French Polynesian Scytosiphonaceae (Ectocarpales, Phaeophyceae): A combined molecular and morphological approach to their diversity and systematics

This study revisited the taxonomy and diversity of brown macroalgae within the Scytosiphonaceae family in French Polynesia, which had previously been recognized as encompassing only six species. Using the chloroplast and mitochondrial genes rbcL, psbA, and cox3 as molecular markers in conjunction with morpho-anatomical observations, we unveiled the presence of 11 species spanning six genera: Chnoospora minima, Colpomenia claytoniae, Co. sinuosa [groups IIIa and IIIb], Hydroclathrus rapanuii, H. tenuis, H. tilesii, Manzaea minuta, Pseudochnoospora implexa, Rosenvingea australis, and the newly described species R. polynesiensis sp. nov. and R. tahitiensis sp. nov. This encompasses the recognition of two previously unreported genera in this region: Manzaea and Pseudochnoospora. Sequences were successfully acquired for four taxa that had been documented previously, while the absence of sequences for H. clathratus and H. tumulis in French Polynesia raises queries about their presence in this region. With these additions, the total species count now stands at 13 (including H. clathratus and H. tumulis), one being an endemic species. The molecular-assisted alpha taxonomic approach used here allowed for a critical revision of the Scytosiphonaceae species checklist for French Polynesia. The diversity revealed in this region accounts for a substantial 20% of the family's global diversity. Additionally, our study presents an updated species-level phylogeny for the Scytosiphonaceae.

Marine Flora of French Polynesia: An Updated List Using DNA Barcoding and Traditional Approaches

Located in the heart of the South Pacific Ocean, the French Polynesian islands represent a remarkable setting for biological colonization and diversification, because of their isolation. Our knowledge of this region's biodiversity is nevertheless still incomplete for many groups of organisms. In the late 1990s and 2000s, a series of publications provided the first checklists of French Polynesian marine algae, including the Chlorophyta, Rhodophyta, Ochrophyta, and Cyanobacteria, established mostly on traditional morphology-based taxonomy. We initiated a project to systematically DNA barcode the marine flora of French Polynesia. Based on a large collection of ~2452 specimens, made between 2014 and 2023, across the five French Polynesian archipelagos, we re-assessed the marine floral species diversity (Alismatales, Cyanobacteria, Rhodophyta, Ochrophyta, Chlorophyta) using DNA barcoding in concert with morphology-based classification. We provide here a major revision of French Polynesian marine flora, with an updated listing of 702 species including 119 Chlorophyta, 169 Cyanobacteria, 92 Ochrophyta, 320 Rhodophyta, and 2 seagrass species-nearly a two-fold increase from previous estimates. This study significantly improves our knowledge of French Polynesian marine diversity and provides a valuable DNA barcode reference library for identification purposes and future taxonomic and conservation studies. A significant part of the diversity uncovered from French Polynesia corresponds to unidentified lineages, which will require careful future taxonomic investigation.

Marine Floral Biodiversity, Threats, and Conservation in Vietnam: An Updated Review

Part of the Indo-Chinese peninsula and located on the northwest edge of the Coral Triangle in the South China Sea, the Vietnamese coastal zone is home to a wealthy marine biodiversity associated with the regional geological setting and history, which supports a large number of marine ecosystems along a subtropical to tropical gradient. The diversity of coastal benthic marine primary producers is also a key biological factor supporting marine biological diversity. The present review provides: (1) an updated checklist of the Vietnamese marine flora, (2) a review of molecular-assisted alpha taxonomic efforts, (3) an analysis of marine floral biodiversity spatial distribution nationally and regionally (South China Sea), (4) a review of the impact of anthropogenic and environmental stressors on the Vietnamese marine flora, and (5) the efforts developed in the last decade for its conservation. Based on the studies conducted since 2013 and the nomenclatural changes that occurred during this period, an updated checklist of benthic marine algae and seagrasses consisted in a new total of 878 species, including 439 Rhodophyta, 156 Ochrophyta, 196 Chlorophyta, 87 Cyanobacteria, and 15 phanerogam seagrasses. This update contains 54 new records and 5 new species of macroalgae. The fairly poor number of new records and new species identified in the last 10 years in a "mega-diverse" country can be largely attributed to the limited efforts in exploring algal biodiversity and the limited use of genetic tools, with only 25.4% (15 species) of these new records and species made based on molecular-assisted alpha taxonomy. The South Central Coast supports the highest species diversity of marine algae, which coincides with the largest density of coral reefs along the Vietnamese coast. Vietnam holds in the South China Sea one of the richest marine floras, imputable to the country's geographical, geological, and climatic settings. However, Vietnam marine floral biodiversity is under critical threats examined here, and current efforts are insufficient for its conservation. A methodical molecular-assisted re-examination of Vietnam marine floral biodiversity is urgently needed, complemented with in-depth investigations of the main threats targeting marine flora and vulnerable taxa, and finally, conservation measures should be urgently implemented.

Diversity and Ecology of Lobophora Species Associated with Coral Reef Systems in the Western Gulf of Thailand, including the Description of Two New Species

The brown macroalgal genus Lobophora plays important ecological roles in many marine ecosystems. This group has received much attention over the past decade, and a considerable number of new species have been identified globally. However, our knowledge of the genus diversity and ecology along south-east Asian coasts are still limited. Given the growing body of research that uses a combination of molecular and morphological data to identify cryptic species, this study investigates the diversity of Lobophora in the western Gulf of Thailand using morphological and molecular data, as well as their interactions with scleractinian corals. A total of 36 Lobophora specimens were collected from 15 sites in the western Gulf of Thailand and used for molecular and morphological analyses. One mitochondrial (cox3) and two chloroplast (psbA and rbcL) genes were amplified and sequenced for molecular phylogenetic analyses. Based primarily on phylogenetic evidence, two new species were formally described, L. chumphonensis sp. nov. and L. thailandensis sp. nov. Additionally, L. lamourouxii was newly recorded from Thailand. Two new lineages of Lobophora obscura were identified, L. obscura12 and L. obscura13. Among the Lobophora species identified, three were found in interaction with corals, the most notable of which was the massive coral Porites. Lobophora chumphonensis sp. nov. only interacted with Porites by growing on bare coral skeleton between Porites colonies. Furthermore, L. obscura13 was observed under the branching coral Pocillopora. Our findings revealed that Lobophora presented both effects and absence of effects on coral. A thorough understanding of Lobophora diversity and ecology is essential for ongoing and future research on coral-macroalgal ecological relationships.

Whole genome population structure of North Atlantic kelp confirms high-latitude glacial refugia

Coastal refugia during the Last Glacial Maximum (~21,000 years ago) have been hypothesized at high latitudes in the North Atlantic, suggesting marine populations persisted through cycles of glaciation and are potentially adapted to local environments. Here, whole-genome sequencing was used to test whether North Atlantic marine coastal populations of the kelp Alaria esculenta survived in the area of southwestern Greenland during the Last Glacial Maximum. We present the first annotated genome for A. esculenta and call variant positions in 54 individuals from populations in Atlantic Canada, Greenland, Faroe Islands, Norway and Ireland. Differentiation across populations was reflected in ~1.9 million single nucleotide polymorphisms, which further revealed mixed ancestry in the Faroe Islands individuals between putative Greenlandic and European lineages. Time-calibrated organellar phylogenies suggested Greenlandic populations were established during the last interglacial period more than 100,000 years ago, and that the Faroe Islands population was probably established following the Last Glacial Maximum. Patterns in population statistics, including nucleotide diversity, minor allele frequencies, heterozygosity and linkage disequilibrium decay, nonetheless suggested glaciation reduced Canadian Atlantic and Greenlandic populations to small effective sizes during the most recent glaciation. Functional differentiation was further reflected in exon read coverage, which revealed expansions unique to Greenland in 337 exons representing 162 genes, and a modest degree of exon loss (103 exons from 56 genes). Altogether, our genomic results provide strong evidence that A. esculenta populations were resilient to past climatic fluctuations related to glaciations and that high-latitude populations are potentially already adapted to local conditions as a result.

Risk of SARS-CoV-2 infection in high and low-risk cohabitants, in Loures and Odivelas, Portugal

Background

Effective contact tracing, vaccination, and isolation of cases of SARS-CoV-2 infection and their high-risk contacts constituted measures to contain the spread of COVID-19. In Portugal, in October 2021, low-risk cohabitants were lifted the obligation to isolate. The aim of this study was to estimate the relative risk of infection for close contacts, regarding the type of close contact and being cohabitants.

Methods

A descriptive longitudinal study, with an analytical component was performed. Sociodemographic and epidemiologic data from close contacts and confirmed cases in Loures and Odivelas, between October and November 2021, was collected from a regional database and from Trace COVID-19 platform. We performed a descriptive analysis and estimated the relative risk of SARS-CoV-2 positive test, stratified by type of contact and cohabitation, with 95% confidence level.

