The anti-proliferative effects of a frankincense extract in a window of opportunity phase ia clinical trial for patients with breast cancer

PURPOSE

Boswellic acids, active components of frankincense, suppress tumor proliferation in vitro with a strong clinical trial safety profile in patients with inflammatory diseases. We performed a Phase Ia window of opportunity trial of Boswellia serrata (B. serrata) in patients with breast cancer to evaluate its biologic activity and safety.

METHODS

Patients with invasive breast cancer were treated pre-operatively with B. Serrata (2400 mg/day PO) until the night before surgery for a median of 11 days (SD 6 days; range: 5-23 days). Paraffin-embedded sections from pretreatment diagnostic core biopsies and post-treatment surgical excisions were evaluated using a tunnel assay and immunohistochemistry staining with Ki-67 antibodies. A non-intervention retrospective control arm consisting of core and surgical tissue specimens from untreated patients was used to compare patients treated with B. Serrata. The change in proliferation and apoptosis between diagnostic core specimens and surgical specimens was compared between the control and treatment groups using a two-tailed paired t-test.

RESULTS

Twenty-two patients were enrolled, of which 20 received treatment, and 18 had sufficient tissue for IHC. There was an increase in percent change in proliferation from core biopsy to surgical excision in the control group (n = 18) of 54.6 ± 21.4%. In the B. serrata-treated group there was a reduction in proliferation between core biopsy and excision (n = 18) of 13.8 ± 11.7%. This difference was statistically significant between the control and B. serrata-treated groups (p = 0.008). There was no difference in change in apoptosis. There were no serious adverse events related to the drug.

CONCLUSION

Boswellia serrata inhibited breast cancer proliferation and was well-tolerated in a Phase Ia window of opportunity trial.

1885: First total laryngectomy and artificial larynx in France

This year, 2023, is the 150th anniversary of the first total laryngectomy for cancer, by Theodor Billroth. The authors reconstruct the conditions under which, on March 12, 1885, this operation was then performed for the first time in France, by Leon Labbé, and present the man himself, and also M. Cadier, the inventive genius who designed the first artificial larynx used in this country.

Harmful impact of treatment refusal in T3-4M0 endolaryngeal squamous cell carcinoma candidates for total laryngectomy: A STROBE analysis

PURPOSE

To evaluate the consequences of treatment refusal in total laryngectomy (TL) candidates with T3-4M0 endolaryngeal squamous cell carcinoma (SCC).

MATERIALS AND METHODS

A retrospective observational study was conducted in an inception cohort of 576 isolated T3-4M0 endolaryngeal SCC candidates for TL consecutively managed between 1970 and 2019 in a French university teaching hospital. The main endpoint was survival time and cause of death in 2 groups. Group A, 4.5% of the cohort, consisted of 26 patients who declined any laryngeal treatment. Group B consisted of 550 patients who accepted TL. Accessory endpoints were causes of TL refusal and associated variables. The STROBE guideline was applied. The significance threshold was set at P<0.005.

RESULTS

One-and 3-year actuarial survival estimates increased significantly (P<0.0001) from 39% and 15% in group A, to 83% and 63% in group B, respectively. In group A, 92% of causes of death implicated index SCC progression, whereas in group B intercurrent disease, metachronous second primary, locoregional and/or metastatic SCC progression and postoperative complications accounted for 37%, 31%, 29%, and 2%, respectively. The actuarial survival estimates within group A increased significantly (P=0.0003) from 0% at 1-year in patients managed with isolated supportive care to 56% in patients managed with chemotherapy (reaching 0% at 5years). Reasons for TL refusal were fear of surgery, refusal of tracheostoma, loss of physiologic phonation, and certain comorbidities. Age and chronologic period correlated significantly with TL refusal. Median age decreased (P<0.001) from 69years in group A to 58 years in group B. Percentage TL refusal increased (P<0.0001) from 2% to 11% before and after start 1990, respectively.

CONCLUSION

The current study determined loss of survival with refusal of any laryngeal treatment including TL, noted benefit of chemotherapy associated to supportive care, and discussed the possible contribution of immunotherapy.

Successful 10-year outcomes after supracricoid partial laryngectomy for selected glottic squamous cell carcinoma classified as T3N0M0: A STROBE analysis

PURPOSE

To evaluate long-term oncological outcome for patients with selected glottic squamous cell carcinoma (SCC) classified as T3N0M0 treated by supracricoid partial laryngectomy (SCPL).

MATERIALS AND METHODS

Analysis of an inception cohort of 46 patients with isolated untreated SCC classified as T3N0M0 and minimum 10-year follow-up, consecutively treated by SCPL between 1982 and 2012 in a French university teaching hospital. The main endpoint was 5- and 10-year actuarial survival and local control estimates. Accessory endpoints comprised cause of death, screening for variables decreasing survival and increasing risk of local recurrence, oncologic consequences of local recurrence, and laryngeal preservation rate.

RESULTS

Five- and 10-year actuarial survival was 78.1%, and 53.3%, respectively. The main causes of death were intercurrent disease and metachronous second primary, each in 33.3% of cases. Postoperative mortality (aspiration pneumonia) was 2.1%. There were no significant correlations between survival and any study variables. Five- and 10-year local control was 90.5%. Overall local recurrence varied significantly (P=0.003), from 2.3% with negative margins (R0) to 100% with positive margins (R1) and/or dysplasia. Local recurrence was associated with a significantly (P<0.005) increased risk of nodal failure and distant metastasis, and reduced survival. Overall laryngeal preservation was 89.1%.

CONCLUSION

The present results suggest that SCPL should continue to be taught and that this type of partial laryngeal surgery should be included in the various organ-sparing strategies considered in advanced laryngeal cancer.

First Dark Matter Search Results from the LUX-ZEPLIN (LZ) Experiment

The LUX-ZEPLIN experiment is a dark matter detector centered on a dual-phase xenon time projection chamber operating at the Sanford Underground Research Facility in Lead, South Dakota, USA. This Letter reports results from LUX-ZEPLIN's first search for weakly interacting massive particles (WIMPs) with an exposure of 60 live days using a fiducial mass of 5.5 t. A profile-likelihood ratio analysis shows the data to be consistent with a background-only hypothesis, setting new limits on spin-independent WIMP-nucleon, spin-dependent WIMP-neutron, and spin-dependent WIMP-proton cross sections for WIMP masses above 9  GeV/c^{2}. The most stringent limit is set for spin-independent scattering at 36  GeV/c^{2}, rejecting cross sections above 9.2×10^{-48}  cm at the 90% confidence level.

Total laryngectomy for laryngeal cancer 150 years after its first description: A boon more than a calamity: A STROBE analysis

OBJECTIVE

To illustrate the boon rather than a calamity that total laryngectomy can be for a patient with laryngeal cancer in the 21st century.

MATERIAL AND METHOD

An observational retrospective analysis using the STROBE guideline compared two cohorts of patients with previously untreated cancer, managed by total laryngectomy: the first consisting of 123 patients collected by Morell Mackenzie during the fifteen years (1873-1887) following the initial description, and the second consisting of 53 patients consecutively treated in a French university otorhinolaryngology department during the fifteen years (2006-2020) preceding the 150th anniversary of the first performance. The main endpoint was the comparison of survival and locoregional control estimates (Kaplan-Meier life table method). Secondary endpoints comprised mortality estimates and causes, adjuvant treatments, and phonation modalities.

RESULTS

The 26.2%, 13.1%, and 13.1% 1-, 3-, and 5-year actuarial survival estimates in the Makenzie cohort increased to 88.6%, 68.4%, and 60.9% in the recent French cohort (P<0.0001). The 50.1%, 40.4%, and 34.7% 1-, 3-, and 5-year actuarial locoregional control estimates in the Mackenzie cohort increased to 83.7% (P<0.0001). The 77.7% overall mortality in the Mackenzie cohort decreased to 37.7% (P<.0001). In the Mackenzie cohort, 97.8% of deaths were related to postoperative complications and locoregional recurrence, compared to 50% in the recent French cohort. Distant metastasis, metachronous second primary tumor and intercurrent diseases, not mentioned in the Mackenzie cohort, generated 45% of deaths in the French cohort. Adjunctive treatment was not used in the Mackenzie cohort, whereas neck dissection and postoperative radiation therapy were associated in respectively 98.1% and 69.8% of cases in the French cohort. Phonation was not documented in the Mackenzie cohort; 50% of survivors in the French cohort used a phonatory implant.

CONCLUSIONS

The 20th century witnessed an incredible turn-around. Total laryngectomy, with limited indications, has transformed the etiology of deaths and no longer leaves patients "in a state of abject misery" as Morell Mackenzie put it in 1888.

Human Colonization with Antibiotic-Resistant Bacteria from Nonoccupational Exposure to Domesticated Animals in Low- and Middle-Income Countries: A Critical Review

Data on community-acquired antibiotic-resistant bacterial infections are particularly sparse in low- and middle-income countries (LMICs). Limited surveillance and oversight of antibiotic use in food-producing animals, inadequate access to safe drinking water, and insufficient sanitation and hygiene infrastructure in LMICs could exacerbate the risk of zoonotic antibiotic resistance transmission. This critical review compiles evidence of zoonotic exchange of antibiotic-resistant bacteria (ARB) or antibiotic resistance genes (ARGs) within households and backyard farms in LMICs, as well as assesses transmission mechanisms, risk factors, and environmental transmission pathways. Overall, substantial evidence exists for exchange of antibiotic resistance between domesticated animals and in-contact humans. Whole bacteria transmission and horizontal gene transfer between humans and animals were demonstrated within and between households and backyard farms. Further, we identified water, soil, and animal food products as environmental transmission pathways for exchange of ARB and ARGs between animals and humans, although directionality of transmission is poorly understood. Herein we propose study designs, methods, and topical considerations for priority incorporation into future One Health research to inform effective interventions and policies to disrupt zoonotic antibiotic resistance exchange in low-income communities.

Aggression, mini-aggression, and abuse against health care workers during the COVID-19 pandemic

Introduction

COVID-19 pandemic brought multiple negative consequences that go beyond the direct damage caused by the disease and that affect health systems as well. Complaints of attacks against health care workers became frequent and concerning. The objective of this survey was to characterize the frequency and type of violent behavior against front-line professionals in Latin America.

Material and methods

A cross-sectional electronic survey was carried out between January 11th to February 28th, 2022. Different health care workers from Latin America who have been delivering care at least from March 2020, regardless of whether they assist or not patients with COVID-19 were included. A non-probabilistic snowball sampling was performed, and the survey was

Results

The survey was responded by 3,544 participants from 19 countries (Figure 1); 58.5% were women, and the mean age was 41.9±11 years. The 70.8% were doctors, 16% nurses, 3.4% physiotherapists, and the remaining 9.8% had other functions within the health team. About 85.1% of physicians were specialists: 33.9% were cardiologists, 14.4% were intensivists or emergency physicians, 10.9% had some surgical specialty, 7.7% were pediatricians or related subspecialties, and the remaining 33.1% had other specialties. The 36.3% and 28.8% worked in public and private practice respectively, the remaining worked in both. Direct and regular care to COVID-19 patients was provided by 74.7% of all contestants.

