anti-tumour necrosis factor agents, 24% [14 out of 59] had a definitive stoma at last follow-up.

CONCLUSION

During the first 6 years of disease, the prevalence of pfCD was similar in elderly and paediatric patients. Rectal involvement was associated with the appearance of pfCD in elderly-onset patients. Around a quarter of patients with elderly-onset CD will have a stoma. Our results suggest that treatment with biologics should be evaluated in these patients.

The FiberTAG project: Tagging dietary fibre intake by measuring biomarkers related to the gut microbiota and their interest for health

The scientific rationale for dietary fibre intake recommendations comes from the recognition of their benefits for health based on studies first published many years ago. It remains unclear which are the key physiological effects generated by dietary fibre in view of the diversity of the food components considered as dietary fibre, of the relevance of their classification (soluble and insoluble) and from the recent discoveries putting forward their interactions with the gut microbiota. The project FiberTAG (Joint Programming Initiative 'A Healthy Diet for a Healthy Life' 2017-2020 https://www.fibertag.eu/) aims to establish a set of biomarkers (markers of gut barrier function and bacterial co-metabolites including volatile compounds and lipid derivatives), measured in different biological compartments (faeces, blood or breath) linking dietary fibre intake and gut microbiota-related health effects. The FiberTAG consortium brings together academic and industrial partners from Belgium, France, Germany and Canada to share data and samples obtained from existing as well as new intervention studies in order to evaluate the relevance of such biomarkers. The FiberTAG consortium is currently working on five existing cohorts (prospective observational or nutritional interventions in healthy or obese patients), and a number of new intervention studies to analyse the effect of insoluble dietary fibre (wheat bran and chitin-glucan, provided by the industrial partners) in healthy individuals or in obese patients at high cardiometabolic risk.

The Burden of Subthreshold Posttraumatic Stress Disorder in World Trade Center Responders in the Second Decade After 9/11

OBJECTIVE

To characterize the prevalence, risk and protective correlates, and clinical characteristics associated with probable subthreshold posttraumatic stress disorder (PTSD) in police and nontraditional (eg, construction workers) World Trade Center (WTC) responders a median of 12.2 years after September 11, 2001.

METHODS

A total of 4,196 WTC responders, monitored via the WTC Health Program, completed a web-based survey between 2012 and 2014 assessing a range of variables, including demographics, WTC exposures, medical and psychiatric comorbidities, and mental health services use. The sample included 2,029 police responders and 2,167 nontraditional responders. Current (past-month) probable WTC-related PTSD level (none, subthreshold, or full PTSD) was assessed based on DSM-IV criteria using the PTSD Checklist-Specific Stressor version (PCL-S).

RESULTS

The prevalence of current probable full and subthreshold WTC-related PTSD in police responders was 9.3% and 17.5%, respectively, and in nontraditional responders was 21.9% and 24.1%, respectively. Risk and protective correlates for subthreshold PTSD included post-9/11 medical comorbidities and traumatic events (odds ratios [ORs] = 1.1-1.2). Clinical characteristics included elevated rates of comorbid depression (OR = 3.2 and 3.9 for subthreshold PTSD and 17.2 and 30.3 for full PTSD for nontraditional and police responders, respectively). Among responders with subthreshold PTSD, police were more likely to have accessed mental health services and utilized a greater variety of treatments than nontraditional responders.

CONCLUSIONS

Overall, 26.8% of police and 46.0% of nontraditional responders met criteria for probable WTC-related full or subthreshold PTSD an average of 12 years after 9/11. Probable subthreshold PTSD, which is not typically assessed in clinical settings, was more prevalent than probable full PTSD and was associated with significantly elevated rates of psychiatric comorbidities, functional impairment, and reduced quality of life. These findings underscore the importance of assessing, monitoring, and possibly treating subthreshold PTSD in WTC and other disaster responders.

