Soares S. P–787 Impact of delaying ART to promote weight loss: a large multicentre study accounting for the combined effect of female/male age and body mass index (BMI)

Study question

Is postponing the start of ART (to promote a reduction in female BMI) beneficial for cumulative live birth rates (CLBR) when accounting for the female/male ageing this delay will cause?

Summary answer

Postponing ART treatment in one year to promote female weight loss could be detrimental in women of advanced maternal age (AMA, >35 years-old).

What is known already

Overweight/obese couples are frequently encouraged to lose weight prior to infertility treatment to enhance ART outcomes. However, a meaningful weight loss is often difficult to achieve for these couples, frequently taking at least one year to accomplish. Given that both female and male ageing are also important for ART success, we were interested in understanding the combined impact on CLBR of BMI reduction and ageing following a one-year delay.

Study design, size, duration

A retrospective study including patients performing their first ART cycle using autologous gametes between 2013–2018 in one of 39 participating ART centres. Only GnRH antagonist cycles were included (n = 14260). CLBR was the primary outcome. Secondary outcomes included time-to-pregnancy, birthweight and gestational age.

Participants/materials, setting, methods

Patients were subdivided according to female BMI (Kg/m2) in either underweight (<18.5), normal-weight (18.5–24.9), overweight (BMI 25.0–29.9 kg/m2) and obese (≥30 kg/m2). Meaningful and extreme weight loss were defined as a reduction from obesity to either overweight or normal-weight, respectively. We performed multivariable regression analysis to account for potential confounding.

Main results and the role of chance

Overweight (36.8%) and obese (33.0%) women had significantly lower CLBR when compared to the underweight (42.6%) and normal-weight (41.4%). When assessing the confounder-adjusted net-effect of male/female age and BMI, the predicted benefit of promoting a meaningful BMI reduction was lower than the estimated hindrance due to male/female ageing as soon as women reached AMA (n = 8365, 58.6%). This absence of benefit was especially important in women >38 years-old, in which even extreme weight-loss did not compensate for the age-related reduction in CLBR caused by the one-year delay. Moreover, male weight-loss failed to provide any additional benefit when accounted for in the regression models. Finally, obesity was also associated with a modest but statistically significant one-month delay in time-to-pregnancy and a 96.1 g (95% confidence interval: 39.9–152.4) increase in birth weight. The diagram of predicted outcomes presented in this study may serve as a useful tool to counsel patients before treatment, namely when recommending treatment postponement to promote short-term (i.e. 3–6 months) or long-term (i.e. 1 year) weight loss.

Limitations, reasons for caution

Caution is recommended when extrapolating these results into everyday practice owing to the retrospective nature of the study and the fact that only GnRH antagonist cycles were included.

Wider implications of the findings: Patients are frequently confronted with the dilemma to either postpone treatment (and promote weight loss) or start treatment immediately (to avoid further ageing). Our results seem to show that women in AMA may have hindered CLBR if recommended to delay treatment even if the desired weight loss is ultimately achieved.

Trial registration number

Not applicable

The impact of COVID-19 pandemic in stroke code activation and time from symptom onset to hospital arrival in a Portuguese comprehensive stroke centre

INTRODUCTION

Coronavirus disease 2019 (COVID-19) impacted emergency services worldwide.

AIM

We aimed to evaluate COVID-19 effect on the number of stroke code activations and timings during the first two months of the pandemic.

MATERIAL AND METHODS

We reviewed the stroke code database of a single comprehensive stroke centre in Portugal for the number of activations through 2019-2020. We compared the pathway timings between March and April 2020 (COVID-19 period) and the homologous months of the previous four years (pre-COVID-19 period), whilst using February as a control.

