FRI0391 METABOLIC FACTORS ASSOCIATED TO RADIOGRAPHIC KNEE OSTEOARTHRITIS IN INDIVIDUALS WITH KNEE PAIN

Background:

Metabolic factors have been shown to be associated to radiographic knee osteoarthritis (OA) [1]. More knowledge about associations between metabolic factors and early clinical knee OA is needed.

Objectives:

The aim was to study associations between metabolic factors and radiographic knee OA in individuals with knee pain

Methods:

In total 272 individuals with radiographs at baseline, from an ongoing longitudinal study of knee pain (without cruciate ligament injury), were included in the present cross-sectional study. At baseline BMI, waist circumference (WC) and visceral fat area (VFA) were assessed. Fasting plasma glucose, triglycerides, cholesterol, HDL-and LDL-cholesterol were analysed. Metabolic syndrome (MetS) was present if central obesity (WC ≥94 cm in men and ≥80cm in women) plus any two of the following factors: raised blood pressure (systolic blood pressure ≥ 130 or diastolic blood pressure ≥ 85 mm Hg or treatment of hypertension), raised triglycerides (≥ 1.7 mmol/L or specific treatment), reduced HDL-cholesterol (men < 1.03 mmol/L and women < 1.29 mmol/L or specific treatment), raised glucose (glucose ≥ 5.6 mmol/L, or type 2 diabetes).

The individuals were divided in two groups according to Ahlbäck [2], one group, who had grade I or more in at least one knee (radiographic knee OA, ROA) n=62 and the other group, not fulfilling Ahlbäck criteria (no radiograhic knee OA, No OA) n=211. The associations between metabolic factors and knee OA were calculated by crude logistic regression analyses, adjusting for age and sex.

Results:

The group with radiographic knee OA were older, had higher BMI, higher amount of visceral fat and more had central obesity, table 1. Ninety- four percent of the group with ROA had central obesity compared to 76%, p=0.002 in the no OA group. There was no difference between the groups regarding MetS, 44% in the ROA group vs. 39%, p=0.5. The group with ROA had increased cholesterol, triglycerides and LDL-cholesterol. There were no differences in fasting glucose between the groups, though both groups had a mean glucose value in the upper range of normal value, table 1. Factors associated to having radiographic knee OA were age (OR 1.11, 95% CI 1.06-1.17), BMI (1.07, 1.003-1.13), central obesity (3.91, 1.32-11.61) and raised triglycerides (2.35, 1.03-5.38).

Table 1.

Baseline descriptives

No OAMean (sd)ROAMean(sd)p-valueN21162Age50 (9)56 (4)<0.001Sex, women, %66710.454BMI25.9 (4.7)27.7 (4.7)0.007VFA (cm2)109 (53)126 (52)0.026WC, cm94 (13)99 (13)0.006Raised Blood pressure, %66530.063Cholesterol (mmol/L)5.2 (1.0)5.5 (1.1)0.033Triglycerides (mmol/L)1.0 (0.6)1.2 (0.7)0.035Raised triglycerides, %9210.008LDL-cholesterol (mmol/L)3.4 (1.0)3.7 (1.1)0.027HDL-cholesterol (mmol/L)1.7 (0.4)1.7 (0.5)0.547Reduced HDL11150.460Glucose (mmol/L)5.5 (0.9)5.5 (0.5)0.858

Conclusion:

There were associations between some metabolic factors and radiographic knee OA in individuals with knee pain. Fasting glucose was increased in both groups. The associations between metabolic risk factors and the development of knee OA needs to be assessed in longitudinal studies.

References:

[1]Sellam J, Bone Spine 2013;80:568-73.

[2]Ahlback S,. Acta Radiol Diagn (Stockh) 1968Suppl 277:7-72.

Disclosure of Interests:

None declared

SAT0026 HIGHER LEVELS OF NATURAL ANTI-PHOSPHORYLCHOLINE ANTIBODIES ARE ASSOCIATED WITH LOWER RISK OF INCIDENT CARDIOVASCULAR EVENTS IN YOUNGER PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

The increased cardiovascular (CV) risk in rheumatoid arthritis (RA), especially in seropositive RA, is not fully explained by traditional risk factors. Immuno-inflammatory mechanisms and autoantibodies could be involved in the pathogenesis of atherosclerotic disease. Recent studies have suggested that anti-phosporylcholine antibodies (anti-PC) of IgM subclass counteract the generation of senescent and IL-17+ T-cells, have atheroprotective effects and may play a role in formation and stabilization of atherosclerotic plaque.