Results

We identified 200 confirmed cases and 428 people who were close contacts, corresponding to 502 different close contacts (59 people had contact with more than a case). From 502 close contacts, 268 were classified as low-risk and 230 as high-risk. Full time cohabitation was present in 310 of close contacts. Between contact tracing day and the next 4 weeks, 58 (10.9%) of close contacts tested positive. Risk of high-risk contacts testing positive was 2.7 [1.5-4.6], compared with low-risk contacts. Risk of cohabitants testing positive was 3.5 [1.6-7.7], compared with non-cohabitants. Risk of a high-risk cohabitant testing positive was 2.2 [1.1-4.4], compared with low-risk cohabitants. There was no higher risk of high-risk cohabitants testing positive compared with high-risk non-cohabitants. Same was true for low-risk cohabitants and non-cohabitants.

Conclusions

These results allow us to understand how to better stratify close contacts and apply isolation measures, according to the risk of testing positive. Further studies should be developed to assess the impact of other variables.

Key messages

• We identified an increased risk of testing positive in high-risk contacts, and in cohabitants.

• Cohabitants could be stratified regarding being high or low-risk, with different measures being applied.

Phytotoxic and cytogenotoxic assessment of glyphosate on Lactuca sativa L

The active ingredient glyphosate is the most commercialized herbicide on the world market due to its capability in eliminating weeds. However, it can harm the development of non-target organisms and threaten environmental quality. This study analyzed the effects of potentially toxic concentrations of glyphosate on germination, growth, cell cycle and genomic stability of Lactuca sativa L., and identified the most sensitive variables for assessing the toxicity of this herbicide to this biomonitor. Seeds of L. sativa were germinated in Petri dishes containing a sheet of filter paper moistened with 5 mL of a concentration of glyphosate (1.34, 3.35, 6.70, 10.05, 13.40 mg L-1). Controls consisted of distilled water (negative) and 3 mg L-1 CuSO4 (positive). Macroscopic and microscopic variables were analyzed. The germination of L. sativa was not affected by the concentrations of glyphosate. Root length and shoot height of the plants and the mitotic index decreased from the lowest concentration tested on. The chromosomal anomaly index and frequency of micronuclei increased by 3.2 and 22 times, respectively, with the presence of the lowest concentration of glyphosate compared to the negative control. The observed phytotoxic and cytogenotoxic effects demonstrate the negative influence that glyphosate has on the development of L. sativa. Root length and microscopic variables showed the highest sensitivity. This study warns of the possible harmful effects that glyphosate can have on non-target organisms and suggests greater control over the use of this herbicide to mitigate its environmental impact.

Providing a phylogenetic framework for trait-based analyses in brown algae: Phylogenomic tree inferred from 32 nuclear protein-coding sequences

In the study of the evolution of biological complexity, a reliable phylogenetic framework is needed. Many attempts have been made to resolve phylogenetic relationships between higher groups (i.e., interordinal) of brown algae (Phaeophyceae) based on molecular evidence, but most of these relationships remain unclear. Analyses based on small multi-gene data (including chloroplast, mitochondrial and nuclear sequences) have yielded inconclusive and sometimes contradictory results. To address this problem, we have analyzed 32 nuclear protein-coding sequences in 39 Phaeophycean species belonging to eight orders. The resulting nuclear-based phylogenomic trees provide virtually full support for the phylogenetic relationships within the studied taxa, with few exceptions. The relationships largely confirm phylogenetic trees based on nuclear, chloroplast and mitochondrial sequences, except for the placement of the Sphacelariales with weak bootstrap support. Our study indicates that nuclear protein-coding sequences provide significant support to conclusively resolve phylogenetic relationships among Phaeophyceae, and may be a powerful approach to fully resolve interordinal relationships with increased taxon sampling.

Whole-genome sequencing reveals forgotten lineages and recurrent hybridizations within the kelp genus Alaria (Phaeophyceae)

The genomic era continues to revolutionize our understanding of the evolution of biodiversity. In phycology, emphasis remains on assembling nuclear and organellar genomes, leaving the full potential of genomic datasets to answer long-standing questions about the evolution of biodiversity largely unexplored. Here, we used whole-genome sequencing (WGS) datasets to survey species diversity in the kelp genus Alaria, compare phylogenetic signals across organellar and nuclear genomes, and specifically test whether phylogenies behave like trees or networks. Genomes were sequenced from across the global distribution of Alaria (including Alaria crassifolia, A. praelonga, A. crispa, A. marginata, and A. esculenta), representing over 550 GB of data and over 2.2 billion paired reads. Genomic datasets retrieved 3,814 and 4,536 single-nucleotide polymorphisms (SNPs) for mitochondrial and chloroplast genomes, respectively, and upwards of 148,542 high-quality nuclear SNPs. WGS revealed an Arctic lineage of Alaria, which we hypothesize represents the synonymized taxon A. grandifolia. The SNP datasets also revealed inconsistent topologies across genomic compartments, and hybridization (i.e., phylogenetic networks) between Pacific A. praelonga, A. crispa, and putative A. grandifolia, and between some lineages of the A. marginata complex. Our analysis demonstrates the potential for WGS data to advance our understanding of evolution and biodiversity beyond amplicon sequencing, and that hybridization is potentially an important mechanism contributing to novel lineages within Alaria. We also emphasize the importance of surveying phylogenetic signals across organellar and nuclear genomes, such that models of mixed ancestry become integrated into our evolutionary and taxonomic understanding.

Effects of grape pomace supplementation on the diet of lactating ewes as compared to vitamin E on the meat shelf life of suckling lambs

Forty-eight Churra ewes and their suckling lambs were assigned to four dietary treatments: control (CTRL), VIT-E (500 mg kg-1 TMR vitamin E), GP-5 (5% grape pomace) and GP-10 (10% grape pomace). After slaughter (11.5 kg live weight), longissimus muscle of lambs was sliced, packaged under modified atmosphere (80,20%/O 2:CO 2) and stored in retail conditions. At each sampling point (0, 3, 7, 10, 14 days), microbiological, physicochemical and sensory characteristics were analysed. Vitamin E and GP-5 were found to be effective (p < 0.05) at preventing enterobacteria growth as of day 10. After day 10, vitamin E and grape pomace in the ewe's supplementation reduced metmyoglobin (p < 0.05) lipid oxidation (p < 0.05) and sensory spoilage throughout the storage period. An effect of the grape pomace dosage was observed, with the supplementation at 5% being more effective. Therefore, we can conclude that grape pomace was just as effective as vitamin E in preventing spoilage during retail storage.

The Predictive role of speckle-tracking and left ventricular ejection fraction estimation using 2D and 3D echocardiography in the detection of chemotherapy related cardiotoxicity

Background

2D left ventricular ejection fraction (LVEF) estimation through echocardiography has been the classic parameter for cancer therapy–related cardiac dysfunction (CTrCD) detection. However, it is hypothesized that other parameters can be used in order to detect early stages of subclinical cardiotoxicity when LVEF is still preserved. Therefore, 3D LVEF and 2D and 3D strain parameters assessments have been evaluated in patients submitted to anthracyclines treatment.

Objectives

To compare 2D and 3D LVEF and strain parameters estimation using echocardiography regarding its ability to predict and detect subclinical and clinical cardiotoxicity during and after anthracyclines treatment.

Search methods and criteria

A systematic review was done and search was performed on PubMed and EMBASE from January 1st of 2000 to October 31th of 2020. Observational studies comparing 2D and 3D echocardiographic exams performed in adult patients submitted to anthracyclines were analyzed. Studies that evaluated survivors of pediatric cancer were excluded. 11 studies were included (n=844 patients).

Main results

2D and 3D LVEF decreased throughout the echocardiographic assessments of 7 studies, but 2D LVEF drops were not statistically significant in 4 studies and 3 studies showed that 3D LVEF detected a superior number of patients with abnormal LVEF. Compared to 3D LVEF,

2D GLS decreased at an earlier point of treatment and detected a superior number of patients with subclinical LV dysfunction. Despite 2D and 3D GLS decreased throughout treatment, 3D GLS measurements were consistently lower and had higher relative variation. All 3D strain parameters decreased during and after the treatment and have higher relative variations than 2D GLS, with the exception of 1 study. 3D GLS reference values are not yet recognized by guidelines, so subclinical LV dysfunction was not evaluated.

Conclusions

LVEF estimation through 3D proved to be a better parameter for CTrCD detection vs 2D imaging. GLS is superior to 3D LVEF in detecting earlier LV changes, even if calculated using 2D echocardiography. Moreover, GLS reduction can be a predictor of subsequent LVEF decrease. 3DE is a growing potential technique and may be superior to 2DE in detecting and predicting subclinical LVEF dysfunction and CTrCD, respectively. Though 3D strain parameters presented promising results, more studies are needed to prove its incremental value over 2D strain echocardiography

Funding Acknowledgement

Type of funding sources: None.

Temporal characterization of ventricular function and deformation after Takotsubo syndrome using cardiovascular magnetic resonance imaging

Funding Acknowledgements

Type of funding sources: None.

