POS1412 FIRSTS RESULTS OF THE PRAISE STUDY (PATIENT-REPORTED AUTOIMMUNITY SECONDARY TO CANCER IMMUNOTHERAPY): MULTICENTRIC PROSPECTIVE COHORT STUDY ON AUTOIMMUNE DISEASES SECONDARY TO CANCER IMMUNOTHÉRAPY

Background

In cancer immunotherapy, T-lymphocyte activation can lead to secondary autoimmune diseases named OASI for Opportunistic Autoimmunity Secondary to cancer Immunotherapy [1]. The epidemiology of OASI deserves to be further studied due to the unadapted reporting of clinical trials and the lack of prospective studies. Moreover, literature focuses on the most severe OASI and/or on specific OASI (myocarditis, colitis, arthritis).

Objectives

Our goal was to determine incidence, severity of all grade OASI using a multicentric prospective patient cohort starting treatment with cancer immunotherapy.

Methods

We present a multicentric, prospective, observational, longitudinal, real life, French e-cohort. 900 patients treated with ipilimumumab and/or nivolumab will be included. Data is collected from the patient and the oncologist at inclusion, then patients report directly any symptom that could be suggestive of OASI with the help of monthly digital questionaries. In case an OASI is suspected, further confirmation is made with the practician in charge and by a paired analysis with the Système National De Santé (SNDS), the French health insurance registry.

Results

On the 19/01/2022, 439 patients were included, 310 males (70.6%) and 129 females (29.4%). Mean age is 66 years old with a median follow up of 192 days. 354 patients (80.6%) are treated with Nivolumab alone, 7 (1.6%) with Ipilimumab alone and 76 (17.8 %) with combined Nivolumab + Ipilimumab. 136 patients (31.6%) are treated for a non-small cell lung carcinoma, 107 patients (24.9%) for a clear cell renal carcinoma, 91 patients (21.2%) for a skin melanoma, 49 patients (11.4%) for a head or neck epidermoid carcinoma, 24 patients (5.6%) for another lung cancer sub-type, and 32 patients (5.3%) for another histological cancer type. The mean follow-up is 294 days (+/- 192). 83 patients (18.9%) died since the beginning of the follow up.

47 patients (10.7%) developed 63 OASI. The mean delay between the beginning of cancer immunotherapy and the OASI is 134.7 days (+/- 103.4).

Approximately, one third of the OASI were musculoskeletal diseases. The OASI included polymyalgia rheumatica (3 patients), psoriatic arthritis (1 patient), polyarthritis (1 patient) systemic lupus (1 patient), arthralgias and myalgias (8 patients), colitis (11 patients), dysthyroïditis (6 patients), hepatitis (4 patients), nephritis (3 patients), pneumonitis (2 patients), hypophysitis (2 patients), adrenal insufficiency (4 patients), myocarditis (1 patient), hemophagocytic lympho-histiocytosis (1 patient), and other types of OASI (15 patients).

26 patients (55% of patients with OASI, 5,9% of all patients) had to stop cancer immunotherapy due to an OASI, one because of a rheumatic disease (systemic lupus). 52 patients were treated with corticosteroids, 1 patient with methotrexate (psoriatic arthritis), 3 patients with infliximab (colitis) and 1 patient with abatacept (myocarditis). 1 patient died after an OASI (colitis).

Conclusion

The first results of this prospective study, using an original patient-centered methodology, confirm the expected incidence of autoimmune events secondary to cancer immunotherapy and the role of rheumatologists in their therapeutic management.

References

[1]Kostine M, Chiche L, Lazaro E, et al. Opportunistic autoimmunity secondary to cancer immunotherapy (OASI): An emerging challenge. Rev Med Interne. 2017;38(8):513-525. doi:10.1016/j.revmed.2017.01.004

Acknowledgements

BMS funded the study (unrestricted grant) but had no role in study design, data collection, analysis or decision to publish.

Disclosure of Interests

Eden Sebbag: None declared, Nicolas Cloarec: None declared, Philippe Barthelemy: None declared, Nathanaël Sedmak: None declared, Naima Hamamouche Consultant of: Work for Sanoia Digital CRO, Hervé Servy Consultant of: Work for Sanoia Digital CRO, Guillaume Desjeux Consultant of: Work for Sanoia Digital CRO, Isabelle Monnet: None declared, Abeer Najem: None declared, Marc Porneuf: None declared, Laetitia-Shanna Rajpar: None declared, Jérôme Meunier: None declared, Tévy San: None declared, Laure Chauvenet: None declared, Ariane DARUT JOUVE: None declared, Sabrina FALKOWSKI: None declared, Claudia Rizzo: None declared, Noémie Litrowski: None declared, Anthony Canellas: None declared, Jean-François Paitel: None declared, Marc Pracht: None declared, Jacques Cadranel: None declared, Laurence Weiss: None declared, Christos Chouaid: None declared, Thomas Aparicio: None declared, Stephane Nancey: None declared, Cécile Arnold: None declared, Erik Sauleau: None declared, Jaqcues-Eric Gottenberg: None declared

POS1218 RELAPSES OF IDIOPATHIC INFLAMMATORY MYOPATHIES AFTER VACCINATION AGAINST COVID19: A REAL-LIFE ITALIAN STUDY

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination plays a crucial role as pivotal strategies to curb the coronavirus disease-19 (COVID-19) pandemic. Despite the mass-scale vaccination, literature data about the incidence of disease flares in IIM patients are still not reported as well as the immunological condition.

Objectives

The present study aimed to describe the clinical status of patients affected by IIM after vaccination against COVID19 in order to assess the number of relapses or immune-mediated reactions in a cohort of Italian patients with such disease.

Methods

We included all patients affected by IIM and followed by Myositis Clinic, Rheumatology and Respiratory Diseases Units, Siena University Hospital, Bari University Hospital, Policlinico Umberto I, Sapienza University, Rome, and Policlinico Paolo Giaccone, Palermo. Inclusion criteria were a recent (<3 months) clinical and serological assessment before the survey and a definite diagnosis of dermatomyositis, polymyositis and anti-synthetase syndrome. All patients underwent a telephone survey in order to establish their clinical status and potential relapses after vaccination.

