Prognostic role of immunohistochemical overexpression of the p16 protein in women under the age of 35 and diagnosed with HSIL (CIN2) subjected to "cervix sparing" excision

OBJECTIVE

To evaluate the role of immunohistochemical staining overexpression of p16 protein (p16 IHC) as a prognostic factor of persistence or recurrence of intraepithelial disease after excision procedure in young women diagnosed with HSIL (CIN2).

PATIENTS AND METHODS

62 women with a histological diagnosis of HSIL (CIN2) subjected to "cervix sparing" excisional procedure were included in this retrospective study. All had age less than or equal to 35 years, negative history of immunosuppression, available follow-up, and assessment of the resection margins state. Immunohistochemical staining for the p16 protein was evaluated on reviewed and confirmed HSIL (CIN2) histological specimens with negative resection margins. The post-treatment follow-up, including cytology, colposcopy, and histology, ranged from a minimum of 6 months to a maximum of 60 months. The persistence or recurrence of SIL during the follow-up period was based on histologic referral and defined as "the presence of SIL", "the presence of HSIL" and "progression to HSIL (CIN3)".

RESULTS

31/62 patients were positive for immunostaining (p16 IHC+), and 31/62 were negative (p16 IHC-). Persistence or recurrence after excision occurred more frequently within the p16 IHC+ than in p16 IHC- group, both as SIL (29% p16 IHC- vs. 32.3% p16 IHC+, p = 0.783) and HSIL (6.5% p16 IHC- vs. 12.9% p16 IHC+, p = 0.671). None of the patients in the p16 IHC- group showed progression to CIN3 for the entire observation period, whereas 9.7% of p16 IHC+ women progressed to CIN3 lesion (p = 0.042). The p16 IHC positivity showed a significant association with progression to CIN3 in 5 years of follow-up (p = 0.029) and with the presence of SIL after two years of follow-up (p = 0.031). The differences between the two groups increased after two years post-treatment: the p16 IHC- patients still had SIL only in 3.2% of cases and no longer had HSIL, while the p16 IHC+ women still showed SIL in 19.4% and HSIL in 6.5% of cases. The negative predictive value (NPV) of p16 IHC in predicting SIL's presence after treatment increased with the severity of the lesion (NPV for SIL 70.97%, for HSIL 93.55%, for CIN3 100%).

CONCLUSIONS

The study suggests that young patients with p16 IHC- HSIL (CIN2) have a better post-excisional course of the cervical intraepithelial disease compared to p16 IHC+ women and that p16 IHC could have prognostic utility during the long-term follow-up, especially in forecasting progression to CIN3 in consideration of the high NPV (up to 100%). The efficacy of the adjuvant HPV vaccination in the management of HSIL (CIN2) p16+ young women is to be evaluated as part of the fertility-sparing treatment.

Fast liquid chromatography-tandem mass spectrometry method for the simultaneous determination of phytocannabinoids in oily based preparations

The reported method aims to be a powerful aid for the simultaneous determination of tetrahydrocannabinol (THC), cannabidiol (CBD), cannabinol (CBN), cannabigerol (CBG), tetrahydrocannabinolic acid (THCA), cannabidiolic acid (CBDA), and tetrahydrocannabivarin (THCV) in oily based preparations. The chromatographic separation was carried out using an Hypersil Gold PFP (50 × 2.1 mm, 1.9 μm) column, using H2O + 2 mM ammonium formate + 0.2 % formic acid (M1) and Methanol + 2 mM ammonium formate + 0.2 % formic acid (M2) as mobile phases. The flow rate was set 0.4 mL/min. Specifically, this method was validated in terms of linearity, limit of detections and quantifications (LODs and LOQs), accuracy (precision and trueness, both intra and interday), selectivity, and matrix effects. This procedure allowed quantifying seven phytocannabinoids in less than 10 min. The validated method shows a good linearity within the range 0.25-1000 ng/mL, while precision and trueness (intra- and inter-day) were below <13.25 % and 7.59 %, respectively. Regarding the matrix effect, the method satisfies all the requirements, except for the THC and THCV, where it reaches about 120 %. This element does not affect the method performances as it has been observed that this value is constant and reproducible and therefore does not involve errors in the quantitative analysis. The method was tested and applied on more 70 different oily based preparations. Furthermore, starting from four different cannabis cultivar (FM2, Bedrolite, Bedrocan, and Bediol), it allowed to evaluate the reproducibility of the magistrali preparations. The real samples, in fact, derive from different local pharmacies, and were analyzed by the accredited UNI CEI EN ISO/IEC 17025:2018, Pharmatoxicology Laboratory (ACCREDIA, lab n. 2274 ASLPE, accreditation number 1822 L), accordingly to the current regulations.

