Metabolic Disorders, the Microbiome as an Endocrine Organ, and Their Relations with Obesity: A Literature Review

The etiology of metabolic disorders, such as obesity, has been predominantly associated with the gut microbiota, which is acknowledged as an endocrine organ that plays a crucial role in modulating energy homeostasis and host immune responses. The presence of dysbiosis has the potential to impact the functioning of the intestinal barrier and the gut-associated lymphoid tissues by allowing the transit of bacterial structural components, such as lipopolysaccharides. This, in turn, may trigger inflammatory pathways and potentially lead to the onset of insulin resistance. Moreover, intestinal dysbiosis has the potential to modify the production of gastrointestinal peptides that are linked to the feeling of fullness, hence potentially leading to an increase in food consumption. In this literature review, we discuss current developments, such as the impact of the microbiota on lipid metabolism as well as the processes by which its changes led to the development of metabolic disorders. Several methods have been developed that could be used to modify the gut microbiota and undo metabolic abnormalities.

METHODS

After researching different databases, we examined the PubMed collection of articles and conducted a literature review.

RESULTS

After applying our exclusion and inclusion criteria, the initial search yielded 1345 articles. We further used various filters to narrow down our titles analysis and, to be specific to our study, selected the final ten studies, the results of which are included in the Results section.

CONCLUSIONS

Through gut barrier integrity, insulin resistance, and other influencing factors, the gut microbiota impacts the host's metabolism and obesity. Although the area of the gut microbiota and its relationship to obesity is still in its initial stages of research, it offers great promise for developing new therapeutic targets that may help prevent and cure obesity by restoring the gut microbiota to a healthy condition.

Clinical Evidence Regarding the Dynamic of Baker Cyst Dimensions after Intermittent Vacuum Therapy as Rehabilitation Treatment in Patients with Knee Osteoarthritis

The Baker cyst (BC), also known as the popliteal cyst or parameniscal cyst, is a fluid-filled sac that normally develops in the back of the knee, between the semimembranosus and medial head of the gastrocnemius. We aimed to evaluate the effectiveness of physiotherapy (10 days of treatment) that associates intermittent vacuum therapy (IVT) on the lower limbs in the treatment of the BC, respectively, in its size reduction. Sixty-five patients with knee osteoarthritis using Kellgren-Lawrence criteria and the presence of BC (ultrasonography evaluation), were divided into the Control and Vacuum groups. We collected the following features: sex, age, level of education, occupation, environment, body mass index, Knee Injury and Osteoarthritis Outcome Score, Western Ontario, and McMaster Universities Osteoarthritis Index, the Functional Independence Measurement, the Fall Risk Score, and the Visual Analog Scale were recorded at baseline and after 10 days. Both groups are similar in terms of demographic features. Regarding the clinical functional parameters, the results elicit a statistically significant change in all parameters between admission and discharge, including the echo volume at BC. Physical medicine and rehabilitation increase the autonomy of patients with BC. Clinical-functional improvement begins in the first 10 days of complex rehabilitation treatment; it is statistically significant and is not different between the two groups, which brings an additional argument for the effectiveness of conservative therapy in the treatment of BC. Although IVT has not demonstrated its superiority over classical balneo-physical therapy, additional research, and long-term monitoring are needed to provide additional arguments regarding this aspect.

The Impact of Complex Rehabilitation Treatment on Sarcopenia-Pathology with an Endocrine Morphological Substrate and Musculoskeletal Implications

