Description of the consumption of toxics in patients with assertive community treatment and prolonged release treatment

Introduction

The Assertive Community Treatment (ACT) was developed by Leonard Stein and Mary Ann. The objective is the treatment of serious Mental Disorders in an integral way and in the community.

Objectives

The Assertive Community Treatment (ACT) was developed by Leonard Stein and Mary Ann. The objective is the treatment of serious Mental Disorders in an integral way and in the community.

Methods

This is a retrospective study with a total of 69 patients whose main diagnosis is Schizophrenia undergoing CT follow-up in 2018-2019. The data obtained have been analyzed by the SPSS statistical program.

Results

Our sample is mainly composed of men (60.9%) with an average age of 48 years (+ - 11.56). The main diagnosis is schizophrenia (62.3%) and the most commonly used long-term injectable treatment is paliperidone palmitate with a dose range of 150mg. Of the total number of patients, 29% of the cases did not maintain active use of any toxic, and the most commonly used toxic is tobacco (49.3% of cases).

Conclusions

The inclusion of patients in a ACT program requires a diagnosis of severe Mental Disorder and poor therapeutic adherence. After analyzing our data, we observed that most of them also have active toxic consumption and high doses of psychotropic drugs.

Disclosure

No significant relationships.

Local versus long-range connectivity patterns of auditory disturbance in schizophrenia

Auditory hallucinations are a debilitating symptom of schizophrenia. Effective treatment is limited because the underlying neural mechanisms remain unknown. Our study investigates how local and long-range functional connectivity is associated with auditory perceptual disturbances (APD) in schizophrenia. APD was assessed using the Auditory Perceptual Trait and State Scale. Resting state fMRI data were collected for N=99 patients with schizophrenia. Local functional connectivity was estimated using regional homogeneity (ReHo) analysis; long-range connectivity was estimated using resting state functional connectivity (rsFC) analysis. Mediation analyses tested whether local (ReHo) connectivity significantly mediated associations between long-distance rsFC and APD. Severity of APD was significantly associated with reduced ReHo in left and right putamen, left temporoparietal junction (TPJ), and right hippocampus-pallidum. Higher APD was also associated with reduced rsFC between the right putamen and the contralateral putamen and auditory cortex. Local and long-distance connectivity measures together explained 40.3% of variance in APD (P < 0.001), with the strongest predictor being the left TPJ ReHo (P < 0.001). Additionally, TPJ ReHo significantly mediated the relationship between right putamen - left putamen rsFC and APD (Sobel test, P = 0.001). Our findings suggest that both local and long-range functional connectivity deficits contribute to APD, emphasizing the role of striatum and auditory cortex. Considering the translational impact of these circuit-based findings within the context of prior clinical trials to treat auditory hallucinations, we propose a model in which correction of both local and long-distance functional connectivity deficits may be necessary to treat auditory hallucinations.

AB0519 PULMONARY INVOLVEMENT IN ANCA ASSOCIATED VASCULITIS (AAV) ACCORDING TO ANTIGENIC SPECIFICITY: A RETROSPECTIVE ARGENTINE COHORT

Background:

The lung in ANCA associated vasculitis (AAV) is one of the most frequently compromised organs (20-80%). The clinical features of pulmonary involvement vary according to the type of vasculitis and some studies have shown its association with the ANCa subtype or antigenic specifity (MPO-ANCA), (PR3-ANCA).

Objectives:

A-Describe the clinical features and tomographic findings of pulmonary involvement in vasculitis associated with ANCA and its association according to the ANCA subtypes.

B-Evaluate outcome, relapses and associated mortality.

Methods:

Observational, analytical, retrospective study. Data was collected from the medical records and tomographic image files of patient evaluated in rheumatology department in a tertiary level hospital (2007-2019).

Patients diagnosed with AAV, who met criteria for ACR 1990 classification or according to nomenclature of Chapel Hill 2012, with thoracic CT performed and dosage PR3 an MPO antibodies by ELISA technique by a pulmonologist and radiologist.

Demographic data, subtype of vasculitis, concomitant organic involvement, disease activity evaluated by Birmingham Vasculitis Activity Score v 3 (BVAS v3), time of evolution of pulmonary involvement, ERS – PCR, serum creatinine, ANCA determined by ELISA were collected. The following findings in parenchyma were evaluated by thorax CT: Consolidation, Ground glass opacities, Reticulation, Honeycomb, cavitated or not nodules, Central airway compromise (thickening or stenosis), Bronchiectasis,Peribronchial thickening, Pleural effusion and the following patterns of disease:NIU (Usual Interstitial Pneumonia), NINE (Unspecified Interstitial Pneumonia),HAD (Diffuse Alveolar Hemorrhage)

Results:

66/87 patients were included, 59% female, with a mean age of 51 (14 SD) years. GPA 46.9%, MPA 39.4%, EGPA13.6%, median follow-up time of 36 months (RIC 12-77).

