Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

BACKGROUND

Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks.

METHODS

The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned.

RESULTS

A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31).

CONCLUSION

Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov).

Green Extraction of Graphene from Natural Mineral Shungite

Conventional fabrication methods to produce graphene are cumbersome, expensive, and not ecologically friendly. This is due to the fact that the processing of a large volume of raw materials requires large amounts of acids and alkalis which, in turn, require special disposal. Therefore, it is necessary to develop new technologies or to refine existing ones for the production of graphene-and to create new, ecologically-safe and effective methods. Here, we utilized physical sonication to extract graphene films from natural mineral shungite rock. From our study of the structure of shungite by Raman spectrometry and X-ray phase analysis, we found that shungite is characterized by graphite-like mineral structures. Transmission electron microscopy images obtained from the processed material revealed graphene films-with surfaces as small as 200 nanometers long and several layers wide. Our green method of fabicating graphene can be widely used in a variety of fields, from electro-optics to ecology, to list a few.

Green-Graphene Protective Overlayer on Optical Microfibers: Prolongs the Device Lifetime

Optical microfibers find new applications in various fields of industry, which in turn require wear resistance, environmental friendliness and ease of use. However, optical microfibers are fragile. Here we report a new method to prolong the microfiber lifetime by modifying its surface with green-extracted graphene overlayers. Graphene films were obtained by dispergation of shungite mineral samples in an aqueous medium. For this, we tapered optical fibers and sculptured them with graphene films mixed with gold nanoparticles. We observed that due to the surface modification the lifetime and survivability of the microfiber increased 5 times, as compared to the bare microfiber. The embedded gold nanoparticles can also be utilized for enhanced sensitivity and other applications.

Impact of microsatellite status in early-onset colonic cancer

BACKGROUND

The molecular profile of early-onset colonic cancer is undefined. This study evaluated clinicopathological features and oncological outcomes of young patients with colonic cancer according to microsatellite status.

METHODS

Anonymized data from an international collaboration were analysed. Criteria for inclusion were patients younger than 50 years diagnosed with stage I-III colonic cancer that was surgically resected. Clinicopathological features, microsatellite status, and disease-specific outcomes were evaluated.

RESULTS

A total of 650 patients fulfilled the criteria for inclusion. Microsatellite instability (MSI) was identified in 170 (26.2 per cent), whereas 480 had microsatellite-stable (MSS) tumours (relative risk of MSI 2.5 compared with older patients). MSI was associated with a family history of colorectal cancer and lesions in the proximal colon. The proportions with pathological node-positive disease (45.9 versus 45.6 per cent; P = 1.000) and tumour budding (20.3 versus 20.5 per cent; P = 1.000) were similar in the two groups. Patients with MSI tumours were more likely to have BRAF (22.5 versus 6.9 per cent; P < 0.001) and KRAS (40.0 versus 24.2 per cent; P = 0.006) mutations, and a hereditary cancer syndrome (30.0 versus 5.0 per cent; P < 0.001; relative risk 6). Five-year disease-free survival rates in the MSI group were 95.0, 92.0, and 80.0 per cent for patients with stage I, II, and III tumours, compared with 88.0, 88.0, and 65.0 per cent in the MSS group (P = 0.753, P = 0.487, and P = 0.105 respectively).

CONCLUSION

Patients with early-onset colonic cancer have a high risk of MSI and defined genetic conditions. Those with MSI tumours have more adverse pathology (budding, KRAS/BRAF mutations, and nodal metastases) than older patients with MSI cancers.

POS0277 EFFECT OF COLCHICINE THERAPY ON ATHEROSCLEROSIS-RELATED CARDIOVASCULAR OUTCOMES IN PATIENTS WITH CALCIUM PYROPHOSPHATE CRYSTAL DEPOSITION DISEASE

Background

anti-inflammatory therapy supposed to influence the rate of cardiovascular events development in pts with calcium pyrophosphate deposition disease (CPPD).