INTRODUCTION

The time course of ventricular recovery in Takotsubo Syndrome (TS) patients(pts) is still not well characterized. Quantification of myocardial deformation using Cardiovascular Magnetic Resonance Feature-Tracking (CMR-FT) may be a useful method to better characterize ventricular recovery during TS.

AIM

To assess the time course of ventricular function using CMR-FT myocardial strain in patients (pts) with an episode of TS.

METHODS

We performed a single-center, retrospective cohort study including 130 pts admitted with TS over a 10-year period. From this cohort, 39 (30%) pts were selected and age and sex-matched with 16 healthy controls for a comparative analysis of myocardial strain using CMR-FT. TS pts were divided in 3 homogeneous subgroups according to the time from index-event and the CMR acquisition: Group 1(G1): &lt;8 days; Group 2(G2): 8 to 30 days; Group 3 (G3): &gt;30 days.

One operator blinded for the study group performed the analysis. Left ventricle (LV) radial strain (RS), longitudinal strain (LS) and right ventricle (RV) LS were quantified.

RESULTS

The mean age of TS group was 66 years and 90% were female. The median ejection fraction (EF) at admission was 38%; 82% displayed an apical ballooning (AB) pattern. Around 19% had at least 1 in-hospital complication and 1.5% died during hospitalization. A significant increase use of CMR was observed over the years (p = 0.001).

Myocardial deformation analysis showed a significant group interaction for LV LS and RS. Specifically, the global values of G1 LV LS and RS were significantly decreased when compared with G3 (LS:-15vs-20%;p = 0.002; RS:40vs61%; p &lt; 0.001) and controls (LS:-15vs-22%;p &lt; 0.001; RS: 40vs70; p &lt; 0.001). There were no significant differences in the RV LS across groups.

The CMR-quantified EF was significantly decreased in G1 when compared with G3 (52vs64%; p &lt; 0.003) and controls (52vs64%; p &lt; 0.001). Differences between G1 and G2 were found in LV RS (LS:40vs57%; p &lt; 0.001) and EF (52vs62%; p &lt; 0.001). No differences were observed for any parameters between G3 and controls.

This study showed that global LV LS (r=-0.6, p &lt; 0.001) and RS (r = 0.7, p &lt; 0.001) had a significant correlation with the CMR-quantified EF.

A comparison between the different patterns of TS was also performed (Figure 1). Pts with AB pattern in G1 displayed lower global RS (P = 0.014), although there were no differences regarding global LS. As expected, in the AB group the reduction in myocardial strain was limited to the apical segments.

Despite not being significantly different across groups RV LS was the only CMR-derived predictor of complications during follow-up (OR = 1.17; p = 0.026).

CONCLUSION

This study revealed that after an episode of TS myocardial function quantified either by EF or CMR-FT strain fully recovers between the 8th and 30th day of the event. RV strain was a predictor of complications during follow-up.

Psychiatric disorders during acute hospital treatment of COVID-19 - a case series

Introduction

Coronavirus disease (COVID-19) has been associated with the development mental and behavioural symptoms and psychiatric disorders. This association is stronger in severe cases of the disease and in those needing inpatient treatment, particularly in intensive care units (ICU).

Objectives

To determine the incidence of psychiatric disorders in a Portuguese hospital-based sample of patients with COVID-19. To describe relevant demographic and clinical data.

Methods

We reviewed all COVID-19 inpatients assessed by liaison psychiatry at our hospital between April and September 2020. Patients admitted due to a psychiatric disorder were excluded from the analysis. We reviewed medical records and retrieved relevant clinical data. ICD-10 was used to classify diagnoses.

Results

We identified 36 cases with a mean age of 62.64 years-old (SD 19.23). The most common disorder was delirium, which occurred in 41.7% of our sample (15 patients), followed by adjustment disorder (22.2%, n=8), and depressive episode (16.7%, n=8). Most patients had no personal (61.1%, n=22) nor family (75%, n=27) history of a psychiatric disorder. Mean length of admission was 36.89 days (SD 28.91). Seventeen cases (47.22%) had at least one risk factor for severe COVID-19 disease and 14 (38.89%) were admitted at some point to the ICU.

Conclusions

In our sample, delirium was the main cause for mental or behavioural symptoms in COVID-19 patients. However, we observed a wide array of presentations in our center. A larger sample would allow to better characterize this often-overlooked symptoms and identify risk factors to psychiatric syndromes.

Disclosure

No significant relationships.

Asymptomatic severe aortic stenosis: what is the current role of exercise stress test and NT-proBNP in patient risk stratification

Funding Acknowledgements

Type of funding sources: None.

Introduction

Aortic stenosis (AS) is prevalent in the elderly population. When severe and the patient is symptomatic or left ventricular dysfunction arises, the prognosis deteriorates and valve replacement (AVR) is recommended. During the asymptomatic phase regular clinical evaluation is advised to detect early onset of symptoms and/or signs of myocardial maladaptation. Due to the inherent difficulties in the evaluation of symptoms, especially in the elderly, as well as the change in prognosis when symptoms appear (even if not perceived), it is crucial to evaluate the behavior of patients with effort and signs of myocardial injury.

Methods

An observational and retrospective study that included 74 patients followed at the Cardiology Service by severe AS (aortic valve area ≤ 1cm2 and/or aortic transvalvular mean gradient ≥40mmHg), who underwent exercise stress test (EST) and NT-proBNP evaluation for risk stratification. The outcome studied was hospitalization for heart failure (HF), or referral to SV, or death during the follow-up period. Independent predictors were obtained using multivariate Cox regression.

Results

Non-progression or decrease in systolic blood pressure (SBP) in EST is the only independent predictor of a short-term adverse event (p = 0.025). This parameter, NT-proBNP levels and interventricular septal thickness (IVS) were independent predictors of a medium (two (p = 0.025; p = 0.014; p = &lt;0.001), three (p = 0.015; p = 0.007; p = 0.001) and four years (p = 0.007; p = 0.049; p = 0.005)) and a long term adverse event (p = 0.006; p = 0.028; p = 0.005).

Conclusion

In asymptomatic patients with severe AS, no progression or decrease in SBP in EST, increased NT-proBNP levels and thickness of IVS were independent predictors of hospitalization for HF, need for VS or death in short, medium and long term.

What is the prognosis for patients who develop new-onset atrial fibrillation in the first 48 hours after an acute coronary syndrome?

 

Atrial fibrillation (AF) is a common complication in acute coronary syndrome (ACS). However, treating patients (pts) with new-onset AF (NOAF) after an ACS remains a challenge. Although it seems intuitive that pts who develop AF within the first 48h have increased morbidity and mortality, your prognosis is unclear because there are no robust studies in the literature to confirm this association.

Aim

To characterize the population of pts who developed NOAF in the first 48 hours after an ACS and to compare the prognosis between these pts and pts who didn't develop AF.

Methods

2916 ACS pts admitted consecutively in our coronary care unit during 6 years were analyzed retrospectively. Of these pts, 343 (11.7%) had AF within the first 48h, of which 99 (3.4%) had pre-existing AF and 243 (8.3%) presented NOAF. Pts were divided into two groups: group 1 -ACS pts who developed NOAF in the first 48h (n=243; 8.8%); group 2 – ACS pts who did not develop AF (n=2517; 91.2%). Pts with pre-existing AF were excluded (n=156; 5.4%). Primary endpoint were the occurrence of death at 6 months; follow-up was completed in 95.8% of pts.

Results

Group 1 pts were older (72±12 vs 62±13, p&lt;0.001), with higher proportion of women (30,9% vs 20,9%, p&lt;0.001), hypertensive (78,5% vs 60,7%, p&lt;0.001), smokers (17,4% vs 32,6%, p&lt;0.001), previous CABG (7,9% vs 3,8%, p=0.06) and stroke (10,7% vs 6,8%, p=0.035). Group 1 had a higher proportion of STEMI pts (58,5% vs 46,5%, p&lt;0.001) and, during hospitalization, had more often respiratory infection (p&lt;0.001), malignant arrhythmias (p&lt;0.001), heart failure (p&lt;0.001), stroke (p=0.001), higher values of NT-proBNP (p&lt;0.001) increased C-reactive protein levels (p&lt;0.001), leukocytes (p=0.020), peak of TropI (p=0.029) and creatinine (p&lt;0.001). On echocardiography, group1 had greater LA diameter (45±6 VS 41±5mm, p&lt;0.001), more frequent significant mitral regurgitation (13,9% vs 2,9%, p&lt;0.001), worst LVEF (41±10% vs 46±10%, p&lt;0.001) and a higher value of pulmonary artery pressure (39±12 vs 24±10, p&lt;0.001). Group 1 were less likely to have undergone coronary revascularization (84% vs 74%, p=0.005). In multivariate analysis, age ≥75 (OR 1.05, p&lt;0.001), LVEF ≤40% (OR 2.50, p&lt;0.001), LA diameter (OR 1.59, p=0.027), more significant mitral regurgitation (OR 2.49, p=0.001) and Killip class &gt;1 (OR 1.51, p=0.015) remained independent predictors of NOAF. In multivariate analysis and after adjusting for different baseline characteristics, pts with NOAF have the same risk of 6-months mortality compared to those who didn't develop AF [OR 1.03, p=0.91].