Among the participants, 54.8% reported acts of violence: 95.6% suffered verbal violence, 11.1% physical violence, and 19.9% other types. 39.5% of respondents experienced it at least once a week. The acts of violence involved patients' relatives (32%), or patients together with their relatives (35.1%). The victims rated the stress level of these events with an average of 8.2±1.8 points (scale from 1 to 10). Approximately half of the health personnel who suffered an assault experienced psychosomatic symptoms after the traumatic event (Figure 2). Among the victims of violence, 56.2% considered changing their care tasks, and 33.6% abandoning their profession. However, only 23% of the health personnel attacked stated that they had made some type of legal action regarding these acts.

In a logistic regression model, doctors (OR 1.95, p&lt;0.01), nurses (OR 1.77, p=0.001), and administrative staff (OR 3.20, p&lt;0.01) suffered more violence than other health workers. Women more frequently suffered violence (OR 1.56, p&lt;0.01), as well as those who worked with patients with COVID-19 (OR 3.59, p&lt;0.01). Conversely, a lower probability of violence was observed at older ages (OR 0.96, p&lt;0.01).

Conclusion

We detected a high prevalence of violence against health personnel in Latin America during the current pandemic. Those caring for COVID-19 patients, younger staff, and women were found to be more vulnerable. It is imperative to develop strategies to mitigate these acts and their repercussions on the health team.

Funding Acknowledgement

Type of funding sources: None.

Effect of 2-hydroxy-4-(methylthio)butanoate (HMTBa) on milk fat, rumen environment and biohydrogenation, and rumen protozoa in lactating cows fed diets with increased risk for milk fat depression

Biohydrogenation-induced milk fat depression (MFD) is a reduction in milk fat synthesis caused by bioactive fatty acids (FA) produced during altered ruminal microbial metabolism of unsaturated FA. The methionine analog 2-hydroxy-4-(methylthio)butanoate (HMTBa) has been shown to reduce the shift to the alternate biohydrogenation pathway and maintain higher milk fat yield in high-producing cows fed diets lower in fiber and higher in unsaturated FA. The objective of this experiment was to verify the effect of HMTBa on biohydrogenation-induced MFD and investigate associated changes in rumen environment and fermentation. Twenty-two rumen cannulated high-producing Holstein cows [168 ± 66 d in milk; 42 ± 7 kg of milk/d (mean ± standard deviation)] were used in a randomized design performed in 2 blocks (1 = 14 cows, 2 = 8 cows). Treatments were control (corn carrier) and HMTBa (0.1% of diet dry matter). The experiment included a 7-d covariate period followed by 3 phases that fed diets with increasing risk of MFD. The diet during the covariate and low-risk phase (7 d) was 32% neutral detergent fiber with no additional oil. The diet during the moderate-risk phase (17 d) was 29% neutral detergent fiber with 0.75% soybean oil. Soybean oil was increased to 1.5% for the last 4 d. The statistical model included the random effect of block and time course data were analyzed with repeated measures including the random effect of cow and tested the interaction of treatment and time. There was no effect of block or interaction of block and treatment or time. There was no overall effect of treatment or treatment by time interaction for dry matter intake, milk yield, and milk protein concentration and yield. Overall, HMTBa increased milk fat percent (3.2 vs. 3.6%) and yield (1,342 vs. 1,543 g/d) and there was no interaction of treatment and dietary phase. Additionally, HMTBa decreased the concentration of trans-10 18:1 in milk fat and rumen digesta. Average total ruminal concentration of volatile FA across the day and total-tract dry matter and fiber digestibility were not affected by HMTBa, but HMTBa increased average rumen butyrate and decreased propionate concentration and increased total protozoa abundance. Additionally, HMTBa increased the fractional rate of α-linoleic acid clearance from the rumen following a bolus predominantly driven by a difference in the first 30 min. Plasma insulin was decreased by HMTBa. In conclusion, HMTBa prevented the increase in trans FA in milk fat associated with MFD through a mechanism that is independent of total volatile FA concentration, but involves modification of rumen biohydrogenation. Decreased propionate and increased butyrate and ruminal protozoa may also have functional roles in the mechanism.

AB0684 Fatigue Assessment in Systemic Sclerosis, Santo Domingo, Dominican Republic

Background

Systemic sclerosis (SSc) is a systemic autoimmune disease.1 Fatigue has been reported in 75% of SSc patients, and is the most problematic symptom due to impact on quality of life. Despite its high prevalence, origin is unknown.2 Some studies associate it with the degree of disease activity and decreased quality of life. Fatigue is defined as a feeling of exhaustion, also as a reduction in physical and mental capacity,3 scales such as FACIT-F (Functional Assessment of Chronic Illness Therapy-Fatigue) are used, which evaluates the last 7 days, with a score of 0-52. For the severity analysis, 4 grades are used: no or mild fatigue (40-52), moderate (27-39), severe (14-26) and extreme (0-13).4,5

Objectives

To evaluate the frequency and degree of fatigue in systemic sclerosis.

Methods

Prospective, longitudinal, observational study of the cohort of patients of the Rheumatology service of the Hospital Docente Padre Billini. Patients were interviewed in November 2021. Inclusion criteria: ≥18 years, diagnosis of SSc according ACR/EULAR 2013 classification criteria. Exclusion criteria: previous diagnosis of fibromyalgia, depression or anxiety, treatment with antidepressants, antihistamines, beta-blockers. Measurement of FACIT-F, HAQ-DI, mRSS scales. Statistical analysis was performed with the Pearson correlation (rp) with p=>0.05. The data was analyzed by SPSS V23.

Results

54 met inclusion criteria. 100% female, mean age 53.3±15.1 years, mean disease duration 11.3 years, SScd 75.9% (41), SScl 24.1% (13), interstitial pneumonia 33.3% (18), gastrointestinal reflux disease 27.8% (15), HAP 20.37% (11). Frequency of fatigue 100% (54): moderate FACIT-F: 29.6% (16), severe FACIT-F 38.8% (21), extreme 31.5% (17). Correlation FACIT-F with mRSS and HAQ-DI: Moderate FACIT-F: mRSS mild 43.8% (7), moderate 12.5% (2), severe 18.8% (3), terminal 25% (4), HAQ-DI mild 25% (4), moderate 37.5% (6), severe 18.8% (3). Severe FACIT-F: mRSS normal 4.8% (1), mild 19% (4), moderate 91% (4), severe 33.3 % (7), terminal 23.8% (5), HAQ-DI mild 4.8% (1), moderate 19% (4), severe 47.6% (10). FACIT-F extreme: mRSS mild 7.61% (3), moderate 29.4% (5), severe 35.3% (6), terminal 17.6% (3), HAQ-DI moderate 11.8% (2), severe 52.9% (9). rp=. 246 p>0.05

Conclusion

The study demonstrated a high frequency of fatigue. The most frequent degree was severe. A statistically significant linear association was observed between skin involvement and the degree of functional limitation.

References

[1]Basta F, Afeltra A, Margiotta DPE. Fatigue in systemic sclerosis: a systematic review. Clin Exp Rheumatol. 2018.

[2]Chernis, J., Buni, M., Kazzaz, S., Ying, J., Lyons, M., Assassi, S. and Mayes, M., 2021. Predictors of Perceived Functional Status in Early Systemic Sclerosis: A Prospective Longitudinal Study of the GENISOS Cohort. Arthritis Care & Research.

[3]Stamm, T., Mosor, E., Omara, M., Ritschl, V., & Murphy, S. L. (2020). How can fatigue be addressed in individuals with systemic sclerosis? The Lancet Rheumatology, 2(3), e128-e129.

[4]Nakayama, A., Tunnicliffe, D., Thakkar, V., Singh-Grewal, D., O’Neill, S., Craig, J. and Tong, A., 2016. Patients’ Perspectives and Experiences Living with Systemic Sclerosis: A Systematic Review and Thematic Synthesis of Qualitative Studies. The Journal of Rheumatology, 43(7), pp.1363-1375.

[5]Acaster, S., Dickerhoof, R., DeBusk, K., Bernard, K., Strauss, W. and Allen, L., 2015. Qualitative and quantitative validation of the FACIT-fatigue scale in iron deficiency anemia. Health and Quality of Life Outcomes, 13(1).

Disclosure of Interests

None declared

AB0217 FREQUENCY OF SEXUAL DYSFUNCTION IN RHEUMATOID ARTHRITIS, SANTO DOMINGO, DOMINICAN REPUBLIC

Background

Rheumatoid arthritis (RA) is an inflammatory, autoimmune systemic disease that affects the synovial membrane of small joints.1 Kamissoko et al found the frequency of sexual dysfunction in RA to be 69.2%.2 Pain is considered to have a fundamental role associated with the decrease in the frequency of sexual intercourse.3 The CSFQ-14 (Changes in Sexual Functioning Questionnaire), evaluates the changes in sexual functioning due to a disease and/or treatment in 5 domains with a score range of 14-70; cut-off point indicating sexual dysfunction <41 men and <47 women.4

Objectives

To evaluate the frequency and degree of sexual dysfunction in patients with rheumatoid arthritis.

Methods

Prospective, observational, cross-sectional study of a cohort of patients of the Rheumatology Service at Hospital Docente Padre Billini. Patients were interviewed in July 2021. Inclusion criteria: > 18 years, diagnosis of RA according to the ACR/EULAR 2010 classification criteria, at least 1 sexual intercourse. Exclusion criteria: previous diagnosis of another autoimmune disease, depression, diabetes, treatment with antidepressants, antiepileptics, narcotics. Scales measured: CSFQ-14, DAS28. Statistical analysis was performed with the Pearson correlation (rp) with p>0.05. Data were analyzed in IBM-SPSS v23.

Results

Of the RA cohort, 483 met inclusion criteria. 93.4% (451) female, mean age 58±12.6 years, mean duration of diagnosis 8 years, married 53.8% (260), single 27.7% (134), widowed 16.6% (80), hypertension 73.9% (357), dyslipidemia 21.5% (104), obesity 18.0% (87), smoking 9.9% (48). Frequency of sexual dysfunction 61.3% (296). Sexual dysfunction in women 93.9% (278) and men 6.1% (18). Global domains: desire/interest 55.7% (165), desire/frequency 56.4% (167), pleasure 58.1% (172), arousal/excitement 67.2% (199), orgasm/completion 50.0% (148). Female: desire/interest 94.5% (156), desire/frequency 93.4% (156), pleasure 93.6% (161), arousal/excitement 93.0% (185), orgasm/completion 93.9% (139). Male: desire/interest 5.5% (9), desire/frequency 11.6% (11), pleasure 6.4% (11), arousal/excitement 7.0% (14), orgasm/completion 6.1% (9). Desire/interest dysfunction: DAS28 remission or low activity 28.5% (47), moderate 53.3% (88), high activity 4.8% (8). Desire/frequency: DAS28 remission or low activity 35.3% (59), moderate 47.3% (79), high activity 3.6% (6). Pleasure: DAS28 remission or low activity 30.2% (52), moderate 50.0% (86), high activity 2.9% (5). Arousal/excitement: DAS28 remission or low activity 25.1% (50), moderate 55.8% (111), high activity 6.0% (12). Orgasm/completion: DAS28 remission or low activity 43.2% (64), moderate 38.5% (57), high activity 6.1% (9).