The pathogenesis of sarcopenia is multifactorial, including changes in the endocrine system. Easy-to-perform screening tests can guide the diagnosis of sarcopenia and the rehabilitation therapeutic conduct, which can act on many physiopathological links. This study was conducted over a period of 5 months, from April to August 2022, and included 84 patients hospitalized for a period of 10 days in the Balneal and Rehabilitation Sanatorium Techirghiol for complex physiotherapy, which included balneotherapy. In dynamics, both at admission and discharge, specific screening tests for sarcopenia (SARC-F questionnaire, grip strength, testing muscle strength at the level of the quadriceps, sit-to-stand tests (the time required for five consecutive rises and the number of rises performed in 30 s)) and the Visual Analogue Scale (VAS) for pain were performed. The study was conducted according to the norms of deontology and medical ethics. Results: A significant proportion of patients had a positive result in at least one of the tests for the screening of sarcopenia syndrome. The most eloquent results were obtained from the statistical analysis of the following parameters evaluated at admission: the SARC-F questionnaire and the sit-to-stand test-the number of rises in 30 s. In terms of dynamics, after performing the complex rehabilitation treatment, the patients recorded improvements in the established screening tests and improvements in pain symptoms evaluated with the help of the VAS. Conclusions: Sarcopenia, a pathology developed with aging, is frequently encountered among adults. In the future, it is important to perform screening for sarcopenia in both endocrinology and medical rehabilitation clinics. Good management of sarcopenia can influence therapeutic conduct and can prevent complications, improving the functional capacity and the quality of life of the patients.

SAT0343 NUTRITIONAL STATUS OF SYSTEMIC SCLEROSIS PATIENTS: A PILOT STUDY

Background:

Gastrointestinal involvement (GI) in systemic sclerosis (SSc) is one of the major disease burdens. Its consequences on the nutritional status of SSc patients and their quality of life is poorly evaluated during routine check-ups. Since malnutrition is an important cause of morbidity and mortality, addressing this issue seems necessary.

Objectives:

The aim of this study was to evaluate the risk of malnutrition in SSc patients and to identify potential associations between the risk of malnutrition and clinical features or laboratory parameters.

Methods:

All patients aged >18 years old with a definite diagnosis of SSc according to the 2013 ACR/EULAR classification criteria from the EUSTAR Center 16 and ERN ReCONNET cohort of the County Emergency Clinical Hospital Cluj-Napoca were included in the study. Patients with localized scleroderma, scleroderma sine scleroderma, overlap syndromes and mixed connective tissue disease were excluded. Clinical and laboratory data was collected from the EUSTAR database and medical charts. A telephone survey was conducted and patients were interviewed using the Malnutrition Universal Screening Tool (MUST) questionnaire.

Results:

75 patients were eligible for the study. Female to male ratio was 10:1 with an almost equal distribution among limited (57%) and diffuse (43%) SSc subtypes. The most prevalent autoantibodies were anti-TOPO-I and anti-centromere. GI symptoms were reported in 48.6% patients out of which 86% SSc patients underwent further evaluation by upper GI endoscopy. Abnormal endoscopic findings, such as esophagitis, Barret esophagus and gastritis were identified in 80% patients. Most patients had a low risk of malnutrition (93%) with only a minority carrying a medium (6%) or high (1%) risk. No significant association was demonstrated between MUST score and the extend of cutaneous involvement (limited SSc versus diffuse SSc; p=0.39), presence of GI symptoms (p=0.35), presence of abnormal endoscopic findings (p=0.45) or presence of anemia (p=0.83).

Conclusion:

The majority of SSc patients from this cohort exhibited a low risk of malnutrition. These results are contradictory to previous literature reports. A possible explanation is that the MUST score is a dynamic screening tool and therefore interviewing patients with a stable disease (outpatient care) versus patients with active disease (inpatient care) might lead to different results. Another limitation of this study is the small number of patients included. This is a pilot study. We aim to further extend the study population to the other EUSTAR cohorts and to prospectively evaluate these patients in an inpatient care setting.

References:

[1]Dupont R et al. Impact of micronutrient deficiency & malnutrition in systemic sclerosis: Cohort study and literature review. Autoimmun Rev. 2018 Nov;17(11):1081-1089;

[2]Caimmi C et al. Malnutrition and sarcopenia in a large cohort of patients with systemic sclerosis. Clin Rheumatol. 2018 Apr;37(4):987-997;

[3]Türk İ et al. Malnutrition, associated clinical factors, and depression in systemic sclerosis: a cross-sectional study. Clin Rheumatol. 2020 Jan;39(1):57-67.