Conclusion

The incidence of NOAF was 8.8% in our population, which is similar to the literature. Age, LVEF, LA diameter, a significant mitral regurgitation and Killip class &gt;1 were independent predictors of NOAF after ACS. Pts with NOAF in the first 48h after an ACS had worse clinical manifestations during hospitalization but no higher 6-months mortality risk.

Funding Acknowledgement

Type of funding source: None

Ferraz de Vasconcelos syphilis: epidemiological profile, investigation and evolution of cases

The increased incidence of syphilis in Brazil can be explained by multiple reasons: increased reports of acquired syphilis, increased coverage of rapid tests in pregnant women provided by the Brazilian Ministry of Health, reduced condom use, inadequate treatment of patients and partners. In Ferraz de Vasconcelos, a city in the metropolitan region of São Paulo, an increasing elevation in syphilis cases in healthcare services and in the epidemiological surveillance system. In 2017, the city reported 148 cases from which 27 cases were congenital syphilis, with one death. The purpose of the survey was to evaluate the cases reported and describe the main sociodemographic, epidemiological, clinical, and syphilis investigation. A high incidence of syphilis in adults, pregnant women, and congenital syphilis was recorded with a detection rate of 45.0 per 100,000 in habitants and 12.4 and 9.3 per 1,000 live births, respectively. These rates reflect failures in the diagnosis, treatment, and follow-up of cases. Syphilis in adults was obtained in this study in a higher incidence in men 54.1%.Being 49.4% between brown and black people. It is noteworthy that more than 97% of the pregnant women reported with syphilis underwent prenatal care; however, 36.1% of them started from the second trimester, only 88.9% were given treatment, and 66.7% with record of healing. In addition, only in 27.8% pregnant women, the sexual partner underwent the specific treatment. Regarding congenital syphilis, only 81.5% newborns were given proper treatment and only 55.6% underwent laboratory investigation of cerebrospinal fluid. It is evident that these results expose the weaknesses of the municipal healthcare system. Greater coordination among services can contribute to early diagnosis and active search of cases. The epidemiological bulletin containing data from this study may enhance the organization of syphilis prevention, planning, and surveillance actions in the city.

Key messages

The increased incidence of syphilis in Brazil can be explained by multiple reasons: increased coverage of rapid tests on people, reduced condom use, inadequate treatment of patients and partners. Greater coordination among services can contribute to early diagnosis and active search of cases.

Taxonomy and toxicity of a bloom-forming Ostreopsis species (Dinophyceae, Gonyaulacales) in Tahiti island (South Pacific Ocean): one step further towards resolving the identity of O. siamensis

Among dinoflagellates responsible for benthic harmful algal blooms, the genus Ostreopsis primarily described from tropical areas has been increasingly reported from subtropical and temperate areas worldwide. Several species of this toxigenic genus produce analogs of palytoxin, thus representing a major threat to human and environmental health. The taxonomy of several species needs to be clarified as it was based mostly on morphological descriptions leading in some cases to ambiguous interpretations and misidentifications. The present study aims at reporting a benthic bloom that occurred in April 2019 in Tahiti island, French Polynesia. A complete taxonomic investigation of the blooming Ostreopsis species was realized using light, epifluorescence and field emission electron microscopy and phylogenetic analyses inferred from LSU rDNA and ITS-5.8S rDNA regions. Toxicity of a natural sample and strains isolated from the bloom was assessed using both neuroblastoma cell-based assay and LC-MS/MS analyses. Morphological observations showed that cells were round to oval, large, 58.0-82.5 µm deep (dorso-ventral length) and 45.7-61.2 µm wide. The cingulum was conspicuously undulated, forming a 'V' in ventral view. Thecal plates possessed large pores in depressions, with a collar rim. Detailed observation also revealed the presence of small thecal pores invisible in LM. Phylogenetic analyses were congruent and all sequences clustered within the genotype Ostreopsis sp. 6, in a subclade closely related to sequences from the Gulf of Thailand and Malaysia. No toxicity was found on the field sample but all the strains isolated from the bloom were found to be cytotoxic and produced ostreocin D, a lower amount of ostreocins A and B and putatively other compounds. Phylogenetic data demonstrate the presence of this species in the Gulf of Thailand, at the type locality of O. siamensis, and morphological data are congruent with the original description and support this identification.

Bromine biogeodynamics in the NE Atlantic: A perspective from natural wetlands of western Portugal

Bromine (Br) cycling in natural wetlands is highly complex, including abiotic/biotic processes and multiphase inorganic/organic Br-species. Wetland ecosystems receive Br primarily from the ocean, functioning as either sinks or sources of Br, with the overall imbalance largely decided by the prevailing climate. Aiming to trace the present-day transport of oceanogenic Br (i.e., derived from salt-water spray-droplets) and its uptake and storage in brackish and freshwater wetlands, we surveyed waters, autochthonous plants, and soils/sediments from coastal marshes and mountain peatlands in the westernmost fringe of northern Portugal. The calculated enrichment factors of bromide (Br^-) relative to chloride in rainfall (EF_sea = 16.8-75.3), rivers (EF_sea = 1.3-13.9) and wetland waters, superficial (EF_sea = 5.8-13.1) and interstitial (EF_sea = 2.1-8.9), increased towards the inland highlands. We hypothesized that these values derived mostly from a known Br autocatalytic (heterogeneous) chemical cycle, starting at the seawater-aqueous interface and progressing in altitude. Br-bearing air masses are carried far from the Atlantic Ocean by moist westerlies, with Br^- rainout from the atmosphere supplying the neighbouring mountain peatlands. Average [Br] in sampled wetland soils/sediments (111-253 mg/kg) agreed with values from other coastal regions, and they were directly correlated with the abundance of organic matter, varying irrespective the [Br^-] of interstitial waters (129 μg/L-79 mg/L). According to the computed bioconcentration factors, the aqueous component was the major source of Br for all plant species investigated (BF_plant/water = 2.1-508.0), as described elsewhere. However, Br contents in plants (14-173 mg/kg) evidenced interspecific differences, also suggesting a divergence from the acknowledged halophytic-glycophytic "model". As plants are recognized producers of Br volatile molecules (e.g., methyl bromide, CH₃Br), we interpreted translocation factors less than one in vascular species as explanatory of phytovolatilization rather than restriction of Br^- upward movement in plants. Further investigation is needed, since considerable intrinsic plant variations in CH₃Br emissions are mentioned in the literature.

Diversity, Ecology, Biogeography, and Evolution of the Prevalent Brown Algal Genus Lobophora in the Greater Caribbean Sea, Including the Description of Five New Species1

Distributed in tropical and warm-temperate waters worldwide, Lobophora species are found across the Greater Caribbean (i.e., Caribbean sensu stricto, Gulf of Mexico, Florida, the Bahamas, and Bermuda). We presently discuss the diversity, ecology, biogeography, and evolution of the Greater Caribbean Lobophora species based on previous studies and an extensive number of samples collected across the eastern, southern, and to a lesser extent western Caribbean. A total of 18 Lobophora species are now documented from the Greater Caribbean, of which five are newly described (L. agardhii sp. nov., L. dickiei sp. nov., L. lamourouxii sp. nov., L. richardii sp. nov., and L. setchellii sp. nov.). Within the Greater Caribbean, the eastern Caribbean and the Central Province are the most diverse ecoregion and province (16 spp.), respectively. Observed distribution patterns indicate that Lobophora species from the Greater Caribbean have climate affinities (i.e., warm-temperate vs. tropical affinities). In total, 11 Lobophora species exclusively occur in the Greater Caribbean; six are present in the western Atlantic; two in the Indo-Pacific; and one in the eastern Pacific. Biogeographic analyses support that no speciation occurred across the Isthmus of Panama, and that the Greater Caribbean acted as a recipient region for species from the Indo-Pacific and as a region of diversification as well as a donor region to the North-eastern Atlantic. The Greater Caribbean is not an evolutionary dead end for Lobophora, but instead generates and exports diversity. Present results illustrate how sampling based on DNA identification is reshaping biogeographic patterns, as we know them.

