Haemostatic gene variations in cervical cancer-associated venous thrombosis: considerations for clinical strategies

Venous thromboembolism (VTE) is a life-threatening haemostatic disease frequently diagnosed among the cancer population. The Khorana Score is currently the primal risk assessment model to stratify oncological patients according to their susceptibility to VTE, however, it displays a limited performance. Meanwhile, intensive research on VTE pathophysiology in the general population has uncovered a range of single-nucleotide polymorphisms (SNPs) associated with the condition. Nonetheless, their predictive ability concerning cancer-associated thrombosis (CAT) is controversial. Cervical cancer (CC) patients undergoing chemoradiotherapy often experience VTE, which negatively affects their survival. Thus, aiming for an improvement in thromboprophylaxis, new thrombotic biomarkers, including SNPs, are currently under investigation. In this study, the predictive capability of haemostatic gene SNPs on CC-related VTE and their prognostic value regardless of VTE were explored. Six SNPs in haemostatic genes were evaluated. A total of 401 CC patients undergoing chemoradiotherapy were enrolled in a retrospective cohort study. The implications for the time to VTE occurrence and overall survival (OS) were assessed. CAT considerably impacted the CC patients' OS (log-rank test, P < 0.001). SERPINE1 rs2070682 (T > C) showed a significant association with the risk of CC-related VTE (CC/CT vs. TT, log-rank test, P = 0.002; C allele, Cox model, hazard ratio (HR) = 6.99 and P = 0.009), while F2 rs1799963 (G > A) demonstrated an important prognostic value regardless of VTE (AA/AG vs. GG, log-rank test, P = 0.020; A allele, Cox model, HR = 2.76 and P = 0.026). For the remaining SNPs, no significant associations were detected. The polymorphisms SERPINE1 rs2070682 and F2 rs1799963 could be valuable tools in clinical decision-making, aiding in thromboprophylaxis and CC management, respectively.

Paradigm Shift: A Comprehensive Review of Ovarian Cancer Management in an Era of Advancements

Ovarian cancer (OC) is the female genital malignancy with the highest lethality. Patients present a poor prognosis mainly due to the late clinical presentation allied with the common acquisition of chemoresistance and a high rate of tumour recurrence. Effective screening, accurate diagnosis, and personalised multidisciplinary treatments are crucial for improving patients' survival and quality of life. This comprehensive narrative review aims to describe the current knowledge on the aetiology, prevention, diagnosis, and treatment of OC, highlighting the latest significant advancements and future directions. Traditionally, OC treatment involves the combination of cytoreductive surgery and platinum-based chemotherapy. Although more therapeutical approaches have been developed, the lack of established predictive biomarkers to guide disease management has led to only marginal improvements in progression-free survival (PFS) while patients face an increasing level of toxicity. Fortunately, because of a better overall understanding of ovarian tumourigenesis and advancements in the disease's (epi)genetic and molecular profiling, a paradigm shift has emerged with the identification of new disease biomarkers and the proposal of targeted therapeutic approaches to postpone disease recurrence and decrease side effects, while increasing patients' survival. Despite this progress, several challenges in disease management, including disease heterogeneity and drug resistance, still need to be overcome.

Cancer-associated thrombosis: What about microRNAs targeting the tissue factor coagulation pathway?

Cancer patients are often diagnosed with venous thromboembolism (VTE), a cardiovascular disease that substantially decreases their quality of life and survival rate. Haemostasis in these patients is deregulated, which is reflected in the common presentation of a blood hypercoagulation state. Despite the inconsistent results, existing evidence suggests that the expression of microRNAs (miRNAs) is deregulated in the context of venous thrombogenesis in the general population. However, few miRNAs are known to be linked to cancer-associated VTE due to the lack of studies with oncological patients. Parallelly, coagulation factor III, also known as tissue factor (TF), tissue factor pathway inhibitor 1 (TFPI1) and tissue factor pathway inhibitor 2 (TFPI2) have been proposed to have a central role in cancer-associated VTE and tumour progression. Yet, contrary to what was expected, the role of miRNAs targeting the TF coagulation pathway (or extrinsic coagulation pathway) is poorly explored in cancer-induced thrombogenesis. In this review, in addition to miRNAs implicated in VTE, TF and TFPI1/2-targeting miRNAs were revised. Future studies should clarify the implications of these non-coding RNAs in tumour coagulome.

Long Non-Coding RNAs: Bridging Cancer-Associated Thrombosis and Clinical Outcome of Ovarian Cancer Patients

Ovarian cancer (OC) and venous thromboembolism (VTE) have a close relationship, in which tumour cells surpass the haemostatic system to drive cancer progression. Long non-coding RNAs (lncRNAs) have been implicated in VTE pathogenesis, yet their roles in cancer-associated thrombosis (CAT) and their prognostic value are unexplored. Understanding how these lncRNAs influence venous thrombogenesis and ovarian tumorigenesis may lead to the identification of valuable biomarkers for VTE and OC management. Thus, this study evaluated the impact of five lncRNAs, namely MALAT1, TUG1, NEAT1, XIST and MEG8, on a cohort of 40 OC patients. Patients who developed VTE after OC diagnosis had worse overall survival compared to their counterparts (log-rank test, p = 0.028). Elevated pre-chemotherapy MEG8 levels in peripheral blood cells (PBCs) predicted VTE after OC diagnosis (Mann-Whitney U test, p = 0.037; Χ2 test, p = 0.033). In opposition, its low levels were linked to a higher risk of OC progression (adjusted hazard ratio (aHR) = 3.00; p = 0.039). Furthermore, low pre-chemotherapy NEAT1 levels in PBCs were associated with a higher risk of death (aHR = 6.25; p = 0.008). As for the remaining lncRNAs, no significant association with VTE incidence, OC progression or related mortality was observed. Future investigation with external validation in larger cohorts is needed to dissect the implications of the evaluated lncRNAs in OC patients.

Does body mass index influence surgical options and overall survival in breast cancer patients?

Obesity is a relevant risk factor in breast cancer (BC), but little is known about the effects of overweight and obesity in surgical outcomes of BC patients. The aim of this study is to analyse surgical options and associated overall survival (OS) in overweight and obese women with BC. In this study, 2143 women diagnosed between 2012 and 2016 at the Portuguese Oncology Institute of Porto (IPO-Porto) were included, and the clinicopathological information was retrieved from the institutional database. Patients were stratified by body mass index (BMI). Statistical analysis included Pearson's chi-squared test with statistical significance set at p < 0.05. Multinomial, binary logistic regression and cox proportional-hazards model were also performed to calculate odd ratios and hazard ratios with 95% confidence intervals for adjusted and non-adjusted models. The results revealed no statistical difference in histological type, topographic localization, tumour stage and receptor status and in the number of surgical interventions. Overweight women have increased probability to be subjected to sentinel node biopsy. Obese and overweight women are more likely to be submitted to conservative surgery and contrariwise, less likely to undergo total mastectomy. Patients submitted to conservative surgery and not submitted to total mastectomy had a favourable OS although without statistical significance. No significant differences were observed in OS when stratified by BMI. Our results revealed significant variations regarding the surgical options in overweight and obese patients, but these were not translated in OS difference. More research is recommended to better address treatment options in overweight and obese BC patients.

Practical lessons learned from real-world implementation of the molecular classification for endometrial carcinoma

OBJECTIVES

This study aimed to explore the practical organisational aspects and difficulties in the implementation of the molecular classification of endometrial carcinoma (EC), and to demonstrate its potential impact in prognostic risk group classification.

METHODS

We conducted a multicentre, retrospective cohort study of 230 patients with EC diagnosed between 2019 and 2022. Sample processing, clinicopathological, treatment and follow-up data were collected. Molecular classification was obtained by p53 and mismatch repair proteins immunohistochemistry, and POLE next-generation sequencing.

RESULTS

Implementation was achieved through centralization of molecular analysis. In practice, it was possible to optimise turnaround times of complete integrative reports for hysterectomy specimens to a median time of 18 workdays. If genetic study was started in endometrial biopsies before surgery, 82.0% were available at the time of multidisciplinary tumour board, compared to 8.4% if performed in hysterectomy. ECs were classified as follows: 37.8% no specific molecular profile, 31.7% p53 abnormal, 24.3% mismatch repair deficient, and 6.1% POLE mutant. Integration of these results with traditional clinicopathologic factors led to a change in prognostic risk group in 15 (6.5%) patients, most being initially allocated to high-intermediate (n = 8) and low (n = 5) risk groups. Eight patients changed to a higher risk, and 7 to a lower risk group, whereas 2 remained in the same group.

CONCLUSIONS

Centralization of EC molecular classification is a feasible option for countries with limited resources. Optimization of workflows may be achieved by earlier analysis in biopsies and prioritisation of patients whose results imply changes in risk group classification.

Long Non-Coding RNAs in Venous Thromboembolism: Where Do We Stand?

Venous thromboembolism (VTE), a common condition in Western countries, is a cardiovascular disorder that arises due to haemostatic irregularities, which lead to thrombus generation inside veins. Even with successful treatment, the resulting disease spectrum of complications considerably affects the patient's quality of life, potentially leading to death. Cumulative data indicate that long non-coding RNAs (lncRNAs) may have a role in VTE pathogenesis. However, the clinical usefulness of these RNAs as biomarkers and potential therapeutic targets for VTE management is yet unclear. Thus, this article reviewed the emerging evidence on lncRNAs associated with VTE and with the activity of the coagulation system, which has a central role in disease pathogenesis. Until now, ten lncRNAs have been implicated in VTE pathogenesis, among which MALAT1 is the one with more evidence. Meanwhile, five lncRNAs have been reported to affect the expression of TFPI2, an important anticoagulant protein, but none with a described role in VTE development. More investigation in this field is needed as lncRNAs may help dissect VTE pathways, aiding in disease prediction, prevention and treatment.

