AB0275 TOFACITINIB EFFECTIVENESS IN PATIENTS WITH RHEUMATOID ARTHRITIS AFTER CONVENTIONAL OR BIOLOGICAL THERAPY - IT REAL ROLE IN DIFFERENT LINES OF TREATMENT

Background:

rheumatoid arthritis (RA) is a chronic and disabling autoimmune disease, with a high clinical and economic burden. This implies the need to investigate therapies that maximize clinical results. Tofacitinib is recommended as a different alternative to biologic therapy when a patient remains with moderate or high disease activity after conventional DMARDs use, or as an option after failure to biologic therapy.

Objectives:

to evaluate the effectiveness of Tofacitinib in RA as first-line (after conventional DMARDs failure) or second-line treatment (after biologic therapy failure) in a real-life cohort of RA patients and its differences.

Methods:

this is a descriptive retrospective cohort study conducted at a specialized center for RA in Bogota, Colombia; databases from 2017 to 2019 were used to select and study patients with indication of Tofacitinib, regardless of their previous treatment or disease status. The indication and initiation of Tofacitinib (5 mg BID or 11 mg once daily) was an independent medical decision made as part of the individualized management of every patient. Effectiveness was evaluated in those patients who met the high adherence criteria (at least three visits with a rheumatologist per year), with no change or addition of other conventional DMARDs. Frequencies and proportions in baseline characteristics, differences in disease activity were calculated between the first and second line tofacitinib treatment. Comparisons of continuous variables data between the two patient groups were made using the t-test; the chi-square test and Fisher’s exact test were used for statistical analysis of categorical variables. Logistic regressions were performed to analyze related factors with therapeutic response outcomes.

Results:

we included 152 RA patients who received tofacitinib: first-line (T1) (n= 85, 55.9%) or second-line (T2) (n= 67, 44.1%). T1 first-line group was younger than the T2 second-line patients (53±12.8 years and 59±11.4 years, p-value 0.01) and they had a shorter disease duration than T2 patients (11.8 vs. 12.8 years, p-value 0.01). Comparative analysis of response to treatment showed a reduction in DAS28 at 3, 6 and 12 months in both study groups. The response in disease activity at 3 months was a major factor related to 6-month response (OR 13.4, 95% CI 4.5-39.4, p value 0.000), while non-response at 3 months were associated with no response at 6 months of follow-up. Baseline DAS28 was significantly associated with response at 12 months (OR 1.9, 95% CI 1.11-3.25, p-value 0.028). At 12 months of treatment, both groups showed disease response and control according to the DAS28 from baseline, but a higher proportion of T1 patients achieved remission (45% vs 23%). A subgroup analysis to evaluate T2 second-line Tofacitinib therapy showed no statistically significant differences in any response criteria according to the number of previously received biologicals.

Table 1.

Regression analysis (risk of response of the disease at 6 and 12 months of treatment with Tofacitinib)

FactorResponse at Month 6Response at Month 12*ORIC95%P valueORIC95%P valueAge1.000.97-1.030.7881.020.98-1.060.211Male1.820.65-5.080.2510.810.27-2.380.709Duration of RA0.990.94-1.040.9081.020.96-1.080.444Positive Rheumatoid Factor0.81026-2.560.7300.630.17-2.260.485Positive Anti-CCP0.340.068-1.60.189Initial DAS281.611.04-2.490.0331.91.11-3.250.018First line0.440.19-1.010.0541.470.56-3.830.423Treatment period1.120.80-1.550.4921.10.75-1.610.607Dose: 11 mg.0.950.42-2.130.9040.750.258-1.90.565Response at Month 313.424.57-39.40.0002.320.87-6.180.091

*Positive Anti-CCP at month 12 was omitted because of collinearity

Conclusion:

Tofacitinib is an effective treatment option for patients with RA after conventional DMARDs and in patients after biologic therapy failure, but maybe is better used it as a T1 first-line of treatment. Further studies are required to determine the real role of tofacitinib in different lines of RA treatment.

Disclosure of Interests:

Wilberto Rivero: None declared, Linda Ibata: None declared, Susan Martinez: None declared, Adriana Rojas-Villarraga: None declared, Pedro Santos-Moreno Speakers bureau: Pedro Santos-Moreno has received fees for conferences from: Abbvie, Biopas-UCB, Bristol, Janssen, Pfizer, Sanofi., Consultant of: Pedro Santos-Moreno has received fees for counseling and advisory boards from: Abbvie, Abbott, Biopas-UCB, Bristol, Janssen, Pfizer, Roche, Sanofi., Grant/research support from: Pedro Santos-Moreno has received research grants from: Abbvie, Abbott, Biopas-UCB, Bristol, Janssen, Pfizer, Roche, Sanofi.

AB0242 CERTOLIZUMAB IN MONOTHERAPY AS EFFECTIVE THAN IN COMBINATION IN RHEUMATOID ARTHRITIS PATIENTS

Background:

Tumour necrosis factor-a (TNFa) inhibitors are one of the most used biological therapy for rheumatoid arthritis (RA) patients without response to conventional disease-modifying antirheumatic drugs (cDMARDs). There is scarce information about biological DMARDs (bDMARDs) effectiveness as monotherapy in real life.