Objectives:

To investigate the association between IgM anti-PC antibodies with cardiovascular (CV) morbidity in patients with RA in age and sex groups and by serostatus.

Methods:

The study population was derived from the BARFOT early RA cohort, recruited in 1994-1999. The outcome was CV events i.e. AMI, angina pectoris, coronary intervention, ischemic stroke and TIA tracked through the Swedish Hospital Discharge and the National Cause of Death Registries. The RA-disease measures and traditional risk factors were assessed according to the protocol. Sera collected at inclusion and the 2-year visit were analyzed with ELISA to determine levels of anti-PC IgM (Athera CVDefine kit, Athera Biotechnologies AB). The Kaplan-Meier estimates and Cox proportional-hazards regression models were applied. Analysis were stratified by median level of IgM anti-PC and performed within strata of age, sex and RA-autoantibodies.

Results:

In all, 654 patients with early RA, 68% women, mean (SD) age 55(14.7) years, DAS28 5.2(1.3), 60% RF-positive and 60% ACPA-positive without prevalent CVD were included in this analysis. The level of IgM anti-PC at baseline was median (IQR) of 60.9(36.4-94.9) and at 2 years 56.0(32.3-84.2) U/ml. During follow-up of > 10 years, 141 incident CV events (21.6%) were registered. The levels of anti-PC both at inclusion and after 2 years of observation were lower in participants who experienced CV event than in those who did not, p=0.020 and p=0.012.

The CV event-free survival differed between patients with levels of anti-PC above median compared with those with levels below, p=0.003 by log-rank test. The risk for incident CV event showed a 0.6-fold hazard (95% CI, 0.4-0.8) among patients with higher anti-PC levels as compared with those with lower levels, p=0.003. In the age groups, the risk for incident CV event was lower in patients aged <55 years at inclusion than in those who were older, hazard ratio (HR) 0.40 (0.17-0.94), p=0.036. This result persisted when adjusted for sex and all traditional risk factors, HR 0.36 (0.14-0.92), p=0.032. Also, the risk for incident CV events was lower in patients with higher anti-PC levels in females, HR 0.61 (0-39-0.45), and double RF- and ACPA- negative patients, 0.44 (0.21-0.90), in crude analyses.

The favourable effect of anti-PC at baseline and the CV outcome was not observed in ages >55 years, males, ACPA+ and RF+ patients. There were no significant association between anti-PC level at 2 years and outcome.

Conclusion:

These results suggest that higher levels of IgM anti-PC are associated with a lower risk of incident CV events over 10 years in younger patients. The favourable atheroprotective effect of IgM anti-PC may be a part of explanation of lower risk of atherosclerotic disease in younger persons, females and in those with seronegative RA.

Acknowledgments :

6th Framework Program of the European Union (grant LSHM-CT-2006-037227 CVDIMMUNE)

Disclosure of Interests:

Sofia Ajeganova: None declared, Maria Andersson: None declared, Johan Frostegård Grant/research support from: Unconditional competitive grant from Amgen, related only to PCSK9, not the topic of this abstract, Ingiäld Hafström: None declared

AB0854 METABOLIC FACTORS ASSOCIATED TO CLINICAL HAND OSTEOARTHRITIS IN INDIVIDUALS WITH KNEE PAIN

Background:

There is some evidence supporting associations between metabolic factors, clinical hand osteoarthritis (OA) and radiographic knee OA. However, more studies are needed regarding early knee OA.

Objectives:

The aim was to study associations between metabolic factors and clinical hand OA at baseline in a cohort of individuals with knee pain, with and without radiographic knee OA

Methods:

In an ongoing five-year longitudinal study of knee pain, hand OA was assessed by clinical examinations in 296 of the included individuals at baseline [1]. BMI, waist circumference (WC) and blood pressure was measured. Body composition was assessed with Inbody 770. Fasting plasma glucose, triglycerides, cholesterol, HDL-and LDL-cholesterol and HbA1c was analysed. Metabolic syndrome (MetS)was present if central obesity (WC ≥94 cm in men and ≥80cm in women) plus any two of the following factors: raised blood pressure (systolic blood pressure ≥ 130 or diastolic blood pressure ≥ 85 mm Hg or treatment of hypertension), raised triglycerides (≥ 1.7 mmol/L or specific treatment), reduced HDL-cholesterol (men < 1.03 mmol/L and women < 1.29 mmol/L or specific treatment), raised glucose (glucose ≥ 5.6 mmol/L, or type 2 diabetes). Hand strength and self-reported disability of the arm, shoulder and hand (quickDASH) was assessed.

