POS0678 DOES SILDENAFIL IMPROVE ENDOTHELIAL DYSFUNCTION IN RHEUMATOID ARTHRITIS? – A PILOT CLINICAL TRIAL

Background:

Rheumatoid arthritis (RA) is independently associated with an increased risk of cardiovascular disease (CVD). One of the early stages of atherosclerosis is endothelial dysfunction, which is increased in RA. Using drugs to target endothelial dysfunction is a promising novel strategy for CVD prevention in RA. Sildenafil has been shown to improve endothelial function in diabetics, who have similar increased CVD risk. Our hypothesis was that sildenafil use may be a novel primary CVD prevention strategy in RA.

Objectives:

To determine if sildenafil use in RA patients improves endothelial dysfunction (as measured by brachial artery flow-mediated dilation [FMD] and peripheral arterial tone [PAT]), as well as serum inflammatory and atherosclerosis biomarkers.

Methods:

This NIH-funded study was a phase II, randomized double-blind placebo-controlled crossover efficacy trial of 25 RA patients, with no known history of CVD, but at least one traditional CVD risk factor. Patients were randomized 1:1 to receive either sildenafil or placebo for 3 months, then after a 2-week washout, crossed over to each respective group for an additional 3 months. Vascular studies (FMD and PAT) and serum atherosclerosis biomarkers (e-Selectin, ICAM-1, VCAM-1) were performed at baseline, 3 months pre- and post-washout, and 6 months. Adverse events were collected. Given the cross-over design, analyses included a random effects model for within-subject comparisons of sildenafil versus placebo periods, adjusting for the baseline (FMD or EndoPAT) within that period and a term for treatment order. All tests were 2-sided with α=0.05.

Results:

A total of 233 subjects were assessed for eligibility, with 25 subjects being randomized after written informed consent. A total of 13 subjects were randomized to placebo first, and 12 to sildenafil first. Baseline characteristics were similar between those randomized to Placebo vs. Sildenafil first. Mean age was 62.0+/-10.9 years; 84% were female; and 92% were white. A total of 6 adverse events experienced in 3 subjects occurred. The primary endpoint (increase in %FMD in Sildenafil period vs. Placebo period) was not significant (p=0.19). However, note the study was powered at 80% to detect an effect size of 0.37 for change in %FMD or biomarker with a sample size of 60, not 25. However, sildenafil use was associated with a significant increase (improvement) by 0.200 units of PAT ratio (p=0.003) compared with placebo, adjusted by treatment order and baseline PAT ratio (within the given treatment period). Exploratory linear mixed models comparing e-Selectin, ICAM-1, and VCAM-1 between Sildenafil vs. Placebo periods, adjusted for treatment order and the baseline biomarker level, did not show any significant differences except for ICAM-1 (55.3 units higher in Sildenafil vs. Placebo periods, p=0.011).

Conclusion:

In this pilot trial of 25 RA subjects, sildenafil use was associated with a significant increase (improvement) in endothelial function as measured by PAT. However, there was no significant difference in FMD. The study is limited due to the small sample size, which was impacted by slow recruitment as well as the COVID-19 pandemic. Future larger studies are required to assess whether other PDE5 inhibitors may improve endothelial dysfunction in RA and other autoimmune disease patients at high risk of CVD.

References:

[1]Maradit-Kremers H, Crowson CS, Nicola PJ, et al. Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study. Arthritis Rheum 2005;52:402-11.

[2]Peters MJ, van Halm VP, Voskuyl AE, et al. Does rheumatoid arthritis equal diabetes mellitus as an independent risk factor for cardiovascular disease? A prospective study. Arthritis Rheum 2009;61:1571-9.

[3]Deyoung L, Chung E, Kovac JR, et al. Daily use of sildenafil improves endothelial function in men with type 2 diabetes. J Andrology 2012;33:176-80.