Objectives:

To assess the effectiveness of Certolizumab pegol in real-life clinical practice in a cohort of patients with RA and previous failure to cDMARDs who received certolizumab as monotherapy, combined with Methotrexate (MTX), combined with leflunomide (LFN), or both MTX and LFN.

Methods:

A retrospective cohort study was conducted at a specialized center for RA management in Colombia. Patients treated with Certolizumab as monotherapy or in combination with MTX, or LFN, or both MTX plus LFN, (2012 – 2020) were included. The indication of certolizumab was a independent decision based on disease activity. Patients could be taking adjuvant medications for pain and/or corticosteroids. Certolizumab was administered 400 mg SC monthly after three induction doses at weeks 0, 2 y 4, as monotherapy or in combination with MTX (until 25 mg/week), LFN (20 mg/day) or both as a first-line treatment after failure with cDMARDs or as a second-line treatment after failure with one or more bDMARDs. Effectiveness was assessed at three, six, and twelve months according to the change in DAS28. Exploratory comparisons of numeric variable data between groups were done (ANOVA). Chi-square test and Fisher’s exact test were used for categorical variables. Multivariate analyses (logistic regressions) were performed to analyse factors related to the response at 6 and 12 months.

Results:

Of 181 enrolled patients, 24 received certolizumab as monotherapy, 62 combined with MTX, 47 in combination with LFN and 48 in combination with MTX and LFN. 55.2% of patients were first-line treatment, without significant differences between groups. Mean age of subjects included was 57.87 ± 12.33 with a mean age of around 60 years in patients treated with CERTO+MTX and CERTO+LFN (p=0,014). Women predominated in all groups (84% of the total) (p=0,275). The duration of arthritis on average was 8.27 ± 8.73 years, without significant differences between treatment groups (p=0,871). In terms of disease activity, 78.5% of patients were in moderate or high disease activity, according to DAS28, without significant differences between the groups (p=0,787). Differences in the number of biologicals and corticoid use were observed, patients in the combination groups had used in a higher proportion two or more biological (p=0,046) than in the monotherapy group and had used corticosteroids (p=0,042) more frequently. Overall, there were decreased disease activity, at 3 and 6 months with no significant differences between groups (p=0,08). At 12 months of treatment, there was a higher maintenance in mild activity/remission response in monotherapy group compared to the others (p=0,01). In the multivariate analysis, no differences were observed in the response at 6 and 12 months between the treatment groups. The response at three months was the only variable associated with the 6-month response (OR 5.46; CI 95% 2.08 – 14.32). The response at three months (OR 4.04; CI 95% 1.28-12.69) and positive anti-CCP (OR 3.83; CI 95% 1.11-13.21) were associated with 12-month response.

Conclusion:

These exploratory results show a clear trend of Certolizumab being effective as monotherapy in patients previously treated with cDMARDs and even after being treated with one bDMARD. Although results are not statistically different, it seems that certolizumab in monotherapy could be as least as effective as combination therapy. Prospective studies with larger sample size and with a structured follow-up are needed to confirm these findings.

Disclosure of Interests:

Paola Osorio: None declared, Laura Villarreal: None declared, Wilberto Rivero: None declared, Linda Ibata: None declared, Susan Martinez: None declared, Adriana Rojas-Villarraga: None declared, Pedro Santos-Moreno Speakers bureau: has received fees for conferences from: Abbvie, Abbott, Biopas-UCB, Bristol, Janssen, Pfizer, Roche, Sanofi, Consultant of: has received fees for counseling, advisory boards from: Abbvie, Abbott, Biopas-UCB, Bristol, Janssen, Pfizer, Roche, Sanofi, Grant/research support from: has received fees for research grants from: Abbvie, Abbott, Biopas-UCB, Bristol, Janssen, Pfizer, Roche, Sanofi

Factor structure and psychometric properties of the Connor-Davidson resilience scale (CD-RISC) in individuals with opioid use disorder

AIMS

Resilience is defined as the capacity for an individual to maintain normal functioning and resist the development of psychiatric disorders in response to stress and trauma. Although previous investigators have acknowledged the important role of resilience in those with substance use disorders, this is the first study to investigate the reliability, validity, and factor structure of the Connor-Davidson Resilience Scale (CD-RISC-25) in a sample of individuals with opioid use disorder (OUD). Additionally, we explored the relationship between trait resilience and the severity of drug-related problems.

METHODS

Four hundred and three participants (22 % female) with OUD completed the CD-RISC-25, Beck Depression Inventory (BDI-II), and the self-report Addiction Severity Index (ASI). Confirmatory factor analysis (CFA) tested the originally proposed 5-factor solution of the CD-RISC-25.

RESULTS

CFA results indicated that a 5-factor model of the CD-RISC-25 performed somewhat better than the 1-factor solution. Pearson correlation revealed a negative association between CD-RISC-25 (M = 75.82, SD = 15.78) and ASI drug-use composite score (M = .25, SD=-0.16), r=-0.148, p<.01, and between CD-RISC-25 and BDI-II (M = 11.33, SD = 10.58), r=-.237, p<.001.

