SAT0386 USEFULNESS OF THE FECAL CALPROTECTIN AS SCREENING TOOL FOR INFLAMMATORY BOWEL DISEASE IN PATIENTS WITH SPONDYLOARTHRITIS AND NO DIGESTIVE SYMPTOMS

Background:

Fecal calprotectin (FC) is a biomarker of bowel inflammation widely spread in diagnosis and follow-up of inflammatory bowel disease (IBD). It is classically estimated that 5% of patients with axial spondyloarthritis (SpA) also have IBD; coexistence of both conditions has definite impact in clinical decisions. Proactive detection of both diseases should be advisable, though appropriate screening tools are still lacking.

Objectives:

To evaluate the usefulness of FC for the diagnosis of IBD in patients diagnosed with SpA with no clinical suggestive manifestations or previous diagnosis of IBD.

Methods:

Patients from a Rheumatology clinic diagnosed with SpA who met ASAS criteria and did not present digestive symptoms suggestive of IBD were consecutively included. Demographics, clinical and analytical data of SpA (uveitis, HLA B27, acute phase reactants) at the time of inclusion, and treatment history were collected. Patients with a positive FC (> 50 mg/Kg) underwent ileocolonoscopy with biopsies of colon and terminal ileum. Patients who were recommended to avoid NSAIDs 2-4 weeks before stool collection and endoscopy.

Patients with no endoscopic findings underwent a second determination of fecal calprotectine. If persisted positive, capsule endoscopy was performed to evaluate small intestine.

Results:

98 patients included; 47% male, mean age 46.1 (20-74) years. BASDAI 3.6 ± 2.5. HLA B27 positive in 78% of patients, high ESR in 31.6%, high CRP in 9.2%. FC positive in 49 patients (50%): mean 147 mg/kg (range 0-3038).

47 underwent ileocolonoscopy: In 13 cases (26.5%), endoscopic findings were suggestive of IBD (7 Crohn’s disease and 1 ulcerative colitis). Microscopic inflammation was found in 2 additional cases. Among those 34 patients with normal ileocolonoscopy, 16 patients refused further investigations; among the remining 18 patients, a second FC was positive in 16. Capsule endoscopy showed findings suggestive of small intestine IBD in 6 additional patients.

In patients with high FC levels,those with high CRP and ESR were more likely to have IBD(29% v 16% and 29% v 12% respectively). Patients with a history ofuveitis(18% vs 12%) orpsoriasis(33% v 16%) also had a higher prevalence of IBD, although none of those differences reached statistical significance.

FC was higher insmokers(72%v 44%; p=0.03). There were no significant differences regarding HLA B27. No statistically significant differences were found in FC between patients with high FC who were diagnosed with IBD and those who were not.

Conclusion:

In our study, patients with SpA and no clinical feature suggestive of IBD who showed FC> 50 mg/kg had high prevalence of IBD, which could indicate theusefulness of FC as screening tool for IBD in patients with SpA.

Patients with SpA and other immune-mediated condition or elevated CRP, seem to be more likely to have subclinical IBD.

Disclosure of Interests:

None declared

Dorsolateral prefrontal N-acetyl-aspartate concentration in male patients with chronic schizophrenia and with chronic bipolar disorder

Objectives

A study of N-acetyl-aspartate (NAA) can provide data of interest about cortical alterations in psychotic illnesses. Although a decreased NAA level in the cerebral cortex is a replicated finding in chronic schizophrenia, the data are less consistent for bipolar disease. On the other hand, it is likely that NAA values in schizophrenia may differ in men and women.

Methods

We used proton magnetic resonance spectroscopy (1H MRS) to examine NAA levels in the prefrontal cortex in two groups of male patients, one with schizophrenia (n = 11) and the other with bipolar disorder (n = 13) of similar duration, and compared them to a sample of healthy control males (n = 10). Additionally, we compared the degree of structural deviations from normal volumes of gray matter (GM) and cerebrospinal fluid (CSF) in the dorsolateral prefrontal cortex.

Results

Compared to controls, schizophrenia and bipolar patients presented decreased NAA to creatine ratios, while only the schizophrenia group showed an increase in CSF in the dorsolateral prefrontal region. There were no differences in choline to creatine ratios among the groups.