Thrombogenesis-associated genetic determinants as predictors of thromboembolism and prognosis in cervical cancer

Venous thromboembolism (VTE) is a leading cause of death among cancer patients. Khorana score (KS) is the most studied tool to predict cancer-related VTE, however, it exerts poor sensitivity. Several single-nucleotide polymorphisms (SNPs) have been associated with VTE risk in the general population, but whether they are predictors of cancer-related VTE is a matter of discussion. Compared to other solid tumours, little is known about VTE in the setting of cervical cancer (CC) and whether thrombogenesis-related polymorphisms could be valuable biomarkers in patients with this neoplasia. This study aims to analyse the effect of VTE occurrence on the prognosis of CC patients, explore the predictive capability of KS and the impact of thrombogenesis-related polymorphisms on CC-related VTE incidence and patients' prognosis regardless of VTE. A profile of eight SNPs was evaluated. A retrospective hospital-based cohort study was conducted with 400 CC patients under chemoradiotherapy. SNP genotyping was carried on by using TaqMan® Allelic Discrimination methodology. Time to VTE occurrence and overall survival were the two measures of clinical outcome evaluated. The results indicated that VTE occurrence (8.5%) had a significant impact on the patient's survival (log-rank test, P < 0.001). KS showed poor performance (KS ≥ 3, χ², P = 0.191). PROCR rs10747514 and RGS7 rs2502448 were significantly associated with the risk of CC-related VTE development (P = 0.021 and P = 0.006, respectively) and represented valuable prognostic biomarkers regardless of VTE (P = 0.004 and P = 0.010, respectively). Thus, thrombogenesis-related genetic polymorphisms may constitute valuable biomarkers among CC patients allowing a more personalized clinical intervention.

Map of thrombogenesis in viral infections and viral-driven tumours

Viruses are pathogenic agents responsible for approximately 10% of all human cancers and significantly contribute to the global cancer burden. Until now, eight viruses have been associated with the development of a broad range of malignancies, including solid and haematological tumours. Besides triggering and promoting oncogenesis, viral infections often go hand-in-hand with haemostatic changes, representing a potential risk factor for venous thromboembolism (VTE). Conversely, VTE is a cardiovascular condition that is particularly common among oncological patients, with a detrimental impact on patient prognosis. Despite an association between viral infections and coagulopathies, it is unclear whether viral-driven tumours have a different incidence and prognosis pattern of thromboembolism compared to non-viral-induced tumours. Thus, this review aims to analyse the existing evidence concerning the association of viruses and viral tumours with the occurrence of VTE. Except for hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection, which are associated with a high risk of VTE, little evidence exists concerning the thrombogenic potential associated with oncoviruses. As for tumours that can be induced by oncoviruses, four levels of VTE risk are observed, with hepatocellular carcinoma (HCC) and gastric carcinoma (GC) associated with the highest risk and nasopharyngeal carcinoma (NPC) associated with the lowest risk. Unfortunately, the incidence of cancer-related VTE according to tumour aetiology is unknown. Given the negative impact of VTE in oncological patients, research is required to better understand the mechanisms underlying blood hypercoagulability in viral-driven tumours to improve VTE management and prognosis assessment in patients diagnosed with these tumours.

Bilateral breast cancer and the influence of body mass index in clinicopathological features and overall survival

BACKGROUND

Breast cancer (BC) and obesity are two closely associated pathologies with increasing incidence and mortality rates. Bilateral Breast Cancer (BBC) displays a low incidence rate within BC and obesity represents a major risk factor.

OBJECTIVE

The aim of this study is to analyzed BBC clinicopathological features distribution and determine the potential influence of obesity in BBC in these same features and overall survival.

METHODS

Clinicopathological information was obtained from 42 cases of women with BBC diagnosed in IPO-Porto. To evaluate the frequency distribution of the clinicopathological data, a chi-square goodness of fit test was performed for BBC cases. A chi-square test of independence was applied for BMI stratification. Cox regression was performed for overall survival. Statistical significance was set at p-value < 0.05.

RESULTS

Distribution of BBC clinicopathological features was found to be statistically significant in family history (p-value < 0.001), BBC type (p-value < 0.001), stage (p-value = 0.005), differentiation grade (p-value < 0.001), receptor expression (p-value < 0.001) and histological type (p-value = 0.031). In comparison to the statistical expected results, we observed an increased cases of absence of family history and less cases of metachronous BBC. Histological types between tumours of BBC were mostly concordant. All cases presented concordant receptor expression. Analysis stratified by BMI revealed that obese women were diagnosed later, although without statistical significance. All obese women presented poor differentiation grade (n = 6). Overweight patients display a tendency to a better overall survival with lower tumour stages and lower differentiation grades.

CONCLUSIONS

Our results reveal the same receptor expression between contralateral tumours. Also, most tumours share the same histological type. When stratified by BMI, we observed a tendency for overweight women to have improved overall survival.

POS1093 EFFECT OF DISEASE MODIFYING ANTI-RHEUMATIC DRUGS ON DEPRESSION IN PATIENTS WITH PSORIATIC ARTHRITIS IN A LONGITUDINAL COHORT

Background

Depression, and its improvement with disease modifying anti-rheumatic drugs (DMARDs) is understudied in psoriatic arthritis (PsA).

Objectives

To determine the effectiveness of DMARDs on depression in PsA patients.

Methods

Patients enrolled from January 2000 to May 2020 in a large PsA cohort were included. Depression was defined as medical outcomes study short form-36 (SF-36) mental component summary score (MCS) ≤ 40 or mental health (MH) subscale score ≤ 56. Primary outcome was resolution of depression within 1 year of DMARDs, defined by two definitions: 1) MCS > 40 and/or MH subscale score of > 56; 2) Increase in MCS by 2.5 and MH subscale score by 5, the minimal clinically important difference (MCID). Baseline medications [non-steroidal anti-inflammatory drugs (NSAIDs) and/or conventional or targeted (c/t) DMARDs] were recorded for all patients and stratified into 3 mutually exclusive ordinal categories: I-No treatment/NSAIDs; II-cDMARDs±NSAIDs without tDMARDs; III-tDMARDs±cDMARDs/NSAIDs. Univariable and multivariable logistic regression models were created to determine the association between medications and resolution of depression, after controlling for age, sex, disease duration and baseline MCS/MH subscale score.

Results

Based on the MCS and MH subscale score definitions, 608 (48%) and 655 (52%) of the 1270 patients, respectively were depressed at baseline. 374 (50.8% males) and 399 (52.4% males) patients were followed up in the groups defined by MCS and MH subscales, respectively for 1 year. Patients in both groups had comparable body mass indices, baseline psoriasis area and severity index and active joint count. Mean MCS and MH subscale scores (standard deviation) were 33.2 (5.2) and 46.0 (10.2). A mean of 11.9 and 11.7 months was noted for resolution of depression in the MCS based analysis and MH subscale-based analysis groups, respectively. More patients achieved resolution of depression based on definition 2 (MCS, 64.7%; MH, 62.2%) as compared to definition 1 (MCS, 54.5%; MH, 53.9). The proportion of patients on each category of medications in both models is shown in the Figure 1. Table 1 depicts the univariate and multivariable regression results by both the definitions of primary outcome in the MH subscales model. The global p-value for medication categories showed a trend towards significance in both models using definition 2. There was a trend towards higher likelihood of response when comparing patients in treatment category III vs category I. A significant response was noted when comparing patients in category III with category II as reference (OR 1.71; 95% CI 1.05-2.76; p 0.03). No significant effect of treatment category on depression was noted using definition 1.

Table 1.

Association between treatment and resolution of depression in the MH Subscale model (n = 399)

VariableResolution by MCIDResolution by MH subscale reductionUnivariable modelMultivariable modelUnivariate modelMultivariate modelOR (95% CI)p valueOR (95% CI)p valueOR (95% CI)p valueOR (95% CI)p valueMale vs. Female0.81 (0.54–1.22)0.310.83 (0.5–1.26)0.391.02 (0.68–1.51)0.940.94 (0.63 –1.42)0.79Baseline age1.01 (1.00 –1.03)0.091.01 (1.00 –1.03)0.161.02 (1.00–1.03)0.051.01 (0.99 –1.03)0.30Baseline PsA duration1.02 (1.00 –1.04)0.121.01 (0.99 –1.03)0.371.02 (1.00– 1.04)0.071.01 (0.99 –1.03)0.22Baseline MH subscale score0.98 (0.96 –1.00)0.030.98 (0.95 –1.00)0.021.04 (1.02– 1.06)<0.00011.04 (1.02 –1.06)<0.0001Medication category0.07*0.09*0.20*0.20* IReference II0.81 (0.48 –1.36)0.420.83 (0.48 –1.41)0.481.09 (0.65– 1.82)0.751.12 (0.66 –1.91)0.67 III1.40 (0.84 –2.36)0.201.41 (0.83 –2.38)0.201.51 (0.92– 2.49)0.101.55 (0.92 –2.59)0.10

*global p value

Figure 1.

Patients in each drug category.

Conclusion

In an observational setting, resolution of depression occurs in majority of patients with PsA within 1 year. Patients on t-DMARDs may experience better improvement in depression compared to other treatments. Future effectiveness studies warrant better definitions of depression and treatment response.

Acknowledgements

AJM was supported by the National Psoriasis Foundation Fellowship grant.

Disclosure of Interests

Ashish Jacob Mathew Speakers bureau: Novartis, IPCA Laboratories, Grant/research support from: Novartis, IPCA Laboratories, Mitchell Sutton: None declared, Daniel Pereira: None declared, Dafna D Gladman Consultant of: AstraZeneca, Grant/research support from: AbbVie, Vinod Chandran Consultant of: AbbVie, Amgen, BMS, Eli Lilly, Janssen, Novartis, Pfizer and UCB, Grant/research support from: AbbVie, Amgen and Eli-Lilly

Inventory of Sources of Stress During Medical Education - Further Validation

Introduction

The Inventory of Academic Sources of Stress in Medical Education (IASSME) evaluates the presence and intensity of the main sources of academic stress for Portuguese Medicine students in five dimensions: Course demands/CD, Human demands/HD, Lifestyle/LS, Academic competition/AC, and Academic adjustment/AA.

Objectives

To further validate the ISSME using Confirmatory Factor Analysis and to analyze[ATP1] the psychometric properties of a new version including additional sources of stress.

Methods

Participants were 666 Portuguese medicine (82.6%) and dentistry (17.4%) students (81.8% girls); they answered an online survey including the ISSME and other validated questionnaires: Maslach Burnout Inventory – Students Survey (MBI-SS) and Depression Anxiety and Stress Scales (DASS).

Results

Confirmatory Factor Analysis showed that the second order model composed of five factors (the original structure by Loureiro et al. 2008), but excluding item 11 (loading=.371), presented good fit indexes (χ²/df=3.274; RMSEA=.0581, p<.001; CFI=.917; TLI=.904, GFI=.919). The Cronbach’s alfas were α=.897 for the total and from α=.669 (F2-HD) to α=.859 (F1-CD) for the dimensions. The expanded version, including two additional items related to lack of interest in medicine/dentistry (F6, α=.543) and two additional COVID-19 stress-related-items (F7, α=.744) also showed acceptable fit indexes (χ²/df=3.513; RMSEA=.061, p<.001; CFI=.88.; TLI=.866, GFI=.892). This new version’s α was of .896. Pearson correlations between ISSME and the other measures were significant (p<.01) and high: >.55 with DASS and >.50 with MBI-SS. Girls presented significantly higher ISSME scores. F6 score was significantly higher in dentistry students.