CONCLUSIONS

Albeit providing only limited support for the original 5-factor structure, our results indicate that the scale may be useful for screening individuals with OUD who have a vulnerability to stress. Consistent with prior studies, higher resilience was associated with lower depression symptoms and addiction severity, further demonstrating the CD-RISC-25 ability to predict psychiatric stability. To inform the development of more targeted interventions, future studies should examine resilience longitudinally, in addition to exploring more comprehensive approaches to measuring resilience.

"Optimization of Surgical Resident Safety and Education During the COVID-19 Pandemic - Lessons Learned"

The COVID-19 pandemic has engendered rapid and significant changes in patient care. Within the realm of surgical training, the resultant reduction in clinical exposure and case volume jeopardizes the quality of surgical training. Thus, our general surgery residency program proceeded to develop a tailored approach to training that mitigates impact on resident surgical education and optimizes clinical exposure without compromising safety. Residents were engaged directly in planning efforts to craft a response to the pandemic. Following the elimination of elective cases, the in-house resident complement was effectively decreased to reduce unnecessary exposure, with a back-up pool to address unanticipated absences and needs. Personal protective equipment availability and supply, the greatest concern to residents, has remained adequate, while being utilized according to current guidelines. Interested residents were given the opportunity to work in designated COVID ICUs on a volunteer basis. With the decrease in operative volume and clinical duties, we shifted our educational focus to an intensive didactic schedule using a teleconferencing platform and targeted areas of weakness on prior in-service exams. We also highlighted critical COVID-19 literature in a weekly journal club to better understand this novel disease and its effect on surgical practice. The long-term impact of the COVID-19 pandemic on resident education remains to be seen. Success may be achieved with commitment to constant needs assessment in the changing landscape of healthcare with the goal of producing a skilled surgical workforce for public service.

The Increasing Prevalence of Fentanyl: A Urinalysis-Based Study Among Individuals With Opioid Use Disorder in New York City

BACKGROUND AND OBJECTIVES

Opioid-related overdose deaths in North America have increased drastically, partially due to the increased prevalence of illicitly manufactured fentanyl. The current study sought to assess the prevalence and intentionality of fentanyl use among individuals with opioid use disorder (OUD).

METHODS

For this secondary analysis (study 1) we screened a total of 1118 urine samples from 316 participants with OUD from 2016 to 2019. Fentanyl knowledge and intentionality of use were assessed in a separate OUD sample (study 2; N = 33).

RESULTS

In study 1, 34.6% of all urine samples tested positive for fentanyl. Overall, 149 (47.2%) participants provided more than or equal to one urine sample that tested fentanyl-positive, and 93 (29.4%) provided more than or equal to two fentanyl-positive samples. The number of fentanyl-positive samples, relative to the number of samples tested each year, increased by 330% from year 1 to 3. Study 2 found all participants had pre-existing knowledge that drugs may be adulterated with fentanyl, yet 67% were surprised by their own fentanyl-positive test result.

DISCUSSION AND CONCLUSIONS

Like previous studies, our data indicate the high prevalence of fentanyl exposure and low perception of fentanyl-related risk among individuals with OUD, respectively, suggesting that opioid overdose harm reduction efforts may need to focus more on drug users' understanding of risks related to fentanyl use and adulteration of drugs.

SCIENTIFIC SIGNIFICANCE

The current studies provide longitudinal data on fentanyl exposure prevalence and risk perception that is uniquely granular by assessing OUD treatment status, and by identifying potential associations between fentanyl exposure with the presence of other drug use and nonfatal overdose. (Am J Addict 2021;30:65-71).

Comparative ecotoxicity of single and binary mixtures exposures of cadmium and nickel on growth and biomarkers of Lemna gibba

The aim of the present study was to investigate the toxicity effects of cadmium-nickel (Cd-Ni) after single and mixtures exposures over the macrophyte Lemna gibba. Effects were assessed on growth, as frond number and fresh weight and biochemical parameters, such as total protein content and activity of antioxidant enzymes. Plants were exposed to single Cd and Ni in concentrations that ranged between 0.13-33 mg/L and 0.18 and 11.82 mg/L, respectively. For binary mixtures, individual metal IC50 values were used for selection of the evaluated concentrations. The experimental design consisted in three different ratios based on the concept of toxic units (TU), each ratio was evaluated by five different concentrations. Both single and mixture treatments were performed for 7 days following the conditions according to OECD (2006). Single and mixture exposures affected plant growth and the biomarkers of the antioxidant response. Growth parameters showed a differential sensitivity after individual metal exposures. Cd was more toxic for L. gibba plants when fresh weight was considered, but on the contrary, considering frond number, Ni was the most toxic metal. IC50-7d, based on growth rate calculated on frond number were 17.8 and 2.47 mg/L, and on fresh weight were 1.08 and 3.89 mg/L, for Cd and Ni respectively. LOEC values for Cd were obtained at 2.06 and 1.03 mg/L, for frond number and fresh weight, respectively; while for Ni, these values were 0.92 and 11.82 mg/L. The three evaluated ratios for binary mixtures resulted in a high toxicity considering the same response variables in single metal exposures. Ratio 1 (2/3 TU Cd-1/3 TU Ni) was the most toxic considering both frond number and fresh weight, showing percentage inhibition of growth rates of 96 and 90%, respectively for the highest concentration. A modification of the protein content was observed in single, but especially in the mixture treatments. The activity of catalase (CAT; EC 1.11.1.6), ascorbate peroxidase (APOX; EC 1.11.1.11) and guaiacol peroxidase (GPOX; EC 1.11.1.7) was also affected in single and mixtures assays. APOX and GPOX showed a higher increase of its activities respect the controls after mixture treatments than for single metal treatments. Such optimization of the antioxidant system could be one of the causes of the antagonistic toxicity observed in mixture exposures. Concentration addition (CA) reference model, based on frond number, in Cd-Ni mixtures was not a good predictor to evaluate toxicity from dissolved metal concentration since the results showed that toxicity was less than additive, with an average of ΣTU = 2.17. The observed antagonisms resulted to be stronger in mixtures with higher metal concentrations.