Lobophora (Dictyotales) Species Richness, Ecology and Biogeography Across the North-Eastern Atlantic Archipelagos and Description of Two New Species1

The brown alga Lobophora (Dictyotales, Phaeophyceae) is an important macroalga in the North-eastern Atlantic archipelagos (i.e., Macaronesia). Notably in the Canaries it can dominate benthic assemblages. While the genus has been the subject of several ecological studies in the Canaries, no study has yet been conducted to assess species-level diversity of Lobophora in Macaronesia. We reassessed the diversity of Lobophora in Macaronesia, reporting the presence of seven species (L. caboverdeana sp. nov., L. canariensis, L. dagamae sp. nov., L. delicata, L. dispersa, L. littlerorum, and L. schneideri). Lobophora spp. from Macaronesia are morphologically and ecologically distinguishable. In the Canaries, L. schneideri dominates the photophilic assemblages from the intertidal to 20-30 m depth. Lobophora dagamae sp. nov. grows in less illuminated shallow habitats, and replaces L. schneideri from 30 to ~80 m. Lobophora canariensis also has a wide vertical distribution, from the intertidal to deep waters, while L. delicata, L. dispersa and L. littlerorum grow in shallow waters. The dominance of species with an upright habit versus prostrate or crustose species may be mediated by the pressure of herbivores. Four species have an amphi-Atlantic distribution: L. littlerorum, L. canariensis, L. delicata, and L. schneideri. Lobophora schneideri and L. delicata are furthermore distributed in the Mediterranean Sea. By sampling a pivotal region in the Atlantic, this study significantly improves our knowledge of Lobophora biogeography in the Atlantic Ocean. Macaronesia constitutes a species-poor region for Lobophora where no diversification events occurred, and a region of overlap between the Greater Caribbean and the Indo-Pacific.

P1308 A peculiar case of an acute pulmonary embolism

CONCLUSION

We experienced a very uncommon case of a metastatic cardiac tumor from urothelial carcinoma. To the best of our knowledge, only a small number of cases were reported and the reason for the rarity of cardiac metastasis from urothelial carcinoma is unclear. Although the echocardiography has become the gold standard for the diagnosis of intracardiac masses, cardiac MRI plays an important role in the evaluation of cardiac masses of non-neoplastic and neoplastic origin, allowing a comprehensive characterization of such lesions.

Abstract P1308 Figure. pediculated and mobile mass (20x56mm) at

P1314 A singular explanation of stroke in young adults

INTRODUCTION

Although primary cardiac tumors are rare, papillary fibroelastoma (PFE) is the most common benign neoplasm of cardiac valvular structures. Because patients are often asymptomatic the true prevalence is unknown, being most commonly recognized given the evolution of higher-resolution imaging technology. The clinical presentation of PFEs can diverge between being asymptomatic to symptomatic based on the serious complications that can occur, such as acute valve dysfunction or embolization, giving rise to a wide variety of presenting features including neurologic events, acute coronary syndrome, and distal embolic events. The location on the mitral valve does not occur frequently, with rare cases reported in the literature. Here, we present an unusual case of a 32-year-old male with an acute stroke secondary to a PFE in the mitral valve.

CASE REPORT DESCRIPTION

A 32-year-old male patient with a history of crohn"s disease was admitted to our emergency department with a transient sudden-onset aphasia associated with a right hemiparesis. At admission, these symptoms had completely resolved. On further questioning, the patient described another episode of transient right hemiparesis in the last year. On physical examination, the patient"s vital signs were stable. The patient was awake, alert, and oriented with full Glasgow Coma Scale. There was no focal neurological deficit on neurological examination and his cardiovascular examination was normal with no murmurs, added sounds or carotid bruit. A cranial CT showed no signs of acute intracranial disease. Head MRI showed multiple areas of restricted diffusion in the left frontal lobe consistent with acute stroke. As part of the workup to determine the cause of his embolic stroke, a transthoracic echocardiogram and transoesophageal echocardiography were performed, showing a spherical and highly mobilemass attached on the downstream side of the anterior mitral valve leaflet of approximately 1.1 cm in diameter, suggesting the diagnosis of PFE. A bubble study was negative which out ruled patent foramen ovale. After completing the rest of the workup, it was determined that PFE was likely the cause of his stroke. Cardiothoracic surgery was consulted and the patient underwent surgical resection. Histology confirmed the diagnosis of PFE. After 5 years the patient remains asymptomatic, without new embolic events.

DISCUSSION AND CONCLUSIONS

We present a special case that illustrates the importance of diagnosing primary cardiac tumours in a young patient presenting with acute stroke with minimal or no risk factors.Although primary cardiac tumours are rare, diagnosis and treatment at an early stage may prevent serious complications and reduce the morbidity and mortality of embolic stroke.

P226 Caseous calcification of the mitral annulus: a silent cause of intracardiac mass

INTRODUCTION

Caseous calcification of the mitral annulus (CCMA) is a very rare variant of mitral annular calcification with a central liquefaction necrosis, being an uncommon echocardiographic finding (0.5 to 1%) which may be mistaken for an intracardiac tumor, thrombus or vegetation. This chronic degenerative process can occurs at advanced ages, particularly in women, and patients with hypertension, chronic renal failure or calcium metabolism abnormalities. Since patients often remain asymptomatic, conservative treatment for this lesion is generally sufficient.

CASE REPORT

DESCRIPTION

We report a case of an 86-year-old female with a known history of hypertension and diabetes, who was referred to our department in order to investigate the diagnosis of an intracardiac mass visualized through a routine transthoracic echocardiography. She reported effort dyspnea, but refused to have other cardiovascular symptoms.

In order to study this intracardiac mass, the patient was submitted to a transthoracic echocardiogram that showed a rounded mass of 16 × 22 mm in the anterior mitral annulus, mainly in P1 scallop, not causing valve stenosis and with a mild mitral regurgitation. This prompted the need for transesophageal echocardiography which revealed a spheroid mass of heterogeneous content with calcification points, regular edges and with faint central echo-lucent area without acoustic shadowing, attached to the anterior mitral valve leaflet. No communication with any cardiac chamber could be detected. The mass did not determine any restriction to the opening of mitral valve cusps. A cardiac MRI was requested to complete the diagnostic evaluation revealing that the lesion was located at the base of the anterior leaflet. In the T1 and T2 sequences the mass was hypointense, whereas in the perfusion sequence, no contrast penetration was detected in the mass and in the late enhancement. These findings, as well as the presence of a calcified envelope in the cardiac computed tomography scan, confirmed the suspicion of caseous calcification of the mitral annulus.

DISCUSSION

AND CONCLUSIONS

We present an unusual case of caseous calcification of the mitral annulus in which the multi-modal approach was crucial to confirme the diagnosis. Although transthoracic echocardiography can be sensitive in the diagnosis of this entity, the diagnosis may sometimes still be inconclusive. Thus, multi-modality with transesophageal echocardiography, cardiac MRI or CT can lead to a definitive diagnosis, avoiding an mistaken diagnosis with the need of a surgical approach. Since this pathology is most frequently detected in asymptomatic patients, the patients should be treated medically and monitored clinically and echocardiographically for an early recognition of possible complications.

Abstract P226 Figure. Caseous calcification of mitral annulus

P725 An unexpected direction: a case report of a double aortic arch in an asymptomatic woman in adulthood

Introduction

Complete vascular rings represent about 0.5-2% of all congenital cardiovascular malformations, with the double aortic arch (DAA) being the most common of the complete vascular rings, causing tracheoesophageal compression. The right (posterior) arch is usually dominant (70%), although the two arches can have the same size (5%). The left (anterior) arch is dominant in only approximately 25% of cases. In most cases, this anomaly is diagnosed during childhood due to symptoms caused by oesophageal or tracheal compression. For this reason, case reports of adults are rare. This report describes a case of a 61-year-old woman with DAA with dominant left arch, diagnosed accidentallyby thoracic CT angiography.

Case Report Description

A 61 years old woman with a previous story of hypertension and type 1 diabetes presented to the emergency service with dyspnoea and thoracic pain. She also referred a history of intermittent dysphagia and cough with at least 12 years of progression. All the parameters of the physical examination were within normal limits. The electrocardiogram showed a normal sinus rhythm with no evidence of acute ischemia and her blood analyses did not show any abnormalitie. She also performed a thoracic CT angiography, which excluded signs of pulmonary embolism, but revealed a vascular ring suggesting a double aortic arch with permeability in both right and left arches as well as their collaterals. The Cardiac MRI was performed with the purpose of excluding ischemia, confirming the double aortic arch with left dominance. The right arch, posterior to the oesophagus and trachea, and the left arch, in an anterior position, showed an anatomic compression of the oesophagus as well as the proximal trachea, capable of eliciting the symptoms mentioned. Other congenital anomalies were excluded. The echocardiography did not demonstrate any additional cardiac malformation. Endoscopy shows a pulsatile extrinsic compression of the esophagus (aortic ring). The patient is currently being studied and closely monitored in the Cardiology consultation.

Discussion

The most common type of complete vascular ring is the double aortic arch, which accounts for 70% of the complete rings. In most cases, there are two permeable arches, usually with right dominance (70% of the cases). Rarely, both arches are symmetrical. Symptoms usually appear in the fifth month of life. In most cases, only supportive treatment is required.

Conclusion

This case illustrates the atypical features of this congenital malformation, namely the diagnosis during adulthood as well as the left dominance.

