SAT0037 HIGH AGREEMENT BETWEEN ANTIBODIES AGAINST MALONDIALDEHYDE PROTEIN ADDUCTS AND ANTIBODIES AGAINST MALONDIALDEHYDE-ACETALDEHYDE ADDUCTS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background:

Rheumatoid arthritis (RA) presents high levels of oxidative stress and reactive species such as malondialdehyde, which modifies proteins forming malondialdehyde adducts (MaP) and, in the presence of acetaldehyde generates adducts called malondialdehyde-acetaldehyde (MaaP). Recently, the presence of malondialdehyde modified proteins in the synovium and antibodies against these adducts (AMaPA) in the serum of patients with RA has been described (1). Previously, a high frequency of antibodies against MaaP (AMaaPA) had been reported in patients with RA (2).

Objectives:

We aimed to confirm the presence of AMaPA in patients with RA and define its relationship with AMaaPA.

Methods:

The sera of 204 healthy controls and 205 patients with established RA that met the 1987 ACR classification criteria and selected to represent the different AMaaPA status were studied. All had information on their status for FR, anti-CCP and AMaaPA antibodies (IgG, IgM and IgA). The AMaPA were determined by indirect ELISA using malondialdehyde-modified serum bovine albumin as antigen and specific secondary antibodies against the IgG and IgM isotypes following the same protocol of the previous study (1). The results were analyzed with the gamma coefficient (γ) for concordance in status and with the Spearman coefficient (ρ) for correlation of titres. The study was approved by the CEIC of Galicia.

Results:

The AMaPA showed higher titres in the patients with RA than in the controls, the positive frequencies being: 17.1% for IgG AMaPA and 25.4% for IgM AMaPA. An important fraction of the patients with RA showed the same status with the two AMaPA isotypes, as reflected in the significant concordance between them (γ = 0.74, Table 1). When comparing the AMaPA and AMaaPA status in patients with RA, a remarkable concordance was observed among the antibodies of the same isotype, especially between the IgM AMaPA and IgM AMaaPA: γ = 0.83 (Table 1). There were fewer patients with the same status when different antibody isotypes were compared, although some of these comparisons reached statistically significant concordance. However, the titres were not significantly correlated in any of the comparisons, even in those that showed the greatest agreement in status (Table 1).

Table 1.

Relationship of antibodies against malondialdehyde adducts (AMaPA) with other autoantibodies in patients with RA.

AMaPA2nd antibodyϒPρPIgGIgM AMaPA0.741.5E-140.230.3IgMIgM AMaaPA0.833.4E-250.260.1IgGIgG AMaaPA0.652.4E-080.110.7IgMIgA AMaaPA0.420.00170.260.4IgGIgM AMaaPA0.390.000960.080.8IgGIgA AMaaPA0.210.2-0.090.9IgMIgG AMaaPA0.160.30.130.7IgMRF0.480.000011nanaIgMAnti-CCP0.390.00076-0.340.031IgGAnti-CCP0.050.7-0.180.4IgGRF0.020.9nana

In relation to the typical RA autoantibodies, significant concordances were observed between the IgM AMaPA and RF or anti-CCP, although they were lower than those observed with the AMaaPA. In contrast, the IgG AMaPA showed no significant agreement with RF or anti-CCP antibodies. These low levels of concordance were reflected in the lack of significant difference in the prevalence of AMaPA between seronegative and seropositive patients (24.1% vs. 35.4%,P= 0.1).

Conclusion:

The presence of AMaPA in patients with RA has been confirmed, and a high concordance between the AMaPA and AMaaPA status has been observed, especially between those with an IgM isotype. However, the lack of correlation in the titres indicates that these two types of autoantibodies are independent. The potential utility as biomarkers of the AMaPA should be similar to that of the AMaaPA.

References:

[1] Grönwall C, et al. J Autoimmun. 2017, 84:29-45

[2] Thiele GM, et al. Arthritis Rheumatol. 2015, 67:645-55

Acknowledgments:

Funded by the Carlos III Health Institute projects PI17/01606 and RD16/ 0012/0014 that are partially co-funded by FEDER

Disclosure of Interests:

None declared

Protective Effect of Angiotensin 1-7 on Sarcopenia Induced by Chronic Liver Disease in Mice