Conclusions

This further validation study underlines that IASSME presents good validity (construct and convergent) and reliability.

Disclosure

No significant relationships.

The Portuguese adapted version of the fear of covid-19 scale for the postpartum period

Introduction

The Portuguese version of the Fear of COVID-19 Scale (FCV-19S; Cabaços et al. 2021), composed of seven items, presented good validity and reliability to be used in general population. To be used within perinatal context, specifically in the postpartum period, we have added an item related to the baby (item 8 – “I’m afraid my baby will be infected with coronavirus-19”).

Objectives

To analyze the psychometric properties of Portuguese adapted version of the Fear of COVID-19 Scale for the postpartum period (FCV-19SP), namely construct validity, internal consistency, and convergent validity.

Methods

207 women (mean age= 33.51 ± 5.23 years) recruited in the postpartum period (9,06 ± 8,52 months after delivery) fill in a set of self-reported validated questionnaires: Perinatal Depression Screening Scale (PDSS), Perinatal Anxiety Screening Scale (PASS) and Coronavirus-19 Fear Scale for the postpartum period (FCV-19SP).

Results

CFA revealed that the unifactorial model composed of eight items presented good fit indexes (X²/df=1.508; CFI=.991; GFI=.974; TLI=.983; p[RMSEA≤.01] = .049), better than those of the seven items version (X²/df=3.963; CFI=.957; GFI=.909; TLI=.905; p[RMSEA≤.01] =.219). Cronbach alpha for the FCV-19SPP was α=.880. The total score significantly (p<.01) and moderately correlated with PDSS (r=.262) and PASS (r=.371).

Conclusions

The FCV-19SP is a valid and reliable questionnaire to assess fear of COVID-19 in women in the postpartum period.

Disclosure

No significant relationships.

Screening Accuracy of the Portuguese version of the Postpartum Depression Screening Scale-7 according to DSM-5 criteria

Introduction

The Portuguese shortest version of the Perinatal Depression Screening Scale/PDSS-7 proved to be valid and reliable, in Portugal and Brazil, but it is essential to analyze its operational characteristics before using it for screening purposes.

Objectives

To determine PDSS-7 cut-off points and associated conditional probabilities to screen for major depression, according to the DSM-5.

Methods

he pregnancy sample was composed of 259 women in the second trimester (Mean gestation weeks=17.83±4.750). The postpartum sample consisted of 241 women assessed between the 2^nd-6^thmonths postpartum(M=17.99±4.689 weeks postpartum). All women completed the PDSS-7 and were interviewed with the Diagnostic Interview for Psychological Distress(Pereira et al., 2017), a semi-structured clinical interview to assess the most prevalent psychiatric disorders in the perinatal period according to the DSM-5 criteria. MedCalc was used to perform ROC analysis.

Results

During pregnancy, the major depression prevalence was of 4.6%(n=12). The cut-off point that maximizes the Youden Index(J=.98, 95%CI: .97-.99; AUC=.99; se=.004; p<.001) was of 18(95%CI:17-19), which resulted in a sensitivity of 100%(71.5%-100%), a specificity of 97.98%(95.3%-99.3%), a positive predictive value/+PP of 68.8%(48.0%-84.0%) and a negative predictive value/-PP of 100%. In the postpartum, the major depression prevalence was of 10.4%(n=25). The cut-off point(J=.79, 95%CI: .63-.82; AUC=.89; se=.036; p<.001) was of 14(95%CI: 12-16), with a sensitivity of 85.0%(69.3%-93.2%), a specificity of 85.0%(69.3%-93.2%), a +PP of 56.5%(46.1%-67.3%) and a -PP of 97.5%(94.6%-98.8%).

Conclusions

The Portuguese version of PDSS-7 presents good combinations of sensitivity and specificity, being accurate and usable to screen for depression during pregnancy and in the postpartum both in research and primary health care.

Disclosure

No significant relationships.

Grief during the COVID-19 pandemic: A cross-sectional online survey in university students

Introduction

Almost 5 million people worldwide have lost their lives due to SARS-CoV-2 (source: WHO coronavirus (COVID-19) dashboard, data of 1.10.2021; https://covid19.who.int/) and therefore, globally, there is an increase of people in grief due to the death of a significant other.

Objectives

To study psychological correlates of grief during the COVID-19 pandemic.

Methods

591 university students, with a mean age of 23.84±7.95 years (range 18-65 years; 76.8% women; 91.2% Portuguese) completed an online questionnaire during the second COVID-19 confinement (from 15.02 to 13.03.2021), with sociodemographic questions, the Pandemic Stress Index, the Mental Health Inventory, Insomnia Scale, questions on physical/ psychological health, and social isolation.

Results

Students bereaving the death of a significant other (n=93, 15.7%; n=25, 26.9% reported cause was SARS-CoV-2; time since death: < 3 months to 1-year), compared to those who did not (n= 498; 84.3%), described poorer psychological health, higher psychological distress (depression, anxiety, lack of control) and sleep difficulties, higher levels of stress (higher impact of COVID pandemic in daily life, and higher behavior changes in response to COVID-19) and more social isolation.

Conclusions

COVID-19 pandemic-related stress is a source of additional stress for bereaved students. Grief is also associated with social isolation, poor mental health (depression, anxiety, lack of control) and sleep difficulties. Screening efforts, guidance, and counseling from professionals of mental health care, primary health care, and universities health care services during and after the COVID-19 pandemic could be extremely beneficial for bereaved students, particularly for those at higher risk of developing prolonged grief disorder.

Disclosure

No significant relationships.

Inventory of Sources of Stress During Medical Education - Further Validation

Introduction

The Inventory of Academic Sources of Stress in Medical Education (IASSME) evaluates the presence and intensity of the main sources of academic stress for Portuguese Medicine students in five dimensions: Course demands/CD, Human demands/HD, Lifestyle/LS, Academic competition/AC, and Academic adjustment/AA.

Objectives

To further validate the ISSME using Confirmatory Factor Analysis and to analyze the psychometric properties of a new version including additional sources of stress.

Methods

Participants were 666 Portuguese medicine (82.6%) and dentistry (17.4%) students (81.8% girls); they answered an online survey including the ISSME and other validated questionnaires: Maslach Burnout Inventory – Students Survey (MBI-SS) and Depression Anxiety and Stress Scales (DASS).

Results

Confirmatory Factor Analysis showed that the second order model composed of five factors (the original structure by Loureiro et al. 2008), but excluding item 11 (loading=.371), presented good fit indexes (χ2/df=3.274; RMSEA=.0581, p<.001; CFI=.917; TLI=.904, GFI=.919). The Cronbach’s alfas were α=.897 for the total and from α=.669 (F2-HD) to α=.859 (F1-CD) for the dimensions. The expanded version, including two additional items related to lack of interest in medicine/dentistry (F6, α=.543) and two additional COVID-19 stress-related-items (F7, α=.744) also showed acceptable fit indexes (χ2/df=3.513; RMSEA=.061, p<.001; CFI=.88.; TLI=.866, GFI=.892). This new version’s α was of .896. Pearson correlations between ISSME and the other measures were significant (p<.01) and high: >.55 with DASS and >.50 with MBI-SS. Girls presented significantly higher ISSME scores. F6 score was significantly higher in dentistry students.

Conclusions

This further validation study underlines that IASSME presents good validity (construct and convergent) and reliability.

Disclosure

No significant relationships.

Further validation of the European and Brazilian Portuguese short version of the Postpartum Depression Screening Scale-7

Introduction

We have recently validated the Portuguese shortest version of the Perinatal Depression Screening Scale-PDSS-7 (items selected from the PDSS-21; each one representing a dimension evaluated by the PDSS-35), for the assessment of depression severity in pregnancy, both in Portugal and Brazil.

Objectives

To analyze the validity and reliability of the PDSS-7 Portuguese version to evaluate postpartum women both from Portugal and Brazil.

Methods

The Portuguese sample was composed of 304 women between the 2nd-6th postpartum months (Mean=20.09±7.21 weeks postpartum). These participants were not the same who participated in the psychometric study that led to the selection of the seven items. The Brazilian sample was composed of 121 women (Mean=10.51±4.53 weeks postpartum). All the participants completed the European/Brazilian Portuguese versions of PDSS-21, which was composed of the same items and included the seven items of PDSS-7. Participants also filled in the validated versions of Perinatal Anxiety Screening Scale and Profile of Mood States.

Results

Confirmatory Factor Analysis revealed that the unidimensional model of PDSS-7 presented acceptable/good fit indexes in both samples (Portuguese/Brazilian: χ²/d.f.=2.6598/1.7897; RMSEA=.0740/.0807, CFI=.8289/.7934, TLI=.7901/.8434, GFI=.9298/.9496; p<.001). The PDSS-7 Cronbach’s alphas were of .841/.856 and all the items contributed to the internal consistency. Pearson correlations with postpartum anxiety (.646/.763) and negative affect (.666/.676) were significantly (p<.01) high. PDSS-7 mean scores were higher in the Brazilian sample (16.06±7.39 versus 11.37±4.37, p<.01).

Conclusions

PDSS-7 presented validity (construct and convergent), reliability and utility in clinical and research settings, including in transcultural studies, in Portugal and Brazil, namely in the postpartum.

Disclosure

No significant relationships.

POS1217 ANTI-TNF THERAPY FOR IMMUNE MEDIATED INFLAMMATORY DISEASES MAY BE ASSOCIATED WITH LOWER ANTIBODY LEVELS AND VIRUS NEUTRALIZATION EFFICACY FOLLOWING SARS-CoV-2 mRNA VACCINATION

Background

The impact of immunosuppressants on COVID-19 vaccination response and durability in patients with immune-mediated inflammatory diseases (IMID) is yet to be fully characterized. Humoral response may be attenuated in these patients especially those on B cell depleting therapy and higher doses of corticosteroids, but data regarding other immunosuppressants are scarce.

Objectives

We aimed to investigate antibody and T cell responses and durability to SARS-CoV-2 mRNA vaccines (BNT162b and/or mRNA 1273) in IMID patients on immunomodulatory maintenance therapy other than B-cell depleting therapy and corticosteroids.