Conclusion

The study showed a high frequency of sexual dysfunction, observing greater dysfunction in females. In the population, the most affected global domain was arousal/excitement, and it was the most frequent in female and male.

References

[1]Gomero García, D., 2018. Artritis reumatoide, epidemiología, fisiopatología, criterios diagnósticos y tratamiento. Revista de Medicina e Investigación Universidad Autónoma del Estado de México, 6(2).

[2]Kamissoko, A.B., Edikou, T.N.R., Barry, A., Sanda, M., Fofana, K., Irie, L.N.E., Diallo, M.L. and Oniankitan, O. (2021) Sexuality of Women with Rheumatoid Arthritis in a West African Hospital. Open Journal of Rheumatology and Autoimmune Diseases, 11, 152-159

[3]Bay, L. et al. Sexual Health and Dysfunction in Patients With Rheumatoid Arthritis: A Cross-sectional Single-Center Study. Sexual Medicine, 8(4), pp.615-630.

[4]Clayton AH, McGarvey EL, Clavet GJ. The Changes in Sexual Functioning Questionnaire (CSFQ): development, reliability, and validity. Psychopharmacol Bull. 1997;33(4):731-45. PMID: 9493486.

Disclosure of Interests

None declared

AB0827 Frequency of sexual dysfunction axial spondyloarthritis, Santo Domingo, Dominican Republic

Background

Axial spondyloarthritis (SpAa) is a chronic inflammatory disease of unknown etiology that affects the axial skeleton, affecting peripheral joints, entheses and extra-articular structures, with a prevalence of 0.5-1% associated with HLA-B27+.1 The impact of Chronic disease is often multifactorial that affects physical, hormonal and psychological alterations, leading to problems of sexuality.2 The CSFQ-14 (Changes in Sexual Functioning Questionnaire), evaluates changes in sexual functioning due to disease and/or or treatment in 5 domains with a score range of 14-70; cut-off point indicating sexual dysfunction <41 men and <47 women.3,4

Objectives

To evaluate the frequency and degree of sexual dysfunction in patients with axial spondyloarthritis.

Methods

Prospective, observational, cross-sectional study. of the SpAa cohort of the Hospital Docente Padre Billini rheumatology service Patients were interviewed in July 2021. Inclusion criteria: > 18 years, diagnosis of SpAa according to the ASAS 2009 classification criteria, at least 1 sexual. Exclusion criteria: previous diagnosis of another autoimmune disease, depression, diabetes mellitus (DM), treatment with antidepressants, antiepileptics, narcotics. Measurement of: CSFQ-14, BASDAI. Statistical analysis was performed with the Pearson correlation (rP) with p>0.05. The data was analyzed by SPSS V23.

Results

Of the SpAa cohort, 87 met the inclusion criteria. Male 67.8% (59), female 32.2% (28), mean age 45.7±8 years, mean diagnosis 7, married 67.8%(59), single 24.1%(21), widowed 8%(7), HLA-B27 + 51.1 %, hypertension 8% (7), diabetes 6.8% (6), dyslipidemia 10.3%(9), smokers 4.5%(4), 100% (87) bDMARD´s, 13.6% (12) combined with csDMARD´s, Frequency of sexual dysfunction 24.1%(21). Sexual dysfunction in women 6.9% (6) and men 17.2% (15) by CSFQ-14. Global domains: Desire/Interest 2.3% (2), Desire/Frequency 2.3% (2), Pleasure 5.7% (5), Arousal 2.3% (2), Orgasm/Completion 2.3% (2). Female: Desire/interest 6.8% (4), desire/Frequency 3.4% (2), pleasure 8.5% (5). Male: Desire/interest 3.4% (2), desire/Frequency 3.4% (2), pleasure 8.5% (5), arousal 6.8% (4), orgasm/completion 3.4% (2). Correlation CSFQ-14 domains with BASDAI: rp =. -0.088 p>0.05: Desire/interest dysfunction: inactive BASDAI 71.4% (15). Desire/frequency: inactive BASDAI 90.5% (20). Pleasure: inactive BASDAI 23.8% (5), active 23.8% (5). Excitation: inactive BASDAI 14.3% (3). Orgasm/completion> inactive BASDAI 90.5% (20)

Conclusion

The study showed a low frequency of sexual dysfunction, being more frequent in males. The greatest dysfunction was found in the pleasure domain in both sexes. A statistically significant inverse linear association was found between sexual dysfunction and disease activity.

References

[1]Gunaydin, R., Karatepe, AG, Cesmeli, N. & Kaya, T. Fatiga en pacientes con espondilitis anquilosante: relaciones con variables específicas de la enfermedad, depresión y trastornos del sueño. Reumatología clínica 28, 1045-1051 (2009).

[2]Helland, Y. et al. Enfermedades reumáticas y sexualidad: impacto de la enfermedad y estrategias de autocuidado. Arthritis Care Res. (Hoboken)63, 743–750 (2011).

[3]Badley EM (2008) Enhancing the conceptual clarity of the activity and participation components of the International Classification of Functioning, Disability and Health. Soc Sci Med 66: 2335–2345

[4]Clayton AH, McGarvey EL, Clavet GJ. The Changes in Sexual Functioning Questionnaire (CSFQ): development, reliability, and validity. Psychopharmacol Bull. 1997;33(4):731-45. PMID: 9493486.

Disclosure of Interests

None declared

AB0216 FATIGUE ASSESSMENT IN RHEUMATOID ARTHRITIS, SANTO DOMINGO, DOMINICAN REPUBLIC

Background

Rheumatoid arthritis (RA) is an inflammatory, systemic autoimmune disease affecting the synovial membrane of small joints.1 Wagan A. et al demonstrated that the frequency of fatigue in rheumatoid arthritis is 62%,2 Hammam et al described a higher rate of fatigue associated with higher disease activity. Fatigue is as a feeling of exhaustion, also as a reduction in physical and mental capacity,3,4 it can be measured with the scale FACIT-F (Functional Assessment of Chronic Illness Therapy-Fatigue), which evaluates the last 7 days, with a score of 0-52. For the severity analysis, 4 grades are used: no or mild fatigue (40-52), moderate (27-39), severe (14-26) and extreme fatigue (0-13).2,5

Objectives

To evaluate the frequency and degree of fatigue in rheumatoid arthritis.

Methods

Prospective, observational, cross-sectional study of a cohort of patients of the Rheumatology Service of the Hospital Docente Padre Billini. Patients were interviewed in July 2021. Inclusion criteria: ≥ 18 years, diagnosis of RA according to the ACR/EULAR 2010 classification criteria. Exclusion criteria: previous diagnosis of fibromyalgia, depression or anxiety, treatment with antidepressants, antihistamines, beta-blockers. Scales measured: FACIT-F, DAS28, CDAI, and HAQ-DI. Statistical analysis was performed with the Pearson correlation (rp). Data were analyzed in IBM-SPSS v23.

Results

597 patients met inclusion criteria. 93% female, mean age 58.5±12.4 years, mean disease duration 7.5 years. HT 73.9% (441), DM 14.2% (85), dyslipidemia 21.3% (127), obesity 17.9% (107), smoking 9.9% (59), high ESR 60.0% (358), high CRP 49.7% (297), scDMARD8 2.7% (494), bDMARDS 36.8% (218), tsDMARDS 18.1 (108). Frequency of fatigue 19.9% (119): moderate 12.9% (77), severe 7.0% (42). Correlation of FACIT-F with DAS28, CDAI and HAQ-DI: No fatigue FACIT-F 80.1% (478): DAS28 remission or low activity 84.9% (406), CDAI remission or low activity 93.5% (447), moderate 4.0% (19), high activity 2.5% (12), HAQ-DI mild 75.9% (363), moderate 16.5% (79), severe 7.5% (36). Moderate FACIT-F 12.9% (77): DAS28 remission or low activity 19.5% (15), moderate 80.5% (62), CDAI moderate 48.1% (37), high activity 51.9% (40), HAQ-DI mild 24.7% (19), moderate 63.6% (49), severe 11.7% (9). Severe FACIT-F 7.0% (42): DAS28 remission or low activity 4.8% (2), high activity 95.2% (40), CDAI low activity or remission 35.7% (15), high activity 64.3% (27), HAQ-DI mild 7.1% (3), moderate 23.8% (10), severe 69.0% (29). Correlation between FACIT-F/DAS28 (rp= .673, p< .001) and FACIT-F/CDAI (rp= .701, p < .001) were strong.

Conclusion

The study showed a low frequency of fatigue; the degree of fatigue most found was moderate. The group of patients with fatigue had a statistically significant linear association with disease activity and degree of functional limitation. There were no patients with extreme fatigue.

References

[1]Gomero García, D., 2018. Rheumatoid arthritis, epidemiology, pathophysiology, diagnostic criteria and treatment. Journal of Medicine and Research Universidad Autónoma del Estado de México, 6(2).

[2]Wagan AA, Raheem A, Bhatti A, Zafar T. Fatigue assessment by FACIT-F scale in Pakistani cohort with Rheumatoid Arthritis (FAF-RA) study. Pak J Med Sci. 2021;37(4).

[3]Hammam N, Gamal RM, Rashed AM, Elfetoh NA, Mosad E, Khedr EM. Fatigue in Rheumatoid Arthritis Patients: Association With Sleep Quality, Mood Status, and Disease Activity. Rheumatol Clin (Engl Ed). 2020 Sep-Oct;16(5 Pt 1):339-344.

[4]James K, Al-Ali S, Tarn J, Cockell SJ, Gillespie CS, Hindmarsh V, et al. (2015) A Transcriptional Signature of Fatigue Derived from Patients with Primary Sjögren’s Syndrome. PLoS ONE.

[5]Cella D. The Functional Assessment of Cancer Therapy-Anemia (FACT-An) Scale: a new tool for the assessment of outcomes in cancer anemia and fatigue. Semin Hematol. 1997 Jul;34(3 Suppl 2):13-9.

Disclosure of Interests

None declared

AB0963 Frequency of sexual dysfunction in psoriatic arthritis, Santo Domingo, Dominican Republic

Background

Psoriatic arthritis (PsA) is an inflammatory joint disease that cause structural damage, disability, and an impairment of quality of life.1Sexual function is a neglected area of quality of life in patients with PsA, with a high prevalence of dissatisfaction.2 It has been described that there is no relationship between the activity of the disease and the degree of joint dysfunction.3 In 1 out of 5 patients consider that the disease negatively impacts their sexuality.4 CSFQ-14 (Changes in Sexual Functioning Questionnaire), evaluates changes in sexual functioning due to an illness or treatment in 5 domains with a score range 14-70; cut-off point indicating sexual dysfunction -41 men and -47 women.5

Objectives

To evaluate the frequency and degree of sexual dysfunction in patients with psoriatic arthritis.

Methods

Prospective, observational, cross-sectional study. The patients of the outpatient clinic of the rheumatology service of the Padre Billini teaching hospital were interviewed during November 2021. Inclusion criteria: ≥18 years, PsA diagnosis according to CASPAR classification criteria 2006. Exclusion criteria: diagnosis of another autoimmune disease, depression, treatment with antidepressants. We analyzed the data in SPSS23 and used the Pearson correlation coefficient with a statistical significance p=<0.05 (rp) to relate the data.