Sarcopenia associated with chronic liver disease (CLD) is one of the more common extrahepatic features in patients with these pathologies. Among the cellular alterations observed in the muscle tissue under CLD is the decline in the muscle strength and function, as well as the increased fatigue. Morphological changes, such as a decrease in the fiber diameter and transition in the fiber type, are also reported. At the molecular level, sarcopenia for CLD is characterized by: (i) a decrease in the sarcomeric protein, such as myosin heavy chain (MHC); (ii) an increase in the ubiquitin–proteasome system markers, such as atrogin-1/MAFbx1 and MuRF-1/TRIM63; (iii) an increase in autophagy markers, such as LC3II/LC3I ratio. Among the regulators of muscle mass is the renin-angiotensin system (RAS). The non-classical axis of RAS includes the Angiotensin 1–7 [Ang-(1-7)] peptide and its receptor Mas, which in skeletal muscle has anti-atrophic effect in models of muscle wasting induced by immobilization, lipopolysaccharide, myostatin or angiotensin II. In this paper, we evaluated the effect of Ang-(1-7) on the sarcopenia by CLD in a murine model induced by the 5-diethoxycarbonyl-1,4-dihydrocollidine (DDC) hepatotoxin administered through diet. Our results show that Ang-(1-7) administration prevented the decline of the function and strength of muscle and increased the fatigue detected in the DDC-fed mice. Besides, we observed that the decreased fiber diameter and MHC levels, as well as the transition of fiber types, were all abolished by Ang-(1-7) in mice fed with DDC. Finally, Ang-(1-7) can decrease the atrogin-1 and MuRF-1 expression as well as the autophagy marker in mice treated with DDC. Together, our data support the protective role of Ang-(1-7) on the sarcopenia by CLD in mice.

0551 Longitudinal Measurement Invariance of the Insomnia Severity Index in Veterans with Sleep Apnea

Introduction

The Insomnia Severity Index is a commonly used instrument to assess the presence of insomnia symptoms as well as an outcome measure following an intervention. Longitudinal measurement invariance is a necessary property of an assessment instrument when it is repeated over time. The validity of conclusions regarding change in the construct ‘insomnia severity’ depend on scale equivalence at each measurement timepoint. Assessment of measurement invariance of the ISI in sleep apnea patients has never been performed.

Methods

Veterans with sleep apnea (n=654; AHI=36±28; 93% male; age=52±12; BMI=33±6) completed the ISI on the night of their overnight PSG and again when they picked up their PAP device. Invariance was determined by imposing a series of more restrictive equivalence constraints on a 2-factor model of the ISI. The series of constraints tested for configural, weak, strong and strict invariance. Invariance testing was modeled with exploratory structural equation modeling in Mplus (v. 7.0).

Results

The 2-factor model that emerged from the analysis showed items relating to nighttime symptoms loading on factor 1 and daytime symptoms loading on factor 2. The sleep ‘satisfaction’ item, however, had weak but similar loadings on both factors. The increasingly restrictive constraints imposed on the model revealed no decrement in model fit (RMSEA=.039 to.043; CFI=.987 to .980; TLI=.981-.977; SRMR=.027-.041).

Conclusion

The ISI met strict criteria for longitudinal measurement invariance demonstrating that it is a valid instrument to be used in repeated measures study designs of insomnia in sleep apnea patients. Change over time on the ISI is not due to the changing measurement characteristics of the ISI but to true changes in the ‘insomnia severity’ construct.

Support

None

Hair Cortisol Concentration and Mental Disorder in Children With Chronic Physical Illness

Background

To examine changes in hair cortisol concentrations (HCC) in children with chronic physical illness and identify patterns of association between HCC and mental comorbidity.

Methods

A sample of 50 children aged 6 to 16 years were recruited within six months of being diagnosed with a chronic physical illness. Data were collected via hair samples, structured interviews, and behavioral checklists.

Results

There was no change in HCC over six months. Baseline HCC was associated with internalizing—odds ratio (OR) = 1.29 (90% confidence interval (CI): 1.01–1.66)—and externalizing disorders—OR = 1.32 (90% CI: 1.07–1.64). Externalizing disorder at six months was associated with elevated baseline—OR = 1.25 (90% CI: 1.02–1.53)—and six-month HCC—OR = 1.25 (90% CI: 1.02–1.54). Associations between HCC and mental disorder weakened over time, and for internalizing disorders, changed direction (i.e., inverse association), albeit not significantly.

Conclusion

Results provide preliminary evidence that physiological stress, measured using HCC, may be implicated in the relationship between physical and mental illness, and these associations align with attenuated stress responses over time.