Methods

This prospective observational cohort study examined the immunogenicity of SARS-CoV-2 mRNA vaccines in adult patients with IMIDs (psoriatic arthritis, psoriasis, inflammatory bowel disease and rheumatoid arthritis) with or without maintenance immunosuppressive therapies (anti-TNF, methotrexate/azathioprine [MTX/AZA], anti-TNF + MTX/AZA, anti IL12/23, anti-IL-17, anti-IL23) compared to healthy controls. Automated ELISA for IgGs to spike trimer, spike receptor binding domain (RBD) and the nucleocapsid (NP) and T-cell release of 9 cytokines (IFNg, IL2, IL4, IL17A, TNF) and cytotoxic molecules (sFasL, GzmA, GzmB, Perforinin) in cell culture supernatants following stimulation with spike or NP peptide arrays were conducted at 4 time points: T1=pre vaccination, T2=median 26 days after dose 1, T3=median 16 days after dose 2 and T4=median 106 days after dose 2. Neutralization assays against four SARS-CoV-2 variants (wild type, delta, beta and gamma) were conducted at T3.

Results

We followed 150 subjects: 26 healthy controls and 124 IMID patients: 9 untreated, 44 on anti-TNF, 16 on anti-TNF with MTX/AZA, 10 on anti-IL23, 28 on anti-IL12/23, 9 on anti-IL17, 8 on MTX/AZA (Table 1). Most patients mounted antibody and T cell responses with increases from dose 1 to dose 2 (100% seroconversion at T3) and some decline by T4, with variability within groups. Antibody levels and neutralization efficacy was lower in anti-TNFgroups (anti-TNF, anti-TNF + MTX/AZA) compared to controls and waned by T4 (Figure 1). T cell responses were not consistently different between groups. Pooled data showed a higher antibody response to mRNA-1273 compared to BNT162b.

Table 1.

Baseline characteristics of study participants

Controluntreated IMIDAnti- TNFAnti- TNF +MTX/AZAAnti-IL-23Anti -IL-12/23Anti -IL-17MTX/AZAn=26n=9n=44n=16n=10n=28n=9n=8p-valueIMID*N/A IBD9301002704 Psoriasis1318122 PA0732172 AS0830010 RA1100011Age median years [IQR]36 [26-46]33 [27-41]38 [30-51]53 [44-59]48 [45-61]34 [28-47]49 [46-61]42 [31-55]<0.001^Sex male (%)16 (62)5 (56)18 (41)8 (50)5 (50)13 (46)6 (67)4 (50)0.772~BMImedian kg/m2 [IQR]25 [23-28]26 [22-27]22 [24-26]26 [24-28]27 [24-35]22 [21-24]32 [26-34]26[25-33]0.001^Vaccine interval median days [IQR]74 [35-84]54 [31-64]60 [45-69]64 [50-72]74 [35-84]62 [49-69]65 [52-75]58 [21-97]0.372^

*multiple IMIDs per patient possible

Figure 1.

Antibody responses (A) Anti spike and anti RBD IgG levels at indicated time points. Blue line represents median ratio in convalescent patients. The red line is the seropositivity threshold: the median antibody level of those that pass both a 1% false positive rate and show ≥3SD from the log means of the negative controls. (B) Relative ratio of RBD, spike and NP across time. Black and gray lines indicate median and mean values, respectively. *p≤0.05, **p≤0.01, ***p≤0.001, ****p≤0.0001

Conclusion

Following 2 doses of mRNA vaccination there is 100% seroconversion in IMID patients on maintenance therapy. Antibody levels and neutralization efficacy in anti-TNF group are lower than controls, and wane substantially by 3 months after dose 2. These findings highlight the need for third dose in patients undergoing treatment with anti-TNF therapy and continued monitoring of immunity in these patient groups, taking into consideration newer variants and additional vaccine doses.

Acknowledgements

This work was funded by a donation from Juan and Stefania Speck and by grants VR-1 172711, VS1-175545, FDN-143250, GA1- 177703 and GA2- 177716, from Canadian Institutes of Health Research and COVID Immunity task force and by Sinai Health Foundation

Disclosure of Interests

Naomi Finkelstein: None declared, Roya M. Dayam: None declared, Jaclyn Law: None declared, Rogier Goetgebuer: None declared, Gary Chao: None declared, Kento T. Abe: None declared, Mitchell Sutton: None declared, Joanne M. Stempak: None declared, Daniel Pereira: None declared, David Croitoru: None declared, Lily Acheampong: None declared, Saima Rizwan: None declared, Klaudia Rymaszewski: None declared, Raquel Milgrom: None declared, Darshini Ganatra: None declared, Nathalia V. Batista: None declared, Melanie Girard: None declared, Irene Lau: None declared, Ryan Law: None declared, Michelle Cheung: None declared, Bhavisha Rathod: None declared, Julia Kitaygorodsky: None declared, Reuben Samson: None declared, Queenie Hu: None declared, Nigil Haroon: None declared, Robert Inman Consultant of: AbbVie, Janssen, Lilly, Novartis., Grant/research support from: AbbVie, Novartis, Vincent Piguet Consultant of: AbbVie, Almirall, Celgene, Janssen, Kyowa Kirin Co. Ltd, LEO Pharma,

Novartis, Pfizer, Sanofi, UCB, and Union Therapeutic, Grant/research support from: Unrestricted educational grants from AbbVie, Bausch Health, Celgene, Janssen, LEO Pharma, Lilly, L’Oréal, NAOS, Novartis, Pfizer, Pierre-Fabre, Sandoz, and Sanofi, Mark Silverberg Speakers bureau: AbbVie, Janssen, Takeda, Pfizer, Gilead and Amgen, Consultant of: AbbVie, Janssen, Takeda, Pfizer, Gilead and Amgen, Grant/research support from: AbbVie, Janssen, Takeda, Pfizer, Gilead and Amgen, Anne-Claude Grigras: None declared, Tania H. Watts: None declared, Vinod Chandran Consultant of: AbbVie, Amgen, BMS, Eli Lilly, Janssen, Novartis, Pfizer and UCB, Grant/research support from: AbbVie, Amgen, Eli-Lilly.

Epileptic Seizures or not, that is the question: a case report

Introduction

Psychogenic nonepileptic seizures (PNES) consist of paroxysmal changes in responsiveness, movements, or behaviour that superficially resemble epileptic seizures.

Objectives

Presentation of a clinical case of a PNES in a patient with a diagnose of secondary epilepsy, illustrating the relevance of an adequate evaluation, differential diagnosis, and intervention.

Methods

Description of the clinical case, with brief literature review and discussion. A search was conducted on PubMed and other databases, using the MeSH terms “nonepileptic seizure”, and “epileptic seizure”.

Results

We report the case of a 45-year-old female patient, brought to the emergency department because of tonic axial and limb nonsynchronous movements, closed eyes, long duration, with immediate awareness, no desaturation, tongue bite, facial flushing, dyspnoea or sphincter incontinency. She was medicated with clonazepam 1 mg and levetiracetam 1000 mg ev. TC-CE had no acute alteration. Bloodwork had no other major alteration except valproic acid below therapeutic levels (her usual medication, along with other antiepileptic drugs, antidepressant and antipsychotic). The antecedents of the patient: mild intellectual disability and an accidental traumatic brain injury in infancy, with secondary epilepsy. She was transferred to Psychiatry department. No electroencephalogram (EEG) was realized, because she had a recent one confirming PNES, and many other emergency observations with the diagnosis of PNES.

Conclusions

This clinical case showcases the diagnostic difficulties that clinicians face when there is an overlap in symptoms, emphasizing the need to combine patient history, witness reports, clinician observations, and ictal and interictal EEG to help distinguish these different clinical identities.

Disclosure

No significant relationships.

Stigma towards mental illness in med students: you label me, I label you?

Introduction

Evidence suggests that besides having stigmatizing misconceptions towards people with mental illness, medical students and doctors often resist seeking help for their own mental issues. This is a vulnerable group for stress and other mental health problems, due not only to professional burden but also high perfectionism and low self-compassion.

Objectives

To analyse the relationship between mental health stigma (MHS) and other variables related to personality and emotional states in a sample of medical students.

Methods

634 medicine and dentistry students (mean age = 21.6±6.9;81.4% female) answered to a survey including sociodemographic data, self-perception of psychological health/SPPH and the Portuguese validated versions of: Link’s Perceived Discrimination and Devaluation (PDD) scale to assess MHS and its two dimensions - social stigma/SocS and self-stigma/SelS; Depression Anxiety Stress Scale (DASS-21); Neff’s Self-Compassion Scale (SCS); and Big Three Perfectionism Scale (BTPS). Correlations, t-student tests and linear regressions were performed with SPSS 27.0.

Results

Stigma correlated negatively to SPPH and positively to DASS, the negative poles of SCS (self-judgement, isolation and over-identification) and BTPS second-order factors (all from p<.05 to p<.01). No gender differences in MHS were observed. Participants with higher mean levels of total and SelS had significantly higher scores in all DASS dimensions and lower SPPH; participants with higher SocS also scored higher in DASS, but didn’t reveal lower SPPH. Isolation was a significant predictor of SocS (R2=2.8%;p<.05); isolation and narcissistic perfectionism were significant predictors of SelS (R2=11%;p<.01).

Conclusions

Our results highlight the importance of including MHS as a main need in the curricula of future doctors.

Disclosure

No significant relationships.

Genetic Polymorphisms as Predictors of Survival in Breast Cancer: Future Lessons in Historical Data

Introduction

Breast cancer is the most common cancer among women worldwide and one of the main causes of death in the female sex. Genetic polymorphisms in the mu-opioid receptor (OPRM1) and catechol-o-methyltransferase (COMT) genes have been shown to increase breast cancer risk. Variants in these genes may carry a prognostic impact in breast cancer. Long follow-up intervals are critical to adequately analyze prognosis in diseases with prolonged survival times and late relapses.

Objective

To analyze the impact of genetic polymorphisms on the survival of a cohort of breast cancer patients with very long follow-up.

Methods

This was a retrospective study of patients treated at Portuguese Oncology Institute of Porto (IPO Porto), a Portuguese comprehensive cancer center, with invasive carcinoma of the breast with very long follow-up, with analysis of genetic polymorphisms OPMR1 rs1799971 (AA vs. G allele) and COMT rs4680 (CC vs T allele) on biological samples. Statistical analysis of survival was performed using the Kaplan-Meier method, log-rank test, and Cox regression method.

Results

A total of 143 patients with invasive breast cancer were included, with a median follow-up of 21.5 years. There was a statistically significant difference in overall survival (OS) at 30 years according to the OPMR1 polymorphism, with lower survival in patients with the AA genotype (p<0.05). The difference in OS according to the COMT polymorphism was also statistically significant, with worse survival in patients with genotype T allele (p<0.05). The genetic variants were not associated with patient age, stage at diagnosis, or tumor grade.

Discussion

The genetic polymorphisms of OPRM1 and COMT affected the overall survival of breast cancer patients, in concordance with previous research. Further investigation is needed in order to clarify the prognostic impact of these genetic alterations on breast cancer.