Disclosure of Interests:

None declared

A comparison of clinical outcomes of acute testicular torsion between prepubertal and postpubertal males

SHORT INTRODUCTION/BACKGROUND

Surgical intervention for acute testicular torsion can require either orchiopexy or orchiectomy. The decision of which surgery to perform is dependant on the amount of time that the testicle experienced ischemia and the viability of the testicle after reperfusion.

OBJECTIVE

It is hypothesized that (1) there is a difference in orchiectomy and orchiopexy rates between prepubertal and postpubertal males with acute testicular torsion and (2) presenting symptoms may vary between the two age groups as prepubertal males may present with atypical symptoms, which could result in delayed presentation and diagnosis.

STUDY DESIGN

A retrospective chart review was conducted on pediatric patients who were diagnosed with acute testicular torsion between June 2010 and August 2017. Demographic and clinical characteristics were extracted: age, ethnicity, referral pattern, primary insurance status, symptoms at presentation, prior history of ipsilateral testicular pain or intermittent torsion, recent trauma to genitalia, duration of symptoms (hours), gradual vs. acute onset of symptoms, time/weekday/season at presentation, and time interval from arrival at the study institution to surgical intervention (minutes). Patients were categorized into two groups: prepubertal group (age 1-12 years) and postpubertal group (age 13-18 years). Statistical analyses were performed using R, version 3.3.1.

RESULTS

Ninety-one patients were included in the study. The overall orchiectomy rate was 30.8%. More prepubertal males underwent orchiectomy than postpubertal males (42.4% vs. 24.1%, respectively). Prepubertal males were more likely to present with abdominal pain than postpubertal males (27.3% vs. 10.3%, respectively). Those who underwent orchiectomy were more likely to present with longer duration of symptoms, testicular swelling, and abdominal pain than those who underwent orchiopexy. The risk of orchiectomy decreased by 14% per 1-year increase in age (odds ratio [OR]: 0.86, 95% confidence interval [CI]: 0.94-1.00, p = .009). A steady decline in the proportion of patients undergoing orchiectomy was seen from 1 to 12 years of age.

DISCUSSION

This study found that prepubertal males are at higher risk for orchiectomy than postpubertal males. The risk of orchiectomy decreases by 14-16% per 1-year increase in age. Prepubertal males are more likely to present with atypical symptoms and delayed presentation and diagnosis, leading to delayed surgical intervention. It is important for providers to perform a genital examination in prepubertal males who present with abdominal pain to rule out acute testicular torsion. Patients presenting with longer duration of symptoms, testicular swelling, and abdominal pain are at higher risk for orchiectomy. No correlation was found between orchiectomy rate and ethnicity, referral status, primary insurance status, and time/weekday/season at presentation.

CONCLUSION

Among patients presenting to a tertiary pediatric hospital with acute testicular torsion, prepubertal males (younger than 12 years) are at higher risk for orchiectomy than postpubertal males. Prepubertal males are more likely to present with atypical symptoms which results in delayed presentation and diagnosis, leading to delayed in surgical intervention.

Heterogeneous oxidation of two triazole pesticides (diniconazole and tebuconazole) by OH-radicals and ozone

Tebuconazole (Tbz) and diniconazole (Dnz) were deposited as thin film on quartz plaques. They were submitted to OH-radicals and ozone and their kinetic was measured. OH-radical oxidation was performed relative to a reference whose rate constant is well known. Terbuthylazine (Tbt) and Chlorpyriphos Ethyl (Clp) were chosen as reference for Tbz and Dnz kinetics determination, respectively. OH-radical rate constants of Tbz and Dnz were found to be: k_OH+Tbz = (1.7 ± 0.2) 10^-13 cm³ molecule^-1 s^-1 and k _OH+Dnz = (1.74 ± 1.21) 10^-12 cm³ molecule^-1 s^-1, respectively. Ozone heterogeneous oxidation rate constants were determined in an absolute way: k_O3+Tbz = (0.5 ± 0.2) 10^-20 cm³ molecule^-1 s^-1; k_O3+Dnz = (1.4 ± 0.2) 10^-19 cm³ molecule^-1 s^-1. Dnz is ten times more reactive toward OH-radicals than Tbz and 27 times more reactive than Tbz toward ozone maybe because of the presence of a double bond in Dnz. Lifetimes of Tbz and Dnz on quartz like surfaces are against OH-radicals are of 68 days and 8 days, respectively and 4 months and several years against ozone, respectively.