Results

A total of 119 IIM patients (median, IQR 58 (47-66) years; 32 males) were consecutively enrolled. Fifty had a diagnosis of DM, 39 had PM and 30 had ASS. The median months of disease duration was 79.62±83.98. According to number of organs involvement, forty-two had only one, 45 had two organs involvement, 20 had three, 11 had four and one had five. The majority of them received two doses of COVID-19 vaccine, except four patients who refused the vaccination: 94 (78.9%) Cominarty, 16 (13.4%) Moderna, 5 (0.04%) AZ. Seven (0.06%) patients had flare after vaccination, the majority of them were mild except one major with three organs involved and one life-threatening with systemic involvement. In order to understand or predict the effect of demographic and clinical features on the flare development after vaccination, a logistic regression analysis was performed. The goodness-of-fit statistics showed a Chi2 associated with the Log ratio (L.R.) of 0.045. From the probability associated with the Chi-square tests, the Type II analysis showed the variable that most influences the development of flare was the number of organs involved (p=0.047).

Sixty-eight patients received the third dose of COVID-19 vaccination: 51 (75%) Cominarty and 17 (25%) Moderna. Only one (0.01%) patient (the same who had life-threatening flare with systemic involvement after two doses) had flare after third dose and eventually died.

Conclusion

Vaccines against SARS-CoV2 have provided, both in registratory studies and in preliminary real-life evidence, an overall good efficacy and safety. Nevertheless, only scanty data are available for rheumatic patients in general and the ones affected by IIM in particular. To the best of our knowledge, ours represent the largest cohort of IIM patients in which immunogenicity of anti-SARS-CoV2 vaccine was assessed. In line with real-life data from other diseases, we found a non-statistically significant risk of relapse in our patients, which occurred seldom, usually mild and in patients with a more severe and aggressive course of disease.

ParametersFlare after two doses (n=7)No-flare after two doses (n=108)P valueAge (years)55 (51-68)59 (47-67)NSGender (M/F)2/530/82NSDiagnosis (DM/PM/ASS)2/2/348/36/28NSAntibodiesJo1225PL7-3PL12-1Ku-2Mi217PM/Scl15Ro5217TIG1g-5MDA5-6SRP-1SAE-2cN1a--NPX-1SSA-12Ds-DNA-1ANA (only positivity)-3negative227Length of disease (months)50 (19-200)60 (24-108)NSNumber of organs involved:One0360.0004Two243Three319Four110Five10Type of vaccination:Cominarty688NSModerna115AZ05Disease activity (PhGA≥2/PhGA<2)3/427/81NSMDI3 (1-6.5)2 (1-4)NSCRP (mg/dL)0.1 (0.01-0.3)0.99 (0.3-2.9)0.0041ESR32 (14-39)15.5 (8-27.5)NSCPK111 (63-905)97.5 (63-158)NSTreatment at time of vaccination: GCs010NS Immunosuppressive319 Biologic12 Combination365 no-treatment-12

Disclosure of Interests

None declared

POS0101 POTENTIAL INVOLVEMENT OF IL-40 AND IL-40 PRODUCING CELLS IN SYSTEMIC LUPUS ERYTHEMATOSUS AND LUPUS ASSOCIATED NEPHRITIS

Background

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder, characterized by a remarkable heterogeneity of clinical presentations. Glomerulonephritis (GN) remains a leading cause of morbidity and mortality in SLE, influencing long-term prognosis. The alteration of both innate and adaptive immune responses plays a pivotal role in SLE pathophysiology [1]. B lymphocytes are mainly involved in SLE through the production of autoantibodies but recent evidence suggests an effector role of these cells in cytokine production. IL-40 is a recently discovered cytokine, produced by B cells and involved in their homeostasis, that may participate in the pathogenesis of B-mediated autoimmune diseases, such as SLE [2].

Objectives

The purpose of this study was to evaluate the role of IL-40 in the pathogenesis of SLE, with a specific focus on renal involvement.

Methods

Peripheral blood and urine samples were collected from 10 consecutive SLE patients and 10 healthy controls; kidney biopsy specimens were obtained from 3 SLE patients and 3 controls. The concentration of IL-40 in serum and urine samples was evaluated by ELISA. IL-40 production by monocytes, B cells and T cells was assessed by flow cytometry at day 0 and after in vitro stimulation. Immunohistochemistry on kidney tissue was also performed to evaluate IL-40 expression.

Results

IL-40 levels were reduced in the serum of patients with active GN. This reduction was further observed in the serum of patients with previous GN. In the serum of active SLE patients, without renal involvement, the concentration of IL-40 did not change significantly compared to controls. Urinary levels of IL-40 showed no significant changes compared to controls. Consistently, immunohistochemistry on kidney showed the expression of IL-40 only in SLE patients (Figure 1). Flow cytometric analysis on T cells, B cells and monocytes isolated from peripheral blood of SLE patients with active GN did not show production of IL-40.

Figure 1.

IL-40 overexpression in lupus nephritis at tissue level. Kidney biopsies stained for IL-40 in controls (A), Class III lupus nephritis (B) and Class V lupus nephritis (C) showed intense IL-40 positivity in lupus nephritis (B, C) compared to controls (A).

Conclusion

To the best of our knowledge this is the first demonstration of IL-40 expression at kidney level in SLE associated nephritis. These preliminary data suggest an active role of IL-40 in SLE, with specific focus on active kidney disease. Our results highlight a potential use of IL-40 as a marker of active GN, although its specific mechanism of action needs to be further elucidated.

References

[1]Tsokos GC, Lo MS, Costa Reis P, Sullivan KE. New insights into the immunopathogenesis of systemic lupus erythematosus. Nat Rev Rheumatol. 2016;12(12):716-730.

[2]Catalan-Dibene J, Vazquez MI, Luu VP, Nuccio SP, Karimzadeh A, Kastenschmidt JM, et al. Identification of IL-40, a Novel B Cell-Associated Cytokine. J Immunol. 2017;199(9):3326-35.