Results

58 met inclusion criteria. 63.8% (37) female, male 36.2% (21), mean age 54.8 + 11.75 y, mean diagnosis 7.9 y, married 55.2% (32), unmarried 39.7% (23), widowed 5.2% (3). Frequency of sexual dysfunction 39.7% (23), CSFQ-14 indicative of dysfunction in women 35.1% (23), men 47.6% (10). Female Domains: Pleasure dysfunction 35.1% (13), desire/interest 32.4% (12), desire/frequency 32.4% (12), arousal 24.3% (9), orgasm/completion 43.2% (16). Male Domains: Pleasure dysfunction 38.1% (8), desire/interest 47.6% (10), desire/frequency 33.3% (7), arousal 23.8% (5), orgasm/completion 42.9% (9). Correlation CSFQ-14/DAPSA28 domains: Pleasure dysfunction: DAPSA remission 19.2% (5), low 32.1% (9), moderate 50% (2). Desire/interest: DAPSA remission 34.6% (9), low 32.1% (9), moderate 100% (4). Desire/frequency: DAPSA remission 30.8% (8), low 37.5% (10), moderate 25% (1). Excitation: DAPSA remission 30.8% (8), low 17.9% (5), moderate 25% (1). Orgasm/completion: DAPSA remission 50% (13), low 37.5% (10), moderate 50% (2). rp=. 042 p<0.05.

Conclusion

The study showed a modest frequency of global sexual dysfunction. In men it was superior. The orgasm/completion domain proved to be the most dysfunctional in both sexes. A statistically significant linear association of sexual dysfunction and disease activity was evident.

References

[1]Reygaerts T. Effect of Biologics on Fatigue in Psoriatic Arthritis: A Systematic Literature Review with Metaanalysis, Joint Bone Spine (2018).

[2]Esteve E et al. Preliminary development of a questionnaire assessing the impact of psoriasis and psoriatic arthritis on patient’s perception of sexuality. Medicine (Baltimore). 2018

[3]Aguiar R, Ambrósio C. Sexuality in spondyloarthritis-the impact of the disease. Acta Reumatol Port. 2014 Apr-Jun;39(2):152-7. PMID: 25254264.

[4]G Haugeberg, (2020): Perceived influence of health status on sexual activity in patients with psoriatic arthritis, Scandinavian Journal of Rheumatology.

[5]Clayton AH, McGarvey EL. The Changes in Sexual Functioning Questionnaire (CSFQ): development, reliability, and validity. Psychopharmacol Bull. 1997;33(4):731-45.

Disclosure of Interests

None declared

AB0682 Frequency of sexual dysfunction in systemic sclerosis, Santo Domingo, Dominican Republic

Background

Systemic sclerosis (SSc) is a systemic autoimmune disease.1 Sexual function has been associated with a high prevalence of dissatisfaction.2,3,4 Various factors have been implicated as causes of impaired sexual function.5 CSFQ-14 (Changes in Sexual Functioning Questionnaire) assesses changes in sexual functioning due to disease and/or treatment in 5 domains with a score range of 14-70; cut-off point indicating sexual dysfunction < 41 men and < 47 women.6

Objectives

To evaluate the frequency and degree of sexual dysfunction in patients with systemic sclerosis.

Methods

Prospective, observational, cross-sectional study of the cohort of the Rheumatology service at Hospital Docente Padre Billini. Patients were interviewed in November 2021. Inclusion criteria: > 18 years, diagnosis of SSc by ACR/EULAR 2013 classification criteria, at least 1 sexual relationship. Exclusion criteria: previous diagnosis of another autoimmune disease, depression, diabetes, treatment with antidepressants, antiepileptics, narcotics. Measurement of CSFQ-14, mRSS. Statistical analysis was performed with the Pearson correlation (rp) with p=>0.05. The data was analyzed by SPSS V23.

Results

Of 63 patients, 54 met the inclusion criteria. 100% female, mean age 53 + 15.07 years, mean duration 11.3 years, lSSc 24.1% (13), dSSc 75.9% (41), single 50% (27), married 44.4% (24), widowed 5.6% (3). Frequency of sexual dysfunction 81.5% (44). Domains: pleasure 79.6% (43), desire/interest 37% (20), frequency desire 81.5% (44), arousal 46.3% (25), orgasm/completion 75.9% (41). Correlation CSFQ-14 with mRSS: Pleasure dysfunction: normal mRSS 2.3% (1), mild 23.3% (10), moderate 20.9% (9), severe 32.6% (14), terminal 20.9% (9). Desire/interest dysfunction: mild mRSS 35% (7), moderate 20% (4), severe 35% (7), terminal 10% (2). Frequency desire dysfunction: normal mRSS 2.3% (1), mild 25% (11), moderate 15.7% (12), severe 36.4% (16), terminal 20.5% (9). Arousal dysfunction: normal mRSS 4% (1), mild 16% (4), moderate 16% (4), severe 36% (9), terminal 28% (7). Orgasm/completion dysfunction: normal mRSS 2.4% (1), mild 22% (9), moderate 22% (9), severe 26.8% (11), terminal 26.8% (11). rp=. 065 p> 0.05.

Conclusion

The study demonstrated a high frequency of sexual dysfunction in most of the population studied. The desire/frequency dysfunction domain turned out to be the one with the highest presentation, followed by the orgasm/completion domain. A statistically significant linear association between sexual dysfunction and cutaneous activity of the disease was evidenced.

References

[1]Basta F, Afeltra A, Margiotta DPE. Fatigue in systemic sclerosis: a systematic review. Clin Exp Rheumatol. 2018

[2]Heřmánková, B., 2019. Sexual Dysfunction in Patients with Systemic Sclerosis. New Insights into Systemic Sclerosis

[3]Gao, R., Qing, P., Sun, X., Zeng, X., Hu, X., Zhang, S., Yang, Y. and Qin, L., 2021. Prevalence of Sexual Dysfunction in People With Systemic Sclerosis and the Associated Risk Factors: A Systematic Review. Sexual Medicine, 9(4), p.100392.

[4]Frikha, F., Masmoudi, J., Saidi, N. and Bahloul, Z., 2014. Sexual dysfunction in married women with systemic sclerosis. Pan African Medical Journal, 17.

[5]Levis B, Burri A, Hudson M, Baron M, Thombs BD, et al. (2012) Sexual Activity and Impairment in Women with Systemic Sclerosis Compared to Women from a General Population Sample. PLoS ONE 7(12): e52129.

[6]Clayton AH, McGarvey EL, Clavet GJ. The Changes in Sexual Functioning Questionnaire (CSFQ): development, reliability, and validity. Psychopharmacol Bull. 1997;33(4):731-45.

Disclosure of Interests

None declared

Groundwater-surface water interactions and flux of organic matter and nutrients in an urban, Mediterranean stream

The chemical quality of dissolved organic matter (DOM) and the speciation of nitrogen exported from urban catchments is of great importance to biogeochemical cycling in riverine and coastal receiving waters. Many urban streams in Mediterranean climates have a flashy hydrologic regime, which would suggest a rapid pulsing and shunting of solutes downstream. However, the role of these systems both as passive pipes for solute transport or as reactors for DOM and nutrient transformation is still an open question for urban, Mediterranean streams. To address this question, we evaluated changes in concentrations of inorganic and organic solutes and DOM optical properties in Alvarado Creek, a perennially-flowing, urban, first-order tributary of the San Diego River in San Diego, CA, USA, during dry weather (baseflow) conditions and during four storm events in 2016-2018. Chloride and sulfate concentrations corroborate the supposed saline groundwater supply that maintains perennial flow and brackish nature in this urban stream. During dry weather, high proportions of protein-like fluorescent component (AC4) and downstream decreases in total dissolved nitrogen (TDN) and nitrate imply in-stream processing (nitrification and denitrification). By contrast, storm hysteresis curves indicate that the supply of DOM and TDN was not exhausted over the duration of a storm event, whereas nitrate was eventually depleted, presumably because nitrification could not keep up with the export of nitrate from source areas. Rapid decreases in chloride during the storm hydrograph coincided with a shift in specific ultraviolet absorbance (SUVA) and fluorescence index (FI) to more terrestrially-derived and aromatic carbon sources, most likely from interflow of stormwater through vadose zone soils. On an annual basis, the export of microbially-derived DOM during dry weather was higher than the export of terrestrially-derived DOM during storm events; both represent important carbon inputs to coastal waters.

Intraoperative Assessment of IDH Mutation Status and Tumor Invasioni in Glioma

Introduction/Objective

Maximizing surgical resection in gliomas, while avoiding compromising non-infiltrated tissue, is associated with survival benefit. Current methodologies are suboptimal in providing rapid, intraoperative molecular characterization of tissue. We address this unmet need by using desorption electrospray ionization mass spectrometry (DESI-MS) for the intraoperative molecular assessment of gliomas.

Methods/Case Report

This prospective study uses intraoperative DESI-MS analysis of fresh tissue to evaluate IDH mutations via 2-hydroxyglutarate intensity and TCP via measurement of N-acetylaspartic acid (NAA) intensity and characteristic lipid profiles in less than three minutes. Blinded review of the tissue smears by a neuropathologist is used to validate IDH mutation status and TCP estimates.

Results (if a Case Study enter NA)

Presently, 529 biopsies from 85 enrolled patients have been collected and analyzed at two institutions. TCP assessment based on NAA intensity in 203 biopsies at the first institution yielded sensitivity, specificity, and accuracy values of 91, 76, and 83%, whereas TCP estimates via characteristic lipid profiles yielded 76, 85, and 81%, respectively. Assessment of IDH mutation status of 71 core biopsies yielded sensitivity, specificity, and accuracy values of 89, 100, and 94%. Ongoing validation of the methodology is being performed at a second institution, where we have collected 282 biopsies from 36 patients. IDH mutation assessment of the first 15 patients indicate 100% sensitivity, specificity, and accuracy.

Conclusion

This study represents the first and largest study using DESI-MS for the intraoperative evaluation of IDH status and TCP measurement in gliomas. Prospectively, we propose to modify our DESI-MS system to allow estimation of IDH mutation status and TCP in surgical cavities without the need for a biopsy by placing a surgical material along the margin and transferring material from the blot to a microscope slide prior to DESI-MS analysis. We envision molecular analysis by DESI-MS as a complementary technique to histopathology capable of providing additional clinical information in near real-time.

Virtual Visits for Outpatient Burn Care during the COVID-19 Pandemic

Burn-injured patients must frequently travel long distances to regional burn centers, creating a burden on families and impairing clinical outcomes. Recent federal policies in response to the coronavirus pandemic have relaxed major barriers to conducting synchronous videoconference visits in the home. However, the efficacy and benefits of virtual visits relative to in-person visits remained unclear for burn patients. Accordingly, a clinical quality assurance database maintained during the coronavirus pandemic (3/3/2020 to 9/8/2020) for virtual and/or in-person visits at a comprehensive adult and pediatric burn center was queried for demographics, burn severity, visit quality, and distance data. A total of 143 patients were included in this study with 317 total outpatient encounters (61 virtual and 256 in-person). The savings associated with the average virtual visit were 130 ± 125 miles (mean ± standard deviation), 164 ± 134 travel minutes, &104 ± 99 driving costs, and &81 ± 66 foregone wage earnings. Virtual visit technical issues were experienced by 23% of patients and were significantly lower in pediatric (5%) than in adult patients (44%; p=0.006). This study is the first to assess the efficacy of synchronous videoconference visits in the home setting for outpatient burn care. The findings demonstrate major financial and temporal benefits for burn patients and their families. Technical issues remain an important barrier, particularly for the adult population. A clear understanding of these and other barriers may inform future studies as healthcare systems and payors move toward improving access to burn care through remote healthcare delivery services.