The individuals were divided according to having clinical hand OA or not, according to Altman [1]. The associations between background factors and clinical hand OA were calculated by crude logistic regression analyses, adjusting for age and sex.

Results:

Fifty-five percent of the individuals in the study was overweight or obese, 40% had MetS and 23% had radiographic knee OA. In total 34% of the individuals had clinical hand OA. The group with hand OA were older, had higher proportion of body fat, fasting plasma glucose, HbA1C, worse quickDASH score and lower hand strength, table 1. Clinical hand OA was significantly associated to higher age (OR 1.04, 95%CI 1.01-1.07), higher fasting plasma glucose (1.56, 1.05-2.30), worse quickDASH (1.04, 1.02-1.06) and lower hand strength (0.99, 0.99 -0.998), but not to proportion of body fat and HbA1c.

Table 1.

Descriptives at baseline

No hand OAMean (sd)Hand OA*Mean(sd)p-valueN194102Age51 (9)53 (8)0.015Sex, women, %69730.374BMI26.2 (4.8)27.1 (4.7)0.114Visceral fat area (VFA)110 (53)122 (54)0.070Percentage of body fat*30 (9)32 (8)0.026Waist circumferance, cm95 (13)97 (13)0.226Central obesity, %77860.067Raised Blood pressure, %61650.492Cholesterol (mmol/l)5.2 (1.0)5.4 (1.2)0.317Triglycerides (mmol/L)1.0 (0.6)1.1 (0.7)0.078Raised triglycerides, %9160.075LDL-cholesterol (mmol/L)3.4 (1.0)3.5 (1.1)0.416HDL- cholesterol mmol/L)1.7 (0.4)1.8 (0.5)0.352Glucose (mmol/L)5.4 (0.5)5.6 (1.2)0.010HbA1c (mmol/L)36 (3)38 (6)0.016quickDASH11.5 (12.8)21.8 (18.6)<0.001Hand strength (N)291 (110)252 (103)0.004

Conclusion:

In this cross-sectional study, the only metabolic factor associated with clinical hand OA was fasting plasma glucose. Contrary to other studies, there were no gender differences found. The association between development of clinical hand OA and metabolic factors in individuals with knee pain need to be further assessed in longitudinal studies.

References:

[1]Altman R, Arthritis Rheum 1990;33:1601-10.

Disclosure of Interests:

None declared

SAT0145 EFFICACY AND SAFETY OF UPADACITINIB MONOTHERAPY IN MTX-NAÏVE PATIENTS WITH EARLY ACTIVE RA RECEIVING TREATMENT WITHIN 3 MONTHS OF DIAGNOSIS: A POST-HOC ANALYSIS OF THE SELECT-EARLY

Background:

Early treatment of RA within the therapeutic window(0-3 months from symptom onset), has been associated with improved clinical outcomes and physical function. However, ≤42% of RA patients(pts) visit a rheumatologist within 90 days of symptom onset1,2.

Objectives:

To assess safety and efficacy of Upadacitinib(UPA), an oral, reversible, potent JAK-1 selective inhibitor3, in pts with moderate to severely active RA who were MTX-naïve or had an inadequate response to csDMARDs/bDMARDs4-6.

Methods:

In SELECT–EARLY, MTX-naïve pts with active RA and poor prognosis were randomized 1:1:1 to once-daily UPA monotherapy at 15 or 30 mg or weekly MTX (titrated up to 20 mg/week through Week 8). Efficacy (including ACR, DAS28(CRP), CDAI responses and change in mTSS) and safety outcomes from a post-hoc analysis of patients who received treatment within 90 days from diagnosis are reported here. The statistical significance defined asp<0.05was exploratory in nature.