Objectives

To assess the effect of colchicine, hydroxychloroquine, and methotrexate on cardiovascular outcomes (CVO) in CPPD pts.

Methods

The study included 305 pts with CPPD: 115 (37.70%) men, 190 (62.30%) women. The average follow-up period was 3.9±2.7 yrs. Among the factors influencing CVO were considered: gender, age, smoking, alcohol intake ≥20 standard doses/week, hypertension, history of cardiovascular disease (CVD): (ischemic heart disease (CHD), acute myocardial infarction myocardial infarction (AMI), acute cerebrovascular insufficiency (ACV), chronic heart failure (CHF) >3 grade, NYHA), diabetes mellitus (DM), BMI >25 kg/m2 and >30 kg/m2, cholesterol level >5.1 mmol/l, GFR <60 ml/min/1.73 m2, serim uric acid (sUA) > 360 µmol/l, hypercalcemia (serum calcium> 2.62 mmol/l), CRP> 2 mg/l, hyperparathyroidism (parathyroid hormone> 65 pg/ml), phenotypes of CPPD (asymptomatic, osteoarthritis with calcium pyrophosphate crystals (OA with CPP crystals), chronic arthritis, acute arthritis), taking colchicine, hydroxychloroquine and methotrexate, glucocorticoids (GCs) and non-steroidal anti-inflammatory drugs (NSAIDs).

Information about mortality, regardless of cause, was noting down throughout the follow-up period.

The causes of death were determined on the patient’s death certificate, and then classified according to the International Classification of Diseases of the 10-th Revision (ICD-10) All newly developed cases of non-fatal cardiovascular events were identified on the basis of medical documentation. The odds ratio (OR) with a 95% confidence interval of developing cardiovascular events was calculated. Statistica 12.0 package was used for statistical data processing.

Results

The mean age at inclusion was 58.9±12.5 yrs. 264 patients were available for follow-up. Any of the studied cardiovascular events were registered in 79 (29.9%) pts. During the follow-up period, 46 (17.4%) pts died; 35 of 46 (76.1%) pts died because of CVD; 11 (23.9%) pts died due to other causes. Non-fatal cardiovascular events were registered in 44 (16.7%) pts.

The risk of cardiovascular events was higher for ps aged >65 years (OR 5.97, 95% CI 3.33-10.71), serum cholesterol level ≥5.1 mmol/l (OR 1.95, 95% CI 1.04-3.65]), GFR <60 ml/min/1.73 m2 (OR 2.78, 95% CI 1.32-5.56]), history of CVD (OR 2.32, 95% CI 1.22-4.44) Colchicine therapy was associated with the lower risk of cardiovascular events (OR 0.20, 95% CI 0.11-0.39]). Therapy with methorexate and hydroxychloroquine did not exert an influence on opportunity of CVO.

Conclusion

Adverse CVD outcomes in CPPD pts are associated with age, hypercholesterolemia, CKD, and a history of CVD. The intake of colchicine, but not methotrexate and hydroxychloroquine, by patients with CPPD is associated with decline of risk of cardiovascular events.

References

[1]Bashir M, Sherman KA, Solomon DH, et al. Cardiovascular disease risk in calcium pyrophosphate deposition disease: A nationwide study of veterans. Arthritis Care Res (Hoboken). 2021 Sep 14. doi: 10.1002/acr.24783.

Disclosure of Interests

Elena Cheremushkina: None declared, Maxim Eliseev Speakers bureau: Berlin Chemie Menarini Group, Sobi, EGIS, CSC, MosFarma, Alium Group, Olga Sheliabina Speakers bureau: Berlin Chemie Menarini Group, Aleksandra Novikova: None declared, Svetlana Glukhova: None declared

POS1291 DEGENERATIVE DISC DISEASE IN YOUNG: IMMUNOHISTOCHEMICAL EXPRESSION OF INFLAMMATORY BIOMARKERS AND ANGIOGENIC FACTORS

Background

Low back pain (BP), associated with the degenerative disc disease (DDD), poses a heavy social and economic burden, emerging among young adults. The pathophysiological basis of accelerated degeneration of the intervertebral disc (IVD) and its contribution to the formation of spine osteoarthritis are at the active study stage.