Disclosure of Interests

Chiara Rizzo: None declared, Lidia La Barbera: None declared, Marianna Lo Pizzo: None declared, Leila Mohammadnezhad: None declared, Vincenzo Luca Lentini: None declared, DENISE DONZELLA: None declared, Francesco Ciccia Speakers bureau: lilly, pfizer, novartis, celgene, abbvie, roche, janssen, UCB, SERENA FASANO: None declared, Giuliana Guggino Speakers bureau: pfizer, novartis, celgene, abbvie, roche, lilly, janssen, UCB

P59 A COMPLEX PCI IN A CARDIOGENIC SHOCK NSTEMI PATIENT NEEDING PTA AND LEFT VENTRICLE ASSISTANCE

A 72–years–old man, smoker, type 2 DM and hypertension in history, was admitted for NSTEMI complicated by cardiogenic shock; Echocardiogram revealed LV dilatation with severe disfunction (EF 20%), moderate mitral regurgitation; he started inotropic support and high dose diuretics, then he needed dialysis and positioning of a temporary PM. Coronary angiography revealed chronic total occlusion (CTO) of the left anterior descending artery (LADA) and CTO of the right coronary artery (RCA). A first CTO PCI procedure was attempted for the LADA occlusion, with the support of IABP, using an antegrade approach, polimeric wire (ASAHI Fielder) and more penetrating ones (ASAHI Gaia I and II), unable to gain the true lumen beyond the occlusion. A second attempt was planned, with the support of Impella CP device for left ventricle assistance; due to critical stenosis in the right common iliac artery, a PTA with stenting (8/38 mm) was preparatory for that. For the second attempt a dual coronary approach was prepared (6 F Amplatz left 1,0 for RCA and 7 F XB 3,5 for left coronary artery); at first a novel antegrade attempt was pursued with a step–up technique (ASAHI wires: Gladius, Gaia I, II and III, Conquest pro), ineffective to reach the true lumen distally the occlusion. The retrograde approach was then pursued, through a collateral originating from the acute marginal branch of the RCA to the distal segment of LADA, using the Caravel microcatheter with ASAHI wires Sion blue, Sion black, Suoh 03, effective to reach the distal cap of the occlusion, this one passed by the Gladius wire. The ASAHI RG3 externalization wire (330 mm) was then used, entering from the radial access and the amplatz catheter for the RCA, reaching the XB catheter in the left coronary artery through a Guideliner extension catheter, and externalized in the femoral access. IVUS analysis was then used to confirm good wire position and the vessel calibers, so pre–dilatation was done and 3 drug–eluting stents were implanted (2,25/23 + 3,25/38 + 3,5/18 mm) distal–to–proximal overlap, with final post–dilatation, obtaining a good final result on angiography and IVUS. During the 4–hours procedure clinical condition was stable and Impella was removed with a rapid weaning; the double pre–mounted Proglide device was used for femoral hemostasis. 5 days after the patient was discharged, II–III NYHA class, 25% EF. At the 3 months f–up he was asymptomatic in good clinical condition, 30% EF, he refused ICD implant.

Predictors of long-term survival in patients undergoing residential cardiac rehabilitation (rCR) after transcatheter aortic valve replacement (TAVR): a multicenter retrospective study

Purpose

To evaluate exercise-based rCR derived outcome predictors in patients referred after TAVR.

Methods

Data of 232 patients (aged 82±6 years, 45%males) admitted to an average 3-week rCR program after TAVR (walking, up to 30 minutes of cycling or treadmill session twice daily, respiratory and calisthenic training) from January 2009 to December 2017 and home discharged, were retrospectively collected at 10 rCR Divisions of Istituti Clinici Scientifici Maugeri. Comorbidity (cumulative illness rated state-comorbidity index) (CIRS-CI) score, echocardiography on admission, disability (Barthel Index) (BI) score at discharge, six minutes walking test distance (6MWT) on discharge and maximal training session intensity (MTSI expressed in METs per minutes) were collected. All-cause mortality was assessed up to 3 years after rCR discharge.

Results

During a 3-year follow-up, there were 74 (32%) deaths. At univariate analysis, at discharge non survivors compared to survivors had significantly higher comorbidity rate (CIRS-ICC 5.2±2.3 vs 4.1±1.9, p=0.000) and disability level (BI 80.4±24 vs 88.8±17, p=0.000). Moreover, they had worse renal function (creatinine 1.6±0.9mg/dl vs 1.2±0.4, p=0.000), were more often on diuretic therapy (73% vs 53.2%, p=0.003) and on beta-blocker therapy (73% vs 57,6%, p=0.042) and had a markedly reduced functional capacity (6MWTD 221±100m vs 265±105m, p=0.001). At multivariate logistic stepwise analysis a lower comorbidity (CIRS-ICC), a more preserved renal function (creatinine level), a reduced use of diuretic therapy and 6MWT at discharge confirmed their power as independent predictors of survival at follow up (Table, Harrel's C = 0.707)

Conclusions

Patients attending rCR after TAVR are very old with significant comorbidity; overall mortality at 3-year follow-up after CR discharge is substantial. Our results suggest the need to implement ad-hoc long-term care strategies based on residual exercise capacity, comorbidity score and renal function for tailoring follow-up in patients discharged from rCR after TAVR.

Funding Acknowledgement

Type of funding sources: None. Table 1

A novel pulsed magnet for magnetic linear birefringence measurements

In this paper, we describe a novel pulsed magnet, called foil coil, which can deliver a field transverse to the light propagation of more than 10 T over about 0.8 m operating without cryogenic equipment. It has been designed for linear magnetic birefringence measurements. We report on testing the coil and also show some physics data taken in vacuum during its commissioning in the framework of the Biréfringence Magnétique du Vide (BMV) apparatus, with special attention to noise induced by the pulse itself. Finally, we compare the preliminary results obtained here with data from the previous BMV coil.

Aedes albopictus bionomics data collection by citizen participation on Procida Island, a promising Mediterranean site for the assessment of innovative and community-based integrated pest management methods

In the last decades, the colonization of Mediterranean Europe and of other temperate regions by Aedes albopictus created an unprecedented nuisance problem in highly infested areas and new public health threats due to the vector competence of the species. The Sterile Insect Technique (SIT) and the Incompatible Insect Technique (IIT) are insecticide-free mosquito-control methods, relying on mass release of irradiated/manipulated males, able to complement existing and only partially effective control tools. The validation of these approaches in the field requires appropriate experimental settings, possibly isolated to avoid mosquito immigration from other infested areas, and preliminary ecological and entomological data. We carried out a 4-year study in the island of Procida (Gulf of Naples, Italy) in strict collaboration with local administrators and citizens to estimate the temporal dynamics, spatial distribution, and population size of Ae. albopictus and the dispersal and survival of irradiated males. We applied ovitrap monitoring, geo-spatial analyses, mark-release-recapture technique, and a citizen-science approach. Results allow to predict the seasonal (from April to October, with peaks of 928-9,757 males/ha) and spatial distribution of the species, highlighting the capacity of Ae. albopictus population of Procida to colonize and maintain high frequencies in urban as well as in sylvatic inhabited environments. Irradiated males shown limited ability to disperse (mean daily distance travelled <60m) and daily survival estimates ranging between 0.80 and 0.95. Overall, the ecological characteristics of the island, the acquired knowledge on Ae. albopictus spatial and temporal distribution, the high human and Ae. albopictus densities and the positive attitude of the resident population in being active parts in innovative mosquito control projects provide the ground for evidence-based planning of the interventions and for the assessment of their effectiveness. In addition, the results highlight the value of creating synergies between research groups, local administrators, and citizens for affordable monitoring (and, in the future, control) of mosquito populations.