RESULTS

Monthly stroke code activation rates decreased up to 34.2% during COVID-19 pandemic. Compared to the pre-COVID-19 period, we observed an increase in the time from symptom onset to emergency call, with a significant number of patients waiting more than four hours (March 20.8% vs. 6.8%, p = 0.034; April 23.8% vs. 6%, p = 0.01); as well as an increase in the time from symptom onset to hospital arrival (March: median 136 minutes [IQR 106-410] vs. 100 [IQR 64-175], p = 0.001; April: median 188 [IQR 96-394] vs. 98 [IQR 66-168], p = 0.007). No difference between both periods was found concerning in-hospital times, patient characteristics, stroke/mimic diagnosis, stroke severity, and mortality.

CONCLUSION

COVID-19 related factors probably reduced healthcare services utilization, and delayed emergency calls and hospital arrival after stroke onset. These highlight the importance of health education to improve the effectiveness of medical assistance. The preservation of in-hospital times validates the feasibility of the protected stroke code protocol.

POS0713 PREDICTORS OF HOSPITALIZATION IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: A 10-YEAR COHORT STUDY OF 398 PATIENTS FROM A TERTIARY CENTRE

Background:

Patients with systemic lupus erythematosus (SLE) often require hospitalization. The cause of admission may vary, but active disease and infection are consistently reported as the main reasons for hospitalization and are associated with worse survival and damage accrual. Recent improvements in the standard of care, including minimization of glucocorticoid dose and more effective and safe immunosuppressive regimens, may have changed the incidence and risk factors for hospitalization due to these causes. Hence, it is useful to identify predictors of hospitalization to further reduce the risk of admission for disease activity and severe infection in patients with SLE.

Objectives:

To identify predictors of hospitalization in patients with SLE, according to the underlying cause.

Methods:

Patients with SLE fulfilling classification criteria (ACR’97 and/or SLICC), regularly followed at an academic lupus clinic from January 2009 to December 2020 and with at least two outpatient visits were included in this cohort study. Time to first hospitalization up to 120 months was identified separately for the following admission causes: (a) any cause; (b) active SLE; (c) infection. Predictors of hospitalization were sought through survival analysis, with distinct models for each of the major admission causes. Univariate analysis was performed using Kaplan-Meier curves and Log-Rank tests. Tested variables assessed at baseline included: gender; age at SLE onset; age; disease duration; SLE Disease Activity Index (SLEDAI-2K) score; ongoing antimalarial use; ongoing immunosuppressants; ongoing prednisolone daily dose; lupus nephritis up to baseline; SLICC Damage Index (SDI) score. Variables with p<0.1 were further tested in multivariate Cox regression models. Hazard ratios (HR) were determined with 95% confidence intervals (95%CI).

Results:

We included 398 patients (female: 86.2%, mean age: 41.2±15.1 years, mean disease duration: 10.1±9.2 years; previous lupus nephritis: 28.9%; mean SLEDAI-2K score: 3.4±2.7; ongoing antimalarials: 78.9%; ongoing immunosuppressant: 29.9%; ongoing prednisolone >7.5 mg/day: 17.1%; SDI score ≥1: 28.4%). During the follow-up period, 50.5%, 23.6% and 17.3% were hospitalized at least once for any cause, active SLE or infection, respectively.

In the multivariate model, significant baseline predictors for hospitalization due to active disease were (table 1): SLEDAI-2K score >5; disease duration ≤2 years; ongoing immunosuppressants; SDI score ≥1. Baseline independent predictors of hospitalization for infection included (table 1): male gender; SDI score ≥1; ongoing antimalarials were protective.

Table 1.

Predictors of hospitalization in multivariate Cox regression according to the admission cause

PredictorsHospitalization for active SLEHospitalization for infectionSLEDAI-2K score >52.43 (1.53-3.88)n.s.SLE duration ≤2 years1.70 (1.04-2.77)n.s.Ongoing immunosuppressant1.91 (1.24-2.95)n.s.SDI score ≥11.82 (1.16-2.86)2.14 (1.33-3.45)Male gendern.s.2.19 (1.23-3.89)No antimalarial treatmentn.s.2.20 (1.34-3.60)

Risk for each predictor reported as Hazard Ratio (95% Confidence Interval); n.s.: non-significant

Conclusion:

Tight control of disease activity, prevention of damage accrual, and treatment with antimalarials may contribute to minimize the risk of hospitalization for these two major causes of admission in patients with SLE.