According to antigenic specificity: 40.9% PR3 positive, 47.6% MPO positive and ANCA negative 11.5%. 74% of the GPA were positive for PR3, and 58% PAM at MPO.

BVAS basal: 17.8 + 7.5 DS.

Frequency of organic involvement: 81.8% pulmonar, 77% systemic, 57.6% renal, 43% ENT.

54% of patients with pulmonary involvement was present at the onset of their disease.

Table 1.

shows the main findings in lung parenchyma.

Parenchymal Findings%Consolidations37Ground glass opacities72Reticulation15Honeycomb9No cavitated nodules41Cavitated nodules20.7Central airways comp (stenosis)9.4Peribronchial thickening11.3Bronchiectasis9.4Pleural effusion7.7

According to the pattern of tomographic condition: 36.5 HAD %, 9.6% NIU, 7.8% NINE and, 1.5% Bronchiolitis obliterans.

The presence of positive MPO was significantly associated with the presence of honeycomb (p 0.017) and NIU (p 0.018).

There were no significant associations with the presence of PR3.

Mortality was 17%.

No association was found in relation to mortality or relapse frequency among PR3 or MPO positive patients.

Conclusion:

The frequency of pulmonary involvement in this cohort of patients was 82%, similar to that reported in the literature and was presented at the beginning of the disease in half of the cases. The presence of positive MPO was associated with a higher frequency of usual interstitial pneumonia.

References:

[1]Sophia Lionaki. Classification of ANCA vasculitides: The role of anti-neutrophil cytoplasmic autoantibody specificity for MPO or PR3 in disease recognition and prognosis. Arthritis Rheum. 2012 October; 64(10): 3452–3462. doi:10.1002/art.34562.

[2]Kouichi Hirayama. Pulmonary involvements of anti-neutrophil cytoplasmic autoantibody-associated renal vasculitis in Japan Nephrol Dial Transplant (2015) 0: 1–11 doi: 10.1093/ndt/gfu385 .3-Beatrice Feragalli.The Lung in Systemic Vasculitis: Radiological Patterns and Differential Diagnosis. British Institute of Radiology

Disclosure of Interests:

None declared

FRI0653-HPR AN OLEUROPEIN-BASED DIETARY SUPPLEMENT IMPROVES JOINT FUNCTIONALITY IN OLDER PEOPLE WITH HIGH KNEE JOINT PAIN

Background:

OLE provides oleuropein the most prevalent phenolic component in olive leaves and has been shown to have potent anti-inflammatory and anti-oxidant effects potentially interesting for joint health (1).

Objectives:

The aim of this study was to investigate the effects of a 6-month intervention with an Olive Leaf Extract (OLE) standardized for oleuropein content on knee functionality and biomarkers of bone/cartilage metabolism and inflammation.

Methods:

The study was a randomized, double-blind, placebo-controlled, multi-centric trial of 124 subjects with mild knee pain or mobility issues. Subjects were randomized equally to receive twice a day one capsule of either maltodextrin (control treatment, CT) or 125-mg OLE (BonoliveTM, an Olive Leaf Extract containing 50 mg of Oleuropein) for 6 months. The co-primary endpoints were Knee injury and Osteoarthritis Outcome Score (KOOS) using a self-administered questionnaire and serum Coll2-1NO2 specific biomarker of cartilage degradation. The secondary endpoints were each of the five sub-scales of the KOOS questionnaire, Knee pain VAS score at rest and at walking, OARSI core set of performance-based tests and serum biomarkers (Coll2-1, MPO, CTX1, osteocalcin, PGE2 and Vplex cytokines assay in serum) and concentration of Oleuropein’s metabolites in urine.