Objectives

To assess infammation and angiogenesis biomarkers in IVD among young patients with chronic LBP, associated with DDD.

Methods

Human IVD tissue from 25 patients was obtained from discectomy surgery to relieve LBP (men – 13, women – 12, age: 36,7 ±3,77) and from autopsy in healthy control group (n=5, age: 37,8±2,52). The grade of DDD was verified by magnetic resonance (MRI) by the classification of C.W. Pfirrmann. Four-micron serial sections of the tissue blocks were stained with hematoxylin and eosin (H-E), than examined by immunohistochemistry staining on the automated VENTANA BenchMark ULTRA platform. Anti-IL-1β, anti-IL-6, and anti-IL-17 were used to study the expression of inflammatory cytokines; anti-VEGF-A and anti-CD31 were used as markers of angiogenesis. All slides were visualized using a Axio Imager.Z2 microscope with EC Plan-Neofluar 40X objective.

Results

In 64% of patients IVD hernias were localized at the level of L5-S1, in 36% - L4-L5. The average Pfirrmann DD stage at the operated level was 4.43±0.57. 72% of patients had Modic changes (MC). 52% of patients had a combination of hernia with endplate erosion (EP) and MC. There were identified evidence of DD on H-E-stained sections, including clusters of cells of the nucleus pulposus (NP), inflammatory cell infiltration and blood vessels in the absence of them in the fissures of the NP and annulus fibrosus (AF). Immunostaining was mainly limited to the cytoplasm of native NP chondrocyte-like cells and AF fibroblast-like cells. IL-1β expression was considerably higher in degenerate samples than in controls for both NP (p < 0,05) and AF (p < 0,01). Staining for IL-17 was more pronounced in the cytoplasm of chondrocyte-like cells of degenerative NP compared to the control (p < 0,01), and statistically lower in AF cells (p < 0,05). The number of IL-6 immunopositive cells was similar in NP and AF degenerate tissue, but a greater proportion of IL-6 immunopositive cells was seen in NP tissue (p<0,05). The percentage of cells immunopositive for VEGF-A and CD-31 was significantly increased in NP DD cell clusters compared to controls (p < 0,001) (88% and 36%, respectively) and was weakly expressed in the extracellular matrix (p < 0,05). This suggests that the PU cells trigger angiogenesis. Blood vessels in native sections were confirmed by CD31 detection in 64% of patient specimens versus 10% of control cartilage specimens (p < 0,001). The number of CD31 immunopositive cells had a tendency for decrease in severe DD (p=0,05), which indicates the extinction of vascularization in the terminal stage of DD. Fissures in the disc did not stained for CD31, which excludes the ingrowth of vessels directly in the area of mechanical damage and proves the immunogenic cause of vascularization. This is confirmed by the synergistic high level of expression of IL-1 and -17 in perivascular, endotheliocytes and intravascular pathological samples versus weak expression in the disc matrix (p<0.01).The high level of expression of all interleukins was in the hyaline cartilage of EP patients versus the absence in the controls (p<0.001). It indicates their association with aseptic inflammation of EP with the formation of EP erosions and reactive spondylitis (MС) development, detected by MRI in young adults with DD.

Conclusion

Local immune inflammation is a component of the degenerative cascade in IVD, it initiates angiogenesis in cartilage and EP, as well as the development of reactive osteitis of adjacent vertebrae with the formation of inflammatory-erosive lesions of the vertebral-motor segment in chronic back pain. The results obtained will help to identify molecular targets and form a new direction of anti-inflammatory therapy of LBP among young people.