Disclosure of Interests:

None declared

HPV ctDNA detection of high-risk HPV types during chemoradiotherapy for locally advanced cervical cancer

BACKGROUND

Chemoradiotherapy (CRT) is the standard of care for patients diagnosed with locally advanced cervical cancer (LACC), a human papillomavirus (HPV)-related cancer that relapses in 30%-60% of patients. This study aimed to (i) design HPV droplet digital PCR (ddPCR) assays for blood detection (including rare genotypes) and (ii) monitor blood HPV circulating tumor DNA (HPV ctDNA) levels during CRT in patients with LACC.

METHODS

We analyzed blood and tumor samples from 55 patients with HPV-positive LACC treated by CRT in a retrospective cohort (n = 41) and a prospective cohort (n = 14). HPV-ctDNA detection was carried out by genotype-specific ddPCR.

RESULTS

HPV ctDNA was successfully detected in 69% of patients (n = 38/55) before CRT for LACC, including nine patients with a rare genotype. HPV-ctDNA level was correlated with HPV copy number in the tumor (r = 0.41, P < 0.001). HPV-ctDNA positivity for HPV18 (20%, n = 2/10) was significantly lower than for HPV16 (77%, n = 27/35) or other types (90%, n = 9/10, P = 0.002). HPV-ctDNA detection (positive versus negative) before CRT was associated with tumor stage (P = 0.037) and lymph node status (P = 0.02). Taking into account all samples from the end of CRT and during follow-up in the prospective cohort, positive HPV-ctDNA detection was associated with lower disease-free survival (DFS) (P = 0.048) and overall survival (OS) (P = 0.0013).

CONCLUSION

This is one of the largest studies to report HPV-ctDNA detection before CRT and showed clearance of HPV ctDNA at the end of treatment in most patients. Residual HPV ctDNA at the end of CRT or during follow-up could help to identify patients more likely to experience subsequent relapse.

Nasal CPAP complications in very low birth weight preterm infants

BACKGROUND

Nasal trauma due to nasal CPAP (nCPAP) use is a commonly reported complication in infants under 1500 g of birth weight and 32 weeks of gestation. With the rise of nCPAP as the gold standard for non-invasive respiratory support, preventive measures should be considered.

OBJECTIVE

To assess the prevalence and risk factors of nasal injury in very low birth weight (VLBW) preterm infants with nCPAP.

METHODS

We retrospectively analyzed neonates hospitalized between 2012 and 2017, with less than 1500 g and 32 weeks of gestational age who received more than 12 hours of nCPAP. Demographic, antenatal and clinical data, along with information regarding respiratory support and nCPAP complications, were collected. We used Fischer's classification to grade nasal trauma.

RESULTS

A total of 135 infants were evaluated. Mean gestational age was 28 weeks (SD 2) and mean birth weight 1072 g (SD 239). Nasal trauma was reported in 65% of patients and it was of stage I, II and III in 49%, 16% and 1% of patients, respectively. The multivariate logistic regression revealed that the risk of trauma was greater in neonates with a longer duration of nCPAP ventilation (OR = 1.098, 95% CI: 1.055-1.142; p < 0.001) and in patients submitted to oxygen therapy (OR = 3.174, 95% CI: 1.014-9.929, p = 0.004). The median of days after nCPAP administration until the onset of an identifiable lesion was 4.

CONCLUSION

Nasal trauma is a frequent complication in VLBW preterm infants using nCPAP for long periods. Preventive measures in patients who are at greater risk of skin breakdown are of major clinical importance for a better outcome.