Evaluation of a standardised protocol to measure the disease burden of respiratory syncytial virus infection in young children in primary care

Background

A better understanding of the burden of respiratory syncytial virus (RSV) infections in primary care is needed for policymakers to make informed decisions regarding new preventive measures and treatments. The aim of this study was to develop and evaluate a protocol for the standardised measurement of the disease burden of RSV infection in primary care in children aged < 5 years.

Methods

The standardised protocol was evaluated in Italy and the Netherlands during the 2019/20 winter. Children aged < 5 years who consulted their primary care physician, met the WHO acute respiratory infections (ARI) case definition, and had a laboratory confirmed positive test for RSV (RT-PCR) were included. RSV symptoms were collected at the time of swabbing. Health care use, duration of symptoms and socio-economic impact was measured 14 days after swabbing. Health related Quality of life (HRQoL) was measured using the parent-proxy report of the PedsQL™4.0 generic core scales (2–4 years) and PedsQL™4.0 infant scales (0–2 years) 30 days after swabbing. The standardised protocol was evaluated in terms of the feasibility of patient recruitment, data collection procedures and whether parents understood the questions.

Results

Children were recruited via a network of paediatricians in Italy and a sentinel influenza surveillance network of general practitioners in the Netherlands. In Italy and the Netherlands, 293 and 152 children were swabbed respectively, 119 and 32 tested RSV positive; for 119 and 12 children the Day-14 questionnaire was completed and for 116 and 11 the Day-30 questionnaire. In Italy, 33% of the children had persistent symptoms after 14 days and in the Netherlands this figure was 67%. Parents had no problems completing questions concerning health care use, duration of symptoms and socio-economic impact, however, they had some difficulties scoring the HRQoL of their young children.

Conclusion

RSV symptoms are common after 14 days, and therefore, measuring disease burden outcomes like health care use, duration of symptoms, and socio-economic impact is also recommended at Day-30. The standardised protocol is suitable to measure the clinical and socio-economic disease burden of RSV in young children in primary care.

POS0177 POTENTIAL INVOLVEMENT OF IL-40 AND IL-40-PRODUCING CELLS IN PRIMARY SJOGREN’S SYNDROME (pSS) AND pSS-ASSOCIATED LYMPHOMA

Background:

The pathogenesis of pSS relies on a complex interplay between both innate and adaptive immune responses in which B cells play a pivotal role. Their chronic aberrant hyperactivation may drive clonal escape and consequent lymphomagenesis [1]. In the last few years, B cells have emerged as potential effector cells, able to release a wide range of cytokines that actively contribute to shape the microenvironment they act in. Recently, IL-40, a novel B cell associated cytokine encoded by an uncharacterized gene (C17orf99; chromosome 17 open reading frame 99) was described. Naïve B cells can express IL-40 at both tissue and peripheral level and the stimulation of B cells with IL-4 and TGF-β significantly increases IL-40 release. In addition, human B cells lymphomas are able to constitutively produce IL-40 [2]. Taking into account this emerging evidence and considering the well-known role of IL-4 and TGF-β in pSS pathogenesis, as well as the association with lymphomas, we decided to focus our attention on IL-40 in pSS patients.

Objectives:

The aim of the present study was to investigate IL-40 expression in the salivary glands of patients affected by pSS and pSS-associated non-Hodgkin’s lymphoma (NHL).

Methods:

Minor salivary gland biopsies were obtained from 22 patients with pSS and 12 patients with non-specific chronic sialoadenitis (nSCS), included as controls. Paraffine-embedded samples of parotid glands from patients with a previous diagnosis of pSS-associated NHL (n=10) were selected from the biopsy bank of the Pathology Unit of the Ospedale Cervello (Palermo, Italy). Quantitative gene expression analysis by TaqMan real-time PCR and immunohistochemistry (IHC) for IL-40, IL-4, TGF-β1 was performed on salivary glands from patients and controls. The cellular sources of IL-40 among infiltrating inflammatory cells were determined by fluorescence-activated cell sorting (FACS) analysis and immunofluorescence (IF). Serum IL-40 levels were measured by ELISA in both patients (n=10) and controls (n=9).

Results:

IL-40 was significantly increased at both protein and mRNA level in the inflamed salivary glands of patients with pSS where a positive strong correlation between the IL-40 mRNA levels and the focus score (FS) was evidenced. The expression of IL-40 in parotid glands of pSS-associated NHL was also markedly increased (Figure 1). IL-40 expression correlated with the presence of IL-4 and TGF-β; both cytokines were significantly increased in pSS at mRNA and protein level. Among infiltrating immune cells, CD19+ B cells resulted the major source of IL-40. However, we identified CD4+, CD8+ T cells and CD68+ macrophages as additional producers of IL-40 in both FACS and IF analysis. The ELISA test also showed a significant increase of serum IL-40 concentration in pSS patients (p value = 0.0190), compared to controls.

Conclusion:

Our preliminary results suggest that IL-40 may play a role in the pathogenesis of pSS and pSS-associated NHL. To the best of our knowledge, this is the first demonstration of the overexpression of this cytokine in salivary gland tissue and sera in pSS. Moreover, we demonstrated that IL-40 is produced by several cellular types, such as T cells and macrophages, and is not exclusively released by B cells. Further studies are necessary to clarify IL-40 pathways and functions in order to unravel IL-40 possible role in pSS development.

References:

[1]Mariette X, Criswell LA. Primary Sjogren’s Syndrome. N Engl J Med. 2018;379(1):97.

[2]Catalan-Dibene J, Vazquez MI, Luu VP, Nuccio SP, Karimzadeh A, Kastenschmidt JM, et al. Identification of IL-40, a Novel B Cell-Associated Cytokine. J Immunol. 2017;199(9):3326-35.

Figure 1.

IL-40 overexpression in pSS and pSS-associated lymphoma A, Salivary gland biopsies stained for IL-40 showing a marked increase in IL-40 expression in presence of higher focus score. B, Parotid gland specimens of pSS-associated lymphoma showing intense staining for IL-40.