Molecular characterization of a cohort of individuals referred to genetic testing with suspected CPVT

Background

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is one of the most lethal inherited arrhythmogenic diseases and it mainly affects the young, in the absence of structural heart disease. This condition is difficult to diagnose and the first expression of disease can be an arrhythmic death. In the last years, genetic testing has become a useful tool in the challenging task of CPVT diagnosis.

The diagnostic yield of the genetic study is highly variable and dependent on the phenotypic characteristics of the individuals evaluated.

Purpose

This study aimed to address the clinical characteristics and genetic testing (GT) results in a cohort of individuals referred to genetic analysis with a non-definitive diagnosis of CPVT, in a real world-setting.

Methods

This is a retrospective cohort study of patients referred for GT with clinical suspicion of CPVT, but who did not strictly meet the diagnostic criteria for this disease (according to current guidelines). NGS genotyping was performed with a library of 251 genes. NGS-based genomic testing was performed with classification of identified variants according to American College of Medical Genetics and Genomics guidelines.

Results

One hundred and sixteen unrelated patients with available clinical information (patients' characteristics are summarized in TABLE1) were included in the analysis. Mean age at GT was 36 y/o (±19), 47% were women and 18% had a familial history of sudden cardiac death.

The first clinical manifestation was: exercise or stress induced syncope in 36%, exercise induced ventricular tachycardia in 30% and sudden cardiac arrest in 15.5% (78% during emotional or physical stress - 89% aborted sudden death). Mean age at sudden death was 20 y/o (±14).

GT was positive in 49.1% (n=57), negative in 37.9% (n=44) and inconclusive in 12.9% (n=15). We had identified pathogenic/likely pathogenic variants in CPVT-related genes in 40% of the referred patients: RYR2 (70.2%-n: 40), KCNJ2 (8.8%-n: 5), CASQ2 in homozygous/compound heterozygous carriers (3.5%-n: 2). In the RYR2 gene we detected 36 different genetic variants (13 were novel) in 40 different individuals. In addition, relevant variants were also identified in other genes associated with channelopathies (SCN5A, 3.5%, n: 2 and KCNQ1, 1.7%, n: 1) and in genes associated with structural heart disease: desmosomal genes (6.8%-DSP n: 1 and PKP2 n: 3) and sarcomeric genes (5.1%- MYBPC3 and MYH7) (figure 1A-B).

Conclusions

In our cohort of patients with non-definitive diagnosis of CPVT, the diagnostic yield of genetic testing was almost 50%. GT allowed confirmation of the suspicion of CPVT in 40% of the patients and, in addition, we were able to detect relevant genetic variants in other genes not associated with CPVT in 10% (differential diagnosis). The use of wide genetic panels would be useful in this context.

Funding Acknowledgement

Type of funding sources: None. Suspected CPVT. Genetic Testing.

Sperm donation: an alternative to improve post-ICSI live birth rates in advanced maternal age patients

STUDY QUESTION

Can sperm donation increase live birth rates following ICSI in advanced maternal age (AMA) patients?

SUMMARY ANSWER

Sperm donation increases the live birth rate in AMA ICSI cycles.

WHAT IS KNOWN ALREADY

In ICSI practice, sperm donation has been predominantly applied to overcome male infertility. The involvement of paternal age and lower sperm quality in the severe reduction in fertility observed in AMA patients remains to be clarified.

STUDY DESIGN, SIZE, DURATION

Retrospective multicenter cohort study including data generated between 2015 and 2019 from 755 ICSI cycles achieving a fresh embryo transfer, of which 337 were first homologous cycles (normozoospermic partner sperm and homologous oocytes) and 418 were first sperm donation cycles (donor sperm and homologous oocytes). The association of sperm origin (partner vs donor) with live birth was assessed by multivariate analysis in non-AMA (<37 years, n = 278) and AMA (≥37 years, n = 477) patients, separately, including in the model all variables previously found to be associated with live birth in a univariate analysis (number of MII oocytes recovered, number of embryos transferred, and maternal age). ICSI outcomes were compared between sperm donation and homologous cycles in overall, non-AMA and AMA patients.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The study was conducted in three fertility clinics and included 755 Caucasian patients aged 24-42 years undergoing their first homologous or sperm donation ICSI cycle achieving a fresh embryo transfer.

MAIN RESULTS AND THE ROLE OF CHANCE

The multivariate analysis revealed that sperm donation was positively associated with the likelihood of a live birth independently of all other variables tested in AMA (P = 0.02), but not in non-AMA patients. Live birth, delivery, and miscarriage rates differed substantially between sperm donation and homologous AMA cycles; live birth and delivery rates were 70-75% higher (25.4% vs 14.5% and 22.5% vs 13.5%, respectively; P < 0.01), while miscarriage occurrence was less than half (18.0% vs 39.5%; P < 0.01) in sperm donation compared to homologous AMA cycles.

LIMITATIONS, REASONS FOR CAUTION

This study is limited by its retrospective nature, differences in patients profiles between sperm donation and homologous-control groups and varying proportion of donor cycles between fertility centers, although these variations have been controlled for in the statistical analysis.

WIDER IMPLICATIONS OF THE FINDINGS

The findings suggest that sperm donation increases live birth rates while reducing miscarriage occurrence in AMA patients, and thus may be a valid strategy to improve ICSI outcomes in this growing and challenging patient group.

STUDY FUNDING/COMPETING INTEREST(S)

N/A.

TRIAL REGISTRATION NUMBER

N/A.

P–079 A spontaneous LH peak before triggering for intrauterine insemination with donor sperm (IUI-D) is associated to lower live birth rates

Study question

Are live birth rates after IUI with donor sperm (IUI-D) and controlled ovarian stimulation comparable between women with a spontaneous LH peak vs those without?

Summary answer

Biochemical, clinical, ongoing pregnancy rates and live birth rates were higher among women without an LH peak.

What is known already

It is common clinical practice to trigger ovulation in IUI cycles once specific criteria are met; if a natural LH surge appears, adjusting the IUI timing may become necessary. Pregnancy rates seem to be slightly better when IUI is scheduled in relation to the presence or absence of an LH peak in non-stimulated cycles. In IUI with stimulated cycles, however, there is no consensus in the medical literature regarding the best moment to program the IUI, due to different inclusion criteria, different IUI timing and definition of LH peak among studies.

Study design, size, duration

Retrospective cohort study of 9,657 IUI-D cycles performed between 2012 and 2019 in one fertility center. IUI-D without LH peak (n = 6,679) versus IUI-D with LH peak (n = 2,978) were compared. Differences in pregnancy outcomes between study groups were evaluated using a Pearson’s Chi2 test. A p &lt; 0.05 was considered statistically significant.

Participants/materials, setting, methods

The definition used to define an LH peak is &gt; 10UI/L in the last follicular control. In cases without an LH peak, when at least one dominant follicle reached 17mm, ovulation was triggered with human chorionic gonadotropin in the following 24h, and IUI-D was performed 38h after triggering. In cases with an LH peak, ovulation was triggered the 6h following the detection, and IUI-D was also performed 38h later.

Main results and the role of chance

The women BMI and age were comparable between groups, with a mean±SD of 35.2±4.8 years old, and 24.3±4.7 for BMI. Other characteristics such as number of previous inseminations, type of stimulation drug, initial dose, total dose, stimulation length and number of follicles &gt; 16mm in the last follicular control were also comparable. As expected, the LH level at the last follicular control was different between groups, with a mean of 5.1UI/L in the no-LH peak and 21.4IU/L in the LH peak group. The group without an LH peak had higher biochemical, clinical, ongoing and live birth rates compared to the group with LH peak: 27.7% vs. 20.7%; 19.5% vs. 15.5%; 17.7% vs. 13.7%; 16.3% vs. 12.6%, respectively (p-value&lt;0.001).

Limitations, reasons for caution

The main limitation of the study is its retrospective nature. Also, a definition of LH peak based in absolute values was used; a definition based in relative values may lead to different results.

Wider implications of the findings: A definition of LH peak based on absolute numbers is imprecise, and the cut-off of 10UI/L does not allow a good scheduling for IUI. A LH peak based on relative values could improve the detection of patients starting ovulation and the accuracy in programming IUI.

Trial registration number

Not applicable

P–225 The effect of rapid and delayed insemination on reproductive outcome in conventional insemination and intracytoplasmic sperm injection invitro-fertilization cycles

Study question

Does rapid or delayed insemination after egg retrieval affect fertilization, blastocyst development and live birth rates in CI and ICSI cycles?

Summary answer

When performing CI or ICSI &lt;1.5h and &gt;6.5h after retrieval, detrimental effects are moderate on fertilization but do not impact blastocyst usage and birth rates.

What is known already

Several studies have shown that CIor ICSI performed between 3 to 5 h after oocyte retrieval has improved laboratory outcomes. However, some studies indicate that insemination of oocytes, by either CI or ICSI, within 2 hours or more than 8 hours after oocyte retrieval has a detrimental effect on the reproductive outcome. With some ART centres experiencing an increase in workload, respecting these exact time intervals is frequently challenging.

Study design, size, duration

A single-center retrospective cohort analysis was performed on 6559 patients (9575 retrievals and insemination cycles) between January 1st2017 to July 31st2019. The main outcome measures were live-birth rates. Secondary outcomes included analysis of fertilization per all oocytes retrieved, blastocyst utilization, clinical pregnancy, and miscarriage rates. All analyses used time of insemination categorized in both CI and ICSI cycles. Fertilization rates across categories was analyzed by ANOVA and pregnancy outcomes compared using Chi-square tests.

Participants/materials, setting, methods

As part of laboratory protocol, oocyte retrieval was performed 36 h post-trigger. Cycles involving injection with testicular/epidydimal sperm, donor or frozen oocytes were excluded. The time interval between oocyte retrieval and insemination was analyzed in eight categories: 0 (0- &lt;0.5h), 1 (0.5-&lt;1.5h), 2 (1.5-&lt;2.5h), 3 (2.5-&lt;3.5h), 4 (3.5-&lt;4.5), 5 (4.5-&lt;5.5), 6 (5.5-&lt;6.5) and 7 (6.5-&lt;8h). The number of retrievals in each group (0–7) was 586, 1594, 1644, 1796, 1836, 1351, 641 and 127 respectively.