Understanding Reentrance in Frustrated Magnets: The Case of the Er_{2}Sn_{2}O_{7} Pyrochlore

Reentrance, the return of a system from an ordered phase to a previously encountered less-ordered one as a controlled parameter is continuously varied, is a recurring theme found in disparate physical systems, yet its microscopic cause is often not investigated thoroughly. Here, through detailed characterization and theoretical modeling, we uncover the microscopic mechanism behind reentrance in the strongly frustrated pyrochlore antiferromagnet Er_{2}Sn_{2}O_{7}. We use single crystal heat capacity measurements to expose that Er_{2}Sn_{2}O_{7} exhibits multiple instances of reentrance in its magnetic field B vs temperature T phase diagram for magnetic fields along three cubic high symmetry directions. Through classical Monte Carlo simulations, mean field theory, and classical linear spin-wave expansions, we argue that the origins of the multiple occurrences of reentrance observed in Er_{2}Sn_{2}O_{7} are linked to soft modes. These soft modes arise from phase competition and enhance thermal fluctuations that entropically stabilize a specific ordered phase, resulting in an increased transition temperature for certain field values and thus the reentrant behavior. Our work represents a detailed examination into the mechanisms responsible for reentrance in a frustrated magnet and may serve as a template for the interpretation of reentrant phenomena in other physical systems.

A Study of Consultant Attitudes to NCHD Less-Than-Full-Time (LTFT) Training

Aims Less-than-full-time (LTFT) training is increasing in availability and flexibility. Negative perceptions by consultants is a concern. This study aims to ascertain the attitudes of consultants to LTFT training and determine potential barriers to LTFT training. Methods A prospective cohort questionnaire-based study was designed with mixed qualitative and quantitative methodology. It was distributed to consultants in a tertiary paediatric hospital. The main outcome measures were likelihood of negative perceptions of LTFT NCHDs, and perceived advantages and disadvantages of LTFT training. Results 35.4% had worked LTFT, and 40.5% (n=17) of those who hadn't had considered or were currently considering it. Most respondents did not have a negative perception of LTFT NCHDs (84.6%). Work-life balance, reduction of burnout, and being fully committed were perceived advantages of LTFT training to NCHDs. Advantages to the team were energy, staffing, and productivity. Disadvantages to the NCHD were training duration, involvement in clinical activities, and negative perceptions. Disadvantages to the team were continuity, roster planning, and workload distribution. Conclusion Consultant perceptions of LTFT trainees are positive. There are common themes in the perceived impact of LTFT training that must be explored to maximise the success of this training pathway.

Healthcare use and costs in early breast cancer: a patient-level data analysis according to stage and breast cancer subtype

Background

The cost of breast cancer care rises with higher stage at diagnosis; however, there are no real-world data regarding the cost of care according to breast cancer subtypes. This study aimed to estimate direct medical costs for early breast cancer care in the first 3 years after diagnosis according to subtype and stage, using patient-level data.

Methods

Women with newly diagnosed stage I–III breast cancer, admitted in 2012 to a Portuguese cancer centre were prospectively followed within the NEON-BC cohort. The use of health resources was obtained from each patient’s clinical and administrative records and costs were computed. Tumours were classified into the classic subtypes (hormone receptor-positive (HR+)/HER2−; HER2-positive (HER2+); triple-negative breast cancer (TNBC)) and surrogate intrinsic subtypes (luminal A-like; luminal B-like; HER2 enriched; basal like).

Results

A total of 703 patients were included: 48.9% had stage I, 35.8% stage II and 15.2% stage III breast cancer; 76.4% had HR+/HER2−, 15.9% HER2+ and 7.7% TNBC. Median cost of care was €9215/patient in stage I, €13 019/patient in stage II and €15 011/patient in stage III and €10 540/patient in HR+/HER2−, €11 224/patient in TNBC and €41 513/patient in HER2+ breast cancer. Systemic therapy accounted for 69.2% of the cost of care among patients with HER2+, 12.0% among HR+/HER2− and 7.5% among TNBC patients. Similar differences were observed across surrogate intrinsic subtypes.

Conclusions

The cost of early breast cancer care was mainly driven by the tumour subtype and, to a lesser extent, by stage. The median cost of care was fourfold higher among patients with HER2+ tumours compared with those with HR+/HER2− and TNBC. These data provide information for the economic evaluation of innovative treatments for early breast cancer and highlight the weight that targeted systemic therapy might have in the overall cost of care among patients with early breast cancer.

AB0457 HIPPOCAMPAL SUBFIELDS VOLUMES REDUCTION IN PATIENTS WITH SYSTEMIC SCLEROSIS: A LONGITUDINAL MAGNETIC RESONANCE IMAGING (MRI) VOLUMETRIC STUDY

Background:

Systemic sclerosis (SSc) is a multisystem disease characterized by functional and structural abnormalities of small blood vessels, fibrosis of the skin and internal organs. In addition, volume reduction and shape abnormality of the hippocampus have been demonstrated in rheumatic and neurodegenerative diseases. However, the neuroanatomy of the hippocampus is complex and is not a uniform structure, consisting of subfields with distinct morphology: cornu ammonis (CA) subfields CA1–4, dentate gyrus (DG), fimbria, and adjacent subiculum and presubiculum [1].

Objectives:

To investigate the hippocampal subfields volumes reduction in SSc patients using MRI.

Methods:

In this study we included 37 SSc patients (33 women, mean age of 53.46, SD ± 12.29; range 30 - 78) and 37 healthy controls (HC) (31 women, mean age of 48.41, SD±12.20; range 29 - 80). Cognitive evaluation was performed using the Montreal Cognitive Assessment (MoCA), mood disorders were determined through Beck’s Depression (BDI) and Beck’s Anxiety Inventories (BAI). SSc patients were further assessed for clinical and laboratory SSc manifestations, disease activity (Valentini Activity Index), severity activity (Medsger Severity Index). MRI protocol consisted of: Sagittal T1-weighted images performed with a Philips 3.0T MRI scanner. MRI brain structure volumetric was done through volBrain [2]. After 48 months MRI acquisition were repeated in 26 SSc patients and 12 healthy volunteers. Statistics was performed according nature of the variable.

Results:

We observed a significant reduction in hippocampal subfields volumes in SSc patients when compared to controls: Total hippocampi (SSc: mean volume = 4.78 cm3; SD = 0.38; HC: mean volume = 5.01 cm3; SD = 0.38; p = 0.033). Reduction in volume of the total hippocampi was associated with Raynaud’s phenomenon (p = 0.006). A longitudinal study showed a reduction in volume of the hippocampus subfields volumes when compared to patient’s baseline: Total hippocampi (mean initial volume = 4.78 cm3; mean follow-up volume = 4.50 cm3, p = 0.027); Total CA1 (mean initial volume = 1.59 cm3; mean follow-up volume = 1.58 cm3, p < 0.0001); Reduction in volume of the total hippocampi was associated with presence of current use of prednisone (p = 0.008). Reduction in left CA1 left associated with current use of prednisone (p = 0.014). Reduction in total subiculum was associated with presence of calcinosis (p = 0.023). No significant changes were observed in hippocampal subfields volumes in controls over the follow-up period.

Conclusion:

This study provides evidence of hippocampus subfields volumes reductions in SSc patients when compared to controls and was associated with Raynaud’s phenomenon, current use of losartan and correlated with BAI scores. Also, a longitudinal study showed a reduction in volume of the hippocampus subfields volumes when compared to patient’s baseline associated with calcinosis and current use of prednisone.

References:

[1]Eichenbaum, Howard. “A cortical–hippocampal system for declarative memory.” Nature Reviews Neuroscience 1.1 (2000): 41-50.

[2]Manjon JV, Coupe P (2016) volBrain: an online MRI brain volumetry system. Front Neuroinform 10:30.

Disclosure of Interests:

None declared.

Genome-scale phylogenies reveal relationships among Parastagonospora species infecting domesticated and wild grasses

Several plant pathogenic Parastagonospora species have been identified infecting wheat and other cereals over the past 50 years. As new lineages were discovered, naming conventions grew unwieldy and the relationships with previously recognized species remained unclear. We used genome sequencing to clarify relationships among these species and provided new names for most of these species. Six of the nine described Parastagonospora species were recovered from wheat, with five of these species coming from Iran. Genome sequences revealed that three strains thought to be hybrids between P. nodorum and P. pseudonodorum were not actually hybrids, but rather represented rare gene introgressions between those species. Our data are consistent with the hypothesis that P. nodorum originated as a pathogen of wild grasses in the Fertile Crescent, then emerged as a wheat pathogen via host-tracking during the domestication of wheat in the same region. The discovery of a diverse array of Parastagonospora species infecting wheat in Iran suggests that new wheat pathogens could emerge from this region in the future. Citation: Croll D, Crous PW, Pereira D, et al. 2021. Genome-scale phylogenies reveal relationships among Parastagonospora species infecting domesticated and wild grasses. Persoonia 46: 116-128. https://doi.org/10.3767/persoonia.2021.46.04.

Not guilty by reason of insanity and dangerousness: A demographic, clinical and forensics description of the patients in the forensic inpatinent service of Coimbra

Introduction

Despite being essential for the service quality improvement, empirical research on the characteristics of people hospitalized in forensic psychiatry units and the psychopharmacological treatment instituted in this care context is scarce in Portugal.

Objectives

To describe the sociodemographic, clinical and criminological characteristics of the patients admitted to a forensic psychiatric unit in Portugal, as well as, the psychiatric drugs prescription pattern in this care context.

Methods

A retrospective observational study was carried out, through the data analysis of patients admitted to the Sobral Cid Forensic Psychiatry unit of the Coimbra Hospital and University over the past 12 years.

Results

The sample had 194 inpatients, 153(78.9%) male and 41(21.1%) females. The mean age was 43.3 years and 74.7% had no professional, school or occupational activity. The most frequent psychiatric diagnoses were psychotic disorders (56.7%) and neurodevelopmental disorders(33.5%). 24.2% had at least two psychiatric diagnoses and 38.7% had concomitant medical conditions. 77.8% had history of psychiatric hospitalizations and 21.6% had history of self-injurious behaviors. 37.1% of the sample had a criminal record. Crimes against people were the most frequent. The use of injectable antipsychotic formulations was frequent and 18.6% of the patients were medicated with Clozapine. The prescribed daily doses were above the defined daily dose. Psychotic disorders and addictive disorders were less frequent in women. Statistically significant differences were found in the frequency of homicide between females(41.5%) and males(22.2%).

Conclusions

Tailored solutions are crucial to accomplish the purpose of security measures, mostly by addressing the identified needs and rethinking the approach on this specific context.

Disclosure

No significant relationships.