Disclosure of Interests:

Chiara Rizzo: None declared, Marianna Lo Pizzo: None declared, Leila Mohammadnezhad: None declared, Vincenzo Luca Lentini: None declared, Diana Di Liberto: None declared, Giulia Grasso: None declared, Piero Ruscitti Consultant of: Pfizer, Novartis, Celgene, Abbvie, Roche, Lilly, Rorberto Giacomelli Consultant of: Pfizer, Novartis, Celgene, Abbvie, Roche, Lilly, francesco ciccia Consultant of: Pfizer, Novartis, Celgene, Abbvie, Roche, Lilly, Giuliana Guggino Consultant of: Pfizer, Novartis, Celgene, Abbvie, Roche, Lilly

Combustion of n-C3-C6 Linear Alcohols: An Experimental and Kinetic Modeling Study. Part I: Reaction Classes, Rate Rules, Model Lumping, and Validation

This work (and the companion paper, Part II) presents new experimental data for the combustion of n-C3-C6 alcohols (n-propanol, n-butanol, n-pentanol, n-hexanol) and a lumped kinetic model to describe their pyrolysis and oxidation. The kinetic subsets for alcohol pyrolysis and oxidation from the CRECK kinetic model have been systematically updated to describe the pyrolysis and high- and low-temperature oxidation of this series of fuels. Using the reaction class approach, the reference kinetic parameters have been determined based on experimental, theoretical, and kinetic modeling studies previously reported in the literature, providing a consistent set of rate rules that allow easy extension and good predictive capability. The modeling approach is based on the assumption of an alkane-like and alcohol-specific moiety for the alcohol fuel molecules. A thorough review and discussion of the information available in the literature supports the selection of the kinetic parameters that are then applied to the n-C3-C6 alcohol series and extended for further proof to describe n-octanol oxidation. Because of space limitations, the large amount of information, and the comprehensive character of this study, the manuscript has been divided into two parts. Part I describes the kinetic model as well as the lumping techniques and provides a synoptic synthesis of its wide range validation made possible also by newly obtained experimental data. These include speciation measurements performed in a jet-stirred reactor (p = 107 kPa, T = 550-1100 K, φ = 0.5, 1.0, 2.0) for n-butanol, n-pentanol, and n-hexanol and ignition delay times of ethanol, n-propanol, n-butanol, n-pentanol/air mixtures measured in a rapid compression machine at φ = 1.0, p = 10 and 30 bar, and T = 704-935 K. These data are presented and discussed in detail in Part II, together with detailed comparisons with model predictions and a deep kinetic discussion. This work provides new experimental targets that are useful for kinetic model development and validation (Part II), as well as an extensively validated kinetic model (Part I), which also contains subsets of other reference components for real fuels, thus allowing the assessment of combustion properties of new sustainable fuels and fuel mixtures.

Combustion of n-C3-C6 Linear Alcohols: An Experimental and Kinetic Modeling Study. Part II: Speciation Measurements in a Jet-Stirred Reactor, Ignition Delay Time Measurements in a Rapid Compression Machine, Model Validation, and Kinetic Analysis

This work presents new experimental data for n-C3-C6 alcohol, combustion (n-propanol, n-butanol, n-pentanol, n-hexanol). Speciation measurements have been carried out in a jet-stirred reactor (p = 107 kPa, T = 550-1100 K, φ = 0.5, 1.0, 2.0) for n-butanol, n-pentanol, and n-hexanol. Ignition delay times of ethanol, n-propanol, n-butanol, and n-pentanol/air mixtures were measured in a rapid compression machine at φ = 1.0, p = 10 and 30 bar, and T = 704-935 K. The kinetic subsets for alcohol pyrolysis and oxidation from the CRECK kinetic model have been systematically updated to describe the pyrolysis and high- and low-temperature oxidation of this series of fuels as described in Part I of this work (Pelucchi M.; Namysl S.; Ranzi E.Combustion of n-C3-C6 linear alcohol: an experimental and kinetic modeling study. Part I: reaction classes, rate rules, model lumping and validation. Submitted to Energy and Fuels, 2020). Part II describes in detail the facilities used for this systematic experimental investigation of n-C3-C6 alcohol combustion and presents a complete validation of the kinetic model by means of comparisons with the new data and measurements previously reported in the literature for both pyrolytic and oxidative conditions. Kinetic analyses such as rate of production and sensitivity analyses are used to highlight the governing reaction pathways and reasons for existing deviations, motivating possible further improvements in our chemistry mechanism.

Residential cardiac rehabilitation (rCR) derived survival predictors in patients after transcatheter aortic valve replacement (TAVR): a retrospective multicenter study

Purpose

To evaluate exercise-based rCR derived outcome predictors in patients referred after TAVR.

Methods

Data of 434 patients (aged 81±6 years) admitted to an average 3-week rCR program after TAVR (walking, up to 30 minutes of cycling or treadmill session twice daily, respiratory and calistenic training) from January 2009 to December 2017 and home discharged, were retrospectively collected at 10 Italian rCR Division of Istituti Clinici Maugeri SpA. Comorbidity (cumulative illness rated state-comorbidity index) (CIRS-CI) score, echocardiography on admission, Disability (Barthel Index) (BI) score, Morse Fall Scale score (MFS), six minutes walking test distance (6MWT) on admission and discharge and maximal training session intensity (MTSI expressed in METs per minutes) were collected. The mortality was assessed up to 3 years after rCR discharge.

Results

During a 3-years follow up there were 120 (28%) deaths. At t-test analysis non survivors compared to survivors had significantly higher CIRS CI (p=0.000), MFS score on admission (p=0.008) and discharge (p=0.017), serum creatinine level on admission (p=0.000) and discharge (p=0.000); moreover they had significantly lower BI score on admission (p=0.000) and discharge (P=0.000), left ventricle ejection fraction (p=0.008),6MWT on admission (p=0.001) and discharge (p=0.000) and MTSI (p=0.022) in comparison to survivors.

At multivariate logistic stepwise analysis, BI score on admission and serum creatinine level at discharge were the only independent predictors of mortality (Table 1); the AUC of the final logistic model was 0.72.

Conclusions

Patients attending rCR after TAVR seem to be very old; overall mortality at 3 years follow up in patients discharged home after rCR is substantial. Disability profile on admission (measured by Barthel Index) and impaired renal function on discharge (measured by creatinine levels) are independently correlated to death at long term follow up.

Funding Acknowledgement

Type of funding source: None

Integrated strategies of participatory surveillance to promote flu vaccine coverage in HCWs

Problem

Influenza represents a threat for healthcare facilities where sudden outbreaks of illness can lead to high morbidity and mortality in vulnerable patients and increase absenteeism in HCWs. Despite WHO recommends annual influenza vaccination of HCWs, flu vaccine coverage (FVC) remain very low in most EU countries.