Main results and the role of chance

This study had a mean patient age of 36.0 years and mean of 12.2 oocytes per retrieval in each category. There were 4,955 CI and 4,620 ICSI retrievals. The smallest groups were time category 7 and 0 for CI and ICSI respectively. The results showed that the mean fertilization rate per egg retrieved for CI ranged from 54.1 to 64.9% with a significant difference between time category 0 and 5 (p &lt; 0.001) and category 1 and 5 (p &lt; 0.0.001). Mean fertilization rate for ICSI per egg retrieved ranged from 52.8 to 67.3% with no significant difference between time categories compared to category 5. Blastocyst utilization rate for CI and ICSI were not significantly different for all time categories. In the CI and ICSI groups there were 6,540 and 6,178 total fresh and frozen transfers. The miscarriage and clinical pregnancy rate in CI and ICSI were not significantly different across time categories. The overall mean live birth rate for CI was 32.4% (range: 23.1 to 35.5%). Live-birth rates differed significantly (p = 0.04) in CI with time categories 0 and 7 the lowest. In the ICSI group, the overall mean live birth rate was 30.8% (range: 29.1 to 35.7%),with no significant differences between time categories.

Limitations, reasons for caution

As this is a retrospective study, the influence of uncontrolled variables cannot be excluded. The group spread was uneven with the early and late time categories having the lowest number of representative retrievals and this could have affected the results obtained.

Wider implications of the findings: Our results indicate that both CI and ICSI are optimal when performed between 1.5–6.5 hours after oocyte retrieval. Further prospective studies on reproductive outcomes related to time of insemination are warranted. This data indicates a minimal detrimental effect when it is untenable to follow strict insemination time intervals.

Trial registration number

2015P000122

O-171 Altered meiotic spindle morphology and composition in in vitro matured oocytes

Study question

How does the meiotic spindle tubulin PTMs of MII oocytes matured in vitro compare to that of MII oocytes matured in vivo?

Summary answer

MII cultured in vitro present detyrosinated tubulin in the spindle microtubules, while MII oocytes matured in vivo do not.

What is known already

A functional spindle is required for chromosomal segregation during meiosis, but the role of tubulin post-translational modifications (PTMs) in spindle meiotic dynamics remains poorly characterized. In contrast with GVs matured in vitro within the cumulus oophorous, in vitro maturation of denuded GVs to the MII stage (GV-MII) is associated with spindle abnormalities, chromosome misalignment and compromised developmental potential. Although aneuploidy rates in GV-MII are not higher than in vivo matured MII, disorganized chromosomes may contribute to compromised developmental potential. However, to date, spindle PTMs morphology of GV-MII has not been compared to that of in vivo cultured MII oocytes.

Study design, size, duration

GV (n = 125), and MII oocytes (n = 24) were retrieved from hormonally stimulated women, aged 20 to 35 years old. GVs were matured to the MII stage in vitro in G-2 PLUS medium for 30h; the maturation rate was 68,2%; the 46 GV-MII oocytes obtained were vitrified, stored, and warmed before fixing and subjecting to immunofluorescent analysis. In vivo matured MII oocytes donated to research were used as controls.

Participants/materials, setting, methods

Women were stimulated using a GnRH antagonist protocol, with GnRH agonist trigger. Trigger criterion was ≥2 follicles ≥18mm; oocytes were harvested 36h later. Spindle microtubules were incubated with antibodies against alpha tubulin and tubulin PTMs (acetylation, tyrosination, polyglutamylation, Δ2-tubulin, and detyrosination); chromosomes were stained with Hoechst 33342 and samples subjected to confocal immunofluorescence microscopy (ZEISS LSM780), with ImageJ software analysis. Differences in spindle morphometric parameters were assessed by non-parametric Kruskal–Wallis and Fisher’s exact tests.

Main results and the role of chance

Qualitatively, Δ2-tubulin, tyrosination and polyglutamylation were similar for both groups. Acetylation was also present in both groups, albeit in different patterns: while in vivo matured MII oocytes showed acetylation at the poles, GV-MII showed a symmetrical distribution of signal intensity, but discontinuous signal on individual microtubule tracts, suggesting apparent islands of acetylation. In contrast, detyrosination was detected in in vivo matured MII oocytes but was absent from GV-MII. Regarding spindle pole morphology, of the four possible phenotypes described in the literature (double flattened and double focused; flattened-focused, focused-flattened, with the first word characterizing the cortex side of the spindle), we observed double flat shaped spindle poles in 86% of GV-MII oocytes (25/29) as opposed to 40.5% (15/37) for the in vivo matured MII oocytes (p = 0.0004, Fisher’s exact test). Further morphometric analysis of the spindle size (maximum projection, major and minor axis length) and the metaphase plate position (proximal to distal ratio, angle) revealed decreased spindle size in GV-MII oocytes (p = 0.019, non parametric Kruskal- Wallis test).

Limitations, reasons for caution

Oocytes retrieved from hyperstimulation cycles could be intrinsically impaired since they failed to mature in vivo. Our conclusions should not be extrapolated to IVM in non-stimulated cycles, as in this model, the cumulus oophorus is a major factor in oocyte maturation and correlation with spindle dynamics has been inferred.

Wider implications of the findings

The metaphase II spindle stability compared to the mitotic or metaphase I meiotic one justifies the presence of PTMs such as acetylation and glutamylation, which are found in stable, long-lived microtubules. The significance of the absence of detyrosinated microtubules in the MII-GV group remains to be determined

Trial registration number

not applicable

P–013 Sperm freezing does not affect live birth rates: results from 6,594 cycles in normozoospermic patients

Study question

Does sperm cryopreservation influence the reproductive outcomes of normozoospermic patients undergoing elective ICSI?

Summary answer

After controlling for confounders, the use of cryopreserved semen from normozoospermic patients does not affect pregnancy and live birth rates after ICSI.

What is known already

Sperm cryopreservation with slow freezing is a common practice in ART. While frozen-thawed semen typically presents reduced motility and vitality, its use for ICSI is generally considered adequate in terms of reproductive outcomes. Nevertheless, most studies comparing reproductive outcomes between fresh versus cryopreserved sperm include patients with oligo- and/or asthenozoospermia, where the altered quality of the sample can partially mask the full effect of freezing/thawing. The objective of this study is to ascertain whether ICSI using fresh or cryopreserved semen from normozoospermic patients results in similar fertilization rates and reproductive outcomes.

Study design, size, duration

Retrospective cohort of 6,594 couples undergoing their first elective ICSI cycle between January 2011 and December 2019, using normozoospermic partner semen (fresh or cryopreserved). All cycles involved a fresh embryo transfer, either at cleavage or blastocyst stage. Cycles were divided in 4 groups: fresh semen with partner’s oocytes (FSPO, n = 1.878), cryopreserved semen with partner’s oocytes (CSPO, n = 142), fresh semen with donor oocytes (FSDO, n = 2.413), and cryopreserved semen with donor oocytes (CSDO, n = 2.161).

Participants/materials, setting, methods

A slow freezing protocol using GM501 SpermStore medium (Gynemed, Lensahn) was used for all sperm cryopreservation. Sperm washing, capacitation, and selection prior to ICSI were performed equally for fresh and frozen-thawed samples, using pellet swim-up in IVF® medium (Vitrolife, Göteborg). Fertilization rate (FR), pregnancy (biochemical, clinical, and ongoing) and live birth (LB) rates were compared among study groups using Pearson’s Chi square and Student’s t-test. A p-value &lt;0.05 was considered statistically significant.

Main results and the role of chance

Male and female age, sperm concentration and motility after ejaculation, and number of oocytes inseminated were similar between study groups compared (FSPO vs. CSPO, FSDO vs. CSDO). As expected, oocyte donation cycles resulted in higher LB rate than cycles in which partner’s oocytes were used (30.04% vs 18.17%, p &lt; 0.001). In cycles using partner’s oocytes, no significant differences were observed between fresh and cryopreserved sperm in FR, pregnancy and LB rates (p &gt; 0.05 for all outcomes). However, in oocyte donation, the mean FR after ICSI using cryopreserved semen (73.6 ± 19.6) was lower than the FR obtained with fresh semen (75.1 ± 19.2), p = 0.010. Similarly, in oocyte donation cycles, the biochemical pregnancy rate was significantly lower when using cryopreserved semen (48.5% in CSDO vs. 52.3% in FSDO, p = 0.009), while clinical, ongoing pregnancy and LB rates were similar between both semen status (p &gt; 0.05). In oocyte donation, a subgroup analysis including only the ICSI cycles with embryo transfer at blastocyst stage (n = 1.187 for FSDO, n = 337 for CSDO) confirmed that the LB rate was comparable between fresh and cryopreserved semen groups (34.7% vs 35.6% respectively, p = 0.76), without significant differences in pregnancy rates neither (p &gt; 0.05 for all outcomes).

Limitations, reasons for caution

Caution should be exerted when extrapolating these results to different protocols for sperm cryopreservation and selection, or to IVM and classical IVF cycles, which were excluded from analysis. Due to the retrospective nature of the study, some uncontrolled for variables may affect the results.

Wider implications of the findings: Sperm cryopreservation does not affect pregnancy and live birth rates in normozoospermic patients, although it may lower slightly fertilization rates. In line with previous studies including patients with an apparent male factor detected after routine semen analysis, sperm cryopreservation is a safe and convenient technique.

Trial registration number

Not applicable

P–093 The use of donor sperm improves post-ICSI live birth rates in advanced maternal age women

Study question

Can the use of donor sperm improve post-ICSI live birth rate in advanced maternal age (AMA) patients?

Summary answer

The use of donor sperm increases post-ICSI live birth rate while substantially reducing abortion occurrence in AMA patients.

What is known already

Oocyte DNA repair capacity decreases with maternal age, when sperm DNA integrity is particularly important to avoid the transfer of gene truncations and de novo mutations to the zygote. Optimal DNA repair activity in the zygote requires paternal inheritance of 8-oxoguanine DNA glycosylase (OGG1), a rate-limiting enzyme in the base excision repair pathway. However, the involvement of paternal aging and sperm quality in the severe drop in fertility observed in AMA patients has not been addressed. While strategies to mitigate the impact of AMA on fertility have exclusively targeted oocyte quality, the sperm contribution in this scenario remains somehow neglected.

Study design, size, duration

Retrospective, multicentric, international study including 755 first ICSI cycles with patients’ own oocytes achieving a fresh ET between 2015 and 2019, 337 of which using normozoospermic partner semen and 418 using donor sperm. The association of sperm origin (partner vs. donor) with live birth was assessed by univariate/multivariate analysis in non-AMA (&lt;37 years, n = 278) and AMA (≥37 years, n = 477) patients. ICSI outcomes were compared between partner and donor sperm in non-AMA and AMA patients.

Participants/materials, setting, methods

The study was conducted in 3 fertility clinics including 755 Caucasian patients aged 24 to 42 years. Univariate/multivariate analyses were performed to test the association of sperm origin with live birth; infertility factor, maternal age, oocyte yield and number of embryos transferred were included in the model as confounding variables. In addition, ICSI outcomes were compared between donor and partner sperm groups with the Chi-square (percentages) or with the Wilcoxon sum rank (continuous variables) tests.