Intervening to shape children's emotion regulation: A review of emotion socialization parenting programs for young children

Emotion regulation patterns are shaped, in part, by the quality of interpersonal interactions during early development. Given the important contribution of caregiver emotion socialization, parenting programs targeting these socialization practices represent an effective method of preventative intervention for childhood difficulties with emotion regulation. This review examines emotion socialization parenting programs that target the development of emotion regulation in young children aged 0-6. Through a systematic search of multiple databases, 1117 articles were retrieved for title, abstract, and full-text screening. After screening, 12 articles remained and were summarized using a narrative approach. Herein, we provide an overview of 3 main intervention frameworks: Tuning in to Kids (TIK), Parent-Child Interaction Therapy-Emotion Development (PCIT-ED), and Emotion Enhanced Triple P (EETP). Overall, these emotion socialization programs have demonstrated efficacy in their ability to improve parenting behaviors related to the coaching of young children's emotion regulation; however, there has been limited examination of their effectiveness in promoting children's emotion regulation. Future research is required to address this limitation, with rigorous parenting intervention studies incorporating valid assessments of children's emotion regulation in order to promote children's development of adaptive emotion regulation. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Hair cortisol concentration mediates the association between parent and child psychopathology

Parent and child mental health are strongly associated and this association may be transmitted via disruption to the hypothalamic-pituitary-adrenal axis in children. This study examined the potential mediating role of hair cortisol concentration (HCC) in the association between parent psychopathology and child mental disorder. Data come from 100 children diagnosed with a mental disorder [major depression (66 %), generalized anxiety (58 %), attention-deficit hyperactivity (33 %), oppositional defiant (35 %)] and their parents. Parent psychopathology was measured using the Center for Epidemiological Studies Depression Scale and State-Trait Anxiety Inventory. Child mental disorder was measured using the Mini International Neuropsychiatric Interview and hair samples were assayed using high-sensitivity ELISA for cortisol extraction. Sex-specific path models were specified to estimate mediating effects (αβ). Children were, on average, 14.4 (SD 2.3) years of age and 70 % were girls. Adjusting for child age, parent sex, and family income, HCC mediated the association between symptoms of parent psychopathology and major depression and attention-deficit hyperactivity in all children (αβ ranging -0.07 to 0.19; 38-46 % effect mediated). Mediating effects for generalized anxiety and opposition defiant were evident for boys only (αβ ranging -0.26 to 0.14; 31-38 % effect mediated). Evidence suggests HCC partially mediates the association between parent psychopathology and child mental disorder, and for generalized anxiety and oppositional defiant, this effect is specific to boys. Family inventions to reduce child stress may be effective in buffering the consequences of parent psychopathology. Further research that considers sex effects is needed to clarify how HCC conditions risk for mental disorder in children.

Impact of mismatches in HbA1c vs glucose values on the diagnostic classification of diabetes and prediabetes

AIMS

To determine whether HbA_1c mismatches (HbA_1c levels that are higher or lower than expected for the average glucose levels in different individuals) could lead to errors if diagnostic classification is based only on HbA_1c levels.

METHODS

In a cross-sectional study, 3106 participants without known diabetes underwent a 75-g oral glucose tolerance test (fasting glucose and 2-h glucose) and a 50-g glucose challenge test (1-h glucose) on separate days. They were classified by oral glucose tolerance test results as having: normal glucose metabolism; prediabetes; or diabetes. Predicted HbA_1c was determined from the linear regression modelling the relationship between observed HbA_1c and average glucose (mean of fasting glucose and 2-h glucose from the oral glucose tolerance test, and 1-h glucose from the glucose challenge test) within oral glucose tolerance test groups. The haemoglobin glycation index was calculated as [observed - predicted HbA_1c ], and divided into low, intermediate and high haemoglobin glycation index mismatch tertiles.

RESULTS

Those participants with higher mismatches were more likely to be black, to be men, to be older, and to have higher BMI (all P<0.001). Using oral glucose tolerance test criteria, the distribution of normal glucose metabolism, prediabetes and diabetes was similar across mismatch tertiles; however, using HbA_1c criteria, the participants with low mismatches were classified as 97% normal glucose metabolism, 3% prediabetes and 0% diabetes, i.e. mostly normal, while those with high mismatches were classified as 13% normal glucose metabolism, 77% prediabetes and 10% diabetes, i.e. mostly abnormal (P<0.001).

CONCLUSIONS

Measuring only HbA_1c could lead to under-diagnosis in people with low mismatches and over-diagnosis in those with high mismatches. Additional oral glucose tolerance tests and/or fasting glucose testing to complement HbA_1c in diagnostic classification should be performed in most individuals.

Identifying children exposed to maltreatment: a systematic review update

Background

Child maltreatment affects a significant number of children globally. Strategies have been developed to identify children suspected of having been exposed to maltreatment with the aim of reducing further maltreatment and impairment. This systematic review evaluates the accuracy of strategies for identifying children exposed to maltreatment.