Parosteal osteosarcoma associated with a low-grade component mimicking well-differentiated liposarcoma: a case report

Parosteal osteosarcomas and well-differentiated liposarcomas are both well-differentiated locally aggressive tumors. They both have simple karyotypes with amplification of the 12q13-15 regions including MDM2 and CDK4 genes. In this report, we describe the case of a parosteal osteosarcoma intertwined with a low-grade component similar to a well-differentiated liposarcoma. The association of a bone component with an adipose component was initially overlooked. We describe the histological, imaging, and molecular characteristics of this tumor stressing the importance of radio-pathological correlation. To our knowledge, this is the second report of a parosteal osteoliposarcoma. Awareness of this rare presentation may allow radiologists and surgeons to recognize the peripheral fatty component as an integral part of the tumor.

Influence of dietary Chlorella vulgaris and carbohydrate-active enzymes on growth performance, meat quality and lipid composition of broiler chickens

Herein, we investigated the effect of Chlorella vulgaris as ingredient (10% of incorporation) in broiler diets, supplemented or not with 2 formulations of Carbohydrate-Active enZymes (CAZymes; Rovabio Excel AP and a mixture of recombinant CAZymes, composed by an exo-β-glucosaminidase, an alginate lyase, a peptidoglycan N-acetylmuramic acid deacetylase and a lysozyme), on growth performance, meat quality, fatty acid composition, oxidative stability, and sensory traits. One hundred twenty 1-day-old Ross 308 male birds were randomly assigned to one of the 4 experimental diets (n = 30): corn-soybean meal–basal diet (control), basal diet with 10% C. vulgaris (CV), CV supplemented with 0.005% of a commercial CAZyme cocktail (Rovabio Excel AP), (CV + R), and CV supplemented with 0.01% of a 4-CAZyme mixture previously selected (CV + M) during the experimental period lasted from day 21 to day 35. Body weight gain and feed conversion rate of broilers were not affected by C. vulgaris but digesta viscosity increased more than 2-fold (P < 0.001) relative to the control. In addition, neither cooking loss, shear force, juiciness, flavor nor off-flavor was impaired by dietary treatments (P > 0.05). By contrast, the dietary C. vulgaris increased tenderness, yellowness (b∗) and total carotenoids in breast and thigh meats. However, no additional protective effect against lipid oxidation was observed in meat with the inclusion of microalga. Chlorella vulgaris, independently of CAZymes, had a minor impact on meat fatty acid composition but improved the proportion of some beneficial fatty acids. In summary, our data indicate a slight improvement of broiler meat quality and lipid nutritional value, without impairment of broilers' growth performance, thus supporting the usefulness of this microalga in poultry diets, up to this high level of incorporation. By contrast, the selected CAZyme mixtures used do not significantly improve the release of microalga nutrients in poultry diets, through the disruption of microalga cell wall, which warrants further research.

Adult polyglucosan body disease - Management and evolution in an intensive rehabilitation program

Adult polyglucosan body disease is a rare neuromuscular genetic disorder. It is characterized by accumulation of an abnormal structural form of glycogen, particularly in central and peripheral nervous system and muscles. Functional impairments and the rehabilitation approach of this entity is rarely reported. We present a case of a 65-year-old female with several years of undiagnosed symptoms. One year after the diagnosis, the patient was evaluated for the first time in a physical and rehabilitation consultation. We describe the inpatient rehabilitation program - an approach planned to achieve high levels of treatment intensity and with intervention of a multiprofessional and multidisciplinary team.

What is the relationship between high-density lipoprotein cholesterol and the extension of coronary heart disease?

Introduction

Coronary atherosclerosis is an important pathophysiological mechanism in the development of coronary artery disease (CAD). While it has been proven via multiple studies that elevated levels of low-density lipoprotein (LDL) contribute to the development of atherosclerosis, high-density lipoprotein (HDL) is widely thought to have atheroprotective effects. Multiple epidemiologic studies have given the idea that high HDL levels protect against CAD, however, other trials also shown that its benefit can be paradoxical.

Objective

To evaluate the relationship between HDL levels and the extent of CAD (one vessel vs multivessel disease) in coronary artery patients.