Disclosure of Interests

None declared

Microsatellite instability in young patients with rectal cancer: molecular findings and treatment response

In this study of 400 patients with early-onset rectal cancer, 12.5 per cent demonstrated microsatellite instability (MSI). MSI was associated with a reduced likelihood of nodal positivity, an increased rate of pathological complete response, and improved disease-specific survival.

Characteristics of Early-Onset vs Late-Onset Colorectal Cancer: A Review

Importance

The incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensitivity to conventional neoadjuvant and adjuvant therapy regimens appear to be unknown. The purpose of this review is to summarize the available literature on early-onset colorectal cancer.

Observations

Within the next decade, it is estimated that 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50 years. Potential risk factors include a Westernized diet, obesity, antibiotic usage, and alterations in the gut microbiome. Although genetic predisposition plays a role, most cases are sporadic. The full spectrum of germline and somatic sequence variations implicated remains unknown. Younger patients typically present with descending colonic or rectal cancer, advanced disease stage, and unfavorable histopathological features. Despite being more likely to receive neoadjuvant and adjuvant therapy, patients with early-onset disease demonstrate comparable oncological outcomes with their older counterparts.

Conclusions and Relevance

The clinicopathological features, underlying molecular profiles, and drivers of early-onset colorectal cancer differ from those of late-onset disease. Standardized, age-specific preventive, screening, diagnostic, and therapeutic strategies are required to optimize outcomes.

POS1140 RISK FACTORS FOR THE DEVELOPMENT OF DIABETES MELLITUS IN PATIENTS WITH GOUT ACCORDING TO A 6-YEAR PROSPECTIVE FOLLOW-UP STUDY

Background:

Gout is often associated with diabetes mellitus (DM), but the role of serum uric acid (sUA) and urate-lowering drugs in its development in patients with gout remains controversial [1].

Objectives:

To study risk factors for DM in patients with gout based on the results of long-term prospective follow-up study.

Methods:

The prospective study included 444 patients with a crystal-verified diagnosis of gout, aged ≥18 years, 49 (11%) women, 395 (89%) men. Patients were followed up at the V.A. Nasonova Research Institute of Rheumatology from 2010 to January 2021, the median follow-up was 6.1 [2.8; 7.8] years. The exclusion criteria were the presence of other rheumatic diseases with symptoms of arthritis, DM. DM was diagnosed on the 1998 WHO criteria. The following parameters were considered as risk factors: gender, family history for diabetes mellitus, body mass index (BMI)>25 kg/m2 and > 30 kg/m2, waist volume ≥88 cm for women and ≥102 cm for men, alcohol consumption > 20 units per week, chronic kidney disease (CKD), intake of diuretics and glucocorticoids, and serum total cholesterol >5 mmol/l, triglycerides>2.25 mmol/l, serum C-reactive protein (CRP) level> 5 mg/l, as well as clinical manifestations of gout: subcutaneous tophi, polyarthritis (simultaneous involvement of ≥5 joints), intake of urate-lowering drugs, sUA (> 480 μmol/L,> 420 μmol/L,> 360 μmol/L,> 300 μmol/L). Statistica 12.0 package was used for statistical data processing.

Results:

A total of 444 patients were included, the mean age was 51.0±12.9 years, the median follow-up was 6.1 [2.8; 7.8] years. In dynamics: 35 (8%) patients died, 6 (1%) patients were not available, 403 patients were examined (44 (11%) - women and 359 (89%) - men). 290 (72%) patients received urate-lowering therapy (263 (65%) patients used allopurinol, 27 (7%) - febuxostat). The target sUA <360 μmol/L was reached by 165 (41%) patients and <300 μmol/L - by 92 (23%) patients. All patients with sUA<300 μmol/L received urate-lowering therapy, 62 (67%) patients used allopurinol, 17 (18%) - febuxostat, 13 (14%) - uricosuric drugs. Diabetes mellitus was developed in 106 (26%) patients. The factors influencing the risk of developing diabetes were - the presence of diabetes in family history (odds ratio (OR) 2.27, 95% confidence interval (CI) 1.37; 3.76); BMI> 30 kg / m2 (OR 1.79, 95% CI 1.14; 2.80), diuretics (OR 2.32, 95% CI 1.36; 3.96) and sUA> 300 μmol / l (OR 2.89, 95% CI 1.50, 5.56).