Methods

We conducted a systematic search of seven databases: Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Cochrane Libraries, Sociological Abstracts and the Education Resources Information Center. We included studies published from 1961 to July 2, 2019 estimating the accuracy of instruments for identifying potential maltreatment of children, including neglect, physical abuse, emotional abuse, and sexual abuse. We extracted data about accuracy and narratively synthesised the evidence. For five studies—where the population and setting matched known prevalence estimates in an emergency department setting—we calculated false positives and negatives. We assessed risk of bias using QUADAS-2.

Results

We included 32 articles (representing 31 studies) that evaluated various identification strategies, including three screening tools (SPUTOVAMO checklist, Escape instrument, and a 6-item screening questionnaire for child sex trafficking). No studies evaluated the effects of identification strategies on important outcomes for children. All studies were rated as having serious risk of bias (often because of verification bias). The findings suggest that use of the SPUTOVAMO and Escape screening tools at the population level (per 100,000) would result in hundreds of children being missed and thousands of children being over identified.

Conclusions

There is low to very low certainty evidence that the use of screening tools may result in high numbers of children being falsely suspected or missed. These harms may outweigh the potential benefits of using such tools in practice (PROSPERO 2016:CRD42016039659).

Angiotensin (1-7) Decreases Myostatin-Induced NF-κB Signaling and Skeletal Muscle Atrophy

Myostatin is a myokine that regulates muscle function and mass, producing muscle atrophy. Myostatin induces the degradation of myofibrillar proteins, such as myosin heavy chain or troponin. The main pathway that mediates protein degradation during muscle atrophy is the ubiquitin proteasome system, by increasing the expression of atrogin-1 and MuRF-1. In addition, myostatin activates the NF-κB signaling pathway. Renin–angiotensin system (RAS) also regulates muscle mass. Angiotensin (1-7) (Ang-(1-7)) has anti-atrophic properties in skeletal muscle. In this paper, we evaluated the effect of Ang-(1-7) on muscle atrophy and signaling induced by myostatin. The results show that Ang-(1-7) prevented the decrease of the myotube diameter and myofibrillar protein levels induced by myostatin. Ang-(1-7) also abolished the increase of myostatin-induced reactive oxygen species production, atrogin-1, MuRF-1, and TNF-α gene expressions and NF-κB signaling activation. Ang-(1-7) inhibited the activity mediated by myostatin through Mas receptor, as is demonstrated by the loss of all Ang-(1-7)-induced effects when the Mas receptor antagonist A779 was used. Our results show that the effects of Ang-(1-7) on the myostatin-dependent muscle atrophy and signaling are blocked by MK-2206, an inhibitor of Akt/PKB. Together, these data indicate that Ang-(1-7) inhibited muscle atrophy and signaling induced by myostatin through a mechanism dependent on Mas receptor and Akt/PKB.

P726 Cardiac amyloidosis: unmasking the simulator

Introduction

A non-invasive diagnosis of cardiac amyloidosis is a challenge, especially in cases of atypical phenotypic presentation. Differential diagnosis includes hypertrophic cardiomyopathy (HCM), hypertensive cardiomyopathy, and other infiltrative disorders. Multimodality imaging is essential to make a final diagnosis.

Case

We present the case of a 65 years old woman, with a personal history of resistant arterial hypertension and mild hypertensive cardiomyopathy. She was diagnosed 6 years earlier with multiple myeloma, treated with chemotherapy and allogeneic hematopoietic stem cell transplant, presenting with several relapses and in a stable situation at the moment of our first consult. The patient was referred for heart failure in context of acquired community pneumonia one month earlier.

Transthoracic echocardiography showed severe asymmetric left ventricle (LV) hypertrophy (Image A), systolic anterior motion of the mitral valve and diastolic dysfunction suggestive of HCM, not present in the previous examination. Strain imaging of the LV showed a typical amyloid infiltration pattern, with lower longitudinal strain values in the base compared to the apical segments (Image D). Further characterization of the myocardial tissue established the diagnosis along with performing a cardiac magnetic nuclear imaging (MRI). It showed the presence of inferior septum severe LV hypertrophy along with extensive patchy late gadolinium enhancement (LGE) of the lateral wall involving the endocardium (Image C), with normal LV contractility. There was no pleural effusion, but a small pericardial effusion was seen (Image B). With the suspicion of infiltrative heart disease, probably amyloid with an atypical LGE pattern, an oral mucosal biopsy was performed confirming amyloid diagnosis (Images E1,E2). Heart failure treatment was continued, but clinical evolution was poor with the deceasement of the patient 3 years after diagnosis.