Results:

Primary (global KOOS score, biomarker Coll2-1 NO2) and secondary endpoints (the five subscales of the KOOS score) improved time dependently in both groups. OLE treatment showed significantly elevated urinary oleuropein metabolites (oleuropein aglycone, hydroxytyrosol, homovanillyl alcohol and isomer of homovanillyl alcohol), and was well tolerated without significant differences in number of subjects with adverse events. At 6 months, OLE group showed a higher global KOOS score compared to placebo (treatment difference = 3.73; 95% CI = [-4.08;11.54]; p = 0.34), without significant changes of inflammatory and cartilage remodeling biomarkers. Subgroup analyses demonstrated a large and significant treatment effect of OLE in subjects with high walking pain at baseline (14.4; 95% CI = [1.19;27.63], p=0.03). This was observed at 6 months for the global KOOS score and each different subscale and for pain at walking (-23.07;95% CI = [-41.8;-4.2];p=0.02). These treatment effects at 6 months were significant for KOOS score as well as for the subscales Pain and QoL and the pain at walking.

Conclusion:

OLE was not effective on joint discomfort in people with low to moderate pain at baseline but significantly benefited subjects with high pain at treatment initiation. As oleuropein is well-tolerated, OLE can be used to relieve knee joint pain and enhance mobility in subjects with articular pain the most painful subjects.

References:

[1] Horcajada MN, Sanchez C, Membrez Scalfo F, Drion P, Comblain F, Taralla S, Donneau AF, Offord EA, Henrotin Y. Oleuropein or rutin consumption decreases the spontaneous development of osteoarthritis in the Hartley guinea pig. Osteoarthritis Cartilage. 2015 Jan;23(1):94-102

Disclosure of Interests:

Marie-Noelle Horcajada Employee of: nestlé, Maurice Beaumont Employee of: nestle, Nicolas Sauvageot Employee of: Nestlé, Laure Poquet Employee of: Nestlé, Madleen Saboudjian Employee of: Nestlé, Anne-Christine Hick Employee of: Artialis SA, Berenice Costes Employee of: Artialis SA, Laetitia Garcia Employee of: Artialis, Yves Henrotin Grant/research support from: HEEL, TILMAN

FRI0405 CARTILAGE BIOMARKERS S-COLL2-1 AND S-COLL2-1NO2 ARE HELPFUL IN IDENTIFYING KNEE OSTEOARTHRITIS PATIENTS AT RISK OF DISEASE WORSENING

Background:

Coll2-1 is a peptide of 9 amino acid located in the triple helix of type II collagen molecule reflecting cartilage degradation (1). Coll2-1NO2 is the nitrated form of Coll2-1 and considered as a biomarker of the inflammatory-related cartilage degradation (2). This peptide is involved in osteoarthritis physiopathology since it was demonstrated that Coll2-1 induced synovitis in rat.

Objectives:

To identify if biochemical markers s-Coll2-1 and s-Coll2-1NO2 are associated to knee osteoarthritis (OA), focusing on pain, function as well as structural features assessed by MRI in various knee compartments and to assess their ability at predicting knee OA worsening.

Methods:

116 subjects with knee OA were followed during one year with pain, function and MRI evaluation (PRODIGE study,NCT02070224). Type II collagen-specific biomarker Coll2-1 and its nitrated form Coll2-1NO2 were directly measured in serum using immunoassays at baseline and after three, six and twelve months follow-up.

Results:

sColl2-1 and sColl2-1NO2 were associated to several baseline knee features quantified with Whole-Organ Magnetic Resonance Imaging Score (WORMS). S-Coll2-1 was significantly correlated with bursitis (r=0.29, P<0.01), bone attrition (r=0.25, P=0.01), cysts (r=0.24, P=0.02) and cartilage (r=0.23, P=0.03) WORMS sub-scores for the whole joint as well as with the medial femorotibial joint sum score (r=0.26, P=0.01) and medial femorotibial joint cartilage (r=0.23, P=0.02). s-Coll2-1NO2 was correlated with WORMS total score (r=0.23, P=0.02), WORMS scores in the patellofemoral (r=0.23, P=0.02) and medial femorotibial compartments (r=0.21, P=0.03) and with osteophytes scores (r=0.27, P<0.01). Baseline s-Coll2-1NO2 was higher in subjects with a pain worsening (426.4 pg/mL [278.04-566.95]) as compared to non-progressors (306.84 [200.37-427.84]) over one year (AUC=0.655, P=0.015).

Conclusion:

Cartilage biomarkers s-Coll2-1 and s-Coll2-1NO2 are associated to several knee OA features quantified with WORMS scoring system on MRI. Serum values of Coll2-1NO2 are also associated to a worsening of target knee pain over one year. Coll2-1 and Coll2-1NO2, in association with other structural features, pain and function, could help at identifying OA phenotypes and patients at risk of OA worsening.