Conclusions

These data suggest that the decrease in NAA in the prefrontal region may be similar in schizophrenia and bipolar disorder, at least in the chronic state. However, cortical CSF may be markedly increased in schizophrenia patients.

Potential of topological descriptors to model the retention of polychlorinated biphenyls in different gas chromatography stationary phases, including ionic liquid-based columns

The aim of this study was to develop a statistical model based on a set of intuitive topological descriptors that will help to determine the influence of the polychlorinated biphenyls (PCBs) structural features on the chromatographic behavior of these analytes in a variety of gas chromatographic stationary phases, including the highly polar ionic liquid (IL)-based SLB-IL76 and SLB-IL60 columns. The model was developed using the stepwise multiple linear regression method, and constructed through several levels of increasing complexity to make evident the relative influence of the selected descriptors. The proposed model was easy to implement and provided similar satisfactory results irrespective of the dependent variables used (i.e., retention index or retention time) or the chromatographic conditions applied (i.e., pseudo-isotherm and programmed temperature) for IL-based phases. The model also allowed the correct prediction of the elution order of selected PCBs in these and other less polar phases evaluated (i.e., SW-10, DB-17, ZB-5 and HT-8). To our knowledge, this is the first models based on topological descriptors described in the literature that provided a satisfactory fitting of the PCB behavior in IL-based phases. Our results indicated that the mechanism governing the chromatographic separation of PCBs in these highly polar columns showed significant differences compared with those observed in other less polar stationary phases.

Vascular Inflammation in Subclinical Atherosclerosis Detected by Hybrid PET/MRI

BACKGROUND

Atherosclerosis is a chronic inflammatory disease, but data on arterial inflammation at early stages is limited.

OBJECTIVES

The purpose of this study was to characterize vascular inflammation by hybrid ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/magnetic resonance imaging (PET/MRI).

METHODS

Carotid, aortic, and ilio-femoral ¹⁸F-FDG PET/MRI was performed in 755 individuals (age 40 to 54 years; 83.7% men) with known plaques detected by 2-/3-dimensional vascular ultrasound and/or coronary calcification in the PESA (Progression of Early Subclinical Atherosclerosis) study. The authors evaluated the presence, distribution, and number of arterial inflammatory foci (increased ¹⁸F-FDG uptake) and plaques with or without inflammation (coincident ¹⁸F-FDG uptake).

RESULTS

Arterial inflammation was present in 48.2% of individuals (24.4% femorals, 19.3% aorta, 15.8% carotids, and 9.3% iliacs) and plaques in 90.1% (73.9% femorals, 55.8% iliacs, and 53.1% carotids). ¹⁸F-FDG arterial uptakes and plaques significantly increased with cardiovascular risk factors (p < 0.01). Coincident ¹⁸F-FDG uptakes were present in 287 of 2,605 (11%) plaques, and most uptakes were detected in plaque-free arterial segments (459 of 746; 61.5%). Plaque burden, defined by plaque presence, number, and volume, was significantly higher in individuals with arterial inflammation than in those without (p < 0.01). The number of plaques and ¹⁸F-FDG uptakes showed a positive albeit weak correlation (r = 0.25; p < 0.001).

CONCLUSIONS

Arterial inflammation is highly prevalent in middle-aged individuals with known subclinical atherosclerosis. Large-scale multiterritorial PET/MRI allows characterization of atherosclerosis-related arterial inflammation and demonstrates ¹⁸F-FDG uptake in plaque-free arterial segments and, less frequently, within plaques. These findings suggest an arterial inflammatory state at early stages of atherosclerosis. (Progression of Early Subclinical Atherosclerosis [PESA]; NCT01410318).

Antimicrobial efficacy of Lippia citriodora natural extract against Escherichia coli and Enterococcus faecalis in "Piel de Sapo" melon juice

BACKGROUND

The minimal inhibitory concentration (MIC) of an aqueous extract of Lippia citriodora with reported functional properties (PLX®) was determined on two strains of Escherichia coli (E. coli) belonging to serogroups commonly associated with foodborne illnesses (E. coli O157:H7 ATCC 700728 and E. coli O111 isolate 172) in vegetable products and two control strains for antimicrobial tests assays (E. coli ATCC 25922 and Enterococcus-En. faecalis ATCC 29212).