SuperCam Calibration Targets: Design and Development

SuperCam is a highly integrated remote-sensing instrumental suite for NASA's Mars 2020 mission. It consists of a co-aligned combination of Laser-Induced Breakdown Spectroscopy (LIBS), Time-Resolved Raman and Luminescence (TRR/L), Visible and Infrared Spectroscopy (VISIR), together with sound recording (MIC) and high-magnification imaging techniques (RMI). They provide information on the mineralogy, geochemistry and mineral context around the Perseverance Rover. The calibration of this complex suite is a major challenge. Not only does each technique require its own standards or references, their combination also introduces new requirements to obtain optimal scientific output. Elemental composition, molecular vibrational features, fluorescence, morphology and texture provide a full picture of the sample with spectral information that needs to be co-aligned, correlated, and individually calibrated. The resulting hardware includes different kinds of targets, each one covering different needs of the instrument. Standards for imaging calibration, geological samples for mineral identification and chemometric calculations or spectral references to calibrate and evaluate the health of the instrument, are all included in the SuperCam Calibration Target (SCCT). The system also includes a specifically designed assembly in which the samples are mounted. This hardware allows the targets to survive the harsh environmental conditions of the launch, cruise, landing and operation on Mars during the whole mission. Here we summarize the design, development, integration, verification and functional testing of the SCCT. This work includes some key results obtained to verify the scientific outcome of the SuperCam system.

Mueller matrix of the particle-free atmospheric enhanced backscatter

The spatially resolved Mueller matrix of a mono-static optical system with the corner-cube retro-reflector operating in the presence of clear-air atmospheric turbulence is measured for the first time, to the best of our knowledge. The changes in the polarization properties of the beam are caused by the combination of deterministic polarimetric modulation by the retro-reflector and random scalar modulation of the return beam by atmospheric turbulence. In particular, the spatial structure of the Mueller matrix within the enhanced backscatter area is revealed.

P1475Risk stratification after STEMI. Ejection fraction by echocardiography as the gatekeeper for a selective use of cardiac magnetic resonance

Introduction

Cardiac magnetic resonance (CMR) has emerged as the most potent non-invasive imaging technique for risk stratification after ST-segment elevation myocardial infarction (STEMI) but an indiscriminate use in all patients is unfeasible. Echocardiography (Echo) has been universally used for prognostication in this scenario. We hypothesized that left ventricular ejection fraction (LVEF) by Echo can represent the gatekeeper for selecting those patients who benefit most from CMR for prognostic purposes.

Methods

Data were obtained from a large prospective registry of reperfused STEMI patients (n=516) in whom Echo (2D and Doppler variables) and CMR (cine images, microvascular obstruction and infarct size) were simultaneously recorded at pre-discharge (7±2 days). Major adverse cardiac events (MACE) were defined as a combined clinical end-point: death or re-admission for acute heart failure (whichever occurred first). Patients were categorized in reduced LVEF (r-LVEF, <40%), mid-range LVEF (mr-LVEF, 40–49%) and preserved LVEF (p-LVEF, ≥50%). Hierarchical multivariate Cox regression analyses including first clinical+Echo variables and then CMR variables where carried out. C-statistics, “net reclassification” (NRI) and “integrated discrimination” (IDI) indexes were obtained.

Results

During a mean and median follow-up of 4 years, 86 first MACE (17%) were registered (39 deaths and 47 re-admissions for acute heart failure). In the whole study group (n=516), the independent predictors of MACE were time to revascularization (min), GRACE score, CMR-LVEF (%) and CMR-microvascular obstruction (% of LV mass); C-statistic 0.82 (p<0.001). The MACE rate in patients with r-LVEF, mr-LVEF and p-LVEF was 47%, 23% and 11% by Echo-LVEF and 45%, 17% and 8% by CMR-LVEF. LVEF was lower by CMR than by Echo (51±13 vs. 54±10, p<0.001) and r-LVEF was more frequently detected by CMR (n=94, 18%) than by Echo (n=48, 9%), p<0.001. CMR significantly improved clinical+Echo stratification in those 112 patients (22%) with mr-Echo-LVEF (C-statistitics 0.74 vs 0.82; NRI and IDI: p<0.05) but it did not in those 355 patients (69%) with p-Echo-LVEF (C-statistitics 0.75 vs 0.76; NRI and IDI: non-significant) and in those 49 patients (9%) with r-Echo-LVEF (C-statistitics 0.77 vs 0.77; NRI and IDI: non-significant).