References:

[1]Mobasheri A, Lambert C, Henrotin Y. Coll2-1 and Coll2-1NO2 as exemplars of collagen extracellular matrix turnover - biomarkers to facilitate the treatment of osteoarthritis? Expert Rev Mol Diagn. 2019 Sep;19(9):803-812. doi: 10.1080/14737159.2019.1646641. Epub 2019 Sep 4.

[2]Lambert C, Borderie D, Dubuc JE, Rannou F, Henrotin Y. Type II collagen peptide Coll2-1 is an actor of synovitis. Osteoarthritis Cartilage. 2019 Nov;27(11):1680-1691. doi: 10.1016/j.joca.2019.07.009. Epub 2019 Jul 17.

Acknowledgments:

PRODIGE study (NCT02070224) was performed in the framework of a convention between the Walloon region and ARTIALIS SA. (convention n°6905).

Disclosure of Interests:

Yves Henrotin Grant/research support from: HEEL, TILMAN, Berenice Costes Employee of: Artialis SA, Michel Malaise: None declared, Damien Loeuille: None declared, Thierry Conrozier Consultant of: LABRHA, SANOFI, MEDAC, Yves Maugars: None declared, Franz Pelousse Shareholder of: Sodiray, Jean-Marc Lemaire Shareholder of: Sodiray, Thibault Helleputte Shareholder of: DNAlytics, Cedric Tits Employee of: DNAlytics, Elisabeth Cobraiville Employee of: Artialis SA, Sebastien Pirson Employee of: Artialis, Laetitia Garcia Employee of: Artialis, Alain Labasse Employee of: Artialis SA, Anne-Christine Hick Employee of: Artialis SA

FRI0318 REAL-LIFE EVALUATION OF HEALTH STATUS USING ASAS HEALTH INDEX ON PATIENTS WITH AXIAL AND PERIPHERAL SPONDYLOARTHRITIS IN ARGENTINA

Background:

The questionnaire “Assessment of Spondyloarthritis international Society Health Index” (ASAS HI) was developed to measure functionality and health status in patients with spondyloarthritis (SpA)1.

Objectives:

To describe the state of health measured by ASAS HI in Argentinian patients with SpA and to evaluate factors associated with poor health.

Methods:

Analytical, cross sectional, multicenter study. Patients with SpA according to ASAS criteria were consecutively included from 15 Argentinian centers. Statistical analysis: frequencies and percentages (%), mean and standard deviation (SD) or median and interquartile range (IQR). Bivariate analysis and logistic regression were performed to evaluate the factors associated with poor health status (ASAS HI > or equal to 12). Correlation with other parameters was evaluated by Spearman correlation.

Results:

We included 274 patients with a mean age 49 (SD 14) years, median disease duration 60 month (IQR 24-135), 155 (56.6%) of patients are male, 47% (n:129) axial SpA and 52.9 (n:145) peripheral SpA. One hundred and nine patients (43.4%) presented good health status, 117 (42.7%) had moderate state of health and 38 (13.9%) had poor health. In the bivariate analyses patients with ASAS health index greater than or equal to 12 (poor status), were older [54 (11) vs 48 (14), p: 0.01], had higher disease duration [11(IQR 57-192) vs 60 (IQR 24-120), p: 0.02], more hypertension [20 (52.6%) vs 67 (28.4%), p:0.004], more diabetes mellitus [10 (26.3%) vs 22(9.3%), p: 0.006], depression [6 (15.8%) vs 10 (4.2%), p:0.013], anxiety [8 (21%) vs (22 (9.3%),p:0.046], less years of education [9.8 (SD 3.5) vs 13 (SD 10), p:0.001], higher ASQol [12.6 (SD 4.6) vs 5.7 (SD4), p < 0.001], BASFI [7(SD2) vs 4(SD6), p: 0.001], DAS28 [4.71 (SD3.2) vs 2.8 (SD1),p: <0.001]. In the multivariate analyses the following variables were independently associated with poor health status: duration of disease, ASQol and DAS28. ASAS HI showed positive correlation with the following parameters: BASDAI (r:0.67, p< 0.001), HAQ (r:0.54, p< 0.001), ASDAS (r:0.67, p< 0.001), ASQol (r:0.80, p< 0.001), BASFI (r:0.72, p< 0.001) and DAS28 (0.56, p< 0.001).

Conclusion:

Poor health status is associated with disease activity, poor quality of life and functional activity. ASAS HI has a good correlation with other parameters to evaluate SpA, reinforcing the construct validity of this new tool.