RESULTS

Mean MIC values at standard pH (7.4) in broth for the E. coli strains tested ranged from 4,444 µg/ml (35ºC) to 1,250 µg/ml (10ºC) and to 182 µg/ml (4ºC). At pH 5.5, conditions resembling those of melon juice, MIC was about 2 times higher at 35 and 10ºC compared with 4ºC. The MIC of En. faecalis was similar or slightly lower than those of E. coli at the conditions tested. In melon juice fortified with PLX® (2,500 µg/ml, maximum sensorial acceptable limit), the three strains of E. coli maintained their viability although none showed growth potential after 4 days at 4ºC.

CONCLUSIONS

PLX® could be added to melon juice to control E. coli O157:H7 and E. coli O111 during refrigerated storage, reducing the risk of microbiological contamination in this food.

Population-Based Pragmatic Trial of Advance Care Planning in Primary Care in the University of California Health System

Introduction: Varying intensity of advance care planning (ACP) interventions at the population level has not been compared among seriously ill patients in primary care. This project will implement, test, and disseminate real-world scalable ACP interventions among primary care clinics across three University of California Health systems. The three ACP interventions are (1) distribution of an advance directive (AD) with targeted ACP messaging, (2) the AD, messaging, plus prompting patients to engage with the Prepare For Your Care website (PREPARE), and (3) the AD, messaging, PREPARE, plus Care Coordinator engagement with patients and clinicians. Methods: We will identify a population cohort of seriously ill primary care patients and implement the ACP interventions using electronic health record (EHR) patient portals and postal mailings. Forty-five clinics across the three health systems will be cluster randomized to one of the three ACP interventions. The primary outcome for the population cohort is AD or Physician Orders for Life-Sustaining Treatment documentation in the EHR. A subset of the population cohort will be surveyed to assess patient-centered outcomes, including care consistent with goals at baseline, 12 months, and 24 months. Caregivers will be interviewed if patients are unable to be surveyed or die. ACP documentation, goal concordant care, and among decedents, health care utilization will be compared among intervention arms. Study Implementation: Challenges and Contributions: The project is guided by a Study Advisory Group and Community Advisory Groups at each site to ensure rigorous patient-centered methods and consistency of implementation. Intervention fidelity will be evaluated using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework. Challenges to implementation of this three-site health system trial and to intervention fidelity stem from site/clinic/system cultures, increasing attention to end-of-life care from payers and regulators, and growing pressures by health systems to implement ACP interventions. Stakeholder engagement is required to ensure consistent interventions across sites.

Cardiac MRI Endpoints in Myocardial Infarction Experimental and Clinical Trials: JACC Scientific Expert Panel

After a reperfused myocardial infarction (MI), dynamic tissue changes occur (edema, inflammation, microvascular obstruction, hemorrhage, cardiomyocyte necrosis, and ultimately replacement by fibrosis). The extension and magnitude of these changes contribute to long-term prognosis after MI. Cardiac magnetic resonance (CMR) is the gold-standard technique for noninvasive myocardial tissue characterization. CMR is also the preferred methodology for the identification of potential benefits associated with new cardioprotective strategies both in experimental and clinical trials. However, there is a wide heterogeneity in CMR methodologies used in experimental and clinical trials, including time of post-MI scan, acquisition protocols, and, more importantly, selection of endpoints. There is a need for standardization of these methodologies to improve the translation into a real clinical benefit. The main objective of this scientific expert panel consensus document is to provide recommendations for CMR endpoint selection in experimental and clinical trials based on pathophysiology and its association with hard outcomes.

A Phragmén-Lindelöf Theorem via Proximate Orders, and the Propagation of Asymptotics

We prove that, for asymptotically bounded holomorphic functions in a sector in C , an asymptotic expansion in a single direction towards the vertex with constraints in terms of a logarithmically convex sequence admitting a nonzero proximate order entails asymptotic expansion in the whole sector with control in terms of the same sequence. This generalizes a result by Fruchard and Zhang for Gevrey asymptotic expansions, and the proof strongly rests on a suitably refined version of the classical Phragmén-Lindelöf theorem, here obtained for functions whose growth in a sector is specified by a nonzero proximate order in the sense of Lindelöf and Valiron.