Discussion

This case represents an example of the variety of imaging patterns we can see in cardiac amyloidosis. Despite the classical pattern of cardiac amyloidosis, with concentric LV hypertrophy, up to 8% of cases may present with asymmetrical LV hypertrophy, mimicking HCM. LGE extension and pattern can shows this variability as well: global transmural or subendocardial LGE is the most common, but focal patterns (up to 6% of cases) are described. The complexity of the diagnosis in these cases require a clinical and multimodality image approach.

Abstract P726 Figure. Images of the case

P754 Severe aortic stenosis with preserved ejection prognostic differences according to flow status and gradient fraction: a Spanish multicentre study

Background and objectives

Low-flow low-gradient (LFLG) aortic stenosis portends bad prognosis in different series. The objective of this study was to evaluate the evolution of this entity in our country.

Methods

We included 1394 consecutive patients evaluated between 2008-2016 with severe AS (AVA &lt;1 cm²) and ejection fraction&gt; 50% from 14 Spanish centres. The results (aortic valve intervention and mortality) were compared using the Kaplan-Meier survival analysis.

Results

Three groups based on gradient and flow status were established (high gradient: HG, normal flow under gradient: NFLG, low gradient low flow: LFLG). No significant demographic or clinical differences between groups were observed. After a follow-up of 61.52 months (IQR 43.5-86.5), 551 (73.8%) HG, 268 (35.4%) with NFLG and 81 (57.9%) LFLG received intervention, with a later surgery/TAVI indication in the LFLG group compared with HG group (p = 0.001) (Figure 1). The analysis of the Kaplan-Meier mortality curves showed no significant differences.

Conclusions

Patients with LFLG aortic stenosis with normal ejection fraction received less and later aortic valve intervention than the HG group with no significant differences in mortality.

Abstract P754 Figure. Time to surgery

1645 Unexpected aortic bioprosthetic valve thrombosis

Introduction

Prosthetic valve thrombosis (PVT) is a rare but feared complication of cardiac valve replacement which usually represents a difficult diagnostic challenge. Although PVT is not frequent in bioprosthetic valves, the advent of transcatheter heart valves and the advances in computed tomography, allowing the detection of subclinical thrombosis, have yielded growing interest in that field, specially taking into account that there is no consensus on optimal antithrombotic approach in these patients.

Clinical Case

A 74-year-old male with prior cardiac antecedents of aortic valve replacement (April 2010) with a bovine pericardial bioprosthesis (Mitroflow 25, Sorin group Inc.), ischemic dilated cardiomyopathy with moderately depressed left ventricle ejection fraction (33%) and carrier of VDD pacemaker due to third degree atrioventricular block was admitted to advanced heart failure unit. During routine follow-up echocardiograms, prosthetic valve presented no signs of dysfunction except slightly increased gradients (image C): max 38 mmHg (normal &lt;36), med 23 mmHg (normal &lt;20). Because of left ventricle dysfunction, high pacing rate (&gt;95%) and dyspnea NYHA class III the patient was referred for upgrade to cardiac resynchronization therapy (CRT).

Computed tomography to asses epicardial venous anatomy prior to CRT implant was performed. In addition to venous distribution, it was described a repletion defect in aortic bioprosthetic valve suggestive of leaflet thrombosis (image A). To complete the study the patient underwent a transesophageal echocardiography (TOE) revealing a swallow’s nest shaped hypoechoic occupation of non-coronary and left aortic leaflets (image B), and 3D effective orifice area of 0,9 cm2.

Oral anticoagulation was started in association to previously taken acetylsalicylic acid (ASA). Control TOE was performed 3 months after diagnosis showing almost complete resolution of thrombi.

During the follow-up a CRT-D was implanted, with significant response in systolic performance, reaching a LVEF of 45%. Interestingly, despite the increase in anterograde aortic flow, progressive decrease of aortic gradients (max 24 mmHg, med 15 mmHg) until normalization was found (image D). Clinical benefit was also patent, being the patient in NYHA class I at the moment.

Discusion

Valve thrombosis could be difficult to diagnose in the presence of left ventricle dysfunction as gradients shall remain low despite an important compromise in valve motion. We present a case of incidental diagnosis of non-obstructive leaflet thrombosis that was managed conservatively with oral anticoagulation and ASA. The descent in transaortic gradients, moreover taking into account the response to CRT increasing LVEF, indicates that gradients slightly increased or in the upper limit of normality should raise suspicion in valve dysfunction in the presence of decreased LVEF.

Abstract 1645 Figure.