References:

[1]Kiltz U,et al.Ann Rheum Dis2018;0:1–7.

Disclosure of Interests:

None declared

Health resource utilization of labor induction versus expectant management

BACKGROUND

Although induction of labor of low-risk nulliparous women at 39 weeks reduces the risk of cesarean delivery compared with expectant management, concern regarding more frequent use of labor induction remains, given that this intervention historically has been thought to incur greater resource utilization.

OBJECTIVE

The objective of the study was to determine whether planned elective labor induction at 39 weeks among low-risk nulliparous women, compared with expectant management, was associated with differences in health care resource utilization from the time of randomization through 8 weeks postpartum.

STUDY DESIGN

This is a planned secondary analysis of a multicenter randomized trial in which low-risk nulliparous women were assigned to induction of labor at 39 weeks or expectant management. We assessed resource utilization after randomization in 3 time periods: antepartum, delivery admission, and discharge through 8 weeks postpartum.

RESULTS

Of 6096 women with data available, those in the induction of labor group (n = 3059) were significantly less likely in the antepartum period after randomization to have at least 1 ambulatory visit for routine prenatal care (32.4% vs 68.4%), unanticipated care (0.5% vs 2.6%), or urgent care (16.2% vs 44.3%), or at least 1 antepartum hospitalization (0.8% vs 2.2%, P < .001 for all). They also had fewer tests (eg, sonograms, blood tests) and treatments (eg, antibiotics, intravenous hydration) prior to delivery. During the delivery admission, women in the induction of labor group spent a longer time in labor and delivery (median, 0.83 vs 0.57 days), but both women (P = .002) and their neonates (P < .001) had shorter postpartum stays. Women and neonates in both groups had similar frequencies of postpartum urgent care and hospital readmissions (P > .05 for all).

CONCLUSION

Women randomized to induction of labor had longer durations in labor and delivery but significantly fewer antepartum visits, tests, and treatments and shorter maternal and neonatal hospital durations after delivery. These results demonstrate that the health outcome advantages associated with induction of labor are gained without incurring uniformly greater health care resource use.

Complete Cognitive Recovery and Survival From Massive Pulmonary Embolism During General Anesthesia after Administration of Alteplase: A Case Report

Presented herein is the case of a 37-year-old male who was scheduled for an anterior decompressive laminectomy after suffering trauma to the cervical area (C6-C7). An intraoperative acute pulmonary embolism (APE) was suspected after persistent hypoxemia and a decreased end-tidal CO2 that was refractory to proper management. After 6 intraoperative episodes of cardiac arrest that followed, intravenous alteplase (thrombolytic therapy) was administered, and the patient was stabilized without major complications. Eventually, APE was successfully diagnosed and treated. The experience served as reference for the diagnosis and management of APE under general anesthesia.

P4421Increased circulating levels of VCAM-1 correlate with left atrial remodeling in highly trained athletes

Introduction

Reports have shown increased risk of atrial fibrillation (AF) in athletes. Vascular cell adhesion molecule-1 (VCAM1) is associated with new onset AF in general population. VCAM1 and its relation with left atrial (LA) remodeling have not been investigated in athletes.

Purpose

To study VCAM1 and LA remodeling in marathon runners.

Methods

Study of 36 male marathon runners in the training period previous to race (42 km) and 18 sedentary controls with no risk factors. Athletes were divided in two groups according to highest training intensity reached (group 1, >100 km/week; group 2, 50–100 km/week). Previous to race in all subjects, VCAM1 serum levels were measured by ELISA and an echocardiogram was performed. In athletes, VCAM1 was measured immediately post-race. Wilcoxon and Spearman were used.

Results

See table. Group 1 showed a significant increment in VCAM1 post-race (651±350 to 905±373 ng/mL; p=0.002) as compared to group 2 with no increment (533±133 to 651±138 ng/mL; p=0.117). In athletes, a moderate correlation between LA volume and VCAM1 was found (rho: 0.483; p=0.007).