Results:

A total of 270 pts commenced treatment within 90 days from RA diagnosis (median: 44 days [11, 89]). Pts in each arm were mostly female (70%), had moderately to severely active RA with mean DAS28(CRP) =5.9±1.02, had structural joint damage (mean mTSS =7.7±21.5) and were seropositive for both ACPA and RF at baseline (72%)4. At Week 24, compared to MTX, significantly greater proportions of pts receiving UPA 15 or 30 mg monotherapy achieved efficacy outcomes including ACR20, 50 and 70 responses, DAS28CRP<2.6, CDAI≤2.8 or Boolean remission. Improvements in physical function (HAQ-DI) and decrease in pain were also significantly greater in pts receiving UPA 15 and 30 mg vs MTX at Week 24. Treatment with UPA was also associated with a greater inhibition of structural joint damage compared with MTX (Figure 1). Safety outcomes were consistent with the full study and the integrated safety analysis (all phase 3 studies of UPA). Compared to MTX, higher frequencies of serious infections and herpes zoster were reported in both UPA groups. There were 2 deaths in total (UPA 30 mg: 1 due to cardiovascular death and 1 due to pneumonia and sepsis) (Figure 2).

Conclusion:

In RA pts, early initiation of treatment with UPA 15 mg and 30 mg monotherapy within 3 months from diagnosis was associated with clinically meaningful improvements in efficacy, including remission and inhibition of progression of structural joint damage compared to MTX. The safety profile was consistent with the overall study and the integrated phase 3 safety analysis7. UPA seems to be a promising treatment option for more patients to reach their treatment targets of remission or low disease activity when treated within 3 months of diagnosis.

References:

[1]Raza K et al. Ann Rheum Dis. 2011;70(10):1822-5.

[2]Stack RJ et al. BMJ Open. 2019;9:e024361.

[3]Parmentier et al. BMC Rheumatol. 2018;2:23.

[4]van Vollenhoven R et al, Arth Rheumatol. 2018; 70 (s10) [Abs ACR2018].

[5]Burmester GR et al. Lancet 2018;391:2503-12.

[6]Genovese MC et al, Lancet 2018;391:2513-24.

[7]Cohen S et al, Ann Rheum Dis [Abs EULAR2019].

Disclosure of Interests:

Meliha C Kapetanovic: None declared, Maria Andersson Shareholder of: AbbVie, Employee of: AbbVie, Alan Friedman Shareholder of: AbbVie Inc, Employee of: AbbVie Inc, Tim Shaw Shareholder of: AbbVie, Employee of: AbbVie, Yanna Song Shareholder of: AbbVie Inc., Employee of: AbbVie Inc., Daniel Aletaha Grant/research support from: AbbVie, Novartis, Roche, Consultant of: AbbVie, Amgen, Celgene, Lilly, Medac, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi Genzyme, Speakers bureau: AbbVie, Celgene, Lilly, Merck, Novartis, Pfizer, Sanofi Genzyme, UCB, Maya H Buch Grant/research support from: Pfizer, Roche, and UCB, Consultant of: Pfizer; AbbVie; Eli Lilly; Gilead Sciences, Inc.; Merck-Serono; Sandoz; and Sanofi, Ulf Müller-Ladner Speakers bureau: Biogen, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB

OP0084 PRESSURE PAIN THRESHOLDS AND THE ASSOCIATIONS WITH CHRONIC WIDESPREAD PAIN, KNEE OSTEOARTHRITIS AND OBESITY IN INDIVIDUALS WITH KNEE PAIN

Background:

Approximate 30% of individuals with symptomatic knee osteoarthritis (OA) had developed chronic widespread pain (CWP) over a period of 20 years [1]. In order to prevent CWP in those with knee pain, it is important to study associated factors.

Objectives:

The aim was to study pressure pain thresholds among individuals with knee pain with or without radiographic changes, and associations with CWP, radiographic knee OA, and obesity.

Methods:

Out of 300 individuals with knee pain (with or without radiographic changes) from an ongoing longitudinal study, 279 conducted pressure pain thresholds (PPT) measurement at baseline in this cross-sectional study (71% women; mean age 51 years). The PPT were measured using a computerized pressure algometry on eight predefined tender points (Figure 1) out of the 18 points as part of the definition of fibromyalgia [2]. PPTs were dichotomised based on the lowest tertial vs the two higher tertials for each of the eight points. A group that had ≥4 points with low PPT (low PPT group) was compared to a group that had <4 low PPT (not low PPT group). A pain mannequin categorised the participants in three different pain groups: CWP, chronic regional pain (CRP), and no chronic pain (NCP) according to the definition of the ACR [2]. Radiographic knee OA was defined according to the Ahlbäck five grading scale as having score ≥1 vs score 0 [3]. Obesity was measured by bioimpedance measuring BMI and visceral fat area (VFA, cm2). To study associations, a crude logistic regression model controlled for age and sex was used including main and significant variables