Abstract P725 Figure. A double aortic arch

P644 A not so innocent athlete"s heart

We report the case of a 17 years old athlete who resorted to the emergency service for palpitations and dizziness during exercising. He mentioned two episodes of syncope associated with exercise in the last 6 months. He was tachycardic (200 bpm) and hypotensive (85/56 mmHg). The electrocardiogram showed regular wide complex tachycardia with left bundle branch block morphology with superior axis restored to sinus rhythm after electrical cardioversion. In sinus rhythm, it showed T-wave inversion in V1-V5. Patient was admitted for study. Transthoracic echocardiography demonstrated mild enlargement and dysfunction of the right ventricle (RV) with global hypocontractility (FAC of 29%). The cardiac magnetic resonance (CMR revealed a RV end-diastolic volume indexed to surface body area of 180 mL/m2, global hypocinesia and RV dyssynchrony, subepicardial late enhancement in the distal septum and in the middle segment of the infero-septal wall. The patient underwent genetic study which showed a mutation in the gene that encodes the desmocolin-2 protein (DSC-2) involved in the pathogenesis of arrhythmogenic right ventricular cardiomyopathy (ARVC). According to the 2010 modified Task Force criteria for this diagnosis, the patient presented 4 major criteria for ARVC (characteristic ventricular tachycardia, repolarization and morphofunctional changes and the presence of pathogenic mutation) and the diagnosis was made. Thus, given the clinical presentation, it was implanted a subcutaneous cardioverter and patient is currently in follow-up at the Cardiology service.

ARVC is present in 1 to 1000-5000 people and is responsible for 20% of all sudden cardiac deaths, especially in athletes. Diagnosis is based on structural, functional, electrophysiological and genetic criteria reflecting underlying histological changes. This case shows and reviews the essential characteristics to the disease recognition and, therefore, to the prevention of its most feared complication: sudden cardiac death.

P1261 A heart with red flags

A 67 years old woman with a previous history of hypertension, atrial fibrillation (AF) and known severe concentric hypertrophy (more pronounced at the interventricular septum) with moderate pulmonary hypertension and diastolic dysfunction of the left ventricle (LV) resorted to the urgency service for weight loss, asthenia and dyspnea for minor efforts. Her physical examination was innocent. Her ECG showed AF and low voltage in limb and precordial leads. Patient was admitted at the Cardiology Department for investigation. A new TTE revealed fast progression of the hypertrophic pattern (IVS 26 mm, and posterior wall 18 mm) with a rest outflow tract gradient of 18 mmHg; free right ventricular wall was also hypertrophied with 12 mm and a type II diastolic dysfunction was present. A complete investigation for ventricular hypertrophy and constitutional syndrome was done. CMR demonstrated preserved biventricular systolic function, LV hypertrophy with septal predominance (24 mm) with elevated myocardial mass indexed to body mass (114 g/m2) and late difuse subendocardial gadolinium enhancement. (99m)Tc -DPD scintigraphy was negative for ATTR; Anderson-Fabry disease was excluded by genetic testing. Blood analysis revealed a normocytic/ normochromic anemia and a disproportional ratio of free light immunoglobulin chains K/λ, with a predominance of lambda chains. β2-microglobulin was also elevated. 24 hours urine analyses were normal. The hypothesis of non-secretor multiple myeloma (MM) with light chain immunoglobulin amyloidosis (AL) was then admitted. The patient underwent bone marrow and salivary gland biopsies which confirmed MM and deposition of amyloid, respectively. The FISH analyses demonstrated a delection of RB1 gene on 13q14.3 sequence and of TP53 on 17p13.1, both associated with a poorly prognosis in MM. The patient was referred for oncology where she is currently undergoing chemotherapy for MM and AL amyloidosis.

Amyloidosis represents a large spectrum of systemic diseases. Heart failure may be its first sign. This case reflects the diagnostic work-up in the presence of a hypertrophic LV pattern as well as the importance of high clinical suspicious and early diagnosis. While AL amyloidosis occurs in isolation, 10% of patients with multiple myeloma develop systemic AL amyloid with cardiac involvement. The distinction between these entities is not only semantic, but has extremely important prognosis and therapeutic considerations.

P6522Overcoming anatomic challenges to transradial access in STEMI patients

Background

Transradial access is associated with fewer access-related complications, earlier discharge and lower mortality, being the preferred route to perform coronary angiogram and interventions due to its safety and cost effectiveness in STEMI patients. However, the radial artery is smaller, more superficial and thinner than the femoral artery and a percentage of patients ranging from 14% to 27% have a radial artery that is smaller than a 6-French introducer, which sometimes makes angioplasty difficult.

Purpose

This study reports our initial experience with the 5F straight (STR) flush catheter, which can be used as a “child” type rapid exchange catheter inside the 6F guiding catheter, creating a distal tip transition, facilitating angioplasty in transradial coronary interventions when the radial artery is small, tortuous or as severe spasm that impedes advancement of guiding catheter after successful angiography with 5F catheter.

Methods

We analysed, retrospectively, 1510 STEMI patients (pts) admitted in our catheterization laboratory, from August of 2010 to October 2017. Of these patients, 95 (6.3%) pts with problems in advancing a 6F guiding catheter, were submitted to this technique and a direct crossover to a femoral approach was performed in 36 pts (2.4%). This technique consists in the use of longer 5F STR flush catheter in order to overcome the larger distal tip of the 6F guiding catheter through the radial access, employing a 5-in-6 F technique.

Results

In 89 of 95 patients (93.7%), this new technique was successful, with a mean reperfusion time since arrival to the catheterization laboratory of 24.5±9.9 minutes. Of the pts submitted to this technique the majority were female 51 (57.3%) and the mean age was 67±14.3 years. Angioplasties were performed in the left main (2; 2.3%), left anterior descending (36; 40.4%), left circumflex artery (8; 9.0%), right coronary artery (40; 44.9%), right posterior descending artery (1; 1.1%) and obtuse marginal branch (2; 2.3%). No complications in arterial access were seen. Throughout these years of study, the need for crossover to femoral approach has decreased with the learning of this technique. The time until reperfusion since catheterization laboratory arrival was 29.3±9.5 minutes when there was a crossover, being statistically higher than with the radial procedure with the STR technique (p<0.017).

Conclusion

This new technique may be a simple and useful approach to perform primary PCI through transradial access in patients with small diameter radial arteries, allowing a reduction of crossover to femoral access, which translates into a lower risk of vascular complications and shorter reperfusion time, that may influence the prognosis of STEMI patients.

P5521Door-to-balloon time and mortality of a PCI centre: how crucial can 30 minutes be for our STEMI patients?

Introduction

STEMI time delays have been presented as an indicator of quality of care. Considering the system delay, the guidelines of European Society of Cardiology (ESC) and American Heart Association (AHA) for the management of STEMI patients (pts) diverge regarding the maximum time from STEMI diagnosis to wire crossing in pts presenting at primary PCI (pPCI) hospitals (≤60min versus ≤90min, respectively).

Objective

To compare the prognosis between pts presenting at pPCI hospital with maximum time from STEMI diagnosis to wire crossing of ≤60min and patients with times between 61 and 90min.

Methods

The records of 1679 STEMI pts admitted consecutively in our coronary care unit during six years were analysed retrospectively. Of this pts, 341 (20%) were admitted directly in a PCI centre and 1338 (80%) were rescued by an emergency medical system or presented to a non-PCI centre. Pts that presented at PCI centre were divided into two groups: group 1 – STEMI pts with maximum time from STEMI diagnosis to wire crossing of ≤60min (n=202,69%); group 2 – STEMI pts with times 61–90 min (n=91,31%). Pts with time from STEMI diagnosis to wire crossing >90min were excluded. Primary endpoints were the occurrence of death at 6 months and 1 year; follow-up was completed in 98% of pts.

Results

Group 2 pts were older (60±14 vs 67±143, p<0.001), with higher proportion of women (14.9% vs 25.3%; p=0.026), hypertension (45.5% vs 61.5%, p=0.035), diabetes (17.1 vs 24.4%, p=0.005) and presented more frequently Killip 4 at admission (2.1% vs 12.5%, p=0.003). Group 1 pts had higher proportion of smokers (62.2% vs 49.4%, p=0.03). Patient delay was statistically higher in group 2 (Mdn (h) 3.8±3.5 vs 5±2, p<0.001), as was the system delay (Mdn (min) 45±9 vs 74±8, p<0.001). In-hospital mortality (3.8% vs 5.1%, p=0.42) wasn't different between groups, but at 1-month (3.8% vs 10.3%, p=0.05), 6-months (4.4% vs 12.8%, p=0.02) and 1-year mortality (5% vs 15.4%, p=0.008) was higher in group 2. In multivariate analysis and after adjusting for different baseline characteristics, pts who complied with the recommended times according to the 2017 ESC guidelines had lower risk mortality at 1 year compared to group 2 [HR 0.42, 95% CI (0.23–0.74), p=0.006].

Conclusion

In patients presenting at this PCI centre, complying with the 2017 ESC STEMI guidelines in order to reduce the system delay to ≤60min was crucial, since pts who were reperfused within this recommended time had lower mortality rates.