Description of the Problem

Despite an important increase in FVC recorded in last years in our hospital, FVC remains under 75%. We pilot a prospective cohort study in HCWs in order to test new methods for influenza vaccination promotion. We create a web-based system integrating information on vaccination status (unvaccinated HCWs, 1/2/3 years vaccinated ones) and demographic data. The Hospital Ethical Committee approved the study. During the 2019/20 influenza season we nested a test-negative case-control study in the cohort to evaluate Influenza vaccine effectiveness against influenza-like-illness (ILI) laboratory confirmed as influenza in HCWs.

Results

A total of 443 on 2675 HCWs were recruited in the cohort and weekly received specific SMS messages and phone call for a personal invitation to get flu shot. The median age of the cohort was 43,3 (range 21-72) with 128 male (28,9%). In the cohort a FVC of 26/205 (12,7%) was registered in HCWs never vaccinated in the previous 3 seasons. Nasopharyngeal swabs were distributed to 205 subjects for influenza confirmation and they received weekly messages in order to check their health status remanding to self-swab in the case of ILI symptoms.

Lessons

Using a new and integrated strategy for influenza vaccination promotion in HCWs can increase the FVC. The use of personal direct messages to HCWs and the possibility of confirming or excluding influenza in case of ILI symptoms in those vaccinated and unvaccinated, seems to be very effective in increasing vaccine coverage. Moreover, the cohort could be also used for further research studies as for example the effect of repeated influenza vaccination.

Key messages

The presented practice appears to be effective and could be applied to larger HCWs population. This strategy could be considered as a good practice of workplace vaccination promotion.

Endoscopic fasciotomy for chronic exertional compartment syndrome of the forearm: Clinical results of a new technique using an endoscopic carpal tunnel release device

Exertional compartment syndrome of the forearm is a rare pathology, occurring almost exclusively in motorcycle racers. The results of endoscopic techniques are similar to those of open fasciotomies, but they are less invasive and leave smaller scars. The aim of our study was to present a new endoscopic technique for superficial fasciotomy using the Agee® system and to describe the results. This was a single-center, retrospective descriptive study of 21 patients (36 forearms) operated on between 2006 and 2016. All patients but one were competitive motorcycle racers. The mean operating time was 38.2min (standard deviation (SD), 10.5min). The QuickDASH score was 23.3±10.2% preoperatively versus 1±2% postoperatively (mean±SD). Among the 18 patients who came back for a follow-up visit after 4.9±2.7 years, 17 (94%) were satisfied or very satisfied. The mean time before returning to sport was 4.3 weeks (SD, 1.8 weeks), 9 patients (50%) at the same level as before surgery, 8 (44%) at a higher level, and one at a lower level. There were a few minor complications (superficial vascular lesions, hematoma, transitory hypoesthesia) and symptoms recurred in two patients. Our technique yields outcomes similar to those of other published endoscopic procedures and allows early return to sport. It has the advantage of being based on the Agee endoscope, which is commonly used to treat carpal tunnel syndrome, making the procedure easy to master.

Combined treatment with myo-inositol, alpha-lipoic acid, folic acid and vitamins significantly improves sperm parameters of sub-fertile men: a multi-centric study

OBJECTIVE

Reduction in motility and number of spermatozoa and change in their morphology are some of the most relevant causes of male infertility. Production of reactive oxygen species may affect motility, morphology and DNA stability of spermatozoa. This study aimed at evaluating the effect of combined treatment with myo-inositol, alpha-lipoic acid, folic acid, betaine and vitamins (namely, Sinopol®) on semen parameters of sub-fertile men.

PATIENTS AND METHODS

We recruited 143 sub-fertile men, 26-53 years aged, no-smokers, without any testicular pathologies, with a normal endocrinological/metabolic profile, and no concomitant consumption of drugs. Out of them, 25 patients did not meet study inclusion criteria mainly due to the history of genital diseases that came to light after Sinopol® prescription. Among the 118 men that fulfilled inclusion criteria, 10 (8.4%) patients were lost at follow-up and in 8 (6.8%) cases the partner got pregnant spontaneously. Thus, 100 patients completed the study and semen analysis was performed before and after 90 days of treatment.

RESULTS

Semen quality improved after 90 days of treatments, with a statistically significant increase of sperm concentration (p=0.0009), of number of spermatozoa (p=0.0017), of progressive motility (p=0.0047), of total motile sperm count (p=0.0010), and of normal sperm morphology (p<0.0001).

CONCLUSIONS

For the first time we reported that a combination of nutraceuticals composed of myo-inositol, alpha-lipoic acid, folic acid, betaine and vitamins improves sperm parameters in sub-fertile men. We are aware that to clarify the clinical relevance of the data studies with larger sample sizes and longer durations are needed, as well as evaluation of myo-inositol and alpha-lipoic acid co-treatment effectiveness in improving the chances to obtain a pregnancy spontaneously or following assisted reproduction.

P4546Acute heart failure: speckle tracking echocardiography, a new ally in intensive care unit

Background

Acute Heart Failure (AHF) is a life-threatening condition with high mortality rate.

Purpose

The aim of our study was to identify the best predictors of in-hospital mortality and stay, among laboratory blood tests, clinic and echocardiographic (standard and by Speckle Tracking Echocardiography, STE) parameters in patients admitted to our Intensive Care Unit (ICU) for AHF.

Methods

We enrolled 57 patients (age 70±13 y, 70% man) admitted to our ICU with de novo AHF or acute decompensation of Chronic Heart Failure (CHF). Exclusion criteria were: active malignancies, chronic liver disease, absent acoustic echocardiographic window and patient refusal. At ICU admission, all patients were assessed with vital signs (heart rate, HR; systolic blood pressure, SBP), blood laboratory tests, standard echo and STE of left ventricle (LV), right ventricle (RV) and left atrium (LA). These indexes were then related to the length of stay and mortality.

Results

The population was finally composed of 52 patients, due to 5 in-hospital deaths. 56% had an ischemic aetiology, 26% idiopathic dilated cardiomyopathy, 11% valvular diseases, 7% other causes of HF. At admission, average HR was 78±16 bpm, SBP 119±24 mmHg and EF 33±13%. Among all the parameters, the ones that showed significant statistical correlation with the length of hospitalization (15,34±7.03 days) were plasmatic creatinine, SBP, Systolic Pulmonary Artery Pressure, high LV filling pressure (E/E' >12) and Peak Atrial Longitudinal Strain (PALS). The maximal dose of intravenous loop diuretics and inotropic drugs also showed a good correlation. Analysing the two sub-populations with mortality data, we observed that patients who died, had a significantly lower EF (19±9.62% vs 35±12.55%; p=0,01), but not a higher left atrial volume indexed (31.04±14.87 vs 26.36±12.03 ml/m2; p= ns) compared to the survivors; instead PALS was significant worse (10.08±4.62 vs 20.64±13,35%; p<001). Free wall RV Longitudinal Strain (fw-RVLS) values for the patients who died (−9.41±4.66%) were significantly lower than in survivors (−13.67±6.02%; p<0.01). LVGLS (Left Ventricular Global Longitudinal Strain) did not show statistical significant differences between the two populations. Based on the results of ROC analysis (Figure 1), we created a score to predict in-hospital mortality, composed of: EF, PALS and RVLS-free wall. The ideal cut point to predict mortality was >1.5.