The acute and repeated effects of cigarette smoking and smoking-related cues on impulsivity

INTRODUCTION AND AIMS

Impulsivity may be a risk factor that increases vulnerability to nicotine dependence. However, nicotine exposure itself may directly increase impulsivity. This is a secondary analysis of the first study in a controlled laboratory setting, which assessed the effects of nicotine administration (acute and repeated) and exposure to smoking cues on behavioural impulsivity in humans (ClinicalTrials.gov Identifier: NCT01395797).

DESIGN AND METHODS

Twenty-seven smokers completed three tasks to assess behavioural impulsivity (the Immediate Memory Task and the Delayed Memory Task assessing response initiation, and the GoStop Task assessing response inhibition) following: (i) 4 days of cigarette smoking (nicotinised or denicotinised cigarette); (ii) acute cigarette smoking (nicotinised); and (iii) exposure to smoking-related cues.

RESULTS

Four days of nicotinised cigarette smoking (vs. denicotinised) did not significantly increase Immediate Memory Task, Delayed Memory Task and GoStop scores. However, acute cigarette smoking increased GoStop impulsivity, but only following 4 days of smoking nicotinised cigarettes (P < 0.05). Exposure to smoking-related cues had no statistically significant effect on impulsivity.

DISCUSSION AND CONCLUSIONS

Our results suggest that repeated nicotine exposure may sensitise subsequent acute nicotine effects on behavioural impulsivity in heavy smokers.

Photodynamic therapy (PDT) in non-surgical treatment of periodontitis

Periodontitis represents a major problem for patients, since it is not possible to eliminate the bacteria that are responsible for this pathology with a pharmacological treatment. The present study included forty-four patients with periodontitis, who had undergone disinfection via photodynamic therapy (PDT) using a laser source having a 635 nm wavelength associated with a photoactivable substance (methylene blue). Clinical assessment of plaque index (PI), bleeding on probing (BOP), probing depth (PD), calculus index (CI), gingival recession (REC) and clinical attachment level (CAL) were recorded at base line, 1 month (4 weeks) after treatment and again 3 months (12 weeks) after treatment, while site radiography (RX) and microbiological test (MT) were recorded at base line and 3 months (12 weeks) after treatment. The outcomes show a good efficacy of the PDT in the elimination of the periodontal pathogenic microflora and in the improvement of the clinical parameters considered: from the base line to the final check after 12 weeks it has been observed a reduction in REC of about 16.9%, a reduction of CAL of about 17.85%, a reduction of the BoP of about 93.3%, a reduction of the PD of about 17%, a reduction of the CI of about 66.3%, a reduction of PI of about 44%, and microbiologically a reduction of the total amount of bacteria with proven parodontopathic properties (red complex bacteria) of about 58.74%. Within the limits of the present study, PDT can be reasonably considered as a good carrier that leads to significant improvements in the parameters (clinical and microbiological) considered.

Comparative ecotoxicity of single and binary mixtures exposures of cadmium and zinc on growth and biomarkers of Lemna gibba

In the present study, single and mixture effects of cadmium (Cd) and zinc (Zn) on Lemna gibba were analyzed and compared using growth parameters, based on frond number and fresh weight, and biochemical parameters, such as pigment, protein content and activity of antioxidant enzymes. Plants were exposed for 7 days to these metals in nutrient solution. Single and mixture exposures affected plant growth and the biomarkers of the antioxidant response. Considering the growth parameters, Cd was found to be much more toxic than Zn. IC50-7d, based on growth rate calculated on frond number, were 17.8 and 76.73 mg/L, and on fresh weight were 1.08 and 76.93 mg/L, for Cd and Zn respectively. For Cd, LOEC values were obtained at 2.06 and 1.03 mg/L, for frond number and fresh weight respectively; while for Zn, at 20.1 and 74.6 mg/L. A high toxicity effect, considering the same response variables, was observed in plants exposed to the mixtures. Three fixed ratios, based on toxic units (TU) were assayed, ratio 1: 2/3 Cd-1/3 Zn, ratio 2: 1/2 Cd-1/2 Zn and ratio 3: 1/3 Cd-2/3 Zn. Ratio 3 (where Zn was added in higher proportion) was the less toxic. All concentrations of Ratio 1 and 2 significantly inhibited plant growth, showing a 100% inhibition of growth rate at the highest concentrations when based on frond number. Catalase (CAT; EC 1.11.1.6), ascorbate peroxidase (APOX; EC 1.11.1.11) and guaiacol peroxidase (GPOX; EC 1.11.1.7) activities in single metals assays were higher than controls. In mixture tests, the activity of APOX and GPOX was significantly stimulated in plants exposed to all evaluated combinations, while CAT was mainly stimulated in Ratio 3. It was observed that the activity of the enzymes was increased in the mixtures compared with similar concentrations evaluated individually. APOX activity was observed to fit the CA model and following a concentration-response pattern. The response of this antioxidant enzyme could serve as a sensitive stressor biomarker for Cd-Zn interactions. Frond number in Cd-Zn mixtures was not well predicted from dissolved metal concentration in solution using concentration addition (CA) as reference model, as results showed that toxicity was more than additive, with an average of ΣTU = 0.75. This synergistic effect was observed up to 50 mg Zn/L in the mixture, but when it was present in higher concentrations a less than additive effect was observed, indicating a protective effect of Zn. A synergistic and dose-ratio deviations from CA model were also observed.