Figure 1

Differences in mean PPT in the eight tender points

Results:

The prevalence of CWP was 37% and higher in the low PPT group compared to those in the not low PPT group (Table 1). No differences were found between the groups in BMI, VFA or radiographic knee OA (Table 1). The low PPT group had significantly lower mean PPT on all eight tender points, was younger, had more pain sites, and more cases of fibromyalgia compared to the group with not low PPT (Table 1, Figure 1). Age (OR 0.95; 95% CI 0.92–0.97), having CWP (OR 3.00; CI 1.66–5.06), fibromyalgia (OR 21.91; CI 2.45–194.69) and increased number of pain sites (OR 1.13; CI 1.05–1.22) were associated with low PPT.

Table 1.

Descriptive statistics for the whole sample and for the groups: low PPT and not low PPT

Alln = 279Low PPTn = 99Not low PPTn = 180p-valueAge, mean years (sd)51 (9)49 (9)53 (8)<0.001Women, n (%)197 (71%)69 (70%)128 (71%)0.804Pain group, n (%)<0.001 NCP/CRP160 (63%)41 (47%)119 (71%) CWP95 (37%)46 (53%)49 (29%)Numbers of pain sites, mean (sd)5 (4)6 (5)4 (3)0.003Fibromyalgia, n (%)8 (3%)7 (9%)1 (1%)0.001Knee OA Ahlbäck, n (%)59 (23%)16 (18%)43 (26%)0.132BMI, n (%)127 (48%)42 (47%)85 (48%)0.801 Normal Overweight/Obese139 (52%)48 (53%)91 (52%)VFA, mean cm2(sd)114 (54)115 (51)113 (55)0.788

Conclusion:

Baseline characteristics of individuals with knee pain showed a higher prevalence of CWP than in the general population [4]. In the group with low PPT, the prevalence was even higher. The study found associations between CWP and low PPT, however, almost half of the individuals with low PPT reported NCP/CRP. Moreover, a third in the group that not had low PPT reported CWP. The development of widespread pain in individuals with knee pain needs to be further studied over time to increase the knowledge of CWP’s origin in order to prevent the condition.

References:

[1]Bergman et al. BMC Musculoskelet Disord. 2019;20:592

[2]Wolfe et al. Arthritis Rheum. 1990;33:160-72

[3]Ahlbäck. Acta Radiol Diagn (Stockh). 1968:7-72

[4]Andrews et al. Eur J Pain. 2018;22:5-18

Disclosure of Interests:

None declared

Non-response did not affect prevalence estimates of asthma and respiratory symptoms - results from a postal questionnaire survey of the general population

BACKGROUND

A high participation rate is warranted in order to ensure validity in surveys of the general population. However, participation rates in such studies have declined during the last decades.

OBJECTIVE

To evaluate the reasons for and potential effects of non-response in a large population-based survey about asthma and respiratory symptoms in Northern Sweden.

METHODS

Within the Obstructive Lung Disease In Norrbotten (OLIN) studies, a random sample of 12,000 adults aged 20-79 was invited to a postal questionnaire survey about asthma, allergic rhino-conjunctivitis and respiratory symptoms in 2016. Three reminders were sent. A random sample of 500 non-responders was invited to a telephone interview.

RESULTS

The participation rate in the initial mailing was 41.4%, and 9.2%, 5.0%, and 2.6% in the subsequent three reminders and totally 58.3% (n = 6854) responded. Of 500 non-responders selected for telephone interviews, 320 were possible to reach and 272 participated. Male sex, younger age, and current smoking were associated with both late and non-response. The prevalence of asthma and most respiratory symptoms did not differ significantly between responders and non-responders while allergic rhino-conjunctivitis and smoking was more common among non-responders. Reminders increased the participation rate but did not alter risk ratios for smoking and occupational exposures. Reasons for non-response were mainly lack of time and having forgotten to answer.

CONCLUSIONS

With a response rate of 58.3%, neither the prevalence estimates of asthma, respiratory symptoms nor the associations to risk factors were affected by non-response, while allergic rhino-conjunctivitis and smoking was underestimated in this Swedish population.