Conclusion:

The risk of developing DM in patients with gout is associated with sUA> 300 μmol/l, which may be one of the probable reasons for choosing this as a target level. Large prospective studies are needed to confirm the antidiabetic effect of urate-lowering drugs.

References:

[1]Chang HW, Lin YW, Lin MH, Lan YC, Wang RY. Associations between urate-lowering therapy and the risk of type 2 diabetes mellitus. PLoS One. 2019 Jan 7;14(1):e0210085. doi: 10.1371/journal.pone.0210085.

Disclosure of Interests:

Olga Sheliabina: None declared, Maxim Elisеev Speakers bureau: Berlin Chemie Menarini Group, Novartis International AG, EGIS, Aleksandra Novikova: None declared, Maria Chikina: None declared.

POS1363 CHONDROCALCINOSIS AS PREDICTOR OF DEVELOPMENT OF PRIMARY HYPERPARATHYROIDISM: RESULTS OF THE FOLLOW-UP OBSERVATION

Background:

The association between chondrocalcinosis and primary hyperparathyroidism (PHPT) is known, but chondrocalcinosis is considered as a late complication of PHPT.

Objectives:

To investigate whether calcium pyrophosphate crystal deposition is an early clinical sign of PHPT.

Methods:

The prospective study included 113 patients aged ≥18 years, 42 (37.2%) men and 71 (62.8%) women, with a crystal-verified diagnosis of calcium pyrophosphate crystal deposition disease (CPPD) (McCarty criteria). Exclusion criteria were the presence of other rheumatic diseases with symptoms of arthritis, the presence of hyperparathyroidism (HPT). Patients were examined at their enrollment and over time, the median follow-up was 3.86 [2.07; 8.36] years. The examination of the patients included assessment of anthropometric parameters, information about the affected joints and the time of onset of symptoms.

Laboratory tests included determination of the following in blood serum: creatinine (with estimating glomerular filtration rate (eGFR) according to the MDRD formula), total and ionized calcium (Ca and Ca++), phosphorus (P), parathyroid hormone (PTH), vitamin D (25-OH); ultrasound and X-ray investigations of the target joints (hands, knee joints) were made for all patients. Scintigraphy and ultrasound of the parathyroid glands were performed if medically required. Statistica 12.0 package was used for statistical data processing.

Results:

113 patients were examined, the average age was 58.4±12.4 years. 10 patients were excluded due to diagnosed HPT at screening. 41 patients dropped out of observation: 5 - died, 36 were not available for dynamic examination. 62 patients were examined in dynamics, 4 (6.5%) of those had HPT. In 1 (1.6%) case, HPT was associated with chronic renal failure, 3 (4.8) patients were diagnosed PHPT. The results of the examination of patients who developed PHPT during screening and in dynamics are presented in Table 1 above.

Table 1.

Results of patients with PHPT at screening and in dynamics.

Сrystals of calcium pyrophosphate in synovial fluidChondrocalcinosis by ultrasoundChondrocalcinosis by X-rayConvulsionsECG changes (shortening of the QT interval)Arthralgias / arthritisPTH, pg/ml (15,0-65,0)Ca, µmol/l (2.10-2.62)Са++, µmol/l (1.10-1.33)vitamin D (25-ОН), ng/ml (30-100)screening / dynamicsРatient А.yes/yesyes/yesnot/yesnot/notnot/notyes/yes61.6/96.22.73/2.671.37/1.24-/31Рatient В.yes/yesyes/yesyes/yesnot/yesnot/yesyes/yes40.7/2522.63/2.561.34/1.7719.1/14.2Рatient С.yes/yesyes/yesnot/yesnot/notnot/notyes/yes26.6/102.42.60/2.651.25/1.26-/40

In all three patients, chondrocalcinosis was revealed by ultrasound and Сrystals of calcium pyrophosphate in synovial fluid during the screening examination, in one patient chondrocalcinosis was revealed by X-ray. In two out of three cases, the level of serum Ca and Ca++ was minimally increased at a normal level of PTH, no other disorders of calcium metabolism were observed during the screening.