Baseline characteristics Group 1 (n=18) Group 2 (n=18) Controls (n=18) p value Age (years) 37±6 38±5 36±4 0.373 Heart rate (bpm) 53±8 57±7 69±6 * 0.001 Body surface area (m2) 1.8±0.1 1.8±0.1 1.9±0.1 0.075 LV diastolic diameter (mm) 49±5 48±5 46±4 0.404 LV systolic diameter (mm) 29±5 30±5 30±4 0.879 Septal wall (mm) 9.1±1.2† 8.2±1.1 8.1±0.8 0.005 Posterior wall (mm) 9.3±2.1† 8.5±1.2 7.6±0.8 0.001 Ejection fraction (%) 55±3 55±6 57±4 0.110 LV mass index (g/m2) 106±27† 78±18 58±11 0.001 LA volume (mL/m2) 42±8† 30±11 25±9 0.001 E wave (cm/sec) 78±13 84±12 77±15 0.217 A wave (cm/sec) 50±12 53±10 48±16 0.438 DT (msec) 233±65 229±65 221±66 0.184 VCAM1 (ng/mL) 651±350† 533±133 440±98 0.022 Mean ± SD. *p<0.05 vs group 1 and 2 post Kruskall-Wallis; †p<0.05 vs other groups post Kruskall-Wallis. LV, left ventricle; LA, left atrium; DT, deceleration time.

Conclusions

Most trained athletes had increased levels of VCAM1 as compared to controls and less trained athletes. They also showed an increment post-effort. VCAM1 is related to LA remodeling in athletes. VCAM1 could be a potential biomarker of AF in athletes which should be confirmed.

Acknowledgement/Funding

FONDECYT 1170963 (LG); FONDAP 15130011 (LG,SL)

The wake project: Improving safe sleep practices in a neonatal intensive care unit

BACKGROUND

Every year, about 50 babies in New York City die from a sleep-related injury. The Bronx County ranked second highest rate of sleep-related infant deaths (SRID) at 0.5 per 1000 among the other boroughs. The highest rate was among blacks and the rate of SRID cases were highest in our population at 0.97 (zip code 10466) among all other Bronx neighborhoods which comprises 77% of non-Hispanic black population. Further, Bronx has the highest preterm birth rate at 9.5%. This quality improvement (QI) project aimed to develop and implement an educational initiative on infant safe sleep (SS) to improve "Safe Sleep Practices (SSP) in a level III neonatal intensive care unit (NICU) for one of the highest risk populations in the country.

METHODS

Baseline data was collected prior to initiating the QI project. Multiple plan-do-study-act (PDSA) cycles were completed over a 12 month period. Run charts were utilized to identify improvement and guide interventions. These interventions included education for nurses, crib cards, posters, feedback forms, grand rounds and small group discussions.

RESULTS

Approximately 600 crib checks (CC) were performed over the duration of this project. At baseline, 7% of infants were placed in a SS position in the NICU. Following the QI project, SS position increased to 96% of infants.

CONCLUSION

Multifactorial interventions significantly improved SS compliance among NICU nurses. Cultivating personal motivation among nurses, consistent empowerment and dedication to culture change by the entire team was crucial for the sustainability of the project.

Variability in sleep disturbance, physical activity and quality of life by level of depressive symptoms in women with Type 2 diabetes

AIMS

To examine (1) the prevalence of depressive symptoms in women with Type 2 diabetes, (2) the associations between depressive symptoms and the following dependent variables: sleep disturbance; physical activity; physical health-related; and global quality of life, and (3) the potential moderating effects of antidepressants and optimism on the relationship between depressive symptoms and dependent variables.

METHODS

Participants in the Women's Health Initiative who had Type 2 diabetes and data on depressive symptoms (N=8895) were included in the analyses. In multivariable linear regression models controlling for sociodemographic, medical and psychosocial covariates, we examined the main effect of depressive symptoms, as well as the interactions between depressive symptoms and antidepressant use, and between depressive symptoms and optimism, on sleep disturbance, physical activity, physical health-related quality of life; and global quality of life.

RESULTS

In all, 16% of women with Type 2 diabetes reported elevated depressive symptoms. In multivariable analyses, women with depressive symptoms had greater sleep disturbance (P<0.0001) and lower global quality of life (P<.0001). We found evidence of significant statistical interaction in the models for quality-of-life outcomes: the increased risk of poor physical health-related quality of life associated with antidepressant use was stronger in women without vs with depressive symptoms, and the association between greater optimism and higher global quality of life was stronger in women with vs without depressive symptoms.

CONCLUSIONS

To improve health behaviours and quality of life in women with Type 2 diabetes, sociodemographic and medical characteristics may identify at-risk populations, while psychosocial factors including depression and optimism may be important targets for non-pharmacological intervention.