Keyword

Forensic Psychiatry Units

Validation of the portuguese version of the mentalization questionnaire in a sample of college students: Preliminary results

Introduction

Mentalization (MZ) is the capacity by which people make sense of their own’s and others’ mental states; when compromised, it is associated with several mental disorders (Bateman & Fonagy, 2010). A valid instrument to assess MZ is missing and required for the Portuguese population.

Objectives

To develop and validate a Portuguese version (Questionário de Mentalização – QMZ) of the Mentalization Questionnaire (MZQ) (Hausberg et al., 2012).

Methods

A sample of 184 Portuguese medical students (mean age = 21.6 ± 2.47 years, 59.8% female) was used to explore the psychometric properties of the scale, using reliability and factor analysis (varimax rotation method).

Results

The QMZ exhibited a Cronbach’s alpha score of .80. All items contributed to its reliability. Based on the scree plot of Cattell and interpretability of items, a 2-factor and a 5-factor structures were further explored. The former explained 38.8% of the total variance (VE) and included a regulation of affect (VE= 27.3%, α=.79) and a self-reflection and emotional awareness (VE= 11.5%, α=.62) factors. The latter explained 60.6% of the total variance and incorporated the following dimensions: self-control (VE= 27.3%, α=.74), daily relationships (VE= 11.5%, α=.67), self-comprehension (VE= 8.1%, α=.54), close relationships (VE= 7.0%, α=.41) and self-monitoring (VE= 6.7%, α=.52). The 5-factor structure was closer to the dimensional concept of mentalization.

Conclusions

The QMZ has proved to be a promising instrument, with adequate psychometric properties, confirmed by its acceptable construct, criterion and factorial validity and reliability to assess mentalization in Portuguese language.

Antepartum depressive and anxious symptoms: Association with physiological parameters of the newborn

Introduction

The Perinatal period is a time of vulnerability for developing psychiatric disorders of higher prevalence in the female gender - depression and anxiety1. Numerous authors have proposed that maternal psychological factors could influence pregnancy course and the well-being of mother and newborn2.

Objectives

To explore the relationship between perinatal psychological disorder and physiological parameters evaluated at birth, such as the Apgar Index (AI; 1, 5 and 10 minutes), head circumference, weight, length and age.

Methods

533 women answered, in the second trimester of pregnancy (16.98±4.83 weeks of gestation), several questions about psychosocial variables, the Perinatal Depression Screening Scale3 and the Perinatal Anxiety Screening Scale4. Of these, 208 (39.0%) women were interviewed with the Diagnostic Interview for Psychological Distress5. Newborn physiological parameters were obtained from electronic health records.

Results

AI was significantly (p<.01) and moderately (r≈.25) correlated with maternal anxious symptomatology, and with the experience of a stressful event in the last year (only AI 1 minute). Newborns of women with clinically relevant anxious symptomatology (>cutoff point, 14.6%) had significantly lower AI (p<.05), which was also observed in newborns of women who considered having had a stressful event (only AI 1 minute). Women’s newborns with maternal anxiety disorders during pregnancy (5.3%), had significantly lower values in AI, head circumference, weight and age of birth. Regression analyses showed that anxiety in pregnancy (symptoms and/or diagnoses) is a predictor of newborn physiological parameters, explaining significant percentages(r≈22%; p<.05) of its variability.

Conclusions

Early detection of psychological disorders in pregnancy, namely anxiety, is determinant to prevent adverse neonatal outcomes.

Disclosure

No significant relationships.

Postpartum depression screening scale-7: A valid and reliable short version both for portugal and brasil

Introduction

Screening programs for perinatal depression are systematicly implemented in developed countries. To circumvent the most commonly pointed limitation by the primary healthcare professionals (the questionnaires length), we have developed shorter forms of the Beck and Gable Postpartum Depression Screening Scale-35. The shortest version consists of seven items, each one representing a dimension evaluated by the PDSS. This PDSS-7 demonstrated equal levels of reliability and validity as the 35-item PDSS with the advantage of being completed in as little as 1-2 minutes(Pereira et al. 2013).

Objectives

To analyze the construct validity of the PDSS-7 using Confirmatory Factor Analysis, to use both in Portugal and in Brazil.

Methods

The Portuguese sample was composed of 616 women (Mean age: 32.29±4.466; Mean gestation weeks=17.13±4.929). These participants were not the same who participated in the psychometric study that led to the selection of the seven items. The Brazilian sample was composed of 350 women (Mean age: 30.01±5.452; Mean gestation weeks=25.17±6.55). They all had uncomplicated pregnancies and completed the European/Brazilian Portuguese versions of PDSS-24 (Pereira et al. 2013/ Barros et al. 2021), which was composed of the same items and included the seven items that compose the PDSS-7.

Results

The unidimensional model of PDSS-7 presented a good fit in both samples (Portuguese/Brazilian: χ²/d.f.=3.439/2.653; RMSEA=.066/.069, CFI=.974/.981, TLI=.947/.957, GFI=.939/.957; p<.001). The PDSS-7 Cronbach’s alphas were .82/.83 and all the items contribute to the internal consistency.

Conclusions

The PDSS-7 is a valid and precise, economic, fast and easy screening instrument for perinatal depression, a major public health problem, both in Portugal and in Brazil.

The role of dysfunctional attitudes towards motherhood in postpartum depressive symptoms and disorder

Introduction

Postpartum depression (PPD) is the commonest postpartum psychiatric condition, with prevalence rates around 20%¹. PPD is associated with a range of adverse outcomes for both the mother and infant². Therefore, identifying modifiable risk factors for perinatal depression is an important public health issue³.

Objectives

To explore the role of dysfunctional attitudes towards motherhood in postpartum depressive symptoms and disorder.

Methods

247 women were evaluated in the third (12.08±4.25 weeks) and sixth months (31.52± 7.16 weeks) postpartum with the Attitudes Towards Motherhood Scale⁴, the Postpartum Depression Screening Scale⁵ and the Diagnostic Interview for Psychological Distress-Postpartum⁶. Correlation analysis was performed followed by linear/logistic regression analysis when the coefficients proved significant (p<.05), using SPSS.

Results

Dysfunctional beliefs towards motherhood concerning judgement by others and maternal responsibility positively correlated with depressive symptoms at the third (.528; .406) and the sixth months (.506; .492) postpartum. Those dysfunctional beliefs were predictors of depressive symptoms at the third (ß=.440; ß=.151) and sixth months (ß=.322; ß.241) explaining 29.4% and 30.2% of its variance, respectively. Having dysfunctional beliefs at the third month significantly increase the likelihood of being diagnosed with Major Depression (DSM5) both in the third (Wald=9.992, OR=1.169; Wald=16.729, OR=1.231) and sixth months (Wald=5.638, OR=1.203; Wald=7.638, OR=1.301) (all p<.01).

Conclusions

Cognitive distortions should be included in the assessment of risk factors for PPD. Early identification of women presenting motherhood-specific cognitive biases may be crucial for implementing preventive interventions favoring a more positive and healthier motherhood experience.

Disclosure

No significant relationships.

Psychosocial risk factors for dysfunctional beliefs towards motherhood

Introduction

Motherhood-related beliefs are characterized by themes of failure and maternal role idealization. Recent studies found that postpartum depression/PPD is both predicted and a predictor by/for dysfunctional beliefs/DB. Additionally, it is possible that when contextual factors (eg. lack of social support) are present, women may anticipate the parenting experience as being of isolation, which in turn can lead to more dysfunctional attitudes.

Objectives

To explore psychosocial risk factors for motherhood-DB.

Methods

233 women were evaluated in the second trimester (17.05±4.82 weeks) of pregnancy and in the third month (12.08±4.25 weeks) postpartum sociodemographically and psychosocially (years of education, previous children and social support) and the Portuguese validated self-report questionnaires to assess: perinatal depression; perinatal anxiety; perfectionism; negative affect; self-compassion; and repetitive negative thinking (all in T0). The Attitudes Towards Motherhood Scale was administered in the postpartum. When Pearson/Spearmen correlation coefficients proved significant (p<.05), linear/logistic (hierarchic) regression analysis were performed.

Results

Motherhood-DB correlated significantly with all the variables, except for years of education, Other-oriented-Perfectionism and Common-Humanity. Motherhood-DB were significantly higher in women without previous children (p<.05). The final regression model was statistically significant (p<.001) explaining 15% of the Motherhood-DB variance, with Socially-Prescribed-Perfectionism and social support being the only statistically significant predictors. Hierarchic regression showed that even after controlling for social support, SSP significantly incremented the variance in 9%.

Conclusions

Our results highlight the need for preventive approaches to help women understand the origins of their dysfunctional beliefs (perfectionism, the myths of perfect motherhood) and for the promotion of positive cognitions.

Disclosure

No significant relationships.

Study on the association between sleep disorders versus oral health related variables

Background

To study the association between sleep quality and oral health related variables, which still have conflicts in the literature.

Material and Methods

This was a population-based case-control study between subjects with versus without sleep disorders from the Brazilian Public Health System (SUS), city of Maringá (N=1,643). Subjects answered self-reported questionnaires: a) Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), b) Sleep Assessment Questionnaire (SAQ) and c) North York Dental Health Survey (NYDHS).

Results

No significant difference was found for gender, marital status, or income; however, non-Caucasians, people with lower levels of education, and those between 20 to 50 years old had worse scores of sleep disorders in the SAQ. Self-perceived oral health, masticatory capacity to eat foods, and gingival bleeding was significantly worse among subjects with self-reported sleep disorders. Self-reported tooth loss, edentulism and use of removable partial dentures (with clasps) or complete dentures showed no significant difference between groups. Self-reported sleep disorder subjects presented significantly higher prevalence of both self-reported tooth and TMJ pain.

Conclusions

It can be concluded that individuals with self-reported sleep disorders presented worse self-perceived oral health for most studied variables.

Key words:Oral health, case control study, sleep; review, gingivitis, periodontitis, tooth loss.

Teaching Cardiopulmonary Auscultation to Medical Students using a Virtual Patient Simulation Technology

The teaching process of auscultation is complex in itself, and difficult to operate since it requires a wide spectrum of patients with the most diverse cardiopulmonary pathologies, readily available during teaching and assessment hours, for an ever-growing number of medical students. In this paper we will focus on how virtual patient technologies can promote the evolution of the current teaching methodologies, promoting better learning. The chosen methodology was: a) a review of available medical simulation technologies for auscultation teaching; b) a case study illustrating how a virtual patient simulation technology has been successfully used to teach and certify auscultation skills. Results show the positive impact and high acceptability of virtual patient simulation technologies in the teaching of auscultation to medical students.