58 Effect of different light sources on the developmental capacity of bovine embryos produced invitro

Under natural conditions, mammalian oocytes and zygotes are never exposed to daylight or artificial light. During assisted reproductive procedures such as invitro production (IVP), oocytes and pre-implantation embryos are exposed to light from time to time before being transferred to recipients. The detrimental effect of visible light is not directly related to the intensity and exposure time, but is also a function of the spectral composition of the light. Recently, a green pass light filter was used during all steps of bovine IVP. Results indicated the protective effect of the filter against harmful blue and infrared regions of the light (Korhonen et al. 2009 Hum Reprod. 24, 308-314; https://doi.org/10.1093/humrep/den432). Data regarding either blue or infrared light are missing. Therefore, the effect of environmental light will be examined on the developmental capacity of bovine oocytes and pre-implantation embryos produced invitro. Three different experimental conditions were set during all IVP steps: (i) light from the microscope filtered with a red pass filter, no artificial light, and no daylight, (ii) artificial light without day light, light from the microscope without a filter, and (iii) artificial and daylight, light from the microscope without a filter, as normally used in the laboratory (control). Bovine cumulus-oocyte complexes were recovered from abattoir-derived ovaries by the slicing method. After 24h of maturation, fertilisation was realised and after 19h of co-culture of cumulus-oocyte complexes and sperm, presumptive zygotes were cultured in SOFaa for 8 days. Cleavage and developmental rates were recorded at Day 3 and Day 7/8 (Day 0=IVF, 10 IVP runs). Blastocysts from all groups were individually stored at −80°C until analyses. Then RT-qPCR (at least 12 replicates) was performed as described previously (Stinshoff et al. 2014 Reprod. Fertil. Dev. 26, 502-510; https://doi.org/10.1071/RD12372) for gene transcripts related to cellular stress (BAX, BCL2L1, HSPA1A, SOD1) and embryo developmental capacity (SLC2A3). The morphological quality of expanded blastocyst was assessed via a differential staining procedure (with propidium iodide and Hoechst, 4 replicates) to determine the number of inner cell masses (ICM), trophectoderms (TE), and total cells and to calculate the ICM/TE ratio. Data were analysed by analysis of variance followed by a Tukey test. Cleavage and developmental rates were similar in all groups of embryos (P&gt;0.05). The relative abundance of all analysed gene transcripts was significantly increased (P ≤ 0.05) in blastocysts stemming from settings (i) and (ii) compared with those from the control group. Blastocysts generated using only artificial light or artificial and daylight did show a significantly increased number of ICM and total cells (86.3±3.2, 56.3±1.4; 183.6±4.0, 161.8±2.8) compared with embryos produced under filtered microscope light without any other light (35.3±0.8; 133.8±1.4; P ≤ 0.05). The number of TE cells was similar (P&gt;0.05) in blastocysts of all groups (i: 98.5±1.3; ii: 97.3±2.6; iii (control): 105.5±2.4). These data suggest that day light exposure might influence bovine embryos at the molecular level, whereas the morphological quality seems to be unaffected when compared with embryos exposed to only artificial light.

Examining the relationships between parent experiences and youth self-reports of slapping/spanking: a population-based cross-sectional study

Background

Slapping/spanking is related to a number of poor health outcomes. Understanding what factors are related to the increased or decreased use of spanking/slapping is necessary to inform prevention. This study used a population-based sample to determine the prevalence of slapping/spanking reported by youth; the relationship between sociodemographic factors and slapping/spanking; and the extent to which parental exposures to victimization and maltreatment in childhood and current parental mental health, substance use and family circumstances, are associated with youth reports of slapping/spanking.

Methods

Data were from the 2014 Ontario Child Health Study, a provincially representative sample of households with children and youth aged 4–17 years. Self-reported lifetime slapping/spanking prevalence was determined using a sub-sample of youth aged 14–17 years (n = 1883). Parents/primary caregivers (i.e., person most knowledgeable (PMK) of the youth) self-reported their own childhood experiences including bullying victimization, slapping/spanking and child maltreatment, and current mental health, substance use and family circumstances including mental health functioning and emotional well-being, alcohol use, smoking, marital conflict and family functioning. Analyses were conducted in 2018.

Results

Living in urban compared to rural residence and family poverty were associated with decreased odds of slapping/spanking. PMK childhood experiences of physical and verbal bullying victimization, spanking, sexual abuse, emotional abuse, and exposure to physical intimate partner violence were associated with increased odds of youth reported slapping/spanking (adjusted odds ratio [AOR] ranged from 1.33–1.77). PMK experiences of physical abuse and exposure to emotional/verbal intimate partner violence in childhood was associated with decreased odds of youth reported slapping/spanking (AOR = 0.72 and 0.88, respectively). PMK’s higher levels of marital conflict, languishing to moderate mental health functioning and emotional well-being, and moderate or greater alcohol use were associated with increased odds of youth reported slapping/spanking (AOR ranged from 1.36–1.61).