Materials and methods

Study analyses of 1676 patients selected from GENEMACOR study population, with at least one &gt;75% coronary stenosis by angiography (median age 53.3±7.9 years, 78.6% male, median HDL 43.0±11.1 mg/dL). Population was divided according to the HDL level quartiles (1st quartile HDL &lt;35.3 mg/dL; 2nd quartile HDL 35.3–42 mg/dL; 3rd quartile HDL 42–49 mg/dL; 4th quartile HDL &gt;49 mg/dL). Population of the 1st and 4th quartiles (825 patients, median age of 53.3±7.9 years and 78.7% male) were adjudicated and prospectively followed-up by 5.0±4.8 years. χ2 and T student tests were used to analyze the demographic, laboratorial, angiographic and anthropometric characteristics of the population according to HDL level.

Results

420 (50.9%) patients were included in the 1st quartile group (median age 53.2±7.9 years, 85.7% men) and 405 (49.1%) patients were included in the 4th quartile group (median age 53.4±8.0 years, 71.4% men). In our population, lower levels of HDL were associated with increased risk of multivessel coronary disease (OR 1.63, 95% CI 1.23–2.14, p 0.001).

Conclusion

Despite uncertainties about HDL benefit, in our population a higer level of HDL was associated with a shortest extent of coronary artery disease. We conclude that higher levels of HDL can be considered protective in coronary patients, and strategies to increase HDL levels may indeed translate in improved outcomes in CAD disease.

Funding Acknowledgement

Type of funding source: None

Shaping the future of metabolic syndrome: genetics, prognosis and individual tailoring

Background

Metabolic syndrome (MetS), characterized by a cluster of cardiovascular risk factors, is considered to be the major health hazard of modern world and a 21st century epidemic. Recent GWAS have identified several susceptibility regions involved in lipid metabolism and oxidation, also associated with MetS. Genetic risk score (GRS) is an emerging method that attempts to establish correlation between SNPs and clinical phenotypes.

Aim

Evaluate the value of a GRS encompassing SNPs involved in lipidic metabolism and oxidation pathways, in predicting CAD outcome (MACEs and long-term cardiovascular Mortality) in a coronary population with MetS.

Methods

1101 coronary patients and MetS, were selected from the GENEMACOR study. Genotyping was performed by TaqMan allelic discrimination assay. A Multiplicative score (mGRS) was constructed according to the multiplicative model with variants belonging to the lipid and oxidative axes (PSRC1, PCSK9, KIF6, ZNF259, LPA, APO E, PON192, PON108, PON55, MTHFR677, MTHFR1298, MTHFD1L). This GRS was categorized using the mean (higher vs lower than mean). Cumulate Mortality Hazards Model (Cox regression) adjusted for age, gender, smoking, hypertension, dyslipidaemia, diabetes, hsCRP, eGFR, Ejection fraction (EF), and multivessel disease) was used to find independent predictors of cardiovascular outcome. We performed Kaplan-Meier Survival curves for both groups (higher vs lower than mean GRS) and log-rank test to compare survival distributions in both groups.

Results

The following variables have emerged independently associated with time to MACE occurrence: mGRS (HR=1.31 95% CI (1.07; 1.59); p=0.008), male gender, EF and multivessel disease. Concerning cardiovascular mortality, mGRS also remained an independent predictor (HR=1.44 (1.04–1.99); p=0.028) alongside age, smoking, diabetes and EF. The Log-Rank test showed significant differences between the two curves related to MACE occurrence and cardiovascular mortality (p=0.001 and 0.002, respectively). The Kaplan-Meier survival showed that as mGRS increases, patient survival decreases.

Conclusion

In patients with MetS, a GRS comprising variants in lipidic and oxidative pathways, proved to be a useful stratification tool, identifying patients likely to have a worst prognosis over time. Our data further underlines the additive potential and clinical utility of genetic information in shaping secondary prevention.