377 Global Recruitment for The RESECT Study (Transurethral Resection and Single-Instillation Intravesical Chemotherapy Evaluation in Bladder Cancer Treatment): An International Observational Cohort Study Aiming to Improve the Quality of Surgery for Non-Muscle Invasive Bladder Cancer

Introduction

Non-muscle invasive bladder cancer (NMIBC) can be curatively treated with ‘good quality’ transurethral resection of the bladder tumour (TURBT). However, despite evidence-based international guidelines, there is anecdotal evidence that practice varies widely, and this may affect oncological outcomes. Launching in 2020, RESECT aims to measure and report variation in TURBT quality globally, and determine if outcome reporting improves outcomes.

Method

RESECT was advertised internationally through social media, mailing lists, websites, and in person. Collaborators at each registered site will collect data about current practice and the experience of local TURBT surgeons. The primary outcome is the rate of achievement of key TURBT quality indicators.

Results

As of August 27, 508 collaborators have registered to participate. Collaborators represent 321 centres from 54 countries, with the highest number from the United Kingdom (54.5%), Spain (5.9%), and Argentina (3.7%). 51.2% are trainees, 29.9% consultants, and 17.5% medical students. Based on current registrations, patient recruitment will far exceed initial projections and considerably improve statistical power.

Conclusions

RESECT has attracted a large number of collaborators globally and from all training levels. Therefore, the RESECT study has the potential to improve the quality of TURBT surgery across the world.

Neural Processing of Cognitive Control in an Emotionally Neutral Context in Anxiety Patients

Impaired cognitive control plays a crucial role in anxiety disorders and is associated with deficient neural mechanisms in the fronto-parietal network. Usually, these deficits were found in tasks with an emotional context. The present study aimed at investigating electrophysiological and vascular signatures from event-related brain potentials (ERPs) and functional near-infrared spectroscopy (fNIRS) in anxiety patients versus healthy controls during an inhibition task integrated in an emotionally neutral context. Neural markers were acquired during the completion of a classical Eriksen flanker task. The focus of data analysis has been the ERPs N200 and P300 and fNIRS activations in addition to task performance. No behavioral or neural group differences were identified. ERP findings showed a larger N2pc and a delayed and reduced P300 for incongruent stimuli. The N2pc modulation suggests the reorienting of attention to salient stimuli, while the P300 indicates longer lasting stimulus evaluation processes due to increased task difficulty. FNIRS did not result in any significant activation potentially suggesting a contribution from deeper brain areas not measurable with fNIRS. The missing group difference in our non-emotional task indicates that no generalized cognitive control deficit but rather a more emotionally driven deficit is present in anxiety patients.

The challenge of learning a new language in adulthood: Evidence from a multi-methodological neuroscientific approach

Being proficient in several foreign languages is an essential part of every-day life. In contrast to childhood, learning a new language can be highly challenging for adults. The present study aims at investigating neural mechanisms supporting very initial foreign language learning in adulthood. For this reason, subjects underwent an implicit semantic associative training in which they had to learn new pseudoword-picture pairings. Learning success was measured via a recognition experiment presenting learned versus new pseudoword-picture pairings. Neural correlates were assessed by an innovative multi-methodological approach simultaneously applying electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS). Results indicate memory-related processes based on familiarity and mechanisms of cognitive control to be present during initial vocabulary learning. Findings underline the fascinating plasticity of the adult brain during foreign language learning, even after a short semantic training of only 18 minutes as well as the importance of comparing evidence from different neuroscientific methods and behavioral data.