A randomized, double-blind, placebo-controlled study of the kappa opioid receptor antagonist, CERC-501, in a human laboratory model of smoking behavior

Preclinical data indicate that selective kappa opioid receptor antagonists reduce nicotine self-administration and withdrawal symptoms. The aim of the current study was to determine whether treatment with CERC-501, an orally available, potent, and selective kappa opioid receptor antagonist, could alleviate nicotine withdrawal and craving and mitigate mood alterations associated with nicotine withdrawal in humans. Healthy, adult cigarette smokers were enrolled into this randomized, multisite, double-blind, placebo-controlled, crossover study. Participants completed two 8-day treatment phases during which they received either CERC-501 (15 mg, p.o., once daily) or placebo. On the seventh day of each dosing phase, participants were admitted as inpatients for an 18-hour cigarette abstinence period followed by experimental testing. The primary outcome measures were (a) performance on the McKee Smoking Lapse test (ie, latency to smoke in exchange for money) and (b) number of cigarettes self-administered during a 60-minute ad lib smoking period. Other outcomes included measures of craving, mood, anxiety, nicotine withdrawal, and subjective effects of cigarette smoking. A total of 71 participants who smoked an average of approximately 23 cigarettes per day were enrolled, and 56 subjects completed the study. CERC-501 was well tolerated, but it did not significantly alter the latency to start smoking (CERC-501: 16.5 min vs placebo: 17.7 min) or the number of cigarettes smoked (CERC-501: 3.3 cigarettes vs placebo: 3.1 cigarettes). Compared with placebo, CERC-501 also did not affect cigarette craving, mood, anxiety, nicotine withdrawal, or subjective effects of smoking. These findings do not support a role for CERC-501 in the treatment of nicotine use disorder.

0683 CPAP Adherence Relative To Sleep Duration And Sleep Period In Different Study Populations

Introduction

CPAP is intended for use during sleep to alleviate disordered breathing. Most patients who use CPAP do so for only a portion of their sleep period, although anecdotally it is known that some also use CPAP while awake. We compared the unusually high levels of CPAP adherence found in a recent study of patients with Overlap Syndrome to a VA clinical population and to participants from the APPLES study.

Methods

CPAP adherence levels were taken from three sources: (1) The O2VERLAP Study, a large comparative effectiveness trial that used two different methods of providing information and support to current CPAP users diagnosed with both OSA and COPD. (2) Combined data from the four most recent clinical CPAP trials conducted at VA San Diego Healthcare System. (3) The APPLES study. Total sample sizes were 332, 957, and 405, respectively. Total sleep time (TST) and total sleep period (TSP) were assessed via the Pittsburgh Sleep Quality Index (PSQI) for (1) and (2) and via polysomnography for (3).

Results

Mean CPAP use, TST, and TSP for each source were: (1) 6.7, 6.8, & 8.1; (2) 4.0, 6.1, & 7.5; (3) 4.5, 6.6, & 8.0. We examined the ratios of adherence over either TST or TSP, and the ratios for each source were: (1) 98% & 83%; (2) 66% & 55%; (3) 68% & 56%.

Conclusion

This comparison demonstrates that unlike many CPAP users who tend to use therapy for only a fraction of time spent asleep, patients with COPD and OSA exhibit higher levels of adherence which often exceed sleep time and may be obtaining additional benefits from CPAP use during non-sleep periods. More research is needed both to improve CPAP delivery and support for patients who are using CPAP sub optimally and to understand the factors that account for the heightened levels of CPAP adherence in COPD.

Support

PPRND #1507-31666; IIR 02-275; IIR 07-163; IIR 12-069; PULM-028-12F.

0995 Nightcap For School-nights: Association Between Milk Intake And Sleep Duration In First-graders

Introduction

Insufficient sleep has been identified as an obesity risk factor due to mechanistic pathways contributing to higher carbohydrate intake, including in children. Dietary intake of macronutrients, such as fats and protein found in milk, may serve as a modifiable risk factor for adequate sleep. We hypothesize that milk intake among a sample of urban first-graders may be associated with sleep duration.