The monofunctional cobalamin biosynthesis enzyme precorrin-3B synthase (CobZRR) is essential for anaerobic photosynthesis in Rhodospirillum rubrum but not for aerobic dark metabolism

The in vivo physiological role of the gene cobZ, which encodes precorrin-3B synthase, which catalyzes the initial porphyrin ring contraction step of cobalamin biosynthesis via the cob pathway, has been demonstrated here for the first time. Cobalamin is known to be essential for an early step of bacteriochlorophyll biosynthesis in anoxygenic purple bacteria. The cobZ (cobZRR) gene of the purple bacterium Rhodospirillum rubrum was localized to a 23.5 kb insert of chromosomal DNA contained on the cosmid pSC4. pSC4 complemented several mutants of bacteriochlorophyll and carotenoid biosynthesis, due to the presence of the bchCX and crtCDEF genes at one end of the cosmid insert, flanking cobZRR. A second gene, citB/tcuB, immediately downstream of cobZRR, shows homologies to both a tricarballylate oxidoreductase (tcuB) and a gene (citB) involved in signal transduction during citrate uptake. CobZRR shows extensive homology to the N-terminal domain of the bifunctional CobZ from Rhodobacter capsulatus, and the R. rubrum citB/tcuB gene is homologous to the CobZ C-terminal domain. A mutant, SERGK25, containing a terminatorless kanamycin interposon inserted into cobZRR, could not grow by anaerobic photosynthesis, but grew normally under dark, aerobic and microaerophilic conditions with succinate and fructose as carbon sources. The anaerobic in vivo activity of CobZ indicates that it does not require oxygen as a substrate. The mutant excreted large amounts of protoporphyrin IX-monomethylester, a brown precursor of bacteriochlorophyll biosynthesis. The mutant was complemented either by the cobZRR gene in trans, or when exogenous cobalamin was added to the medium. A deletion mutant of tcuB/citB did not exhibit the cob phenotype. Thus, a role for tcuB/citB in cobalamin biosynthesis could not be confirmed.

A Controlled Study of Sorbent Suspension Dialysis in Chronic Liver Disease and Hepatic Encephalopathy

To investigate the role of extracorporeal detoxification in cirrhotic patients with advanced hepatic encephalopathy not responding to medical treatment, 20 patients were randomized to receive six hours of additional sorbent dialysis or ongoing standardized medical treatment. Following treatment, the clinical stage of encephalopathy remained unchanged in both groups. Abnormal sensory evoked potentials improved following sorbent dialysis (N70 latency, 128 ms before versus 110 ms after treatment, P<0,05; cervico-cranial transmission, 7.7 ms versus 6.8 ms, P<0.01) indicating improvement in important aspects of cerebral function. In contrast, brain function remained unchanged following medical treatment (N70 latency, 114 ms versus 113 ms; cervico-cranial transmission, 7.7 ms versus 7.2 ms, P=NS, respectively). Serum benzodiazepine levels decreased significantly after sorbent dialysis but not after medical treatment. Biocompatibility of sorbent dialysis was limited and clinical complications occurred in a proportion of patients. In conclusion, a six-hour treatment with sorbent suspension dialysis did not ameliorate the clinical stage of HE but improved neurophysiologic function in cirrhotic patients who had not responded to conventional medical treatment.