Immunofluorescence mapping, electron microscopy and genetics in the diagnosis and sub-classification of inherited epidermolysis bullosa: a single-centre retrospective comparative study of 87 cases with long-term follow-up

BACKGROUND

Epidermolysis bullosa (EB) comprises a heterogeneous group of skin fragility disorders, classified in four major types based on skin cleavage level, i.e. EB simplex (EBS), junctional EB (JEB), dystrophic EB (DEB), Kindler EB, and in more than 30 subtypes defined by the combination of laboratory and clinical data, including disease course.

OBJECTIVES

Our aims were to address whether, in the age of genomics, electron microscopy (TEM) has still a role in diagnosing EB, and whether the genotype per se may be sufficient to sub-classify EB.

METHODS

A thoroughly characterized single-centre EB case series was retrospectively evaluated to compare the power of TEM with immunofluorescence mapping (IFM) in establishing the EB type, and the ability of TEM, IFM and genetics to predict selected EB subtypes, i.e. severe dominant EBS (DEBS), severe JEB, severe recessive DEB (RDEB) and DEB self-improving, using genetic and final diagnosis, respectively, as gold standard.

RESULTS

The series consisted of 87 patients, including 44 newborns, with a median follow-up of 54 months. Ninety-five mutations were identified in EB-associated genes, including 25 novel variants. Both IFM and TEM were diagnostic in about all cases of JEB (21/21 for both) and DEB (43/44 for IFM, 44/44 for TEM). TEM sensitivity was superior to IFM for EBS (19/20 vs. 16/19). As to EB subtyping, IFM performed better than genetics in identifying severe JEB cases due to laminin-332 defect (14/14 vs. 10/14) and severe RDEB (eight/nine vs. seven/nine). Genetics had no role in self-improving DEB diagnosis; it almost equalled TEM in predicting severe DEBS (eight/nine vs. nine/nine) and enabled to discriminate dominant from recessive non-severe DEB phenotypes and to identify special subtypes, e.g. DEBS with KLHL24 mutations.

CONCLUSIONS

Transmission electron microscopy remains relevant to the diagnosis of EBS. IFM and genetics are essential and complementary tools in the vast majority of EB cases.

The Sleep Side of Aging and Alzheimer's Disease

As we age, sleep patterns undergo significant modifications in micro and macrostructure, worsening cognition and quality of life. These are associated with remarkable brain changes, like deterioration in synaptic plasticity, gray and white matter, and significant modifications in hormone levels. Sleep alterations are also a core component of mild cognitive impairment (MCI) and Alzheimer's Disease (AD). AD night time is characterized by a gradual decrease in slow-wave activity and a substantial reduction of REM sleep. Sleep abnormalities can accelerate AD pathophysiology, promoting the accumulation of amyloid-β (Aβ) and phosphorylated tau. Thus, interventions that target sleep disturbances in elderly people and MCI patients have been suggested as a possible strategy to prevent or decelerate conversion to dementia. Although cognitive-behavioral therapy and pharmacological medications are still first-line treatments, despite being scarcely effective, new interventions have been proposed, such as sensory stimulation and Noninvasive Brain Stimulation (NiBS). The present review outlines the current state of the art of the relationship between sleep modifications in healthy aging and the neurobiological mechanisms underlying age-related changes. Furthermore, we provide a critical analysis showing how sleep abnormalities influence the prognosis of AD pathology by intensifying Aβ and tau protein accumulation. We discuss potential therapeutic strategies to target sleep disruptions and conclude that there is an urgent need for testing new therapeutic sleep interventions.

Inner versus Overt Speech Production: Does This Make a Difference in the Developing Brain?

Studies in adults showed differential neural processing between overt and inner speech. So far, it is unclear whether inner and overt speech are processed differentially in children. The present study examines the pre-activation of the speech network in order to disentangle domain-general executive control from linguistic control of inner and overt speech production in 6- to 7-year-olds by simultaneously applying electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS). Children underwent a picture-naming task in which the pure preparation of a subsequent speech production and the actual execution of speech can be differentiated. The preparation phase does not represent speech per se but it resembles the setting up of the language production network. Only the fNIRS revealed a larger activation for overt, compared to inner, speech over bilateral prefrontal to parietal regions during the preparation phase. Findings suggest that the children's brain can prepare the subsequent speech production. The preparation for overt and inner speech requires different domain-general executive control. In contrast to adults, the children´s brain did not show differences between inner and overt speech when a concrete linguistic content occurs and a concrete execution is required. This might indicate that domain-specific executive control processes are still under development.