Main results and the role of chance

The multivariate analysis revealed that the use of donor sperm was positively and independently associated with live birth occurrence in AMA [1.82 OR (1.08–3.07) 95% IC; p = 0.024], but not in non-AMA patients [1.53 (0.94–2.51); p = 0.090]. Maternal age [0.75 (0.64–0.87); p &lt; 0.001], number of MII oocytes recovered [1.14 (1.05–1.23); p = 0.001] and number of embryos transferred [1.90 (1.27–2.86); p = 0.002] were also independently associated with live birth in AMA patients. Live birth and delivery rates were 70–75% higher, while miscarriage rate was less than half in donor sperm compared to partner sperm AMA cycles (LBR: 25.4% vs. 14.5%, p = 0.003; DR: 22.5% vs. 13.5%, p = 0.008; MR: 18.0% vs. 39.5%; p = 0.009). Implantation (17.4% vs. 13.5%; p = 0.075) and clinical pregnancy rates (27.5% vs. 22.3%; p = 0.121) did not significantly differ between sperm donation and partner sperm AMA cycles. Male age was substantially lower (23.6 ± 5.2 vs. 41.4 ± 5.0; p &lt; 0.0001) and oocyte yield was higher (5.1 ± 3.1 vs. 4.3 ± 2.6; p &lt; 0.0001) in sperm donation compared to partner sperm AMA cycles, while maternal age did not vary (39.8 ± 1.6 vs. 39.6 ± 1.7; p = 0.348).

Limitations, reasons for caution

This study is limited by its retrospective nature and by differences in patients’ profiles between sperm donation and homologous cycles, although this variation has been controlled for in the statistical analysis.

Wider implications of the findings: The findings suggest that donor sperm can improve live birth rates by drastically reducing miscarriage occurrence in AMA patients. Therefore, the present results may influence AMA treatment decisions and, above all, contribute for AMA patients to achieve a healthy birth.

Trial registration number

Not applicable

P–159 Slow-growing embryos should be frozen on day 5

Study question

What is the live birth rate after frozen embryo transfer (FET) of slow-growing embryos frozen on day 5 (D5) or on day 6 (D6)?

Summary answer

The live birth rate after single FET is significantly higher for slow-growing embryos frozen on D5 compared to those frozen on D6.

What is known already

Most data on the outcomes of blastocyst transfer stem from studies that evaluate fresh transfer from normal growing D5 blastocyst ET. However not all embryos will begin blastulation nor reach the fully expanded stage by D5; those are the slow-growing embryos. Studies that compare D5 to D6 embryos in FET cycles show contradictory results. Some have reported higher clinical pregnancy rates after D5 FET, while others have reported similar outcomes for D5 and D6 cryopreserved blastocyst transfers. There is a lack of evidence regarding the best approach for vitrifying embryos that exhibit a slow developmental kinetic.

Study design, size, duration

This retrospective cohort study included 821 single FET of slow-growing embryos frozen on D5 or D6, belonging to patients undergoing in vitro fertilization with donor oocytes between January 2011 and October 2019, in a single fertility center. The origin of blastocysts was either supernumerary embryos after fresh embryo transfer or blastocysts from freeze-all cycles. All embryos were transferred 2- 4h after thawing.

Participants/materials, setting, methods

We compared reproductive outcomes of slow-growing embryos frozen on D5 versus (n = 442) slow-growing embryos frozen on D6 (n = 379). D5 group consisted in embryos graded 0, 1, 2 of Gardner scale and frozen on D5. Similarly, D6 group consisted in embryos graded 3, 4, 5 of Gardner scale (blastocyst stage) and frozen on D6. Differences in pregnancy rates between study groups were compared using a Chi2 test. A p-value &lt;0.05 was considered statistically significant.

Main results and the role of chance

Baseline characteristics were comparable between study groups. Overall, mean age of the woman was 42.3±5.4 years old; donor sperm was used in 25% of cycles, and it was frozen in 73.2% of cycles. Pregnancy rates were significantly higher when transferring slow D5 embryos compared to D6 for all the pregnancy outcomes analyzed: biochemical pregnancy rate was 27.7% vs 20.2%, p &lt; 0.016; clinical pregnancy rate was 17.5% vs 10.2%, p &lt; 0.004); ongoing pregnancy rate was: 15.7% vs 7.8% (p &lt; 0.001); live birth rate was: 15.4% vs 7.5%, (p &lt; 0.001). These results suggest that when embryos exhibit a slow development behavior (not reaching full blastocysts at D5), waiting until D6 for blastulation and expansion does not improve clinical outcomes. Vitrification at D5 will should the preferred option in cases where the oocyte is assumed of high quality

Limitations, reasons for caution

The retrospective design of the study is its main limitation. Also, morphology as sole selection criterion for transfer. However, blastocyst morphology is a very good predictor of implantation and pregnancy, and a good indicator of the embryo’s chromosomal status (higher euploidy rate in higher morphological quality blastocysts).

Wider implications of the findings: These results can help to the standardization of laboratory protocols. As the decision of vitrifying slow developing embryos on D5 or D6 is made by the laboratory team or by the gynaecologist in agreement with the patient, having an evidence based strategy simplifies patient counselling and decision making.

Trial registration number

Not applicable

DNA fragmentation of sperm: a radical examination of the contribution of oxidative stress and age in 16 945 semen samples

STUDY QUESTION

What is the relationship between sperm DNA fragmentation and oxidative stress (OS) with increasing male age?

SUMMARY ANSWER

Sperm DNA fragmentation increases with age and is likely related to both defective spermatogenesis and increasing OS levels.

WHAT IS KNOWN ALREADY

Sperm quality declines with age. The presence of DNA damage in a high fraction of spermatozoa from a raw semen sample is associated with lower male fertility in natural conception and intrauterine insemination.

STUDY DESIGN, SIZE, DURATION

A retrospective cohort study of 16 945 semen samples analysed at a single reference laboratory between January 2010 and December 2018.

PARTICIPANTS/MATERIALS, SETTING, METHODS

All males were undergoing an infertility evaluation. The cohort was divided into seven age categories: <30, 30-34, 35-39, 40-44, 45-49, 50 to <54 and ≥55 years. The mean age was 37.6 years (SD 6.8). Sperm DNA fragmentation index (DFI) and high DNA stainability (HDS) were calculated using flow cytometry. OS levels were measured using the oxidative stress adducts (OSA) test, by spectrophotometry. ANOVA with weighted polynomial contrast analysis was used to evaluate trends for DFI, OSA and HDS values across age categories.

MAIN RESULTS AND THE ROLE OF CHANCE

Mean DFI significantly increased across all age groups (Ptrend < 0.001). OSA was lowest in patients <30 years old (mean 3.6, SD 1.0) and also increased as age increased (Ptrend < 0.001). There was a statistically significant difference between age groups for each of the three parameters (P < 0.001). There was a significant linear trend for DFI, OSA and HDS across the seven age categories (P < 0.001). Among patients with high DFI, there was a decreasing age-dependent trend in the patients observed with high OSA (P < 0.001).

LIMITATIONS, REASONS FOR CAUTION

This is a retrospective study. All males included in the study were undergoing a work-up for infertility and may not be representative of a fertile population. Additional patient demographics and clinical data were not available.

WIDER IMPLICATIONS OF THE FINDINGS

DNA and/or oxidative damage in sperm may be just as important to understand as the chromosomal aberrations that are carried in the oocyte. Further studies are needed to evaluate the effect of advancing paternal age on the male genome and, ultimately, on the health of the offspring.

STUDY FUNDING/COMPETING INTEREST(S)

No funding was obtained for this study. V.D. is an employee of Reprosource/Quest Diagnostics. D.S. reports he was a Scientific Advisor to Cooper Surgical.

TRIAL REGISTRATION NUMBER

N/A.

Evaluation of transport media for laboratory detection of SARS-CoV-2 in upper respiratory tract swab specimens

The reduced availability of commercial swabs and transport media for testing and administrative demands for increased testing capacity during the coronavirus disease 2019 (COVID-19) public health emergency has seriously challenged national laboratory testing programs, forcing many to use nontraditional collection devices, often without typical analytical assessment of their suitability in testing. Five common transport media (four commercial and one in-house) were evaluated for their suitability in the collection of nasopharyngeal swab specimens for subsequent molecular detection of severe acute respiratory syndrome-associated coronavirus 2 (SARS-CoV-2). Results suggest that these transport media provide dependable temporal stability of the SARS-CoV-2 virus without significant analytical interference of molecular assays. These findings are not only important for addressing critical laboratory supply chain shortages of transport media in the current COVID-19 health crisis but also for future pandemic planning, when again supplies of commercially available transport media might be depleted.

Pharmacokinetics of apixaban in patients with end stage renal disease on hemodialysis and atrial fibrillation: results from the RENAL-AF trial

Background/Introduction

Apixaban use is increasing for stroke prevention in patients with atrial fibrillation (AF) and end stage renal disease (ESRD) on hemodialysis. There is uncertainty as to the optimal dose in this population in part related to the limited available pharmacokinetic (PK) data.

Purpose

We comprehensively evaluated the PK of apixaban collected over 1 month of apixaban dosing in 63 patients with AF and ESRD on hemodialysis.

Methods

Patients with AF and ESRD on hemodialysis were randomized to warfarin versus apixaban within the RENAL-AF trial with 5 mg BID dosing, except for 2.5 mg BID in those age ≥80 years or weight ≤60 kg. The 5 mg BID dose could be reduced to 2.5mg BID for minor bleeding. Day 1 PK data was collected on all patients pre- and post-hemodialysis. Day 3 and 1 month pre- and post-hemodialysis PK samples were collected in 49 patients. The timing of apixaban dosing and hemodialysis relative to PK samples was recorded. Dosing history, hemodialysis, and PK samples were chronologically integrated with patient specific data such as body size, age, race and gender. This dataset was combined with the ARISTOTLE dataset, and the published PK model from ARISTOTLE describing exposures in the AF population was updated to incorporate an additional clearance term for hemodialysis. The model estimated apixaban exposures (AUC) in RENAL-AF were compared to ARISTOLTE AUC values.

Results

There were 285 PK concentrations collected among 63 patients in the RENAL-AF trial. Patients had median age 69 years with 41% women (N=26) and a median weight of 84 kg (49, 157). The median AUCs for patients with ESRD on hemodialysis were 5,452 and 2,990 for patients treated with 5mg BID and 2.5mg BID doses, respectively. The median AUCs for patients treated with 5mg BID from ARISTOTLE increased from 2,802 for patients with class 1 CKD to 5,863 for class 4 CKD, while they increased from 2,392 for class 1 CKD to 2,881 for class 4 CKD in patients treated with 2.5mg BID. The median AUC for patients with ESRD on hemodialysis were within 50% of the exposure of patients from ARISTOTLE for all classes of CKD for the 2.5mg BID dose and for classes 2, 3A, 3B, and 4 CKD for the 5mg BID dose (Figure).

Conclusions

The steady state apixaban exposure data in patients with AF and ESRD on hemodialysis were modestly higher but consistent with the results of non-ESRD patients from ARISTOTLE, using 5 mg BID unless patients had age ≥80 years or weight ≤60 kg. Additional clinical outcomes data on the use of apixaban in patients with AF and ESRD on hemodialysis are needed.

Funding Acknowledgement

Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Investigator sponsored grant from Bristol-Myers Squibb and Pfizer

Genotype/Phenotype correlation and prognosis for undescribed ACTC1 missense variants

Purpose

Establish the genotype/phenotype correlation for missense undescribed variants in ACTC1, and evaluate their prognostic implications.