Methods

Cross-sectional analysis of parent reports of an adapted version of the Child Sleep Health Questionnaire (CSHQ) and Block Dietary Data Systems Food Frequency Questionnaire (FFQ) were analyzed among a sample of 837 Black children in Brooklyn, New York. Summary scores were created for milk type. Milk intake was classified by fat content: whole milk and 2% categorized as high-fat, and 1% and skim as low-fat. Independent t-test, correlations and regression analysis to identify associations between parent reports of child’s sleep duration and milk intake were conducted.

Results

On average, children were 7.3 + 0.6 years old and 52% female. Nearly 57% of parents were immigrants. Children’s mean BMI was 17.27, approximately at the 85th BMI percentile according to CDC index-for-age percentiles. On average, FFQ data reported children consumed high-fat milk 6 days a week. Linear variable regression analysis between high-fat milk intake and sufficient sleep were significant (β =, 0.090, p &lt; 0.05). BMI was significantly associated with high-fat milk intake (β= 0.17, p&lt;0.05). However, high-fat milk intake was not significantly associated with (in)sufficient sleep, after controlling for BMI, sex and age. No difference was reported between immigrant parents and U.S. born parents.

Conclusion

Plausibly, high-fat milk is contributing to satiety and longer sleep duration. Future studies should include more comprehensive measurement of milk consumption (i.e. time of day and volume) to consider possible effects on children’s sleep. Actigraphy measures and sleep diaries should also be considered.

Support

Bezos Grant and Community Service Plan grant.

0238 Campus Food Pantry Assistance is Related to Better Physical And Mental Health Through Adequate Sleep Among College Students in a Public University System

Introduction

Food insecurity is an issue among students in higher education and has been linked to insufficient sleep, and poor mental and general health. College campuses have quickly responded by establishing campus food pantries. However, the extent to which campus food pantries are ameliorating the impacts of food insecurity is unknown.

Methods

Online survey data were collected from a cross-sectional sample of 1,855 students who were food pantry users in the 10-campus UC system. Students were asked to report their number of visits to a food pantry in the past month, and to rate their general health, depressive symptoms, and number of days of enough sleep (in a week) before and after food pantry access. Changes in days of enough sleep, depressive symptoms and general health were computed. Demographic characteristics were obtained from institutional data. Path analysis was used to examine direct and indirect pathways from food pantry use to depressive symptoms and general health through enough sleep days, controlling for workstudy receipt, Pell grant receipt and family income.

Results

Students on average were 21.7 years old (SD= 3.5), and had more days of adequate sleep (25%), and improved depressive symptoms (43%) and general health (31%) after obtaining services from a campus food pantry. An increase in monthly food pantry use was directly related to a decrease in depressive symptoms (β= 0.08, p&lt;0.001) and an increase in general health (β= 0.07, p=0.001). Additionally, an increase in food pantry use related to an increase in getting more days of enough sleep (β=0.07, p=0.001), which in turn positively related to a decrease in depressive symptoms (β=0.18, p&lt;0.001) and improved general health (β=0.24, p&lt;0.001).

Conclusion

Food pantry use had a positive relationship with student health outcomes, and enough sleep days played an important mediating role. Findings suggest that emergency food access may have a positive impact on student health outcomes.

Support

This study was funded by the UC Campus Basic Needs Committees.

0696 The O2VERLAP Study: High Cpap Use Levels Found In Overlap Syndrome (OSA And COPD) Patients

Introduction

CPAP therapy is prescribed to help manage disordered breathing during sleep time periods. Most users, especially those with non-severe obstructive sleep apnea (OSA), use it only for some portion of their sleep period. Patients with Overlap Syndrome have both OSA and chronic obstructive pulmonary disease (COPD). While there has been some research on CPAP use levels in this patient population, there has been little indication that they use CPAP any differently than those with OSA only.

Methods

The O2VERLAP Study was a large comparative effectiveness trial enrolling people with COPD and OSA and using two different methods of providing information and support to current users of CPAP therapy. The study utilized an electronic national recruitment strategy and 332 participants were enrolled. CPAP data from the 12-week study period was analyzed. The Pittsburgh Sleep Quality Index was used to determine both estimated total sleep period (TSP) and total sleep time (TST). Because participants were all current users of CPAP, data from the total sample was combined and used. The percentage of TST and TSP that CPAP was used was calculated as CPAP use divided by either TST or TSP.

Results

The mean TST was 6.8 hours, TSP was 8.1 hours, and CPAP use was 6.7 hours. CPAP was used during 98.5% of the TST and during 82.7% of the TSP. Over 35% of the sample used CPAP at a level that was equal to or greater than their total sleep period.

Conclusion

Most OSA study populations use CPAP for some fraction of their night’s sleep. This COPD/OSA study population used CPAP to a markedly high level, including over one-third of the sample (n=~100) who used CPAP more than their self-reported sleep period. Further research on the extent and reasons for non-sleep period (i.e., daytime) CPAP use in COPD patients is warranted.

Support

PPRND #1507-31666.