Figure 1

Funding Acknowledgement

Type of funding source: None

AB0982 SERUM ALBUMIN LEVELS AND DEPRESSION IN JSLE

Background:

Albumin is a negative acute phase response protein synthesized in the liver, being an important marker of inflammation. Under inflammatory conditions, the transcapillary escape rate of albumin may increase, leading to hypoalbuminaemia. Systemic lupus erythematosus (SLE) is a chronic condition involving multiple organ systems, inducing functional disability and psychological burden responsible for noteworthy depressive symptoms1. Depression may be related with psychosocial, environmental and biological factors, disease activity and its severity, age and sex2. Several studies show that immune activation and increased concentrations of positive and decreased concentrations of negative acute phase proteins are involved in the pathogenesis of depression3. As albumin has the capacity to bind homocysteine, lowered serum albumin levels leads to hyperhomocysteinemia, a well-known risk factor for depression. Moreover, hypoalbuminaemia decrease the availability of tryptophan, an essential amino acid from which the neurotransmitter serotonin is derived, and induce oxidative stress, which further decreases antioxidant levels in people with depression.

Objectives:

To assess the association between serum albumin levels and depressive symptoms in juvenile-onset SLE (jSLE) patients.

Methods:

A cross-sectional sample of jSLE patients, currently aged ≥ 16 years, completed a psychosocial assessment including quality of life (SF-36) anxiety and depressive symptoms (HADS) and cognitive assessment (MMSE), between October 2018- May 2019. Local Ethics Committee approved the study. All patients fulfilled both 2012 and 2019 EULAR/ACR classification criteria for SLE. Juvenile-onset was defined as age at diagnosis <18 years. Demographics and clinical characteristics were collected. Statistical analysis was performed with SPSS®. Variables were compared with spearman correlations tests.

Results:

30 jSLE patients were included (90%female) in the study, with median (min-max) age of 21 (16-35) years, with mean (SD) age of diagnosis of 15.8 ± 2.1. Median albumin serum level was 41.7 (16.7-46.3) g/dL. Psychosocial assessment revealed a mean (SD) score in HADS - Depression of 3.9 (3.3), HADS - Anxiety of 9 (4.3), MMSE of 27.7 (1.8), Physical health SF-36 of 66.8 (9.9) and Mental health SF-36 of 68.9 (17.5). 23.3 % jSLE showed mild cognitive impairment, 63.3% anxiety and 13.3% depression. We observed significant inverse linear relationships between serum albumin levels and depressive symptoms score (p=0.042, ρ=-0.380) and with anxiety symptoms score ((p=0.029, ρ=-0.406). No significant correlations were detected between albumin serum concentrations and cognitive assessment.

Conclusion:

Our findings are consistent with studies previously reporting the potentially protective effect of high serum albumin levels on mental health in different populations. A possible inflammation related aetiology for depression in jSLE patients is highlighted, further explained through the protective roles played by albumin in inflammation, infection, and oxidative damage.

References:

[1]Zhang, L. et al. Prevalence of depression and anxiety in systemic lupus erythematosus: a systematic review and meta-analysis. BMC Psychiatry 17, 70 (2017)

[2]Figueiredo-Braga M et al. Depression and anxiety in systemic lupus erythematosus: The crosstalk between immunological, clinical, and psychosocial factors. Medicine (Baltimore). 2018;97(28)

[3]Livia Ambrus & Sofie Westling. Inverse association between serum albumin and depressive symptoms among drug-free individuals with a recent suicide attempt, Nordic Journal of Psychiatry, 73:4-5, 229-232

Disclosure of Interests:

None declared

Current Point-of-Care testing in cancer and future perspectives: a systematic review

Introduction Cancer is the most prevalent disease worldwide, causing a major impact on society. Early detection and monitorization of the tumour can provide a more effective treatment. Point-of-care (POC) testing allows the patient to have a handheld test that gives the results rapidly. No expertise or special knowledge is required which is vital namely when carried out in low-resource areas. Recent studies analysed established and emerging biomarkers and how to incorporate them into POC devices, but a systematic review reporting the existing POC platforms for cancer is still not available.