Abstract P1-13-03: Grade of leukopenia predicts treatment effect in early breast cancer in patients treated with tailored epirubicin/cyclophosphamide chemotherapy

Background: Body surface based dosing of chemotherapy is unreliable due to marked inter-individual variations in pharmacokinetics/-dynamics. Multiple retrospective studies have demonstrated that hematological toxicity could be a surrogate marker for efficacy of chemotherapy. The SBG 2000-1 trial was the first adjuvant randomized trial designed to compare the same drugs and number of courses of individually dosed chemotherapy based on grade of toxicity vs. standard dosed chemotherapy in early breast cancer. The aim was to study the relations between dose of chemotherapy, leukopenia nadir grade and prognosis.

Methods: Women (n=1452) in Sweden and Denmark with early breast cancer aged 18-60 years, received the first cycle at a standard dose of FEC (fluorouracil 600 mg/m2, epirubicin 60 mg/m2, cyclophosphamide 600 mg/m2). Patients (n=1052) with nadir leukopenia grade 0-2 after first cycle were randomized between either 6 tailored FEC with increased doses of epirubicin and cyclophosphamide aimed at achieving grade 3 leukopenia or treatment with 6 standard FEC. Patients with nadir leukopenia grade 3-4 represented a second control group (registered group) treated with 6 standard FEC. Dose escalation did not significantly improve 10 year distant disease-free survival (HR 0.87, p=0.32, Eur J Cancer 13:79-86, 2018). In this report grade of leukopenia at course 3 (after final escalation) was assessed as a prognostic marker in a Cox regression model adjusted for chemotherapy doses.

Results: Eight-year distant disease-free survival (DDFS) was 73%, 77%, 78% and 83% for patients with leucocyte nadir grade 0, 1, 2 and 3-4 and overall survival (OS) 77%, 81%, 81% and 86% respectively. Cox regression analysis of leucocyte grade and DDFS showed a statistically significant hazard ratio (HR) of 0.84 (CI 0.74-0.96, p=0.008) per grade of leukopenia, with non-significant trend for OS (HR 0.88, CI 0.76-1.02, p=0.066). The correlations with DDFS and cumulative dose of epirubicin and cyclophosphamide were not significant with hazard ratios of 0.96 (0.91-1.014 p=0.15) and 1.002 (1.00-1.005 p=0.21) per mg cumulative dose per meter squared. Patients with grade 3 tumors had a significantly stronger impact of leukopenia on DDFS (HR 0.76, 95% CI 0.65-0.90 p&lt;0.001) and a test of interaction between the prognostic effect of grade and leukopenia was significant (p=0.026).

Conclusions: The grade of leukopenia predicts the individual treatment effect better than chemotherapy doses. The results of this prospective trial are in agreement with previous retrospective studies indicating that chemotherapy induced leukopenia is predictive for outcome in early breast cancer. Dose dependent toxicity should be monitored for optimal adjustment of the dosage of chemotherapy.

Citation Format: Lindman H, Poikonen-Saksela P, Ahlgren J, Andersson M, Bergh J, Blomqvist C. Grade of leukopenia predicts treatment effect in early breast cancer in patients treated with tailored epirubicin/cyclophosphamide chemotherapy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-13-03.

Geochemistry of a copper mine tailings deposit in Repparfjorden, northern Norway

This study investigates copper ore tailings deposited in Repparfjorden, Norway in the 1970's. Bathymetric show that the tailings deposit still occurs as a series of cone-shapes and has retained its original shape for four decades. Analytical data of 51 chemical elements show that some of the tailings are spreading, affecting fjord surface sediments in the inner part of the fjord. The deposited tailings are clearly enriched on the elements Ba, Bi, Cu, Hf and Zr and depleted of Ca, Li, Nb, Pb, Sc, V and Y. A hard pan horizon occurs at 20 cm sediment depth in large parts of the inner inlet, which seems to have precipitated during the deposition of tailings. New tailings were fabricated from the two local mineralisations and these display varying chemical results from each other but also in respect to the old, deposited tailings. Therefore, caution should be taken when making chemical predictions for a future deposit.

Correction to: The effect of magnesium on early osseointegration in osteoporotic bone: a histological and gene expression investigation

This article was originally published under a CC BY-NC-ND 4.0 license, but has now been made available under a CC BY 4.0 license. The PDF and HTML versions of the paper have been modified accordingly.

Preoperative platelet function predicts perioperative bleeding complications in ticagrelor-treated cardiac surgery patients: a prospective observational study

BACKGROUND

Treatment with P2Y12 receptor antagonists increases the risk for perioperative bleeding, but there is individual variation in the antiplatelet effect and time to offset of this effect. We investigated whether preoperative platelet function predicts the risk of bleeding complications in ticagrelor-treated cardiac surgery patients.