Hyperbaric oxygen for radiation-induced cystitis: A long-term follow-up

INTRODUCTION AND OBJECTIVES

Bladder complications may be seen in up to 12% of patients treated with pelvic irradiation. Hyperbaric oxygen therapy (HBOT) is an option for the management of radiation-induced hemorrhagic cystitis (RIHC). The aim of this study was to evaluate the efficacy of HBOT in radiation cystitis and to identify the predictive factors for a successful outcome.

MATERIAL AND METHODS

We retrospectively reviewed 105 patients diagnosed with RIHC which were treated with HBOT between 2007 and 2016 in our institution. Patients received 100% oxygen in a multiplace hyperbaric chamber at 2.4atm for 80minutes. All patients fulfilled a questionnaire documenting symptom severity pre-HBOT and at the end of the follow-up period.

RESULTS

After a median of 40 HBOT sessions, there was success rate of 92,4% in the control of hematuria. During our follow-up period (median of 63 months) 24,7% patients presented with recurrence of hematuria. The mean score of the questionnaire-assessed variables: dysuria, urinary frequency and hematuria, was significantly lower after the follow-up period (P<.05). Our data shows that the sooner HBOT is delivered after the first episode of hematuria, better response rates are achieved and lower recurrences concerning hematuria were registered (P<.05). No serious complications were observed.

CONCLUSIONS

Our results support the safety and long-term benefits of HBOT on RIHC and other distressful bladder symptoms, which represents an expected improvement of quality of life in our patients.

Tumor Testing for Somatic and Germline BRCA1/BRCA2 Variants in Ovarian Cancer Patients in the Context of Strong Founder Effects

Deleterious variants in the BRCA1/BRCA2 genes and homologous recombination deficiency (HRD) status are considered strong predictors of response to poly (ADP-ribose) polymerase (PARP) inhibitors (PARPi). The introduction of PARPi in clinical practice for the treatment of patients with advanced ovarian cancer imposed changes in the molecular diagnosis of BRCA1/BRCA2 variants. BRCA1/BRCA2 tumor testing by next-generation sequencing (NGS) can detect simultaneously both somatic and germline variants, allowing the identification of more patients with higher likelihood of benefiting from PARPi. Our main goal was to determine the frequency of somatic and germline BRCA1/BRCA2 variants in a series of non-mucinous OC, and to define the best strategy to be implemented in a routine diagnostic setting for the screening of germline/somatic variants in these genes, including the BRCA2 c.156_157insAlu Portuguese founder variant. We observed a frequency of 19.3% of deleterious variants, 13.3% germline, and 5.9% somatic. A higher prevalence of pathogenic variants was observed in patients diagnosed with high-grade serous ovarian cancer (23.2%). Considering the frequencies of the c.3331_3334del and the c.2037delinsCC BRCA1 variants observed in this study (73% of all BRCA1 pathogenic germline variants identified) and the limitations of NGS to detect the BRCA2 c.156_157insAlu variant, it might be cost-effective to test for these founder variants with a specific test prior to tumor screening of the entire coding regions of BRCA1 and BRCA2 by NGS in patients of Portuguese ancestry.

Dataset of GWAS-identified variants underlying venous thromboembolism susceptibility and linkage to cancer aggressiveness

Venous thromboembolism (VTE) is a common cardiovascular disease, for which several single nucleotide polymorphisms (SNPs) underlying susceptibility were identified. Apart from candidate gene approach, genome-wide association studies (GWAS) have contributed to the identification of novel VTE-associated SNPs, including some with no clear role in the haemostatic system. These genetic variants constitute potential cancer-related biomarkers, particularly predictive and prognostic biomarkers, as a two-way association between VTE and cancer is well established. The present dataset comprises the data obtained from GWAS performed to identify genetic variants associated with VTE risk. Furthermore, this dataset also comprises data regarding previously reported candidate gene and validation reports performed in adults of European ancestry that also analysed the VTE GWAS-identified variants. Lastly, to evaluate the impact of these genetic variants in carcinogenesis, a broad search was made, which has let us to establish putative links between several VTE-associated genes and cancer hallmarks in a review article entitled “Venous thromboembolism GWAS reported genetic makeup and the hallmarks of cancer: linkage to ovarian tumour behaviour”.

Abstract P2-03-01: The (in)effectiveness of staging exams in asymptomatic breast cancer patients

Background: During breast cancer follow-up, there is no data suggesting that, besides annual mammography, laboratory and imaging tests in asymptomatic patients lead to survival benefit. However, most available data come from a period of fewer quality of diagnostic procedures and less efficacy of treatment for advanced breast cancer.

In our centre, in the absence of disease recurrence after 5 years of follow-up, and when endocrine therapy ends, we transfer the surveillance of breast cancer patients for primary care physicians. Before that, by protocol, we use to request as staging exams a bone scan, a chest x-ray and liver ultrasound, or a thoracoabdominal computed tomography, as well as the quantification of CA15.3, in order to detect asymptomatic cancer recurrence before discharge.

This study aimed to evaluate the effectiveness of that strategy in detecting asymptomatic disease and its impact on patients’ outcomes, compared to those who recurred symptomatically during the following 5 years of surveillance.

Methods:

A retrospective cohort study of all adult patients admitted to our institution due to breast cancer in stage I-III during 2008 was performed. We included those who were asymptomatic and considered for discharge after 5 years of follow-up. Laboratory and imaging tests done at that time were reviewed. We also looked for symptomatic disease recurrence in the following 5 years of surveillance, with median follow-up of 43 months (95% CI 24.6-61.4), after discharge. Data were analyzed using descriptive statistics and survival was estimated by Kaplan-Meier method. Survival between groups was compared using log-rank test. Hazard ratios and respective 95% CI were estimated using Cox-regression models. Statistical significance was set at P&lt; 0.05.

Results:

A total of 576 patients met inclusion criteria, 99.7% female (574/576), with median age of 59 years (IQR, 18). Disease was staged as IA in 48.5% of patients (279/575). At discharge, 75.2% of patients (433/576) did staging exams, and the remaining did not according to clinical criteria defined by the attending physician (mainly age, comorbidities and stage IA). Exams were positive in 2.1% of patients screened (9/433), due to bone metastasis detection in 88.9% (8/9). For these 9 patients, median PFS was 30 months (95% CI 0.0-76.7) and 5-year OS was 62.5%. During surveillance after discharge, 4.4% of patients (24/549) presented disease recurrence, 3.1% (17/549) with distant metastasis. From those, 70.6% (12/17) had visceral metastasis and 29.4% (5/17) had recurrent disease limited to bone. For these 17 patients, median PFS was 16 months (95% CI 5.3-26.7) and 2-year OS was 50.1%. For bone metastasis patients, median PFS was not different between asymptomatic and symptomatic group (p=0.378); but median OS was not reached in asymptomatic patients and was of 34 months in symptomatic patients (p=0.029). We did not find predictive factors for PFS or OS by multivariable Cox-regression analysis.

Conclusion:

In our cohort, asymptomatic recurrence detection rate was low, mainly presented as bone metastasis. Nevertheless, it seemed to impact positively on OS, compared to those who presented symptomatic bone disease. Disease recurrence due to visceral metastasis was detected, more frequently, in symptomatic patients.

New trials are needed to reassess the question concerning staging exams in asymptomatic breast cancer patients. It would also be interesting to perform a cost-effectiveness analysis of that approach.

Citation Format: Andreia Cruz, Ana Rita Lopes, Maria Leitão, Sarah Lopes, Sofia Patrão, Maria Cassiano, Cristina Oliveira, Miguel Abreu, Júlio Oliveira, Joana Bordalo Sá, Ana Rodrigues, Marta Ferreira, Rosário Couto, Inés Pousa, Cláudia Vieira, Ana Ferreira, Susana Sousa, Deolinda Pereira. The (in)effectiveness of staging exams in asymptomatic breast cancer patients [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-03-01.

Abstract P3-08-60: Patterns of development and prognostic factors in central nervous system metastasis according to breast cancer subtypes

Introduction: Central nervous system (CNS) metastasis are detected in approximately 10-30% of breast cancer (BC) patients, being associated with poor prognosis despite local and systemic therapeutics available. In the current study, we aimed to evaluate the association between BC subtypes and CNS metastasis development and prognosis. Methods: Retrospective analysis of 258 BC patients’ records with pathological and/or radiological documented CNS metastasis, treated at a Cancer Center between 2003-2019, median follow-up of 61 months (range: 0-351). For analysis purpose, three BC subtypes were considered according to hormone receptor status and HER-2 expression: luminal, HER-2 positive and triple negative. Survival was evaluated by Kaplan-Meier method and groups were compared with log-rank test. Independent prognostic factors were identified using Cox regression model. A p value &lt; 0.05 was considered statistically significant. Results: Ninety four (42%) patients had HER-2 positive, 87 (39%) luminal and 41 (19%) triple negative disease. The median time between the diagnosis of BC and the detection of CNS metastasis was significantly shorter in triple negative group (18 months) compared to the others (HER-2 positive: 31 months; luminal: 54 months; p=0.001), and CNS was more often the first site of recurrence (with or without concomitant extracranial disease progression) in this group (triple negative: 25 (61%) vs. HER-2 positive: 31 (33%) vs. luminal: 27 (31%); p=0.002). Most of the patients had parenchymal metastasis (n=245), being exclusively parenchymal in 227 (88%), and 31 (12%) had leptomeningeal (LM) disease, that was isolated in 13 (5%). More than half (n=136) had multiple (&gt;3 lesions) CNS metastasis, without differences between BC subtypes. Among the patients with LM disease, 17 (68%) had luminal tumors, 5 (20%) HER2-positive and 3 (12%) triple negative (p=0.007). Forty five patients (17%) were treated with surgery for CNS metastasis, with similar proportions between BC groups. In the patients submitted to CNS surgery, the concordance between primary tumor and metastasis subtype was higher in HER-2 positive (73%) compared to 57% in triple negative and 50% in luminal groups (p=0.004). After CNS involvement, 62% (n=24) of patients with triple negative disease did not receive any systemic therapy, compared to 44% (n=37) in luminal and 33% (n=29) in HER-2 positive groups (p=0.010). Median survival after CNS metastasis documentation was longer in HER-2 positive group (27 months vs. luminal: 18 months vs. triple-negative: 14 months, p=0.004) and also in patients submitted to surgical resection of CNS metastasis (38 months vs. 6 months in other treatment modalities). In multivariate Cox regression analysis, having HER-2 positive tumor was an independent prognostic factor for increasing survival after CNS metastasis (HR 0.62, 95% CI: 0.47-0.84, p=0.002), regardless the therapeutic strategy. Conclusions: Pattern of CNS metastasis development and prognosis varies according to BC subtype. The association between LM disease and luminal tumors should be explored in future studies. Treatment modalities also play a decisive role in the prognosis of this patients, therefore, new and effective therapeutic strategies are needed.