Disclosure of Interests:

None declared

AB0615 MORTALITY AND CAUSES OF DEATH AMONG ROMANIAN SYSTEMIC SCLEROSIS PATIENTS

Background:

Systemic sclerosis (SSc) is associated with an increased risk of death compared to the general population. Survival in SSc patients has improved significantly over the last 20 years with a decrease in renal involvement as a cause of early death and an increase in death caused by cardiopulmonary involvement (1,2). Causes of death in SSc patients have not been described in a Romanian cohort so far.

Objectives:

To study the causes of death in patients with SSc prospectively followed-up from 2002 to 2018 in a single tertiary centre from Romania.

Methods:

The cohort consists of 197 patients who fulfill the American College of Rheumatology /EULAR 2013 criteria for SSc. We examined the data of patients who had died during follow up. Patients were reviewed at least twice a year and the cause of death was classified as SSc-related or nonSSc-related. SSc-related deaths were then attributed to the major organ involved. A univariate Cox proportional hazard (PH) regression was used to examine the association between each variable and mortality. Variables reported in the literature to associate with mortality were considered in the multiple Cox PH regression model.

Results:

Of 197 SSc patients (87.8% females), 47.7% had diffuse SSc and 52.2% had limited SSc. The mean age at diagnosis was 47 (SD 12) years and mean follow up duration was 6.75 years. There were 41 deaths (20.8%). Survival rate was substantially lower in men (P <0.003). The mean age at the time of death in those with diffuse SSc was lower compared to limited SSc (55.8 years vs 68.7 years). Sixty percent of deaths were SSc-related (pulmonary cause[n=11], cardiac cause[n=6], gastrointestinal involvement [GI, n=3], renal crisis [n=2] and others [n=4]). Deaths no related to SSc were associated with cancer and infections. Age at onset of Raynaud phenomenon [HR 1.05], male gender [HR 3.41], diffuse SSc [HR 0.48], presence of tendon friction rub [HR 4.54], digital ulceration [HR 3], esophagitis [HR 2.07] and cardiovascular involvement [HR 3.68], use of corticosteroids[HR 2.13] and cyclophosphamide [HR 2.02] were associated with poor prognosis in multivariate analysis.

Conclusion:

In our cohort the main causes of death were lung and cardiovascular involvement. Deaths occurred early after the onset of the disease and the survival rate was significantly reduced among men. Multivariate analysis showed that age at onset of Raynaud phenomenon, male gender, diffuse disease form, presence of tendon friction rub, digital ulceration, esophagitis and cardiovascular history, use of corticosteroids and cyclophosphamide were independently associated with mortality.

References:

[1]Tyndall AJ, Bannert B, Vonk M, Airo P, Cozzi F, Carreira PE, et al. Causes and risk factors for death in systemic sclerosis: a study from the EULAR Scleroderma Trials and Research (EUSTAR) database. Ann Rheum Dis. 2010 Oct;69(10):1809–15.

[2]Rubio-Rivas M, Royo C, Simeon CP, Corbella X, Fonollosa V. Mortality and survival in systemic sclerosis: systematic review and meta-analysis. Semin Arthritis Rheum. 2014 Oct;44(2):208–19.

Disclosure of Interests:

None declared

Atypical antipsychotic switching versus atypical antipsychotic combination in schizoaffective disorder – A clinical case

Introduction

Recent studies suggest that aripiprazole (ARP) shows a better profile in terms of mental state and extrapyramidal symptoms (EPS) in psychosis. However, other studies consider that a combination of atypical antipsychotics (AAP) may also be an option for some refractory patients. We present a case of a schizoaffective disorder, manic type (SAFM) (F25.0, ICD-10 criteria) that improved in terms of EPS adverse effects after switching from long-term fluphenazine (LTF) to Long-acting injectable aripiprazole (LAIA) but showed relapse symptoms.

Objective

We present a clinical case of SAFM that improved clinically in our outpatient clinic after 1 month of bi-therapy with low doses of oral risperidone and standard dose of LAIA. We study oral AAP-LAIA drug combination utility in this clinical setting.

Aims

To study “oral AAP-LAIA combo” benefits in refractory SAFM cases.

Methods

Our patient is a 68-year-old female diagnosed of SAFM clinically stable with a combination of lithium and LTF. She presented severe cogwheel stiffness in the upper limbs and postural tremor. We switched from long-term fluphenazine to LAIA and 4 weeks later, she showed discrete cogwheel stiffness but also persecutory delusions and dysphoria.