Conclusions

It may be important to consider parent/primary caregiver’s childhood experiences with victimization and maltreatment along with their current parental mental health, substance use and family circumstances when developing and testing strategies to prevent slapping/spanking.

The link between maternal and child verbal abilities: An indirect effect through maternal responsiveness

Language abilities in early childhood show stability over time and play an important role in the development of other cognitive processes. Identifying modifiable environmental risk factors is important to informing prevention and early intervention efforts. Maternal verbal ability has been previously linked to child verbal ability. The current study examined whether maternal and child verbal abilities were linked indirectly through early childhood maternal responsiveness. Data come from a longitudinal birth cohort study. Participants included 133 mothers and their children recruited from maternity wards shortly after birth. Maternal verbal ability was measured using the Vocabulary subtest from the Wechsler Abbreviated Scale of Intelligence, Second Edition (child age 8 months). Child verbal ability was assessed using the Peabody Picture Vocabulary Test (36 months). A latent maternal responsiveness variable was estimated using three developmentally sensitive indicators; one during infancy (child age 8 months) and two when children were 36 months. Results of a structural equation model indicated a significant indirect effect from maternal verbal abilities to child verbal abilities through maternal responsiveness. This indirect path was significant even after inclusion of another indirect path from maternal executive functioning to child verbal ability through maternal responsiveness (which was not significant). Future studies will benefit from experimental, genetically sensitive and/or cross-lagged designs to allow for conclusions related to directionality and causality. This body of research has implications for the study of the intergenerational transmission of verbal abilities and associated skills, behaviours and adaptive outcomes.

P3370Prevalence of right ventricular dysfunction according to different parameters: basal and one year after transcatheter aortic valve implantation

Background

Right ventricle (RV) is not often specifically studied in patients with severe aortic stenosis (AS). It's difficult to find the correct tool to assess RV function with echocardiographic parameters, and the percentage of patients with dysfunction may vary depending on the parameter that we use.

The aim of the study was to evaluate the prevalence of RV dysfunction basal and one year after transcatheter aortic valve implantation (TAVI), according to different parameters.

Methods

Consecutive patients with severe AS undergoing TAVI from January 2016 to July 2017 were included. RV anatomical and functional parameters were analyzed according to ESC and ASE guidelines. RV dysfunction was assessed using tricuspid annular plane systolic excursion (TAPSE) <17 mm, fractional area change <35%, systolic movement of the RV lateral wall by tissue Doppler imaging (RV-S'TDI) <9.5 cm/s, global longitudinal (RV-GLS) and free wall strain (RV-FWS) using as cutting point [20]. Pre procedure echo, immediate post procedure and 1 year echo were analyzed. Statistical analysis was performed using SSPS version 22.

Results

The final study population consisted of 78 patients (115 patients were included, 37 were excluded due to suboptimal acoustic window for RV anatomical and functional evaluation), mean age 83.73±6.31 year-old, 38.2% females. We analyzed the percentages of RV dysfunction according to the different parameters evaluated before and in the control one year after. They are shown in Figure 1.

Prevalence of RV dysfunction

Conclusions

The presence of RV dysfunction in patients with severe AS is higher than expected Our data suggest that RV function improve one year after TAVI, in terms of a reduction in the number of patients with dysfunction. The assessment of RV function is difficult, and there is no agreement on what tools are more accurate and useful. RV strain seems to be the most sensible parameter to assess RV function in patients with AS undergoing TAVI. Impact of these measurements in patients management needs further evaluation.

The British Columbia Healthy Connections Project: findings on socioeconomic disadvantage in early pregnancy

Background

Maternal exposure to socioeconomic disadvantage increases the risk of child injuries and subsequent child developmental and mental health problems — particularly for young mothers. To inform early intervention planning, this research therefore aimed to describe the health and social adversities experienced by a cohort of girls and young women in early pregnancy in British Columbia (BC), Canada.

Methods

Participants were recruited for the BC Healthy Connections Project (BCHCP), a randomized controlled trial examining the effectiveness of Nurse-Family Partnership, a home visitation program, in improving child and maternal outcomes. Baseline data were collected from 739 participants on trial entry. Participants were selected on the basis of preparing to parent for the first time and experiencing socioeconomic disadvantage. Analyses involved descriptive statistics and age-group comparisons.