Citation Format: IoIanda Vieira, Miguel Abreu, Tiago Alpoim, Isabel Pereira, Susana Sousa, Isabel Azevedo, Machado Carvalho, Deolinda Pereira. Patterns of development and prognostic factors in central nervous system metastasis according to breast cancer subtypes [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-08-60.

104 SOFaaci-HEPES or holding media can be used for embryo loading without changes in pregnancies per embryo transfer nor pregnancy loss in an invitro-produced embryo transfer program

Time elapsed between removal from culture and embryo transfer (ET) can have a profound effect on the success of an invitro-produced (IVP) ET program. The embryo culture medium provides the necessary nutrients for embryo development and the use of media with a different nutrient composition to load embryos into straws could negatively affect embryo viability. The objective of the present study was to evaluate the effect of type of media used for embryo loading on pregnancy establishment and maintenance. Holstein heifers (n=800) were synchronized using a modified 5-day CO-Synch + controlled internal drug release (CIDR) as follows: Day −8: CIDR inserted, Day −3: CIDR removed, prostaglandin F2α treatment (500μg cloprostenol sodium), Day 0: gonadotrophin-releasing hormone (GnRH; 100μg of gonadorelin acetate). Five days after GnRH, heifers were evaluated by ultrasonography to determine presence of a corpus luteum (CL). Embryos were removed from culture on Day 7 (Day 0=fertilization), placed into tubes containing SOFaaci, and transported in an incubator (LabMix, WTA) to the transfer facility within 1.5h. Upon arrival embryos were removed from transport tubes and randomly assigned to be loaded into 0.25-mL straws containing either holding media (Vigro Holding Plus) or SOFaaci-HEPES. After loading into straws, embryos were placed in an ET gun and AI gun warmers set at 35°C until transfer by 1 of 5 technicians. Heifers with a CL were randomised for transfer of a fresh IVP embryo loaded into a straw containing either holding media or SOFaaci-Hepes on Day 7±1. Interval from embryo loading to transfer ranged from 1 to 3h. Pregnancy was determined by ultrasonography on Days 32 and 60. Data were analysed by logistic regression and included the fixed effects of loading media, embryo stage, embryo quality, interval between GnRH and ET, and biologically relevant interactions. Pregnancies per ET (P/ET) on Day 32 were not different between the groups in which embryos were loaded using holding media and those which used SOFaaci-Hepes, nor there were interactions between loading medium and embryo stage, embryo quality, or interval from GnRH to ET (P&gt;0.10; Table 1). Pregnancies per ET (P/ET) on Day 60 were not different between the loading media groups, nor were there interactions between loading medium, embryo stage, and embryo quality, or interval from GnRH to ET (P&gt;0.10). Pregnancy loss between Days 32 and 60 was not different between groups, nor there were interactions between loading media groups and any other factor (P&gt;0.10). In conclusion, the use of either holding medium or SOFaaci-HEPES for fresh IVP embryo loading does not affect fertility; thus, both are suitable alternatives for loading of embryos into transfer straws. Table 1.Pregnancies per embryo transfer (P/ET) and pregnancy loss in recipient heifers transferred with fresh invitro-produced embryos, using either holding medium or SOFaaci-HEPES medium for loading Item P/ET Day 32 (n) P/ET Day 60 (n) Pregnancy loss (n) Loading medium Holding 47.0% (186/396) 41.3% (163/395) 11.9% (22/185) SOFaaci-HEPES 48.8% (197/404) 43.1% (174/404) 11.7% (23/197) P-value 0.77 0.22 0.84

109 Effect of ruminal infusion with propylene glycol on the invitro embryo production of Holstein (Bos taurus) prepubertal heifers and pregnancy rate of the embryo transfer

The aim of this study was to evaluate the effect of ruminal infusion with propylene glycol (PG) on the invitro embryo production (IVEP) of Holstein (Bos taurus) prepubertal heifers (7 to 8 months). For this study, 16 prepubertal heifers were distributed into two groups: Propylene Glycol Group (PGG; n=8) and Control Group (CG; n=7). Additionally, 8 pubertal heifers were used for the positive control group (PUB). All animals (n=23) underwent an ovum pickup (OPU) for follicular ablation on Day 0, followed by an FSH protocol treatment (160mg performed in 4 injections twice a day in decreasing doses, designated as D2PM, D3AM, D3PM, and D4AM). Animals from PGG received a ruminal infusion with 250mL of PG twice a day on Days 0, 1, 2, 3, and 4, using a drench. Animals from CG and PUB did not receive any additional treatment. On Day 5 all animals underwent another OPU, and oocytes were used for the IVEP (Sexing Technologies commercial laboratory). The produced embryos were transferred fresh to Holstein heifer recipients. Additionally, blood sampling was performed on D4PM (M1) and on the day of OPU (D5AM, M2) for insulin-like growth factor (IGF-1, via radioimmunoassay) and glucose (hexokinase) analysis. Data were analysed using the GLIMMIX procedure of SAS. No difference was observed between groups for number of recovered oocytes (CG: 14.28±1.9; PGG: 14.87±3.9; PUB: 10.50±2.2; P=0.24), number of viable oocytes (CG: 10.71±2.5; PGG: 10.75±2.7; PUB: 9.50±2.0; P=0.80), cleaved oocytes (CG: 7.71±1.5; PGG: 9.50±2.1; PUB: 6.25±1.4; P=0.14), cleavage rate (CG: 54.2% (7.7 out of 14.2); PGG: 64.1% (9.5 of 14.8); PUB: 59.0% (6.2 of 10.5); P=0.35) and number of blastocysts (CG: 1.71±0.5; PGG: 2.00±0.6; PUB: 3.12±1.0; P=0.71). Pubertal heifers had higher blastocyst rates compared with prepubertal heifers, regardless of PG treatment (CG: 11.9% (1.7 of 14.2); PGG: 13.5% (2 of 14.8); PUB: 29.5% (3.1 of 10.5); P=0.01). No difference was observed between groups for 30-day (CG: 41.7% (5 of 12); PGG: 46.7% (7 of 15); PUB: 42.9% (6 of 14); P=0.96) or 60-day pregnancy rates (CG: 41.7% (5 of 12); PGG: 33.3% (5 of 15); PUB: 42.9% (6 of 14); P=0.86). In addition, no difference was observed for pregnancy loss between 30 and 60 days (CG: 0.0% (0 of 12); PGG: 13.3% (2 of 15); PUB: 0.0% (0 of 14); P=0.99). Regarding metabolic blood analysis, no difference was observed for IGF-1 (ngmL−1) between groups (P=0.38), moment of sample collection (P=0.06), and interaction of group×moment (P=0.87; CG/M1: 263.36±15.2; CG/M2: 297.71±18.7; PGG/M1: 304.25±26.9; PGG/M2: 332.61±31.6; PUB/M1: 309.16±19.9; PUB/M2: 311.07±18.8). Glucose (mg dL−1) was higher (P=0.0001) for pubertal heifers (91.63±1.4) compared with the other groups (CG: 102.25±1.1; PGG: 107.71±3.5); however, no difference was observed for moment of sample collection (P=0.35) or interaction of group×moment (P=0.36). These data show that treatment with PG was not efficient to improve the IVEP of prepubertal Holstein heifers, embryos from prepubertal heifers treated with PG did not have increased pregnancy rate, and treatment did not increase IGF-1 or glucose blood levels.

176 Synchronisation of follicle wave emergence prior to superstimulation with purified FSH for ovum pickup affects blastocyst rate in pregnant Holstein heifers

The timing of initiation of superstimulatory treatments relative to follicle wave emergence has been shown to affect ovulatory response and invivo embryo production. The significant increase of invitro embryo production (IVP) and the possibility of using pregnant animals as oocyte donors has created the need to optimise superstimulatory treatments for IVP in pregnant cattle. Thus, the objective of the present study was to evaluate the effect of synchronisation of follicle wave emergence before superstimulation for ovum pickup (OPU) and IVP in pregnant heifers. Pregnant (47-62 days of gestation) Holstein heifers (n=28) 19.5±0.3 months of age were assigned in a completely randomised design to one of two groups: synchronisation of follicular wave emergence by dominant follicle removal (DFR; all follicles &gt;6mm) or untreated control (no DFR). Superstimulatory treatments were initiated 36h after DFR or at random stages of the follicular wave in the no-DFR group and consisted of the administration of 160mg of purified FSH (Folltropin-V, Vetoquinol) over four injections 12h apart as follows: 48.0, 42.7, 37.3, and 32.0mg. Ovum pickup was performed in all heifers 40h after the last purified FSH injection. Heifers were subjected to OPU for oocyte recovery, and the number of follicles was determined. Recovered oocytes were processed in groups by treatment, and IVP was performed. Differences between treatment groups were evaluated using generalised linear mixed models. Results are presented in Table 1 and are expressed as means±s.e.m. for data collected at the time of OPU or as proportions for embryo production results. The number of small follicles (&lt;6mm) at the time of OPU was greater in the no-DFR group than in the DFR group (P=0.04). Conversely, there were no differences between treatments in the number of medium follicles (6-10 mm; P=0.17), large follicles (&gt;10 mm; P=0.11), total follicles (P=0.93), total number of recovered oocytes (P=0.4), or number of viable oocytes (P=0.53). The mean oocyte percentage recovery rate was not different between heifers in the DFR (53.6±4.7%) and no-DFR (56.5±4.7%) groups (P=0.52). Both cleavage and blastocyst rate were greater (P&lt;0.008) in the DFR group than in the no-DFR group; as a result, the number of transferable embryos per animal was 5.6 in the DFR group and 2.8 in the no-DFR group. In summary, initiation of superstimulatory treatments at the time of follicle wave emergence improves cleavage and blastocyst rates, thus leading to greater embryo production. Table 1.Ovarian response and embryo production in pregnant heifers superstimulated with or without synchronisation of follicle wave emergence Variable DFR No DFR Small follicles, n 8.1±1.2A 12.1±1.8B Medium follicles, n 18.3±1.3 13.7±2.0 Large follicles, n 2.4±0.6 1.4±0.4 Total follicles, n 28.8±1.4 27.2±2.2 Total oocytes, n 15.4±1.5 16.0±1.9 Viable oocytes, n 13.7±1.5 13.4±1.8 Cleavage rate,% (n) 77.1 (192)A 64.4 (188)B Blastocyst rate,% (n) 40.6 (192)A 20.7 (188)B A,BMeans within a row with different superscripts differ (P&lt;0.05).