Facilitating Positive Psychosocial Outcomes in Craniofacial Team Care: Strategies for Medical Providers

Objective:

Psychosocial issues associated with craniofacial diagnoses and the ongoing burden of care can impact the quality of life of patients and families, as well as treatment adherence and outcomes. Utilizing available literature and clinical expertise across 6 centers, the present article summarizes key psychosocial issues for the benefit of nonmental health medical providers and offers suggestions as to how all members of craniofacial teams can promote positive psychosocial outcomes.

Results:

Family adjustment across developmental phases is outlined, with strategies to support adaptive parental coping. Teasing is a common concern in craniofacial populations and medical providers can promote coping and social skills, as well as link families to mental health services when needed. Academic issues are described, alongside suggestions for medical providers to assist families with school advocacy and ensure access to appropriate services within the school setting. Medical providers are key in preparing patients and families for surgery, including consideration of medical, social, and logistical supports and barriers. As craniofacial care spans infancy to adulthood, medical providers are instrumental in assisting patients and families to navigate treatment transition periods. In addition to ongoing clinical team assessments, medical providers may utilize screening measures to identify and track patient and family adjustment in multiple areas of team care.

Conclusions:

Multidisciplinary providers play an important role in supporting positive adjustment in patients affected by craniofacial conditions and their families.

Impact of Speller Size on a Visual P300 Brain-Computer Interface (BCI) System under Two Conditions of Constraint for Eye Movement

The vast majority of P300-based brain-computer interface (BCI) systems are based on the well-known P300 speller presented by Farwell and Donchin for communication purposes and an alternative to people with neuromuscular disabilities, such as impaired eye movement. The purpose of the present work is to study the effect of speller size on P300-based BCI usability, measured in terms of effectiveness, efficiency, and satisfaction under overt and covert attention conditions. To this end, twelve participants used three speller sizes under both attentional conditions to spell 12 symbols. The results indicated that the speller size had, in both attentional conditions, a significant influence on performance. In both conditions (covert and overt), the best performances were obtained with the small and medium speller sizes, both being the most effective. The speller size did not significantly affect workload on the three speller sizes. In contrast, covert attention condition produced very high workload due to the increased resources expended to complete the task. Regarding users' preferences, significant differences were obtained between speller sizes. The small speller size was considered as the most complex, the most stressful, the less comfortable, and the most tiring. The medium speller size was always considered in the medium rank, which is the speller size that was evaluated less frequently and, for each dimension, the worst one. In this sense, the medium and the large speller sizes were considered as the most satisfactory. Finally, the medium speller size was the one to which the three standard dimensions were collected: high effectiveness, high efficiency, and high satisfaction. This work demonstrates that the speller size is an important parameter to consider in improving the usability of P300 BCI for communication purposes. The obtained results showed that using the proposed medium speller size, performance and satisfaction could be improved.

Abstract P1-08-33: Molecular breast cancer subtypes in a Guatemalan population. Classification according to immunohistochemical markers: Clinicopathologic feature and survival analysis

Introduction: Breast cancer is a heterogeneous malignancy and it's possible to identify by simple techniques, such as inmmunohistochemistry, four subtypes with different clinical and biological behavior. Our aim was to evaluate the influence of these subtypes on the local and distant recurrences rates.

Method: data of 954 unilateral breast cancer patients primarily treated with radical or conservative surgery from 2008 to 2014 were obtained from medical records. Breast cancer subtypes were categorized in Luminal A (RE+ and/or RP+, HER2-), Luminal B (RE+ and/or RP+, HER2+ o Ki-67&gt; 14%); HER2 (RE-, RP-, HER2+) and triple negative tumors (TNT) (RE-, RP-, HER2-). Patterns of recurrence for each subtype and clinicopathological variables and the influence of each variable on the overall survival (OS) by the Kaplan-Meier method. In all cases, we determined histological type, grade nuclear (low, intermediate vrs high), tumor size, lymph node involvement

Results: Median age at diagnosis was 52 years (range, 23-95). Of these patients 55% were premenopausal. We found that 522 (56%) of the cases were luminal A breast cancer, 190 (20%) of the cases were triple negative tumors (TNT), luminal B were 73 (8%) and it was HER2-positive in 152 (20%) of cases. Nine patients (3%) had other breast cancer contralateral. In 70% of all the cases were found in locally advanced stages (IIB – IIIC). In 438 (70%) of all the cases were found in locally advanced stages (IIB – IIIC), 773 (81%) patients underwent radical mastectomy and 181 (19%) undergoing conservative surgery. We performed univariate analysis to evaluate recurrence-related factors. Variables included in the analysis clinical stage (I – IIa vs IIb – IIIC; 88% vs 70%; p = 0.001, ), nuclear grade (grade 1, 2 vs 3; 83% vs 62%; p = 0.01) and pathologic response (total vs parcial, stable disease; 76% vs 54%; p = 0.01), and status Her-2 subtype so borderline (positive vs negative; p= 0.079). A univariate survival analysis stratification according to clinicapathologic characteristics. Clinical stage, histologic grade, response to neoadjuvant and tumor size were identified as significant factors of prognosis for the OS. (p=0.5) and histological subtypes Luminal A (94%), Luminal B (75%), HER2 (79%) and TNT (68%), p= 0.001.