S, Anthony C, Coleman P, Cottingham B, Culmo R, Curtis R, Dingman L, Johnson R, Lehman G, Loughran J, Martinez S, Moody J, Paisley C, Radloff H, John AS, Schrader E, Sizemore J, Wenger J, White G. Combustion Method for Determination of Crude Protein in Meat and Meat Products: Collaborative Study

Twelve laboratories participated in a collaborative study to compare a combustion method with the AOAC mercury catalyst Kjeldahl method (928.08) for the determination of crude protein in meat and meat products. Three different combustion instruments were used; consequently, the combustion method for this study is written in generic terms describing the principle, the apparatus specifications, and the performance requirements needed. Fifteen sample pairs were used for the study; each pair consisted of the same commercial meat product from each of 2 different manufacturers. Protein content of all samples ranged from about 10 to 20%. In addition, nicotinic acid and lysine monohydrochloride were used as standards to assess combustion equipment performance. All laboratories and all instruments performed the combustion method satisfactorily on the basis of results for the standards. For the meat samples, repeatability standard deviations (sr) ranged from 0.11 to 0.40 for the Kjeldahl method and from 0.12 to 0.41 for the combustion method; the repeatability relative standard deviations (RSDr) ranged from 0.82 to 2.41% and from 0.60 to 2.23% for the Kjeldahl and combustion methods, respectively. Reproducibility standard deviations (SR) ranged from 0.20 to 0.49 for the Kjeldahl method and from 0.18 to 0.46 for the combustion method, whereas the reproducibility relative standard deviations (RSDR) ranged from 1.59 to 2.84% for the Kjeldahl method and from 1.32 to 3.35% for the combustion method. Overall grand means were 15.59% protein for the Kjeldahl method and 15.75% protein for the combustion method. The combustion method was adopted first action by AOAC International.

Naloxone-Induced Withdrawal in Individuals With and Without Fentanyl-Positive Urine Samples

BACKGROUND AND OBJECTIVE

This retrospective analysis of data from heroin users screening for clinical research, sought to determine if more naloxone is needed to precipitate opioid withdrawal among those who regularly use heroin with fentanyl, as opposed to those who use heroin without fentanyl.

METHODS

Over the course of three to five screening visits, participants completed assessments of drug use, along with urine toxicology tests at each visit. To test for opioid dependence, 29 participants completed a modified Wang test (score: 0-150) during which an intramuscular dose of naloxone (0.2-0.4 mg) was administered and the severity of withdrawal was quantified.

RESULTS

The severity of opioid withdrawal was compared between individuals whose urine toxicology regularly tested positive for fentanyl (N = 15), and those only positive for other opioids (N = 14). No significant differences were found in demographic or drug use between the fentanyl-positive (mean: age 41.1 years, 9.1 bags heroin/d) and fentanyl-negative (42.0 years, 10.0 bags heroin/d) groups. Intramuscular naloxone-precipitated robust withdrawal in both samples (P < .01) with no significant difference (P = .8) in the severity (fentanyl positive [100.6 ± 13.4]; fentanyl negative [82.7 ± 9.6]).

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

These data suggest that a standard naloxone dose can be equally effective at precipitating withdrawal in individuals using heroin with fentanyl compared to heroin without fentanyl. These data contribute to our understanding of how naloxone antagonizes the effects of fentanyl and may have significant implications for the clinical laboratory and opioid overdose. A prospective clinical laboratory study with the proper opioid maintenance controls is needed to provide a more definitive finding. (Am J Addict 2019;00:00-00).

Assessing the contribution of opioid- and dopamine-related genetic polymorphisms to the abuse liability of oxycodone

BACKGROUND

Attempts to identify opioid users at increased risk of escalating to opioid use disorder have had limited success. Data from a variety of sources suggest that genetic variation may mediate the subjective response to opioid drugs, and therefore contribute to their abuse potential. The goal of the current study was to observe the relationship between select genetic polymorphisms and the subjective effects of oxycodone under controlled clinical laboratory conditions.

METHODS

Non-dependent, volunteers with some history of prescription opioid exposure (N = 36) provided a blood sample for analyses of variations in the genes that encode for the μ-, κ- and δ-opioid receptors, and the dopamine metabolizing enzyme, catechol-O-methyltransferase (COMT). Participants then completed a single laboratory test session to evaluate the subjective and analgesic effects of oral oxycodone (0, 10, and 20 mg, cumulative dose = 30 mg).

RESULTS

Oxycodone produced typical μ-opioid receptor agonist effects, such as miosis, and decreased pain perception. Oxycodone also produced dose-dependent increases in positive subjective responses such as: drug "Liking" and "Good Effect." Genetic variants in the μ- (rs6848893) and δ-opioid receptor (rs581111) influenced the responses to oxycodone administration. Additionally, self-reported "Stimulated" effects of oxycodone varied significantly as a function of COMT rs4680 genotype.

DISCUSSION

The current study shows that the euphoric and stimulating effects of oxycodone can vary as a function of genetic variation. Though the relationship between the stimulating effects of opioids and their abuse liability is not well established, we know that the ability of opioids to provide intense feelings of pleasure is a significant motivator for continued use. If replicated, specific genetic variants may be useful in predicting who is at increased risk of developing maladaptive patterns of use following medical exposure to opioid analgesics.