Results

Most participants reported having low income (84%), having limited education (52%) and being single (91%) at trial entry. Beyond these eligibility criteria, other health and social adversities included: housing instability (52%); severe anxiety or depression (47%); other diagnosed mental disorders (22%); prenatal nicotine and cannabis use (27 and 21%); physical health problems (20%); child maltreatment when younger (56%); and intimate partner violence recently (50%). As well, few (29%) had received income assistance entitlements. More than two thirds (70%) were experiencing four or more forms of adversity. Age-group differences were observed for cognitive functioning, being single, low income, limited education, psychological distress and service use (p-value ≤0.05).

Conclusions

This cohort was selected on the basis of socioeconomic disadvantage. Yet all participants were experiencing substantial added adversities — at higher rates than other Canadians. Furthermore, despite Canada’s public programs, these pregnant girls and young women were not being adequately reached by social services. Our study adds new data to inform early intervention planning, suggesting that unacceptably high levels of socioeconomic disadvantage exist for some young British Columbians. Therefore greater health and social supports and services are warranted for these young mothers and their children.

Trial registration

Registered August 24, 2012 with ClinicalTrials.gov Identifier: NCT01672060. Active not recruiting.

The relationship between gender, parenthood and practice intentions among family medicine residents: cross-sectional analysis of national Canadian survey data

BACKGROUND

Family medicine (FM) residents choose among a range of options as they enter practice, including practice model, clinical domains, settings, and populations. The choices they make have implications for primary care workforce planning and may differ between FM residents who are parents and those who are not, as well as between male and female FM residents. We investigate whether parenthood shapes intentions among FM residents entering practice and whether the effect of parenthood differs between male and female FM residents.

METHODS

We conducted cross-sectional analysis of national survey data collected from FM residents in Canadian residency programs by the College of Family Physicians of Canada between 2014 and 2017. The survey captures information on intentions for comprehensive or focused practice, practice model, clinical domains, practice setting, and populations. We used chi-square tests and multivariable logistic regression to investigate the relationships between parenthood, gender, and practice intentions, adjusting for other physician personal characteristics.

RESULTS

Almost a quarter of FM residents were parents or became parents during residency. Intentions for the provision comprehensive care were higher among parents, and intentions for clinically focused practice were lower. Differences in intentions for practice models, domains, and settings/population were primarily by gender, though in several cases the effects of parenthood differed between female and male FM residents. Even during residency, the effects of parenthood differ between male and female residents: while three quarters of male parents finish residency in two years, fewer than half of female parents do.

CONCLUSIONS

Both parenthood and gender independently shape practice intentions, but the effect of parenthood differs for male and female FM residents. Supporting FM residents who are parents may positively impact the quality and availability of primary care services, especially since parents are more likely to report intentions to provide  comprehensive care soon after entering practice.

Cascaded harmonic generation from a fiber laser: a milliwatt XUV source

Recent progresses in femtosecond ytterbium-doped fiber laser technology are opening new perspectives in strong field physics and attosecond science. High-order harmonic generation from these systems is particularly interesting because it provides high flux beams of ultrashort extreme ultraviolet radiation. A great deal of effort has been devoted to optimize the macroscopic generation parameters. Here we investigate the possibility of enhancing the single-atom response by producing high-order harmonics from the second, third and fourth harmonics of a turnkey 50 W, 166 kHz femtosecond Yb-fiber laser providing 135 fs pulses at 1030 nm. We show that the harmonic efficiency is optimal when the process is driven by the third harmonic, producing 6.6 ± 1.3 × 10¹⁴ photons/s at 18 eV in argon, which corresponds to 1.9 ± 0.4 mW average power.

Mental-Physical Multimorbidity in Youth: Associations with Individual, Family, and Health Service Use Outcomes

Prevalence, correlates, and outcomes of youth with comorbid mental and physical conditions (i.e., multimorbidity) were examined in this cross-sectional study. Participants were 92 youth (14.5 years [SD 2.7]; 69.6% female) and their parents. Mental disorder was assessed using structured interviews and physical health using a standardized questionnaire. Twenty-five percent of youth had multimorbidity and no child or parent demographic or health characteristics were correlated with multimorbidity. Youth with multimorbidity reported similar quality of life and better family functioning [B = - 4.80 (- 8.77, - 0.83)] compared to youth with mental disorder only (i.e., non-multimorbid). Youth with multimorbidity had lower odds of receiving inpatient services [OR = 0.20 (0.05, 0.85)] and shorter stays in hospital for their mental health [OR = 0.74 (0.57, 0.91)] over the past year. Family functioning was found to mediate the association between youth multimorbidity and length of stay [αβ = 0.14 (0.01, 0.27)]. Findings reinforce the need for family-centered youth mental health care.