Interestingly, the first clinical manifestation of HPT in all patients was damage of the musculoskeletal system - mainly arthralgia, as well as arthritis of large and small joints. Moreover, all patients had a different CPPD phenotype: patient A - asymptomatic chondrocalcinosis, patient B - chronic arthritis (pseudo-rheumatoid form) and patient C - chronic arthritis (pseudosteoarthritis).

Conclusion:

The deposition of calcium pyrophosphate crystals may be an early predictor of the development of PHPT and precedes other manifestations.

Disclosure of Interests:

Aleksandra Novikova: None declared, Maxim Elisеev Speakers bureau: Berlin Chemie Menarini Group, Novartis International AG, EGIS, Olga Sheliabina: None declared, Maria Chikina: None declared

POS1139 COMPARISON OF THE FREQUENCY OF DETECTION OF EARLY SIGNS OF ATHEROSCLEROSIS IN PATIENTS WITH CALCIUM PYROPHOSPHATE CRYSTAL DEPOSITION DISEASE AND OSTEOARTHRITIS

Background:

Crystal-induced inflammation can significantly increase cardiovascular risk (CVR) and cause early development of atherosclerosis [1]. However, no studies have been performed in patients with calcium pyrophosphate crystal deposition disease (CPPD).

Objectives:

To compare the presence of atherosclerosis early signs (increased thickness of the intima-media complex (CIMT)) in patients with CPPD and osteoarthritis (OA).

Methods:

A cross-sectional study included 48 patients, aged 18 to 65 years, 26 patients with crystal-verified diagnosis of CPPD (McCarty criteria) (6 (23%) men and 20 (77%) women) and 22 patients with OA (7 (32%) men and 15 (68%) women). Exclusion criteria are the presence of other rheumatic diseases with symptoms of arthritis, diabetes mellitus, coronary heart disease (CHD), prior myocardial infarction, stroke or myocardial revascularization surgery, estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2, high and very high CVR on the SCORE scale. The examination of the patients included the history taking, assessment of anthropometric parameters and the following laboratory tests: determination of serum creatinine level (eGFR according to the MDRD formula), total cholesterol (TC), high density lipoprotein cholesterol (HDL cholesterol) and low density lipoprotein cholesterol (LDL cholesterol), C-reactive protein (CRP). Doppler ultrasound of the carotid arteries with an assessment of the thickness of the intima media complex (CIMT) was made for all patients - CIMT up to 0.9 mm was taken as the norm, CIMT> 0.9 mm and <1.3 mm as increased, and CIMT>1.3 mm was regarded as an atherosclerotic plaque. Statistica 12.0 package was used for statistical data processing.

Results:

The groups were completely comparable by gender, age and all laboratory parameters (see Table 1), an increase in CRP>5 mg/l was more often detected in patients with CPPD - 31% vs 14% patients with OA (p=0.16).

Table 1.

Clinical characteristics of patients included in the study.

ParametersCPPD (n=26)OA(n=22)p value (reliable at р<0,05)Age, years M±SD55.9±5.952.4±8.30.14Gender, men/women,n (%)6 (23)/20 (77)7 (32)/15 (68)0.50Smoking, n (%)5(19)6(27)0.50Systolic blood pressure, mmHg, M±SD134±20127±150.19Arterial hypertension, n (%)13(50)10(45)0.75Family history of CVD, n %6(23)7(32)0.50TC, mmol/L, M±SD5.4±1.35.3±1.30.95TC >5,0 mmol/L, n (%)17(65)10(45)0.17HDL, mmol/L M±SD1.7±0.51.4±0.50.10LDL, mmol/L, M±SD2.9±1.33.4±1.40.33Creatinine, μmol/l, M±SD73.2±13.878.9±11.50.16CRP, mg/l, Me [25-75th percentiles]1.1 [0.6; 6.4]1.2 [0.3; 2.8]0.60CRP ≥5 mg/l,n (%)8 (31)3(14)0.16