METHODS

Ninety patients with ticagrelor treatment within <5 days of surgery were included in a prospective observational study. Preoperative platelet aggregation was assessed with impedance aggregometry using adenosine diphosphate (ADP), arachidonic acid (AA), and thrombin receptor-activating peptide (TRAP) as initiators. Severe bleeding complications were registered using a new universal definition of perioperative bleeding. The accuracy of aggregability tests for predicting severe bleeding was assessed using receiver operating characteristic (ROC) curves, which also identified optimal cut-off values with respect to sensitivity and specificity, based on Youden's index.

RESULTS

The median time from the last ticagrelor dose to surgery was 35 (range 4-108) h. The accuracy of platelet function tests to predict severe bleeding was highest for ADP [area under the ROC curve 0.73 (95% confidence interval 0.63-0.84, P<0.001); TRAP 0.61 (0.49-0.74); AA 0.53 (0.40-0.66)]. The optimal cut-off for ADP-induced aggregation was 22 U. In subjects with ADP-induced aggregation below the cut-off value, 24/38 (61%) developed severe bleeding compared with 8/52 (14%) when aggregation was at or above the cut-off value (P<0.001). The positive and negative predictive values for this cut-off value were 63 and 85%, respectively.

CONCLUSIONS

Preoperative ADP-induced platelet aggregability predicts the risk for severe bleeding complications in ticagrelor-treated cardiac surgery patients.

Clinical Application of a Chromogenic Substrate Method for Determination of Factor VIII Activity

A chromogenic substrate kit for the determination of factor VIII activity (COATEST® Factor VIII) has been evaluated in five different laboratories, one of them using a semi-automated procedure. This chromogenic method was compared to one-stage clotting assays for factor VIII determination in plasmas from healthy subjects, carriers of hemophilia A, severe, mild and moderate hemophilia A as well as von Willebrand’s patients. In all these cases, a high correlation between these two methods was obtained (r = 0.96-0.99, n = 385) with a good agreement of the assigned potencies at all levels of factor VIII. A good correlation (r = 0.94) was also obtained for the levels of factor VIII after infusion of concentrates in six severe hemophiliacs or after administration of DDAVP to von Willebrand’s patients.

The chromogenic method is insensitive to preactivation of factor VIII by thrombin, thus yielding valid potency assignments also in these situations.

The precision was higher with the chromogenic method than with the one-stage clotting assays (C.V. = 2-5% vs 4-15%). Altogether, the new chromogenic substrate method has proven itself suitable for determination of factor VIII in plasma and concentrates.

Comparison of infliximab with adalimumab in 827 biologic-naïve patients with Crohn's disease: a population-based Danish cohort study

BACKGROUND

There are conflicting data on comparative effectiveness of adalimumab and infliximab in patients with Crohn's disease (CD).

AIMS

To compare the effectiveness and safety of adalimumab and infliximab in biologic-naïve patients with CD, in a nationwide register-based propensity score-matched cohort study in Denmark.

METHODS

A total of 2908 Danish adults with CD had been treated with adalimumab or infliximab as their first biologic agent between 2005-2014. By Cox regression, we compared rates of all-cause hospitalisation, CD-related hospitalisation, major abdominal surgery and serious infections after variable 2:1 propensity score matching, accounting for baseline disease characteristics, healthcare utilisation and use of CD-related medications.

RESULTS

After propensity-score matching, we included 315 adalimumab- (34.9 ± 12.9 years, 41.9% males) and 512 infliximab-treated (33.6 ± 12.6 years, 40.8% males) patients, with median disease duration 4.0 years; 36.9% had prior abdominal surgery. Over a median follow-up 2.3 years after starting biological therapy, there were no significant differences in rate of CD-related hospitalisation (hazard ratio [HR], 0.81 [95% CI, 0.55-1.20]) or major abdominal surgery (HR, 1.24 [0.66-2.33]) between adalimumab- and infliximab-treated patients, though rate of all-cause hospitalisation was lower in adalimumab-treated patients (HR, 0.74 [0.56-0.97]). There was no significant difference in incidence of serious infections requiring hospitalisation (HR, 1.06 [0.26-4.21]). These results were stable in patients treated with biological monotherapy (all-cause hospitalisation: HR, 0.75 [0.53-1.05]; CD-related hospitalisation: HR, 0.82 [0.51-1.32], abdominal surgery: HR, 1.47 [0.63-3.47]) or in combination with immunomodulators (all-cause hospitalisation: HR, 0.70 [0.44-1.11]; CD-related hospitalisation: HR, 0.80 [0.42-1.52], abdominal surgery: HR, 1.02 [0.39-2.64]).