Objectives This systematic review aims to report current and recent advances for point-of-care testing in cancer.

Methodology A literature review was conducted through research in the databases “PubMed” and “B-On” for relevant reviews published in the last ten years, using the keywords “Point-of-care testing” AND “Cancer” AND “Rapid Test” AND “Cancer detection”.

Results In 2015 there were eight commercially available POC tests for prostate, bladder, colorectal, cervical, HPV-causing head and neck cancer, liver, breast and lung cancer. After 2018 a small number of POC devices were tested in screening programs and multicentric studies, and more recently, promising novel POC prototypes for early detection of cancer, namely a 3D prototype micro device for multiple singleplex RNA expression analysis in liver cancer and a POC microscopy prototype for digital diagnostics of breast cancer lymph node metastases, with potential to be used in resource-limited settings.

Conclusion The use of POC testing can deliver accurate, fast results, and in the case of cancer it is no exception, contributing to the progression of treatment and reduction in cancer-related deaths. In low-resource settings a POC test is fundamental and it should be simple and low-cost. But there are limitations in the tests which is a challenge for improvement and investigation in the future.

Development of a Virtual Game with Android Operating System for the Rehabilitation of Chewing and Swallowing in the Elderly

Introduction With the aging, the orofacial structures may suffer changes related to disorganization of the stomatognathic system, with a reduction in the strength and resistance of the tongue reflecting delays in the handling of the boluses in the mouth and the elevation of the hyolaryngeal complex; it may result in changes in swallowing (presbifagia or dysphagia). Changes in swallowing may be adjuvants for the illness of the elderly with great socioeconomic impact due to the high costs that bring to the public health with prolonged hospitalizations.

Objectives Before it an app was created with a board game for android operating system with the possibility of training in the functions of chewing and swallowing in elderly using biofeedback.

Methodology A hardware was built capable of capturing, conditioning and transmitting the electrical signal of the masseter and supra-hyoid muscles, with surface electrodes, using an interface system scan with four channels for a mobile device with Android operating system via Bluetooth. The electrical signal is received by software through a biogame, which originally held the calibration of the data, being the value range of the strength of the bite ranging from zero to 255 µV. The participant will receive the information to chew and swallow through the simulation of a “virtual farm” with the displacement of a tractor irrigating the earth which will create a plantation. The chewing cycle was standardized in 10 insect chewing’s, five for each side, ending with the swallowing.

Results At the end of the game a report stating: date of the examination, consistency of the food chosen, testing time, masticatory cycles completed and incomplete, maximum and average power of bite and muscle activity of the swallowing of each side.

Conclusion The application with game developed is a promising resource for training of the masticatory muscles and the swallowing of the elderly.

AB0983 LIPID METABOLISM AND DISEASE ACTIVITY IN JSLE PATIENTS

Background:

Systemic lupus erythematosus (SLE) is an autoimmune systemic disease associated with premature atherosclerosis. Risk factors include dyslipoproteinemia, inflammation, oxidized low-density lipoprotein (LDL), hyperhomocysteinemia and antiphospholipid antibodies. Hyperlipidemic condition is being reported to promote the production of proinflammatory cytokines such as IL-1β, IL-6, and IL-27 and lowering blood lipid levels improves the disease. Oxidative stress is elevated, mainly due to mitochondrial dysfunction, further disrupting lipid metabolism. Some drugs also have an impact on lipid profile, such as chronic steroid use, which worsens LDL, HDL, and TG levels.

Objectives:

To assess the relationship between lipid profile and disease activity in juvenile SLE (jSLE) patients.

Methods:

Retrospective study of jSLE patients, fulfilling both 2012 and 2019 EULAR/ACR classification criteria for SLE. Juvenile-onset was defined as age at diagnosis <18 years. Demographics and clinical characteristics were collected. To evaluate the activity of jSLE, the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) was used. Statistical analysis was performed with SPSS®. Spearman’s rank non-parametric test or Pearson’s parametric test were used to assess the bivariate correlation for inflammatory and metabolic variables. P value <0.05 was considered significant for all the statistical tests.