Noninvasive Brain Stimulation & Space Exploration: Opportunities and Challenges

As NASA prepares for longer space missions aiming for the Moon and Mars, astronauts' health and performance are becoming a central concern due to the threats associated with galactic cosmic radiation, unnatural gravity fields, and life in extreme environments. In space, the human brain undergoes functional and structural changes related to fluid shift and changes in intracranial pressure. Behavioral abnormalities, such as cognitive deficits, sleep disruption, and visuomotor difficulties, as well as psychological effects, are also an issue. We discuss opportunities and challenges of noninvasive brain stimulation (NiBS) methods - including transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (tES) - to support space exploration in several ways. NiBS includes safe and portable techniques already applied in a wide range of cognitive and motor domains, as well as therapeutically. NiBS could be used to enhance in-flight performance, supporting astronauts during pre-flight Earth-based training, as well as to identify biomarkers of post-flight brain changes for optimization of rehabilitation/compensatory strategies. We review these NiBS techniques and their effects on brain physiology, psychology, and cognition.

Individual differences in working memory capacity moderate effects of post-learning activity on memory consolidation over the long term

Similar to sleeping after learning, a brief period of wakeful resting after encoding new information supports memory retention in contrast to task-related cognition. Recent evidence suggests that working memory capacity (WMC) is related to sleep-dependent declarative memory consolidation. We tested whether WMC moderates the effect of a brief period of wakeful resting compared to performing a distractor task subsequent to encoding a word list. Participants encoded and immediately recalled a word list followed by either an 8 min wakeful resting period (eyes closed, relaxed) or by performing an adapted version of the d2 test of attention for 8 min. At the end of the experimental session (after 12–24 min) and again, after 7 days, participants were required to complete a surprise free recall test of both word lists. Our results show that interindividual differences in WMC are a central moderating factor for the effect of post-learning activity on memory retention. The difference in word retention between a brief period of wakeful resting versus performing a selective attention task subsequent to encoding increased in higher WMC individuals over a retention interval of 12–24 min, as well as over 7 days. This effect was reversed in lower WMC individuals. Our results extend findings showing that WMC seems not only to moderate sleep-related but also wakeful resting-related memory consolidation.

Relationship between burnout and nursing practice environment in pediatric cardiology: a cross-sectional study

Introduction

The relationship between burnout and patient safety is widely demonstrated in the literature. Recent studies have shown that in pediatrics the burnout rates are even higher, thus increasing young patients' exposure to risks. Pediatric cardiology is often characterized by acute onset in the pre-natal period and requires long periods of hospitalization. Strategies to reduce burnout and its impact on patient safety is a priority.

Purpose

To test the relationship between nursing work environment and emotional exhaustion in nurses in pediatric cardiology.

Methods

Data were drawn from the database of a larger study, RN4CAST@IT-Ped, a cross-sectional study in which 13 Italian hospitals were involved.

Convenience sampling was adopted, and inclusion criteria were nurses providing direct routine care in wards. For this study, only data relating to nurses working in Pediatric Cardiology were extracted.

The data were collected through a web survey from September 2017 to January 2018. The questionnaire investigated several aspects relating to care and nursing staff including workload, skill mix, work environment measured with PES-NWI, and emotional exhaustion with the Maslach Burnout Inventory. Descriptive statistical analyses were conducted to describe the sample and variables taken into consideration; a binomial logistic regression model was built to test the relationships between the dependent variable “high Emotional Exhaustion” and the independent variables “PES-NWI composite score”, adjusted for “workload” and “skill mix”.

Results

The responses from eighty-five pediatric nurses from 7 units (mixed cardiology-cardiac surgery, cardiology, arrhythmology, cardiac surgery and a cardiology intensive care unit), in 5 hospitals, were analyzed.

These findings show that with the same skill mix and workload, the improvement of the workplace environment conditions decreased by 81% (OR 0.192; 95% CI 0.062–0.591) the risk that nurses working in pediatric cardiology would develop a high level of Emotional Exhaustion.

Conclusions

Demonstrating the association between emotional exhaustion and work environment in pediatric cardiology is only a first step towards improvement. Workplace environment includes relational, logistic, and organizational aspects that require further investigation to ensure that nursing in pediatric cardiology is even safer and of better quality in all its key aspects: urgency, intensity, chronicity and complexity.