Mean CIMT values on the right (0.76±0.22 mm vs 0.70±0.18 mm) and on the left (0.75±0.18 mm vs 0.70±0.17 mm) did not significantly differ in CPPD and OA (p=0.34 and 0.32, respectively), the maximum CIMT values on the right (0.67±0.16 mm vs 0.67±0.16 mm) and on the left (0.67±0.14 mm vs 0,66±0.16 mm) with CPPD and OA were also comparable (p=0.95 and 0.77, respectively). However, an increase in CIMT> 0.9 mm was found in 13 (50%) patients with CPPD and only 5 (23%) with OA (p=0.02). No increase in CIMT>1.3 mm was found in patients of both groups.

Conclusion:

Early signs of atherosclerosis are detected in 50% of patients with CPPD without clinical signs of atherosclerosis and with low or moderate CVR according to SCORE, significantly more often than in patients with OA (23%), which can be reflection of chronic crystal-induced inflammation.

References:

[1]Hoseini Z, Sepahvand F, Rashidi B, Sahebkar A, Masoudifar A, Mirzaei H. NLRP3 inflammasome: Its regulation and involvement in atherosclerosis. J Cell Physiol. 2018 Mar;233(3):2116-2132. doi: 10.1002/jcp.25930. Epub 2017 May 23. PMID: 28345767.

Disclosure of Interests:

Maxim Elisеev Speakers bureau: Berlin Chemie Menarini Group, Novartis International AG, EGIS, Aleksandra Novikova: None declared, Olga Sheliabina: None declared, Maria Chikina: None declared, Eugenia Markelova: None declared.

AB0640 MORTALITY IN CALCIUM PYROPHOSPHATE CRYSTAL DEPOSITION DISEASE: PRELIMINARY DATA

Background:

Calcium pyrophosphate crystal deposition disease (CPPD) is associated with a high frequency of comorbidities and vascular calcification [1], but it is unknown whether these factors affect cardiovascular mortality.

Objectives:

To study the structure of mortality in patients with CPPD and compare with the structure of mortality in the Russian Federation.

Methods:

217 patients with crystal-verified diagnosis of CPPD (McCarty criteria) were included in the prospective study, aged ≥18 years, mean age 59.2 ± 12.6 years, 82 (38%) men and 134 (62%) women. The median follow-up was 3.9 [1.9; 7.2] years, patients were followed up for at least a year. The exclusion criteria are the presence of other rheumatic diseases with arthritis symptoms. The examination of patients included the history taking, assessment of anthropometric parameters, the presence of comorbidity and the following laboratory tests: determination of serum creatinine level (with calculation of glomerular filtration rate (eGFR) using the MDRD formula), total cholesterol (TC), C-reactive protein (CRP). Statistica 12.0 package was used for statistical data processing.

Results:

A total of 217 patients were included. Arterial hypertension was detected in 115 (53%) patients, coronary heart disease in 51 (24%) patients, diabetes mellitus in 26 (12%) patients, chronic renal failure in 17 (8%) patients, hyperparathyroidism in 18 (8%) patients, chronic heart failure in 22 (10%) patients. 65 (30%) patients had a family history for CVD, 31 (14%) patients were smokers. 122 (56%) patients had an increased level of total cholesterol> 5.0 mmol/L and 54 (25%) patients – the level of CRP>5 mg/L.