Results:

35 patients were included, with current median (min-max) age of 22 (16-35) years, mean (SD) age of diagnosis of 15.8 (2.4) years; 91.4%female. Median ESR was 19 (2-75) mm/h, CRP 1.65 (0.1-9.6) mg/L, albumin 41.6 (16.7-46.3) g/L, proteinuria 0.2 (0-3) g/dL, leukocyturia 0 (0-1362.7)/uL, erythrocyturia 0 (0-501.9)/uL and anti-double stranded DNA 89.3 (10-800) U/mL. Mean C3 was 102.1 (21.6), C4 17.1 (7.4) mg/dL and creatinine 0.63 (0.1) mg/dL. Median SLEDAI was 2 (0-12). All were ANA positive, 40 % positive for antinucleossome antibodies, 25.7% anti-ribossomal P protein antibody, 11.4% anti-Sm, 8.6% autoantibodies againstβ2-glycoproteinI, 8.6% anti-cardiolipin, 14.3% lupus anticoagulant, 37.1% anti-SSA and 8.6% anti-SSB. Articular manifestations were present in 48.6%, mucocutaneous in 77.1%, haematological in 45.7%, lupus nephritis in 42.9%, serositis in 8.6% and pulmonary interstitial disease in 2.9%. Mean (SD) total cholesterol values (TC) was 165.5 (44.7) mg/dL and LDL 94.5 (29.9) mg/dL. Median high-density lipoprotein was 52 (28-92) and triglycerides (TG) 81.5 (41-253) mg/dL. Median daily prednisolone dose was 5 (0-40) mg. 88.6% were treated with hydroxychloroquine, 31.4% with mychophenolate mophetil and 14.3% with azathioprine. TC was negatively correlated with serum albumin (p=0.043, rho=-378) and positively with SLEDAI (p=0.032; rho= 0.392), proteinuria (p=0.009; rho= 0.469) and leukocyturia (p=0.031; rho= 0.394). A positive correlation was found between LDL and proteinuria (p=0.043; rho= 0.385) and between TG and CRP (p=0.001; rho= 0.575). TG were also positively correlated with prednisolone daily dose (p=0.035; rho= 0.394). Mean LDL was higher in anti-Sm positive patients (p=0.022). No differences were found regarding anti-phospholipids antibodies. Nephritic lupus patients had worse lipid metabolism, but this did not reach statistical significance.

Conclusion:

In out cohort, increased expression of TC, LDL and TGs is associated with disease activity in SLE. As expected, higher doses of prednisolone also correlated with lipid metabolism.

References:

[1]Machado D et al. Lipid profile among girls with systemic lupus erythematosus. Rheumatol Int. 2017 Jan;37(1):43-48

Disclosure of Interests:

None declared

A reconfigurable PID fault tolerant tracking controller design for LPV systems

This paper considers the design of a reconfigurable PID Fault Tolerant Tracking Controller (PID-FTTC) for Linear Parameter Varying (LPV) systems affected by actuator faults with the presence of disturbance. The LPV systems are represented through a polytopic LPV description with measurable gain scheduling functions. A new PID-FTTC scheme with a model reference, an adaptive PID controller and an Adaptive Polytopic Observer (APO), is developed. The main idea is to improve and to compare performances with this developed PID-FTTC versus previous similar FTC techniques especially about the settling time, the overshoot and integral error indices. By the way, this paper can reduce the conservatism of previous methods with more parameters design so as to avoid their disadvantages and to give better control loop performances especially in terms of accuracy and speed of trajectory tracking even when a fault occurs. So, in order to establish the stability of the reconfigured PID-FTTC, a new theoretical study is developed through the use of Linear Matrix Inequality (LMI). This new method is illustrated through a two-tank process where the results compared to previous ones, underline the improvements.