Figure 1. Risk stratification after STEMI

Conclusions

Applied in an individualized manner, Echo-LVEF appears as a useful gatekeeper for a selective use of CMR soon after STEMI for prognostic purposes. The event rate is high in patients with reduced Echo-LVEF and low in those with preserved Echo-LVEF; CMR does not seem to significantly improve risk stratification in these scenarios. Nevertheless, the occurrence of mid-range Echo-LVEF permits discriminating the specific subset of STEMI patients (less than a quarter) who really benefit from pre-discharge CMR in terms of risk assessment.

Acknowledgement/Funding

Funded by “Instituto de Salud Carlos III”/FEDER (PIE15/00013, PI17/01836, and CIBERCV16/11/00486 grants) and Generalitat Valenciana (GV/2018/116).

P6397Ejection fraction by cardiac magnetic resonance 6 months after STEMI: impact on risk stratification in chronic phase

Background

Left ventricular ejection fraction (LVEF) has traditionally been used as the cornerstone for risk stratification after STEMI and it can be accurately quantified by cine cardiovascular magnetic resonance (CMR). In recent years, the additional prognostic value of contrast CMR-derived infarct size (IS) and microvascular obstruction (MVO) soon after infarction has been demonstrated. The usefulness of CMR-derived LVEF in chronic phase for risk stratification late after STEMI is unclear.

Purpose

We hypothesized that 6-month CMR-derived LVEF can contribute in the prediction of clinical events late after STEMI beyond pre-discharge LVEF, IS and MVO.

Methods

Data were obtained from a prospective registry of reperfused STEMI patients (n=456) who were stable 6 months after infarction and in whom 1-week and 6-month CMR-derived LVEF, IS and MVO were sequentially quantified. Major adverse cardiac events (MACE) were defined as a combined clinical end-point that included death or re-admission for acute decompensated heart failure (r-ADHF), whichever occurred first, occurring after the 6-month CMR.

Results

During a mean and median follow-up of 6 years, 56 late MACE (12%, 32 deaths and 24 r-ADHF) were registered. From 1-week to 6-month, CMR parameters exhibited significant dynamic changes (p<0.001): LVEF improved (52±12 vs. 56±13%), IS decreased (21±14 vs. 18±12% of LV mass) and MVO vanished (2±4 vs. 0±1% of LV mass). At 6-month CMR, 60 patients (13%) displayed reduced LVEF (<40%), 69 (15%) mid-range LVEF (40–50%) and 327 (72%) preserved LVEF (≥50%). Late MACE rates were 28% in patients with reduced LVEF, 14% in those with mid-range LVEF and 9% in those with preserved LVEF at 6-month CMR (p<0.001 for the trend). After adjustment for baseline characteristics and for 1-week and 6-month CMR parameters, more preserved LVEF at 6 months independently associated with a lower risk of MACE late after STEMI (hazard ratio 0.96 [0.94–0.98] per 1% increase).

Conclusions

Dramatic dynamic changes occur in CMR parameters within the first months after STEMI. Reassessment of CMR-derived LVEF in chronic phase in those patients who remain stable provides relevant prognostic information for long-term risk stratification.

Acknowledgement/Funding

Funded by “Instituto de Salud Carlos III”/FEDER (PIE15/00013, PI17/01836, and CIBERCV16/11/00486 grants) and Generalitat Valenciana (GV/2018/116).