23 (11%) patients, 12 (52%) men and 11 (48%) women, died, the average age of the deceased being 62.7±9.2 years. In 15 (65%) cases out of 23, death occurred due to cardiovascular complications, which is higher than the cardiovascular mortality rate in the Russian Federation (53%). Among CVD, the distribution was as follows: acute myocardial infarction - 6 (40%) patients,apoplectic attack - 5 (33) patients, thrombosis - 2 (13%) patients, rhythm disturbances – 1 (7%) patient and decompensation of chronic heart failure - 1 (7%) patient.

Conclusion:

CVD is the main cause of death in patients with CPPD and the total frequency of mortality from CVD exceeds the population one. Further research is needed, including studies of the risk factors for overall and cardiovascular mortality in patients with CPPD.

References:

[1]Abhishek A, Doherty S, Maciewicz R, et al. Association between low cortical bone mineral density, soft-tissue calcification, vascular calcification and chondrocalcinosis: a case-control study. Ann Rheum Dis. 2013;73(11):1997-2002. doi: 10.1136/annrheumdis2013-203400

Disclosure of Interests:

Maxim Elisеev Speakers bureau: Berlin Chemie Menarini Group, Novartis International AG, EGIS, Aleksandra Novikova: None declared., Olga Sheliabina: None declared., Maria Chikina: None declared.

The fifth cranial nerve in headaches

The fifth cranial nerve is the common denominator for many headaches and facial pain pathologies currently known. Projecting from the trigeminal ganglion, in a bipolar manner, it connects to the brainstem and supplies various parts of the head and face with sensory innervation. In this review, we describe the neuroanatomical structures and pathways implicated in the sensation of the trigeminal system. Furthermore, we present the current understanding of several primary headaches, painful neuropathies and their pharmacological treatments. We hope that this overview can elucidate the complex field of headache pathologies, and their link to the trigeminal nerve, to a broader field of young scientists.

Improvement of Phenolic Compounds, Essential Oil Content and Antioxidant Properties of Sweet Basil (Ocimum basilicum L.) Depending on Type and Concentration of Selenium Application

The effect of selenium biofortification on phytomass yield, selenium, essential oil and phenolic compounds content as well as antioxidant properties of basil leaves was investigated. Selenium in form of sodium selenate was applied either in nutrient solution or by foliar spraying at three levels (2.0, 5.0 and 10.0 μM). Selenium treatment significantly increased Se concentration in leaves up to 20.23 μg g⁻¹ (addition in nutrient solution) and 10.74 μg g⁻¹ (foliar application). Neither a toxic nor a beneficial effect of Se addition on the plants was observed. Se application of 2 µM Se in nutrient solution and of 5 µM Se by foliar spraying successfully enhanced production of essential oils, hydroxycinnamic acids, total phenolics and antioxidant activity of basil leaves. The anthocyanin content was positively affected only by application of Se in nutrient solution. Considering both an increase in the Se concentration in basil leaves and an increase in the production of phytonutrients, the optimal doses of selenium can be considered to be 5 and 10 μM for Se addition in nutrient solution and by foliar treatment, respectively. The results confirm the possibility of the enrichment of basil plants with selenium and thereby improving the nutritional qualities of the human diet.

Growth and magnetic properties of vertically aligned epitaxial CoNi nanowires in (Sr, Ba)TiO3 with diameters in the 1.8-6 nm range

The growth by pulsed laser deposition of fully epitaxial nanocomposites made of Co _x Ni_1-x nanowires (NW) vertically self-assembled in Sr_0.5Ba_0.5TiO₃/SrTiO₃(001) layers is reported. The diameter of the wires can be tuned in the 1.8-6 nm range. The composition of the wires can be controlled, with the growth sequence and the fcc crystallographic structure of the wires preserved for Co content up to 78%. The nanocomposite systems obtained display a uniaxial magnetic anisotropy with out-of-plane easy axis as shown through analysis of ferromagnetic resonance measurements. It is shown that the magnitude of the magnetic anisotropy depends sensitively on the structural quality of the nanocomposites.The energy barrier for magnetization reversal scales as the square of the diameter of the NW and reaches 60 [Formula: see text] for 6 nm diameter, with T _amb = 300 K.