Results

We maintained LAIA (400 mg/28 days) and lithium (800 mg/day) doses and added-on risperidone 1 mg/day. She presented clinical relapse 1 month later. She kept her better EPS tolerance as she only had discrete cogwheel in upper limbs only by using attention distraction techniques.

Conclusions

Oral risperidone-LAIA drug combination appears as an effective and well-tolerated treatment in refractory SAFM cases.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Cardiovascular profiles of scleroderma patients with arrhythmias and conduction disorders

Introduction Arrhythmias and conduction disorders are common among patients with scleroderma. Their early identification is important, since scleroderma patients with arrhythmias have a higher mortality risk compared with scleroderma patients without arrhythmias. The aim of this study was to characterize the cardiovascular profiles of scleroderma patients with different types of arrhythmias and conduction disorders. Methods One hundred and ten consecutive patients with a diagnosis of systemic sclerosis according to the ACR criteria were included in the study. Patients underwent a 12-lead ECG and a 24-hour Holter ECG monitoring for arrhythmias and conduction disorders identification. Blood sample testing, echocardiography, spirometry, chest X-ray and, when considered appropriate, high resolution chest CT were also performed. A subgroup of 21 patients underwent NT-pro BNP level measurements. Patients' clinical and para-clinical characteristics were compared according to the presence or absence of arrhythmias and conduction disorders. Results The prevalence of arrhythmia and conduction disturbances was 60.9%. Patients with such disorders were older (54.4 ± 13.3 vs. 49.7 ± 10.1 years, p=0.05), had a higher prevalence of pulmonary hypertension (p=0.008), valve disease (p < 0.001), especially mitral and tricuspid regurgitation, chamber enlargement on echocardiography (left atrial and right ventricular, p = 0.012 and 0.005, respectively) as well as higher NT-pro BNP levels: 265.5 ± 399.7 vs. 163 ± 264.3 pg/ml, p=0.04. Conclusion Arrhythmias and conduction disorders are common in patients with scleroderma. Patients with such disorders are older, have a higher prevalence of pulmonary hypertension, more severe mitral and tricuspid regurgitation, left atrial and right ventricular dilation on echocardiography.

M-DPOP: Faithful Distributed Implementation of Efficient Social Choice Problems

In the efficient social choice problem, the goal is to assign values, subject to side constraints, to a set of variables to maximize the total utility across a population of agents, where each agent has private information about its utility function. In this paper we model the social choice problem as a distributed constraint optimization problem (DCOP), in which each agent can communicate with other agents that share an interest in one or more variables. Whereas existing DCOP algorithms can be easily manipulated by an agent, either by misreporting private information or deviating from the algorithm, we introduce M-DPOP, the first DCOP algorithm that provides a faithful distributed implementation for efficient social choice. This provides a concrete example of how the methods of mechanism design can be unified with those of distributed optimization. Faithfulness ensures that no agent can benefit by unilaterally deviating from any aspect of the protocol, neither information-revelation, computation, nor communication, and whatever the private information of other agents. We allow for payments by agents to a central bank, which is the only central authoritythat we require. To achieve faithfulness, we carefully integrate the Vickrey-Clarke-Groves (VCG) mechanism with the DPOP algorithm, such that each agent is only asked to perform computation, report information, and send messages that is in its own best interest. Determining agent i's payment requires solving the social choice problem without agent i. Here, we present a method to reuse computation performed in solving the main problem in a way that is robust against manipulation by the excluded agent. Experimental results on structured problems show that as much as 87% of the computation required for solving the marginal problems can be avoided by re-use, providing very good scalability in the number of agents. On unstructured problems, we observe a sensitivity of M-DPOP to the density of the problem, and we show that reusability decreases from almost 100% for very sparse problems to around 20% for highly connected problems. We close with a discussion of the features of DCOP that enable faithful implementations in this problem, the challenge of reusing computation from the main problem to marginal problems in other algorithms such as ADOPT and OptAPO, and the prospect of methods to avoid the welfare loss that can occur because of the transfer of payments to the bank.