Cord blood transplantation is associated with good outcomes in secondary Acute Myeloid Leukaemia in first remission

BACKGROUND

We conducted a retrospective survey within the European Society for Blood and Marrow Transplantation (EBMT) registry to assess the outcomes of cord blood transplantation (CBT) in secondary acute myeloid leukaemia (sAML).

METHODS

Inclusion criteria consisted of ≥18 years of age, sAML, first CBT between 2002 and 2016, and either first complete remission (CR) or active disease at CBT.

RESULTS

One hundred forty-six patients met the study inclusion criteria. Status at transplantation was first CR (n = 97), primary refractory sAML (n = 30) or relapsed (n = 19) sAML. Neutrophil engraftment was achieved in 118 patients while the remaining 25 patients (17%) failed to engraft. This includes 13% of patients transplanted in first CR versus 30% of those transplanted with active disease (P = 0.008). Two-year incidences of relapse were 25% in first CR patients versus 36% in those with advanced disease (P = 0.06) while 2-year incidences of nonrelapse mortality were 35% and 49% (P = 0.03), respectively. At 2-year overall survival, leukaemia-free survival and graft-versus-host disease (GVHD)-free relapse-free survival were 42% vs. 19% (P < 0.001), 40% vs. 16% (P < 0.001), and 26% vs. 12% (P = 0.002) in first CR patients versus those with advanced disease, respectively.

CONCLUSIONS

We report here the first study of CBT in a large cohort of sAML patients. Main observation was that CBT rescued approximately 40% of patients with sAML in first CR.

High Ampacity Carbon Nanotube Materials

Constant evolution of technology is leading to the improvement of electronical devices. Smaller, lighter, faster, are but a few of the properties that have been constantly improved, but these developments come hand in hand with negative downsides. In the case of miniaturization, this shortcoming is found in the inherent property of conducting materials-the limit of current density they can withstand before failure. This property, known as ampacity, is close to reaching its limits at the current scales of use, and the performances of some conductors such as gold or copper suffer severely from it. The need to find alternative conductors with higher ampacity is, therefore, an urgent need, but at the same time, one which requires simultaneous search for decreased density if it is to succeed in an ever-growing electronical world. The uses of these carbon nanotube-based materials, from airplane lightning strike protection systems to the microchip industry, will be evaluated, failure mechanisms at maximum current densities explained, limitations and difficulties in ampacity measurements with different size ranges evaluated, and future lines of research suggested. This review will therefore provide an in-depth view of the rare properties that make carbon nanotubes and their hybrids unique.

EXPERIMENTAL EVALUATION OF NEUTRON SHIELDING MATERIALS

A new proposed design of neutron shielding material-based on the commercial material Borotron UH050 with an addition of Al(OH)3-is evaluated in order to determine if its neutron and gamma shielding properties match those of a reference material, NS4FR. Neutron and gamma dosimetry measurements are performed, as well as neutron spectrometry measurements and Monte Carlo simulations. Negligible differences are found between the materials for neutron shielding, while significant differences are found for gamma shielding. The effect of Al(OH)3 addition to Borotron UH050 is to reduce neutron shielding properties while increasing gamma shielding properties. The resulting material is as efficient as NS4FR for neutron shielding but less efficient for gamma shielding-thicknesses 20% higher are required to match gamma shielding properties of NS4FR. Monte Carlo models of the materials are validated based on the performed measurements of neutron spectra and neutron and gamma ambient dose equivalent.

NEUTRON CHARACTERIZATION OF ENSA-DPT TYPE SPENT FUEL CASK AT TRILLO NUCLEAR POWER PLANT

The Neutron Standards Laboratory of CIEMAT has conducted the characterization of the independent spent fuel storage installation at the Trillo Nuclear Power Plant. At this facility, the spent fuel assemblies are stored in ENSA-DPT type dual purpose casks. Neutron characterization was performed by dosimetry measurements with a neutron survey meter (LB6411) inside the facility, around an individual cask and between stored casks, and outside the facility. Spectra measurements were also performed with a Bonner sphere system in order to determine the integral quantities and validate the use of the neutron monitor at the different positions. Inside the facility, measured neutron spectra and neutron ambient dose equivalent rate are consistent with the casks spatial distribution and neutron emission rates, and measurements with both instruments are consistent with each other. Outside the facility, measured neutron ambient dose equivalent rates are well below the 0.5 μSv/h limit established by the nuclear regulatory authority.