Funding Acknowledgement

Type of funding source: None

Bridging the information gap on cancer survivors in Europe: results from the iPAAC Joint Action

Background

Due to demographic transition cancer survivors are dramatically growing and challenging the sustainability of public health systems. Despite accurate indicators are increasingly needed for Health Technology Assessment and health care planning, population-based cancer prevalence is not systematically available in many countries. The European Joint Action “Innovative Partnership for Action Against Cancer” (iPAAC) aims at bridging this gap by supporting the inclusion of indicators on prevalence to complement the cancer burden statistics already available in the European Cancer Information System (ECIS).

Methods

Analysis of a European-wide standardized dataset gathering information on 26 million patients from 100 cancer registries in 29 countries (EUROCARE-6). Methods to estimate and project complete and limited duration population-based prevalence indicators by demographic variables, cancer type and phase of care.

Results

Cancer survivors are mostly women (about 55%) and people over-60 years. Highest crude prevalence proportions in women are observed for breast, colon-rectum, corpus uteri, skin melanoma and cervical cancer (from 1,600 to 200 x 100,000). Prostate, colon-rectum, bladder, non-Hodgkin lymphoma and skin melanoma were the most frequent cancers among male survivors (from 1,000 to 200 x 100,000). Between-country differences are wide, consistently with varying demographic structure, incidence and survival patterns. Impact of long-term survivorship strongly depends on disease lethality.

Conclusions

Cancer survivors are a quite heterogenous population in respect of age, sex, cancer type and disease duration. Reliable and comparable prevalence indicators are essential to improve cancer care planning in European countries. Joint analysis of European wide population-based datasets strengthens the impact of cancer registries information and foster the release of complete statistics on cancer survivors.

Key messages

Cancer survivors are a growing and heterogeneous population to be monitored in public health. Detailed and comparable indicators on cancer prevalence are proposed to complement the cancer burden statistics of the European Cancer Information System (ECIS) through improved collaborative efforts.

Portrait of young Italian university smoker student

Background

Smoking is a widespread problem in all age and social groups. Number of smokers is increasing among students and the years of university are those in which it is most common to start smoking.

The aim of this study is to outline the profile of the smoker university student.

Methods

Between October 2018 and January 2019, a sample of 150 smoking students of Siena University were randomly selected. We administered the structured Fagerstrom test. This test contained six items to evaluate the dependence and the quantity of cigarettes consumption. We conducted a descriptive analysis and a linear regression using software Stata.

Results

The sample was composed of 75 males (50%) and 75 females (50%), with a mean age of 24.6 years (sd 3.1). About 45% of the participants smoked between 11 and 20 cigarettes a day. Fifty per cent of the respondents lighted the first cigarette after 1 hour since they woke up, indeed only about the 25% preferred to smoke just woke up and would hardly give up the first cigarette. About the 80% did not show difficulty to avoid smoking in forbidden places or when they were ill. The mean degree of dependence of cigarettes was 2.7 (sd 2.3), considered as medium-low level of dependence. The degree of dependence (0 -10) was correlated with every items of the test, resulting: time to lighted the first cigarette (r = 0.71, p &lt; 0.005), difficulty to refrain from smoking in places where is forbidden (r = 0.41, p &lt; 0.005), cigarette hate to give up (r = 0.32, p &lt; 0.005), number of cigarettes smoked a day (r = 0.69, p &lt; 0.005), smoking more frequently in the morning (r = 0.26, p &lt; 0.005), smoking even if being sick (r = 0.27, p &lt; 0.005). The gender did not show correlation with any variables.

Conclusions

The our sample showed a medium-low level of dependence from nicotine (11-20 cigarettes a day) with the time to light up the first cigarette after 60 minutes; as resulted from the linear regression analysis. The gender did not have correlation with the dependence from cigarettes.

Key messages

Outline the profile of the joung smoker university student. Smoking is a widespread problem in all age and social groups.

Lung cancer management: monitoring and treating resistance development in third-generation EGFR TKIs

INTRODUCTION

Patients treated with third-generation EGFR TKIs will develop resistance to treatment at a certain point. Early detection of resistance occurrence could allow more options for treatment.