P1723Predictors of in-hospital mortality in STEMI patients complicated by cardiogenic shock treated with primary percutaneous coronary intervention

Introduction

Cardiogenic shock (CS) is an uncommon complex syndrome in patients (pts) with acute myocardial infarction (AMI). However, it remains the most serious complication and the most common cause of in-hospital mortality, with mortality rates ranging from 40% to 60%. The majority of pts are thought to develop CS after admission (late CS), but the incidence in a contemporary STEMI cohort admitted for percutaneous coronary intervention (PCI) remains unknown.

Objective

The aim of the present study was to evaluate pts with STEMI and cardiogenic shock undergoing pPCI, in order to establish the timing of CS onset, mortality rates and predictors of in-hospital mortality.

Methods

The records of 1679 STEMI pts admitted, consecutively, in our coronary care unit during six years were analysed retrospectively. Of this pts, 137 (8%) developed CS based on clinical criteria. Univariate and multivariate logistic regression analyses were used to identify independent predictors of in-hospital mortality. Primary endpoint was the occurrence of death at 30 days and 1 year; follow-up was completed in 100% of patients. Statistical analysis was performed using SPSS 20.0.

Results

The sample was formed by 90 (65.7%) men and 47 (34.3%) women, with mean age of 67±15 years. The incidence of CS was 8%. The majority of this pts (48%) were transferred from a non-PCI centre, 27% were rescued by an emergency medical system and 26% were admitted directly at a PCI centre. Around of 39% of pts had to be resuscitated before coronary intervention. Regarding the timing of CS onset, 66% of pts had CS on admission and 34% developed late CS. The left anterior descending artery was the most affected artery (47%), and 55% of the patients had multivessel disease. All-cause in-hospital and 1 year mortality was 45% and 53%, respectively. A multivariate analysis identified age >75 (HR 1.1, p=0.002), eGFR <60 ml/min/1.73 m2 (HR 2.2, p=0.02), left ventricular dysfunction (LVEF<40%) (HR 2.1, p=0.027), resuscitation before PCI (HR 1.2, p=0.045), and Intra-Aortic Balloon Pump (IABP) implantation after PCI (HR 4.4, p=0.026) as independent predictors of in-hospital mortality.

Conclusion

Despite the therapeutic advances and early revascularization have substantially improved the survival of pts with STEMI and CS, the in-hospital mortality is still significant. This study identified age, acute renal failure, left ventricular dysfunction, resuscitation before PCI, and IABP implantation after PCI as independent predictors of in-hospital mortality in patients with cardiogenic shock due to AMI. Consequently, only the timing of IABP insertion was the only modifiable factor predicting in-hospital mortality in our study, and its implantation before PCI can be considered to improve the outcome of these patients. These results should motivate the search for potentially modifiable factors that can lead to better results in the prognosis of these patients.

The systematics of Lobophora (Dictyotales, Phaeophyceae) in the western Atlantic and eastern Pacific oceans: eight new species

Lobophora is a common tropical to temperate genus of brown algae found in a plethora of habitats including shallow and deep-water coral reefs, rocky shores, mangroves, seagrass beds, and rhodoliths beds. Recent molecular studies have revealed that Lobophora species diversity has been severely underestimated. Current estimates of the species numbers range from 100 to 140 species with a suggested center of diversity in the Central Indo-Pacific. This study used three molecular markers (cox3, rbcL, psbA), different single-marker species delimitation methods (GMYC, ABGD, PTP), and morphological evidence to evaluate Lobophora species diversity in the Western Atlantic and the Eastern Pacific oceans. Cox3 provided the greatest number of primary species hypotheses(PSH), followed by rbcL and then psbA. GMYC species delimitation analysis was the most conservative across all three markers, followed by PTP, and then ABGD. The most informative diagnostic morphological characters were thallus thickness and number of cell layers in both the medulla and the dorsal/ventral cortices. Following a consensus approach, 14 distinct Lobophora species were identified in the Western Atlantic and five in the Eastern Pacific. Eight new species from these two oceans were herein described: L. adpressa sp. nov., L. cocoensis sp. nov., L. colombiana sp. nov., L. crispata sp. nov., L. delicata sp. nov., L. dispersa sp. nov., L. panamensis sp. nov., and L. tortugensis sp. nov. This study showed that the best approach to confidently identify Lobophora species is to analyze DNA sequences (preferably cox3 and rbcL) followed by comparative morphological and geographical assessment.

Abstract P1-15-19: Carboplatin-addition in neoadjuvant treatment of women with triple negative breast cancer (TNBC): Prognostic value in real-world patients

Background

The addition of carboplatin to an anthracycline/taxane-based chemotherapy(CT) in neoadjuvant setting has been suggested to improve pathological complete response(pCR) in TNBC. However, the impact of pCR in prognosis is unknown. We aim to study the value and feasibility of the addition of carboplatin in neoadjuvant setting.

Methods

Demographic and clinical data of TNBC patients treated with neoadjuvant CT in a comprehensive cancer center between 2010-2018 were retrospectively collected. Two cohorts were defined: one treated with Carboplatin/Paclitaxel followed by dose-dense Doxorrubicin/Cyclophosphamide(CP-AC) and other with AC followed by Docetaxel(AC-D). Median follow-up time was 3.1 and 6.9 years, respectively. pCR was defined as absence of residual invasive tumor in breast/axilla. Survival analysis using Kaplan-Meier method and Cox proportional-hazards model were applied. Statistical significance was set at p&lt;0.05.

Results

One-hundred and sixty patients were enrolled: 78 CP-AC and 38 AC-D. Groups were balanced regarding patients and tumor characteristics with exception of pre-menopausal status, more frequent in CP-AC(68% vs 47%;p=.04). Age at diagnosis was 47(28-76)years, the majority had ECOG 0(92%) ductal carcinomas(82%), clinicalT2/3 stages(76%), grade 3(81%) with lymph node involvement(N+)(57%). 14% had Inflammatory breast cancer(IBC)(CP-AC 14%;AC-D 13%; p=.9).

Neutropenia was the most prevalent adverse event(G3/4: CP-AC 61%;AC-D 16%;p=.02), 12% and 16% of febrile neutropenia(p=.8). G3/4 thrombocytopenia occurred only in CP-AC(6%). Hypersensitivity reactions were more prevalent in CP-AC(19% vs 2.7%;p=.02), majority to paclitaxel, all G1/2. Hospital admission occurred in 12%(CP-AC 13%;AC-D 9%; p=.8). There were no treatment-related deaths. Treatment schedule was complete in 89%(CP-AC 87%;AC-D 92%;p=.5), with 20% dose reductions(CP-AC 25%;AC-D 11%;p=0.9).

pCR was achieved in 42%(CP-AC 50%;AC-D 28%;p=.03). 1- and 3-year disease-free survival(DFS) was 94%/85% for CP-AC and 72%/58% for AC-D(p=.3). Risk of recurrence was higher in IBC(HR 25.1;CI95% 7.7-81.3;p&lt;.0001), N+ disease(HR 3.6;CI95% 1.2-10.5;p=.02) and non-pCR(HR 10.9;CI95% 2.3-52.3,p=.003). N+ disease was associated with higher recurrence only in AC-D(HR 11.7;CI95% 1.3-104;p=.03).

Cancer-related deaths were 20%(CP-AC 10%;AC-D 40%;p=.001). 1- and 2-year overall survival (OS) was 99%/95% for CP-AC and 70%/61% for AC-D(p=.06). N+ disease was associated with higher risk of death in AC-D(HR 6.3;CI95% 1.1-24.6;p=.04). Risk of death was independently associated with IBC(HR 4.1;CI95% 2.1-18.7; p=.001) but not with N+ disease(HR 2.7;CI95% 0.8-9.5;p=.13) or pCR(HR 4.1;CI95% 0.9-19.7;p=.08) although pCR was statistically significant in univariate analysis (1- and 2-year OS 97% vs 92% and 94% vs 86% for pCR and non-PCR;p=.003).

Conclusions

Carboplatin addition clearly increased pCR with a trend to DFS and OS benefit. This regimen was associated with more, nevertheless manageable, adverse events with most of the patients able to tolerate and complete the full-dose regimen. Though we did not find a subgroup of patients that benefit with carboplatin regimen, we should consider avoiding AC-D at least in N+ disease.

Citation Format: Coelho S, Abreu MH, Sales C, Lopes AR, Sousa MF, Couto R, Pousa I, Ferreira A, Ferreira M, Vieira C, Leal C, Castro F, Sousa S, Pereira D. Carboplatin-addition in neoadjuvant treatment of women with triple negative breast cancer (TNBC): Prognostic value in real-world patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-15-19.