Figure 1

Conclusions

AHF represents one of the major challenges in ICU. The use of a combined echocardiographic score, assessed at admission, could help to better predict mortality risk, in addition to commonly used indexes.

Natural history of a cohort of ABCD1 variant female carriers

BACKGROUND AND PURPOSE

The therapeutic scenario of X-linked adrenoleukodystrophy (X-ALD) is rapidly changing. Whereas the disease is well characterized in men, the condition remains to be fully clarified in women carrying ATP binding cassette subfamily D member 1 (ABCD1) variants. Specifically, data on clinical progression are needed, in order to recommend any appropriate management. The objective of this study was to outline the natural history of a cohort of untreated ABCD1 heterozygous female carriers.

METHODS

Longitudinal data from a single-center population of 60 carriers were retrospectively reviewed. Demographics, anthropometrics, serum very long chain fatty acid (VLCFA) levels, clinical parameters and the Adult ALD Clinical Score (AACS) were collected from every recorded visit in a 7-year period and analyzed to define the phenotype modifications, to determine factors associated with clinical features, and to estimate the annual progression rate and the subsequent sample size for interventional trials.

RESULTS

Thirty-two patients were eligible for the study, and 59.4% were symptomatic at baseline. Clinical severity worsens with age which increases risk of symptom onset, the cut-off of 41 years being crucial for phenoconversion. VLCFA levels were not predictive and did not change over time. Symptomatic carriers were followed up for 3.45 ± 2.1 years. The AACS increased at an annual rate of 0.24 points. The estimated sample size for 30% reduction in annual progression at 80% power was 272.

CONCLUSIONS

This study provides data on the natural disease progression of untreated ABCD1 heterozygous female carriers, demonstrating the relevance of aging. The estimated annual increase of the AACS will be useful for future interventional studies.

Global seroprevalence of rubella among pregnant and childbearing age women: a meta-analysis

Background

We conducted a meta-analysis of articles published between January 2000 and July 2016 with the aim of defining the proportion of rubella seronegative women of childbearing age (WCBA), providing the best information available on the seroprevalence of rubella in this population. We selected articles published in the time period between 2000 and 2016. The pooled prevalence of rubella seronegative women was calculated by a fixed effect model and a random effect model, according to the heterogeneity among studies. Studies were sub-grouped by population type (pregnant women and WCBA with no mention of ongoing pregnancy) and by geographic area [World Health Organization (WHO) region]. Sensitivity analysis was performed to assess the stability of results. We found important differences in rubella seronegativity prevalence estimates by WHO Region. About 88% of the studies conducted on pregnant women reported a seronegativity rate >5%. The pooled rubella seronegativity prevalence was 9.3%. When considering population groups, we obtained a seronegativity pooled estimate of 9.4% for pregnant women and of 9.5% for WCBA with no mention of ongoing pregnancy. This meta-analysis shows that the proportion of WCBA who are susceptible to rubella is still high. The figures are worrisome, taking into account that the WHO set at 5% the rubella susceptibility threshold for WCBA.

Noise characterization for resonantly enhanced polarimetric vacuum magnetic-birefringence experiments

In this work we present data characterizing the sensitivity of the Biréfringence Magnetique du Vide (BMV) instrument. BMV is an experiment attempting to measure vacuum magnetic birefringence (VMB) via the measurement of an ellipticity induced in a linearly polarized laser field propagating through a birefringent region of vacuum in the presence of an external magnetic field. Correlated measurements of laser noise alongside the measurement in the main detection channel allow us to separate measured sensing noise from the inherent birefringence noise of the apparatus. To this end, we model different sources of sensing noise for cavity-enhanced polarimetry experiments, such as BMV. Our goal is to determine the main sources of noise, clarifying the limiting factors of such an apparatus. We find our noise models are compatible with the measured sensitivity of BMV. In this context, we compare the phase sensitivity of separate-arm interferometers to that of a polarimetry apparatus for the discussion of current and future VMB measurements.

Prokaryotic assemblages in the maritime Antarctic Lake Limnopolar (Byers Peninsula, South Shetland Islands)

The potentially metabolically active components within the prokaryotic assemblages inhabiting the Antarctic Lake Limnopolar (Byers Peninsula, Maritime Antarctica) were investigated by a polyphasic approach which included culture-dependent and culture-independent methods (based on RNA molecules). Results support previous observations on the Proteobacteria and Bacteroidetes dominance, followed by Actinobacteria, in Antarctic lakes. In particular, Alpha-, Betaproteobacteria and Bacteroidetes were mainly detected by CARD-FISH and cDNA cloning, whereas Gammaproteobacteria and Actinobacteria dominated within the cultivable fraction. Overall, this study demonstrates the survival potential and physiological heterogeneity of the prokaryotic community in the Lake Limnopolar. The microbial community composition in the lake is affected by external influences (such as marine environment by sea spray and seabird dropping, and microbial mats and mosses of the catchment). However, most external bacteria would be inactive, whereas typical polar taxa dominate the potentially active fraction and are subsidized by external nutrient sources, thus assuming the main biogeochemical roles within the lake.

Pulsed high magnetic field measurement with a rubidium vapor sensor

We present a new technique to measure pulsed magnetic fields based on the use of rubidium in gas phase as a metrological standard. We have therefore developed an instrument based on laser inducing transitions at about 780 nm (D2 line) in rubidium gas contained in a mini-cell of 3 mm × 3 mm cross section. To be able to insert such a cell in a standard high-field pulsed magnet, we have developed a fibred probe kept at a fixed temperature. Transition frequencies for both the π (light polarization parallel to the magnetic field) and σ (light polarization perpendicular to the magnetic field) configurations are measured by a commercial wavemeter. One innovation of our sensor is that in addition to the usual monitoring of the light transmitted by the Rb cell, we also monitor the fluorescence emission of the gas sample from a volume of 0.13 mm³. Our sensor has been tested up to about 58 T.