AREAS COVERED

We discuss the development of third-generation EGFR TKIs, focusing on osimertinib and discuss the most common resistance mechanisms under evaluation. We also debate how this resistance can be detected; particularly we review the possible application of liquid biopsy in this scenario. Lastly we discuss available treatment options when resistance occurs, with an eye on ongoing trials and possible future developments.

EXPERT OPINION

As resistance will ultimately develop, a strict instrumental follow-up as per international guidelines is required with the aim of detecting this resistance in an early phase. Detecting an oligoprogression could allow the integration of local ablative therapies while further delaying the need for a systemic therapy change. By exploiting the increasing potentiality of liquid biopsy, in the near future, physicians could be able to understand why a patient develops resistance and therefore can choose the best possible individualized treatment option.

A clinical, histopathological and laboratory study of 19 consecutive Italian paediatric patients with chilblain-like lesions: lights and shadows on the relationship with COVID-19 infection

Background

Acral chilblain‐like lesions are being increasingly reported during COVID‐19 pandemic. However, only few patients proved positivity for SARS‐CoV‐2 infection. The relationship between this skin manifestation and COVID‐19 infection has not been clarified yet.

Objective

To thoroughly characterize a prospective group of patients with chilblain‐like lesions and to investigate the possible relationship with SARS‐CoV‐2 infection.

Methods

Following informed consent, patients underwent (i) clinical evaluation, (ii) RT‐PCR and serology testing for SARS‐CoV‐2, (iii) digital videocapillaroscopy of finger and toe nailfolds, (iv) blood testing to screen for autoimmune diseases and coagulation anomalies, and (v) skin biopsy for histopathology, direct immunofluorescence and, in selected cases, electron microscopy.

Results

Nineteen patients, all adolescents (mean age: 14 years), were recruited. 11/19 (58%) of them and/or their cohabitants reported flu‐like symptoms one to two months prior to skin manifestation onset. Lesions were localized to toes and also heels and soles. Videocapillaroscopy showed pericapillary oedema, dilated and abnormal capillaries, and microhaemorrhages both in finger and toe in the majority of patients. Major pathological findings included epidermal basal layer vacuolation, papillary dermis oedema and erythrocyte extravasation, perivascular and perieccrine dermal lymphocytic infiltrate, and mucin deposition in the dermis and hypodermis; dermal vessel thrombi were observed in two cases. Blood examinations were normal. Nasopharyngeal swab for SARS‐CoV‐2 and IgG serology for SARS‐CoV‐2 nucleocapsid protein were negative. Importantly, IgA serology for S1 domain of SARS‐CoV‐2 spike protein was positive in 6 patients and borderline in 3.

Conclusions

Chilblain‐like lesions during COVID‐19 pandemic have specific epidemiologic, clinical, capillaroscopic and histopathological characteristics, which distinguish them from idiopathic perniosis. Though we could not formally prove SARS‐CoV‐2 infection in our patients, history data and the detection of anti‐SARS‐COV‐2 IgA strongly suggest a relationship between skin lesions and COVID‐19. Further investigations on the mechanisms of SARS‐CoV‐2 infection in children and pathogenesis of chilblain‐like lesions are warranted.

So young, yet so mature? Electrophysiological and vascular correlates of phonotactic processing in 18-month-olds

The present study investigated neural correlates of implicit phonotactic processing in 18-month-old children that just reached an important step in language development: the vocabulary spurt. Pseudowords, either phonotactically legal or illegal with respect to their native language, were acoustically presented to monolingually German raised infants. Neural activity was simultaneously assessed by means of electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS). The former method excellently tracks fast processing mechanisms, whereas the latter reveals brain areas recruited. Results of the present study indicate that 18-month-olds recognize the linguistic properties of their native language based on phonotactics. This manifested in an increased N400 for legal compared to illegal pseudowords in the EEG conforming to adult-like mechanisms. Unfortunately, fNIRS findings did not support this discrimination ability. Possible methodological and brain maturational reasons might explain this null finding. This study provides evidence for the advantage of a multi-methodological approach in order to get a clear picture on neural language development.