Conclusion: this study demonstrates that treatment efficacy is similar to that reported in the literature and emphasizes the need for establishing the molecular breast cancer subtypes and efforts should be made to reduce the high frequency of advanced-stage diagnoses.

Citation Format: Castro H, Garcia L, Jimenez F, Ramos P, Castro N. Molecular breast cancer subtypes in a Guatemalan population. Classification according to immunohistochemical markers: Clinicopathologic feature and survival analysis [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-33.

Mifepristone mediates anti-proliferative effect on ovarian mesenchymal stem/stromal cells from female BRCA1-/2- carriers

INTRODUCTION

Women with hereditary mutation in breast cancer-associated genes (BRCA^1-/2- ) have a higher lifetime risk of developing ovarian cancer. Here, we aimed to investigate the effect of mifepristone, a selective progesterone receptor modulator of ovarian mesenchymal stem/stromal cells (MSC) from BRCA^1-/2- carriers.

MATERIAL AND METHODS

Ovarian BRCA^1-/2- MSC were positively selected using the markers CD90, CD73 and CD105 from nine healthy women. The effect of dose response and combination treatment with mifepristone and analogs of progesterone- or glucocorticoid-receptors were investigated on BRCA^1-/2- MSC in vitro using a panel of markers for proliferation (ki67, BrdU, CDK2, p21^CIP ), apoptosis (BAX, BCL2, CASPASE3), tumor suppression (TP53, PTEN) and cell survival (PI3KCA, MAPK3, mTOR).

RESULTS

The dose response with mifepristone treatment suggested an optimal effect with 10 μm mifepristone, exhibiting >90% viability and significantly reducing growth signaling markers (TP53 and MAPK3). Furthermore, combined treatment with progesterone plus mifepristone (PG+MIFE) gave an enhanced anti-proliferative effect in comparison with hydrocortisone plus mifepristone (HC+MIFE) by significantly reducing markers of proliferation (BrdU⁺ and Ki67 expression) and tumor suppressors (PTEN, TP53), and increasing the percentage of pro-apoptotic cells. Consequently, accumulation of p21^CIP together with reduced levels of CDK2 confirms growth inhibition by reversibly arresting cell-cycle progression at the G1-S phase, not by inducing apoptosis.

CONCLUSIONS

Our study showed an anti-proliferative effect on ovarian BRCA^1-/2- MSC on in vitro combined treatment with mifepristone and progesterone. These findings suggest that mifepristone or other selective progesterone receptor modulators could be developed as a preventive treatment and postpone early use of prophylactic salpingo-oophorectomy as well as reduce the risk of ovarian cancer.

Transport of nano-objects in narrow channels: influence of Brownian diffusion, confinement and particle nature

This paper presents experimental results about transport of dilute suspensions of nano-objects in silicon-glass micrometric and sub-micrometric channels. Two kinds of objects are used: solid, rigid latex beads and spherical capsule-shaped, soft polymersomes. They are tracked using fluorescence microscopy. Three aspects are studied: confinement (ratio between particle diameter and channel depth), Brownian diffusion and particle nature. The aim of this work is to understand how these different aspects affect the transport of suspensions in narrow channels and to understand the different mechanisms at play. Concerning the solid beads we observe the appearance of two regimes, one where the experimental mean velocity is close to the expected one and another where this velocity is lower. This is directly related to a competition between confinement, Brownian diffusion and advection. These two regimes are shown to be linked to the inhomogeneity of particles distribution in the channel depth, which we experimentally deduce from velocity distributions. This inhomogeneity appears during the entrance process into the sub-micrometric channels, as for hydrodynamic separation or deterministic lateral displacement. Concerning the nature of the particles we observed a shift of transition towards the second regime likely due to the relationships between shear stress and polymersomes mechanical properties which could reduce the inhomogeneity imposed by the geometry of our device.