CONCLUSIONS

In this population-based, propensity score matched, real-life cohort study using administrative claims, there was no significant difference in effectiveness and safety of adalimumab and infliximab in biologic-naïve patients with CD.

Non-specific effects of BCG vaccination on morbidity among children in Greenland: a population-based cohort study

Background

The potential non-specific effects of BCG (Bacillus Calmette-Guérin) vaccination, with reported reduction of infectious disease morbidity among vaccinated children, in addition to the protective effect against tuberculosis (TB), are highly debated. In Greenland, BCG vaccination was introduced in 1955, but temporarily discontinued from 1991 to 1996 due to nationwide policy changes. Using the transient vaccination stop, we aimed to investigate possible non-specific effects of BCG vaccination by measuring nation-wide hospitalization rates due to infectious diseases other than TB among vaccinated and unvaccinated children.

Methods

A retrospective cohort study including all children born in Greenland aged 3 months to 3 years from 1989 to 2004. A personal identification number assigned at birth allowed for follow-up through national registers. Information on hospitalization due to infectious diseases was obtained from the Greenlandic inpatient register using ICD-8 and ICD-10 codes. Participants with notified TB were censored. Incidence rate ratios (IRR) were estimated using Poisson regression.

Results

Overall, 19 363 children, hereof 66% BCG-vaccinated, were followed for 44 065 person-years and had 2069 hospitalizations due to infectious diseases. IRRs of hospitalization in BCG-vaccinated as compared with BCG-unvaccinated children were 1.07 [95% confidence interval (CI) 0.96-1.20] for infectious diseases overall, and specifically 1.10 (95% CI 0.98-1.24) for respiratory tract infections. Among BCG-vaccinated children aged 3 to 11 months, the IRR of hospitalization due to infectious diseases was 1.00 (95% CI 0.84-1.19) as compared with BCG-unvaccinated children.

Conclusion

Our results do not support the hypothesis that neonatal BCG vaccination reduces morbidity in children caused by infectious diseases other than TB.

Inflammatory response in dogs with spontaneous cranial cruciate ligament rupture

The inflammatory response in 73 dogs with spontaneous rupture of the cranial cruciate ligament was studied. Collagen I and II antibodies (CI, CII), antinuclear antibodies (ANA) and anti-neutrophil cytoplasmic antibodies (ANCA) in synovial fluid (SF) and serum were analysed, as well as serum thyroxine (T4) and free thyroxine (fT4). The type and degree of synovitis did not affect the concentration of antibodies to CI&II. The histological findings of the synovial membranes in 47 dogs were graded as mild non-specific synovitis in 21%, moderate nonspecific synovitis in 32%, moderate lymphoplasmacytic synovitis in 36% and nodular lymphoplasmacytic synovitis in 11% of the dogs. Of 45 dogs four had lower than normal concentration of T4 and fT4. There was not any evidence of a primary autoimmune response.

Probing the activity of a recombinant Zn2+ -transporting P-type ATPase

P-type ATPase proteins maintain cellular homeostasis and uphold critical concentration gradients by ATP-driven ion transport across biological membranes. Characterization of single-cycle dynamics by time-resolved X-ray scattering techniques in solution could resolve structural intermediates not amendable to for example crystallization or cryo-electron microscopy sample preparation. To pave way for such time-resolved experiments, we used biochemical activity measurements, Attenuated Total Reflectance (ATR) and time-dependent Fourier-Transform Infra-Red (FTIR) spectroscopy to identify optimal conditions for activating a Zn²⁺ -transporting Type-I ATPase from Shigella sonnei (ssZntA) at high protein concentration using caged ATP. The highest total activity was observed at a protein concentration of 25 mg/mL, at 310 K, pH 7, and required the presence of 20% (v/v) glycerol as stabilizing agent. Neither the presence of caged ATP nor increasing lipid-to-protein ratio affected the hydrolysis activity significantly. This work also paves way for characterization of recombinant metal-transporting (Type-I) ATPase mutants with medical relevance.