AB0027 B CELL SYNOVITIS IN RELATION TO DIAGNOSIS AND CLINICAL PHENOTYPE: COMPARISON BETWEEN RHEUMATOID AND PSORIATIC ARTHRITIS

Background:

Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are both characterized by significant heterogeneity in terms of clinical presentation and outcomes. Furthermore, RA and PsA may share some overlapping features such as autoantibody-negativity, polyarticular involvement, response to certain therapies and pattern of joint damage. The pathobiological bases underlying the intra-disease heterogeneity and the inter-disease similiarities between RA and PsA are however unkown.

Objectives:

Aim of the current study was to investigate the relationship between the synovial immune phenotype and different clinical subsets in patients with RA and PsA.

Methods:

The study population included 96 patients undergoing ultrasound-guided synovial biopsy of the knee and serum sampling on the same day. Patients were recruited according to defined clinical subtypes: anti-citrullinated positive (ACPA) RA (n=26), ACPA-negative RA (n=32), polyarticular (≥5 involved joints) PsA (n=15), and oligoarticular PsA (n=23). Patients were compared for: (i) demographic and clinical features; (ii) synovial histopathological characteristics including CD68-positive infiltrating macrophages, CD3-positive T lymphocytes, CD20-positive B lymphocytes (semi-quantitative scores 0-3); (iii) serum levels of the lymphoid chemokine CXCL13 as a marker of germinal centre activity.

Results:

Collectively, ACPA-positive RA patients, ACPA-negative RA patients and patients with polyarticular PsA presented comparable demographic and clinical features including gender distribution, age, number of involved joints and levels of acute phase reactants. Patients with oligoarticular PsA were instead younger, more frequently males, and with lower levels of acute phase reactants. The degree of macrophage and T cell infiltration correlated with the erythrocyte sedimentation rate (rho 0.38, p=0.001 and rho 0.24, p=0.04 respectively) and C-reactive protein levels (rho 0.38, p=0.001 and rho 0.28, p=0.01 respectively) irrespective of diagnosis, and was significantly lower in oligoarticular PsA (Figure 1A,B). In contrast, the degree of B cell infiltration showed significant differences in relation to the disease subtype: the lowest levels were found in oligoarticular PsA, the highest levels in ACPA-positive RA, whilst ACPA-negative RA and polyarticular PsA presented with intermediate and comparable levels between the two extremes (Figure 1C). Serum levels of CXCL13 correlated with the synovial B cell score (rho 0.30, p=0.03) and, similarly to synovial B cell infiltration, were differentially increased according to the clinical phenotype, with again similarities between ACPA-negative RA and polyarticular PsA (Figure 1D).

Figure 1.

Conclusion:

In patients with chronic inflammatory arthritis, synovial B cell infiltration and systemic markers of germinal centre activity are heterogeneously increased irrespective of disease diagnosis. ACPA-positive RA and oligoarticular PsA appear located at the extremes of a pathobiological continuum, whilst ACPA-negative RA and polyarticular PsA present with intermediate and comparable degrees of B cell involvement. Collectively, our findings open the interesting perspective of a tailored management of patients with inflammatory arthritis based on the disease pathotype rather than on clinical diagnosis.

Disclosure of Interests:

Ludovico De Stefano: None declared, Serena Bugatti Speakers bureau: Bristol-Myers Squibb, Sanofi, Lilly, Novartis, Pfizer, Abbvie, Silvia Rossi: None declared, Carlomaurizio Montecucco: None declared, Antonio Manzo Speakers bureau: Bristol-Myers Squibb, Abbvie, Pfizer

Selection of photosynthesis and respiration models to assess the effect of environmental conditions on mixed microalgae consortia grown on wastewater

This study aimed at evaluating the effects of different environmental conditions (irradiance, temperature, pH and dissolved oxygen) on a microalgae-bacteria consortium cultivated in a pilot-scale open pond and fed on the liquid fraction of anaerobic digestate. A standardized photo-respirometry protocol was followed to evaluate the activity of microalgae under different conditions. Two datasets (specific photosynthetic oxygen production rates and respiratory oxygen consumption rates) were obtained for each environmental parameter, throughout the entire range of conditions found in the outdoor cultivation system. Different kinetic models available in literature were fitted to experimental data and the resulting outputs were compared through model selection estimators, in order to select the most appropriate equations. The proposed set of equations constitute a modelling tool for the prediction of algal growth rates in algae-bacteria systems, as a function of environmental conditions.