Methods

A systematic screening for the ACTC1 gene was performed using NGS in 17,683 individuals with inherited cardiovascular disease, 6,984 of them with hypertrophic cardiomyopathy, 3,507 with dilated cardiomyopathy, and 760 left ventricular non-compaction. These phenotypes were clinically diagnosed by each center prior to the genetic study. Frequency of the variants was compared with gene gnomAD and ClinVar databases. A systematic review of the literature was performed to search for previously reported variants.

We evaluated available follow up data and constructed Kaplan-Meier survival curves free from cardiovascular death (sudden death, Heart transplant, heart failure death, appropriate ICD discharge and stroke related death). Log-rank test was used to compare event-free survival time between males and females.

Results

39 missense variants were identified in 283 carriers (125 index cases; 158 first-degree relatives). Twenty-two have not been previously described or identified in public databases. 17 have been reported in gnomAD or Clinvar. Carriers phenotypes were: 120 HCM; 43 LVNC; 16 DCM; three had cardiac septal defect and two had sudden death. Some of the carriers had overlapped or combined phenotypes: 7 HCM and LVNC, 7 septal defects and LVNC, 3 HCM and septal defects, 4 MCD and LVNC. 24 were healthy carriers, and we have no phenotypic data of the remaining individuals. Family studies were performed in 12 families out of the 22 undescribed variants, showing cosegregation in 8 variants. One case was “de novo”.

Interestingly, a rare variant, previously identified as VUS in ClinVar, showed a clearly cosegregation with HCM. The Leu10Met variant with a frequency of 9/282084 alleles in gnomAD (1/15671 individuals) was identified in 20 index cases, which represents 1/884 of all the genotyped (0.11%), and 1/387 patients with HCM (0.35%). We found it in 2/9289 patients with other phenotypes (p&lt;0.001).

51 patients (18%) presented an event during follow up. In several cases, carriers developed early atrial fibrillation.

The survival curve shows adverse events from the first decade of life, with a 10% cumulative rate of events at age 40, 80% survival at age 60, and a 60% survival at age 70. No significant differences in the incidence of cardiovascular death between men and women were observed.

Conclusion

HCM is the most frequent phenotype in carriers of ACTC1 variants, followed by LVNC, and DCM. Septal defects are not rare, and they are usually described in combination with cardiomyopathies.

Disease course seems to have a good prognosis. Sudden death is an exception at early ages and appears to be associated with severe morphological expression.

Given the presence of cosegregation with disease in rare variants, many of the ACTC1 variants may have an incomplete penetrance, and late disease expression.

ACTC1

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Health in Code

Comparison of two different oocyte vitrification methods: a prospective, paired study on the same genetic background and stimulation protocol

STUDY QUESTION

Can two different methods for oocyte vitrification, one using an open tool and the other a closed tool, result in similar oocyte survival rates?

SUMMARY ANSWER

The oocyte survival rate was found to be higher in the closed method.

WHAT IS KNOWN ALREADY

Open vitrification is performed routinely in oocyte donation cycles. Closed oocyte vitrification may result in slower cooling rates and thus it is less used, even though it has been recommended in order to avoid the risk of cross-contamination between material from different patients.

STUDY DESIGN, SIZE, DURATION

This is a prospective cohort study with sibling oocytes carried out in a fertility center between July 2014 and January 2016. The study included 83 oocyte donors each providing a minimum of 12 mature oocytes (metaphase II: MII) at oocyte retrieval. Oocyte survival rate and fertilization rate, as well as reproductive outcomes (biochemical, clinical, ongoing pregnancy and live birth rates) per embryo transfer and also cumulatively between the two methods were compared by Chi2 tests.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Donor oocytes were denuded and six MII oocytes from each donor were vitrified using an open method and later assigned to one recipient, while another six MII oocytes were vitrified using a closed method and assigned to a different recipient (paired analysis). ICSI was used in all cases and embryo transfer was performed on Day 2-3 in all cases.

MAIN RESULTS AND THE ROLE OF CHANCE

Oocyte donors were 24.8 years old on average (SD 4.7). Recipient age (average 41.2 years, SD 4.7) and BMI (mean 23.8 kg/m2, SD 4.0) were similar between recipient groups. Oocytes vitrified using the closed method had higher survival rate (94.5% versus 88.9%, P = 0.002), but lower fertilization rate (57.1% versus 69.8%, P < 0.001) compared to the open method. The number of fresh embryos transferred in the two groups was 1.8 on average (SD 0.4). Biochemical (45% closed versus 50% open), clinical (40% versus 50%) and ongoing (37.5% versus 42.5%) pregnancy rates were not different between groups (P > 0.05) and neither were live birth rates (37.5% versus 42.5%, P > 0.05). Cumulative reproductive results (obtained after the transfer of all the embryos) were also similar between groups.

LIMITATIONS, REASONS FOR CAUTION

The participants of this study were oocyte donors, i.e. young women in good health, and care should be exerted in extending our results to other populations such as infertility patients, oncofertility patients and women freezing oocytes to delay childbearing.

WIDER IMPLICATIONS OF THE FINDINGS

Our results suggest that, in spite of different survival and fertilization rates, closed and open oocyte vitrification methods should offer similar reproductive outcomes up to cumulative live birth rates.

STUDY FUNDING/COMPETING INTEREST(S)

The authors report no conflict of interest. Vitrolife provided the media and the closed method tool needed for the study at no cost.

What is Elective Oncologic Surgery in the Time of COVID-19? A Literature Review of the Impact of Surgical Delays on Outcomes in Patients with Cancer

Background

The impact of the COVID-19 pandemic has spread beyond those infected with SARS-CoV-2. Its widespread consequences have affected cancer patients whose surgeries may be delayed in order to minimize exposure and conserve resources.

Methods

Experts in each surgical oncology subspecialty were selected to perform a review of the relevant literature. Articles were obtained through PubMed searches in each cancer subtype using the following terms: delay to surgery, time to surgery, outcomes, and survival.

Results

Delays in surgery > 4 weeks in breast cancer, ductal carcinoma in situ, T1 pancreatic cancer, ovarian cancer, and pediatric osteosarcoma, negatively impacted survival. Studies on hepatocellular cancer, colon cancer, and melanoma (Stage I) demonstrated reduced survival with delays > 3 months.

Conclusion

Studies have shown that short-term surgical delays can result in negative impacts on patient outcomes in multiple cancer types as well as in situ carcinoma. Conversely, other cancers such as gastric cancer, advanced melanoma and pancreatic cancer, well-differentiated thyroid cancer, and several genitourinary cancers demonstrated no significant outcome differences with surgical delays.

MON-532 Characterization of the Angiogenic Factor SFRP2 in Papillary Thyroid Carcinoma

Over the last decade, there has been an average annual increase of 3.1% in thyroid cancer diagnosis in the U.S. Papillary thyroid carcinoma (PTC) accounts for 80% of all thyroid cancer diagnoses. However, few molecular markers exist to identify clinically aggressive phenotypes. The angiogenic factor, secreted frizzled-related protein 2 (SFRP2), is associated with a poor prognosis in several malignancies including breast cancer and melanoma. The role of SFRP2 in PTC has yet to be investigated. The aims of this study were to determine the differential expression of SFRP2 in PTC, benign thyroid adenomas, normal thyroid tissue (from patients without cancer), and normal adjacent tissue (NAT) (non-cancerous tissue from patients with PTC) and investigate the role of SFRP2 in tumor development in two PTC cell lines, PTC classical variant (PTC-CV) and PTC follicular variant (PTC-FV), upon treatment with a humanized anti-SFRP2 monoclonal antibody (hSFRP2 mAb). Immunohistochemistry (IHC) was performed using human tissue protein microarrays including 226 PTC, 79 benign adenomas, 112 NAT, and 30 normal thyroid tissue samples. In-vitro proliferation and apoptosis experiments were performed on MDA-T41 (PTC-CV) and MDA-T68 (PTC-FV) cell lines by treating with hSFRP2 mAb, Xolair IgG control, and a vehicle control. SFRP2 expression was significantly higher in PTC compared with benign adenomas and normal thyroid (mean expression scores 9, 6, and 1, respectively; p<0.05). SFRP2 expression was significantly higher in NAT than normal thyroid (mean expression score 4 and 0, respectively, p<0.05). Apoptotic rates were increased by 40% and 62% in the PTC-CV hSFRP2 mAb treatment group compared with the Xolair and vehicle treatment groups, respectively (p<0.05). Apoptotic rates were increased by 126% and 59% in the PTC-FV hSFRP2 mAb treatment group compared with the Xolair and vehicle treatment groups, respectively (p<0.05). Treatment with hSFRP2 mAb had no significant effect on proliferation in either cell line. In conclusion, SFRP2 expression is significantly higher in PTC than in benign adenomas and normal thyroid tissue. SFRP2 expression in NAT is significantly higher than in normal thyroid tissue and not significantly different from benign adenomas. SFRP2 expression in nonmalignant tissue adjacent to PTC could be due to expression in the tumor microenvironment. Treatment with a novel hSFPR2 mAb increases apoptotic rates in two different PTC cell lines. These data suggest that SFPR2 is involved in tumorigenesis of PTC.

Constraints on Lorentz Invariance Violation from HAWC Observations of Gamma Rays above 100 TeV

Because of the high energies and long distances to the sources, astrophysical observations provide a unique opportunity to test possible signatures of Lorentz invariance violation (LIV). Superluminal LIV enables the decay of photons at high energy. The high altitude water Cherenkov (HAWC) observatory is among the most sensitive gamma-ray instruments currently operating above 10 TeV. HAWC finds evidence of 100 TeV photon emission from at least four astrophysical sources. These observations exclude, for the strongest of the limits set, the LIV energy scale to 2.2×10^{31}  eV, over 1800 times the Planck energy and an improvement of 1 to 2 orders of magnitude over previous limits.

Multiple Galactic Sources with Emission Above 56 TeV Detected by HAWC

We present the first catalog of gamma-ray sources emitting above 56 and 100 TeV with data from the High Altitude Water Cherenkov Observatory, a wide field-of-view observatory capable of detecting gamma rays up to a few hundred TeV. Nine sources are observed above 56 TeV, all of which are likely galactic in origin. Three sources continue emitting past 100 TeV, making this the highest-energy gamma-ray source catalog to date. We report the integral flux of each of these objects. We also report spectra for three highest-energy sources and discuss the possibility that they are PeVatrons.

Multianalyte assay system developed for drugs of abuse

A simple, 10-min immunoassay system has been developed that simultaneously screens for five different classes of drugs of abuse in a urine sample. This system tests for amphetamines, cannabinoids, cocaine metabolites, opiates, and phencyclidine, and each assay has a specific preset cutoff concentration. Accuracy is &gt; 99% for reporting positive or negative results for samples with 200% or 50%, respectively, of the cutoff concentrations of the drugs. Tests of a panel of 96 compounds yielded only three cases of nonspecific reactivity (at a drug concentration of 100 mg/L). Another panel of 12 compounds that could normally be found in urine samples was also evaluated and no interferences were observed. Concordance was &gt; 95% between this system and the comparable automated immunoassays for detecting drugs of abuse. Greater than 98% of GC/MS-confirmed positive samples gave positive results with this assay system.