Hypoxia-Induced Caveolin-1 Expression Promotes Migration and Invasion of Tumor Cells

BACKGROUND

Exacerbated proliferation of cancer cells in nascent tumors leads to the genesis of a hypoxic microenvironment, which is associated with poor patient prognosis, because these stress conditions enhance migratory, invasive and metastatic capacities of tumor cells. These changes are associated with the induction of the hypoxia-inducible factors (HIFs, mainly HIF1α) and increased expression of target genes, including Caveolin-1 (CAV1). Results from our group have shown that CAV1 expression in metastatic cancer cells promotes cell migration/invasion in vitro and metastasis in vivo in a manner dependent on tyrosine-14 phosphorylation by src family kinases. Here, we evaluated whether hypoxia-induced expression of CAV1 was required for hypoxia-dependent migration and invasion in cancer cells.

METHODS

B16-F10 murine melanoma and HT29(US) colon adenocarcinoma cells were exposed to hypoxia (1% O2). CAV1 expression was evaluated by western blotting. Endogenous CAV1 and HIF1α were knocked-down using different shRNA constructs. Cell migration and invasion were evaluated in Boyden Chamber and Matrigel assays, respectively.

RESULTS

We observed that hypoxia increased CAV1 protein levels in a HIF1 α- dependent manner, in B16-F10 and HT29(US) cells. Importantly, hypoxia-dependent migration of both tumor cell lines was blocked upon CAV1 knock-down. Likewise, pharmacological inhibition of HIF prevented hypoxia-induced migration and invasion in B16-F10 cells. Finally, hypoxia-induced migration was also blocked by the src-family kinase inhibitor 4-amino-5-(4-chloro-phenyl)-7-(t-butyl) pyrazolo3,4-dpyrimidine (PP2), an inhibitor of CAV1 phosphorylation.

CONCLUSION

Hypoxia induced migration and invasion of metastatic cancer cells require HIF1α-dependent induction of CAV1 expression and src family kinase activation.

Origin and composition of cell-free DNA in spent medium from human embryo culture during preimplantation development

STUDY QUESTION

What is the origin and composition of cell-free DNA in human embryo spent culture media?

SUMMARY ANSWER

Cell-free DNA from human embryo spent culture media represents a mix of maternal and embryonic DNA, and the mixture can be more complex for mosaic embryos.

WHAT IS KNOWN ALREADY

In 2016, ~300 000 human embryos were chromosomally and/or genetically analyzed using preimplantation genetic testing for aneuploidies (PGT-A) or monogenic disorders (PGT-M) before transfer into the uterus. While progress in genetic techniques has enabled analysis of the full karyotype in a single cell with high sensitivity and specificity, these approaches still require an embryo biopsy. Thus, non-invasive techniques are sought as an alternative.

STUDY DESIGN, SIZE, DURATION

This study was based on a total of 113 human embryos undergoing trophectoderm biopsy as part of PGT-A analysis. For each embryo, the spent culture media used between Day 3 and Day 5 of development were collected for cell-free DNA analysis. In addition to the 113 spent culture media samples, 28 media drops without embryo contact were cultured in parallel under the same conditions to use as controls. In total, 141 media samples were collected and divided into two groups: one for direct DNA quantification (53 spent culture media and 17 controls), the other for whole-genome amplification (60 spent culture media and 11 controls) and subsequent quantification. Some samples with amplified DNA (N = 56) were used for aneuploidy testing by next-generation sequencing; of those, 35 samples underwent single-nucleotide polymorphism (SNP) sequencing to detect maternal contamination. Finally, from the 35 spent culture media analyzed by SNP sequencing, 12 whole blastocysts were analyzed by fluorescence in situ hybridization (FISH) to determine the level of mosaicism in each embryo, as a possible origin for discordance between sample types.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Trophectoderm biopsies and culture media samples (20 μl) underwent whole-genome amplification, then libraries were generated and sequenced for an aneuploidy study. For SNP sequencing, triads including trophectoderm DNA, cell-free DNA, and follicular fluid DNA were analyzed. In total, 124 SNPs were included with 90 SNPs distributed among all autosomes and 34 SNPs located on chromosome Y. Finally, 12 whole blastocysts were fixed and individual cells were analyzed by FISH using telomeric/centromeric probes for the affected chromosomes.

MAIN RESULTS AND THE ROLE OF CHANCE

We found a higher quantity of cell-free DNA in spent culture media co-cultured with embryos versus control media samples (P ≤ 0.001). The presence of cell-free DNA in the spent culture media enabled a chromosomal diagnosis, although results differed from those of trophectoderm biopsy analysis in most cases (67%). Discordant results were mainly attributable to a high percentage of maternal DNA in the spent culture media, with a median percentage of embryonic DNA estimated at 8%. Finally, from the discordant cases, 91.7% of whole blastocysts analyzed by FISH were mosaic and 75% of the analyzed chromosomes were concordant with the trophectoderm DNA diagnosis instead of the cell-free DNA result.

LIMITATIONS, REASONS FOR CAUTION

This study was limited by the sample size and the number of cells analyzed by FISH.

WIDER IMPLICATIONS OF THE FINDINGS

This is the first study to combine chromosomal analysis of cell-free DNA, SNP sequencing to identify maternal contamination, and whole-blastocyst analysis for detecting mosaicism. Our results provide a better understanding of the origin of cell-free DNA in spent culture media, offering an important step toward developing future non-invasive karyotyping that must rely on the specific identification of DNA released from human embryos.

STUDY FUNDING/ COMPETING INTEREST

This work was funded by Igenomix S.L. There are no competing interests.