High metabolic variation for seaweeds in response to environmental changes: a case study of the brown algae Lobophora in coral reefs

In the marine environment, macroalgae face changing environmental conditions and some species are known for their high capacity to adapt to the new factors of their ecological niche. Some macroalgal metabolites play diverse ecological functions and belong to the adaptive traits of such species. Because algal metabolites are involved in many processes that shape marine biodiversity, understanding their sources of variation and regulation is therefore of utmost relevance. This work aims at exploring the possible sources of metabolic variations with time and space of four common algal species from the genus Lobophora (Dictyotales, Phaeophyceae) in the New Caledonian lagoon using a UHPLC-HRMS metabolomic fingerprinting approach. While inter-specific differences dominated, a high variability of the metabolome was noticed for each species when changing their natural habitats and types of substrates. Fatty acids derivatives and polyolefins were identified as chemomarkers of these changing conditions. The four seaweeds metabolome also displayed monthly variations over the 13-months survey and a significant correlation was made with sea surface temperature and salinity. This study highlights a relative plasticity for the metabolome of Lobophora species.

Pertuzumab, trastuzumab, and standard anthracycline- and taxane-based chemotherapy for the neoadjuvant treatment of patients with HER2-positive localized breast cancer (BERENICE): a phase II, open-label, multicenter, multinational cardiac safety study

Background

Anti-HER2 therapies are associated with a risk of increased cardiac toxicity, particularly when part of anthracycline-containing regimens. We report cardiac safety of pertuzumab, trastuzumab, and chemotherapy in the neoadjuvant treatment of HER2-positive early breast cancer.

Patients and methods

BERENICE (NCT02132949) is a nonrandomized, phase II, open-label, multicenter, multinational study in patients with normal cardiac function. In the neoadjuvant period, cohort A patients received four cycles of dose-dense doxorubicin and cyclophosphamide, then 12 doses of standard paclitaxel plus four standard trastuzumab and pertuzumab cycles. Cohort B patients received four standard fluorouracil/epirubicin/cyclophosphamide cycles, then four docetaxel cycles with four standard trastuzumab and pertuzumab cycles. The primary end point was cardiac safety during neoadjuvant treatment, assessed by the incidence of New York Heart Association class III/IV heart failure and of left ventricular ejection fraction declines (≥10 percentage-points from baseline and to a value of <50%). The main efficacy end point was pathologic complete response (pCR, ypT0/is ypN0). Results are descriptive.

Results

Safety populations were 199 and 198 patients in cohorts A and B, respectively. Three patients [1.5%; 95% confidence interval (CI) 0.31% to 4.34%] in cohort A experienced four New York Heart Association class III/IV heart failure events. Thirteen patients (6.5%; 95% CI 3.5% to 10.9%) in cohort A and four (2.0%; 95% CI 0.6% to 5.1%) in cohort B experienced at least one left ventricular ejection fraction decline. No new safety signals were identified. pCR rates were 61.8% and 60.7% in cohorts A and B, respectively. The highest pCR rates were in the HER2-enriched PAM50 subtype (75.0% and 73.7%, respectively).

Conclusion

Treatment with pertuzumab, trastuzumab, and common anthracycline-containing regimens for the neoadjuvant treatment of early breast cancer resulted in cardiac and general safety profiles, and pCR rates, consistent with prior studies with pertuzumab.

Clinical Trial Information

NCT02132949.

Abstract P5-20-04: Safety of adjuvant treatment with pertuzumab plus trastuzumab after neoadjuvant anthracycline-based chemotherapy in patients with HER2-positive localized breast cancer: Updated results from the BERENICE study

Background Anti-HER2 therapies are associated with a risk of cardiac toxicity, particularly as part of anthracycline-based regimens. BERENICE (NCT02132949), a nonrandomized, Phase 2 cardiac safety study showed neoadjuvant treatment with pertuzumab (P) + trastuzumab (H) and 2 common anthracycline–taxane-based regimens had a safety profile consistent with prior studies of P+H, and was associated with high pathologic complete response rates. Here we report safety data from the P+H adjuvant treatment period (AP).

Methods Patients (pts) with centrally confirmed, localized HER2-positive breast cancer and normal cardiac function received 4 q2w dose-dense doxorubicin and cyclophosphamide cycles (60/600mg/m2) then 12 qw paclitaxel injections (80mg/m2; Cohort A), or 4 q3w fluorouracil/epirubicin/cyclophosphamide cycles (500/100/600 mg/m2) then 4 q3w docetaxel cycles (75mg/m2, up to 100mg/m2;Cohort B). In both cohorts, 4 q3w cycles of P (loading:840mg; maintenance:420mg) + H (loading:8mg/kg; maintenance:6mg/kg) were started with taxane therapy and continued in the adjuvant setting (for up to 13 cycles to complete 1 year of treatment). Surgery was scheduled after 8 cycles of preoperative therapy. Primary endpoints were incidence of New York Heart Association (NYHA) Class III/IV heart failure and incidence of left ventricular ejection fraction (LVEF) declines (≥10%-points from baseline to &lt;50%; asymptomatic and symptomatic events) assessed by ECHO/MUGA. Confirmed LVEF declines were defined as significant LVEF declines at 2 consecutive visits.

Results In total, 397 pts received ≥1 dose of study medication and were included in the overall treatment period (OTP) safety analysis. Of these, 371 (Cohort A:181; Cohort B:190) pts entered the AP and were included in the AP safety analysis. Mean (SD) number of AP treatment cycles of P and H were 12.3 (2.0) in Cohort A and 12.3 (2.2) in Cohort B. In the AP, incidence of heart failure was minimal (0.5%) and confirmed LVEF decline incidence was low (Table 1).

Table 1: Cardiac AE Cohort ACohort B OTP n=199AP n=181OTP n=198OTP n=190NYHA Class III/IV heart failure    Events, n4011Pts with event, n (%)3(1.5)01(0.5)1(0.5)LVEF decline    Events, n36223429Pts with LVEF decline, n (%)21(10.6)14(7.7)22(11.1)20(10.5)Pts with confirmed LVEF decline, n (%)7(3.5)5(2.8)7(3.5)6(3.2)

General adverse events (AEs) are shown in Table 2; 26 (14.4%) pts in Cohort A and 45 (23.7%) in Cohort B had diarrhea AEs (mostly grade 1).

Table 2: General AE Cohort ACohort BPts, n (%)OTP n=199AP n=181OTP n=198AP n=190Any AE198(99.5)171(94.5)198(100.0)171(90.0)Grade ≥3 AE109(54.8)23(12.7)126(63.6)40(21.1)Serious AE54(27.1)15(8.3)61(30.8)17(8.9)AE leading to P or H discontinuation19(9.5)9(5.0)14(7.1)11(5.8)

Conclusion P+H in the adjuvant setting, following P+H with anthracycline-based regimens in the neoadjuvant setting, are associated with low incidence of cardiac AEs. Cardiac safety results for P+H in the AP and OTP of BERENICE were consistent with results from prior studies evaluating adjuvant treatment with single-agent H, suggesting the addition of P to H in the adjuvant setting does not increase cardiac toxicity.

Citation Format: Dang C, Ewer MS, Delaloge S, Ferrero J-M, Verrill M, Colomer R, Vieira C, de la Cruz Merino L, Lucas J, Werner TL, Douthwaite H, Bradley D, Waldron-Lynch M, Eng-Wong J, Swain SM. Safety of adjuvant treatment with pertuzumab plus trastuzumab after neoadjuvant anthracycline-based chemotherapy in patients with HER2-positive localized breast cancer: Updated results from the BERENICE study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-20-04.

Efecto del nivel de androstenona en chorizos elaborados a partir de cerdos enteros

Como consecuencia de los cambios en la normativa europea sobre bienestar animal, en un futuro próximo la industria porcina podría afrontar la prohibición de la castración de lechones machos, lo que implicaría un riesgo medio o alto de obtener carne con olor sexual. La castración física afecta a la cantidad de grasa de depósito y a la composición de ácidos grasos de los tejidos magro y graso. Por lo tanto, el uso de cerdos enteros en la industria podría afectar al procesado y a la calidad de los productos cárnicos. El objetivo de este estudio fue evaluar el efecto del nivel de androstenona (AND) en las características de un embutido crudo curado (chorizos). Para ello, se analizó la composición química, el perfil de ácidos grasos y las características sensoriales de chorizos de cerdos castrados y de cerdos machos enteros con dos niveles de AND (Medio: 0,5-0,8 µg/g de grasa, Alto: 1,1-2,9 µg/g de grasa). Los chorizos procedentes de cerdos con niveles de AND medio y alto presentaron el mayor contenido en proteína y el menor contenido de grasa (P

Adolescent cybervictimization - Who they turn to and their perceived school climate

The purpose of this study was to understand how adolescent cybervictims perceive their school climate and whether telling school community members, such as teachers, play a significant role in these perceptions. Another objective was to understand whether age and gender played a significant role in the relation between whom cybervictims told and their perceived school climate. The Cybervictims Scale for Adolescents and Children and the Perceived School Climate Scale were applied to 3525 Portuguese students of whom 218 were cybervictims attending 6th, 8th^, and 11th grades. Results showed that even though adolescent cybervictims reported cybervictimization more to friends and parents, those who told teachers about their experience, tended to report more positive perceptions of their school climate. Gender and age did not play a significant role in the relationship between cybervictimization and perceived school climate. Implications of the findings are discussed with regards to the role of teachers and in-service training in preventing cyberbullying.