Hybrid supramolecular gels of Fmoc-F/halloysite nanotubes: systems for sustained release of camptothecin

Novel supramolecular gel hybrids were prepared by self-assembly of Fmoc-l-phenylalanine in the presence of functionalized halloysite nanotubes and employed as carriers for the delivery of camptothecin molecules.

The impact of influenza virus B in Italy: myth or reality?

We describe the burden of influenza B infections in Italy over a 12-year study period. Influenza A and B viruses co-circulated throughout the period, with numbers of influenza B cases approaching or exceeding those of influenza A during three influenza seasons. Influenza B virus infections led to fewer admissions to an intensive care unit (ICU) and a lower mortality rate than influenza A from 2010 to 2015. However, only 16% of those admitted to ICU with influenza B had been immunized. This highlights the need for consistent influenza vaccination for identified risk groups. Our study demonstrates that influenza B virus infections are associated with substantial morbidity and that influenza surveillance and interventions including vaccination and treatment are still suboptimal. Our findings have important public health implications. Incorporating virus and epidemiological data will help obtain more accurate estimates of influenza disease burden and result in a better selection of influenza prevention and control strategies.

Large and prolonged food-borne multistate hepatitis A outbreak in Europe associated with consumption of frozen berries, 2013 to 2014

In May 2013, Italy declared a national outbreak of hepatitis A, which also affected several foreign tourists who had recently visited the country. Molecular investigations identified some cases as infected with an identical strain of hepatitis A virus subgenotype IA. After additional European Union/European Economic Area (EU/EEA) countries reported locally acquired and travel-related cases associated with the same outbreak, an international outbreak investigation team was convened, a European outbreak case definition was issued and harmonisation of the national epidemiological and microbiological investigations was encouraged. From January 2013 to August 2014, 1,589 hepatitis A cases were reported associated with the multistate outbreak; 1,102 (70%) of the cases were hospitalised for a median time of six days; two related deaths were reported. Epidemiological and microbiological investigations implicated mixed frozen berries as the vehicle of infection of the outbreak. In order to control the spread of the outbreak, suspected or contaminated food batches were recalled, the public was recommended to heat-treat berries, and post-exposure prophylaxis of contacts was performed. The outbreak highlighted how large food-borne hepatitis A outbreaks may affect the increasingly susceptible EU/EEA general population and how, with the growing international food trade, frozen berries are a potential high-risk food.

Comparative safety evaluation of 7-valent and 13-valent pneumococcal vaccines in routine paediatric vaccinations in four Italian regions, 2009 to 2011

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Hepatitis A outbreak in Italy, 2013: a matched case–control study

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Signal-based deployment planning for robot teams in tunnel-like fading environments

Deploying a multi-robot team in confined environments poses multiple challenges that involve task and motion planning, localization and mapping, safe navigation, coordination of robots and also communications among all of them. In recent years, increasing attention has been paid to these challenges by the robotics community, but many problems remain unresolved. In this paper we address a technique for planning the deployment of a robot team in so-called fading environments, such as tunnels or galleries, where signal propagation presents specific characteristics. In order to maintain constant connectivity and high signal quality in the communication network formed by the robots and the base station, the robot deployment is driven by real-time signal measurements. First, an analysis of the signal propagation to obtain the general characteristic parameters of the signals in this kind of environment is carried out. Second, a technique which uses these parameters to drive the deployment is developed. A general strategy for this kind of environment in which the signals exhibit similar behavior is implemented. A complete system involving all of the above-mentioned robotics tasks has been developed. Finally, the system has been evaluated by means of simulation and in a real scenario.

Ongoing outbreak of hepatitis A in Italy: preliminary report as of 31 May 2013

Since January 2013, an unusual increase in hepatitis A cases has been detected in northern Italy. A total number of 352 cases were reported to the integrated surveillance system between January and the end of May 2013 and this represents a 70% increase compared to the same period of the previous year. The outbreak is ongoing and the public health authorities are continuing their investigations to establish the transmission vehicle and to control the outbreak.

Low and decreasing vaccine effectiveness against influenza A(H3) in 2011/12 among vaccination target groups in Europe: results from the I-MOVE multicentre case-control study

Within the Influenza Monitoring Vaccine Effectiveness in Europe (I-MOVE) project we conducted a multicentre case–control study in eight European Union (EU) Member States to estimate the 2011/12 influenza vaccine effectiveness against medically attended influenza-like illness (ILI) laboratory-confirmed as influenza A(H3) among the vaccination target groups. Practitioners systematically selected ILI / acute respiratory infection patients to swab within seven days of symptom onset. We restricted the study population to those meeting the EU ILI case definition and compared influenza A(H3) positive to influenza laboratory-negative patients. We used logistic regression with study site as fixed effect and calculated adjusted influenza vaccine effectiveness (IVE), controlling for potential confounders (age group, sex, month of symptom onset, chronic diseases and related hospitalisations, number of practitioner visits in the previous year). Adjusted IVE was 25% (95% confidence intervals (CI): -6 to 47) among all ages (n=1,014), 63% (95% CI: 26 to 82) in adults aged between 15 and 59 years and 15% (95% CI: -33 to 46) among those aged 60 years and above. Adjusted IVE was 38% (95%CI: -8 to 65) in the early influenza season (up to week 6 of 2012) and -1% (95% CI: -60 to 37) in the late phase. The results suggested a low adjusted IVE in 2011/12. The lower IVE in the late season could be due to virus changes through the season or waning immunity. Virological surveillance should be enhanced to quantify change over time and understand its relation with duration of immunological protection. Seasonal influenza vaccines should be improved to achieve acceptable levels of protection.

Magnetic and electric properties of a quantum vacuum

In this report we show that a vacuum is a nonlinear optical medium and discuss what the optical phenomena are that should exist in the framework of the standard model of particle physics. We pay special attention to the low energy limit. The predicted effects for photons of energy smaller than the electron rest mass are of such a level that none have yet been observed experimentally. Progress in field sources and related techniques seem to indicate that in a few years vacuum nonlinear optics will be accessible to human investigation.

Circulation of West Nile virus lineage 1 and 2 during an outbreak in Italy

In 2011, from 26 September to 16 October, a small outbreak of West Nile virus (WNV) disease occurred on the island of Sardinia (Italy). According to the national case definition, six cases with acute neurological disease were confirmed in hospitalized patients, and four of them died; one of these was only 34 years old. In two case, WNV RNA was detected in urine, suggesting renal involvement. Sequence analysis showed lineage 1 and 2 circulation.