Effects of long term raw pig slurry inputs on nutrient and metal contamination of tropical volcanogenic soils, Uvéa Island (South Pacific)

In small Polynesian islands, family pig breeding is usually conducted without recovery of pig slurry. Raw pig slurry is spread onto the soil without any treatment. So far, most of the studies were carried out in temperate climate and for industrial digested pig slurry applications on agricultural lands. In the present case study, conducted in Uvéa Island, the aim is to determine if long term application of raw pig slurry on tropical soils, naturally rich in heavy metals has a significant influence on elements concentrations and mobility. Two types of tropical soils and two pig breeding systems, pig enclosure on small concrete pens or pig enclosure in large land pens, were investigated. Here we demonstrate that raw pig slurry inputs on soils can lead to an increase of total nitrogen and phosphorus content with high Contamination Factors. The Pollution Load Index values (1.3; 5.3; 2.5; 2.3) were indicative of multi-heavy metals pollution (Fe, Mn, Al, Cu, Zn, Cr and Ni) in mixed calcareous soils of the coastal area and they are exchangeable while they are immobilized or less mobile in inland pure ferralitic soils. For mixed calcareous soils of the coastal area, family pig breeding represents a drainage risk of soluble species (phosphorus, inorganic nitrogen, Fe, Mn, Al, Cu, Zn, Cr and Ni). For inland ferralitic soils, family pig breeding is more compatible with a sustainable management of the environment in Uvéa Island and by extension in volcanic tropical islands with respect to the investigated chemical elements.

Kinetics of the heterogeneous photo oxidation of the pesticide bupirimate by OH-radicals and ozone under atmospheric conditions

This article is concerned with the study of the photochemical degradation of bupirimate adsorbed on a quartz surface by atmospheric oxidants, namely ozone and OH radicals. OH oxidation experiments were conducted relative to two reference compounds, terbuthylazine and (4-chlorophenyl)(3,4-dimethoxyphenyl) methanone. Meanwhile, ozone oxidation experiments were performed in the absolute mode and were interpreted by both, the Surface Layer Reaction and the Gas Surface Reaction models of heterogeneous reactions. The obtained results show that the rate constants for the reactions between bupirimate and OH radicals and ozone are (cm(3)molecule(-1)s(-1)): (1.06 ± 0.87) × 10(-12) and (5.4 ± 0.3) × 10(-20), respectively. As a consequence, for the experimental conditions used in this study, the lifetime of bupirimate at quartz like surface/atmosphere interfaces is several months against ozone and a tenth of days against OH-radical.

Impact of raw pig slurry and pig farming practices on physicochemical parameters and on atmospheric N2O and CH 4 emissions of tropical soils, Uvéa Island (South Pacific)

Emissions of CH4 and N2O related to private pig farming under a tropical climate in Uvéa Island were studied in this paper. Physicochemical soil parameters such as nitrate, nitrite, ammonium, Kjeldahl nitrogen, total organic carbon, pH and moisture were measured. Gaseous soil emissions as well as physicochemical parameters were compared in two private pig farming strategies encountered on this island on two different soils (calcareous and ferralitic) in order to determine the best pig farming management: in small concrete pens or in large land pens. Ammonium levels were higher in control areas while nitrate and nitrite levels were higher in soils with pig slurry inputs, indicating that nitrification was the predominant process related to N2O emissions. Nitrate contents in soils near concrete pens were important (≥ 55 μg N/g) and can thus be a threat for the groundwater. For both pig farming strategies, N2O and CH4 fluxes can reach high levels up to 1 mg N/m(2)/h and 1 mg C/m(2)/h, respectively. CH4 emissions near concrete pens were very high (≥ 10.4 mg C/m(2)/h). Former land pens converted into agricultural land recover low N2O emission rates (≤ 0.03 mg N/m(2)/h), and methane uptake dominates. N2O emissions were related to nitrate content whereas CH4 emissions were found to be moisture dependent. As a result relating to the physicochemical parameters as well as to the gaseous emissions, we demonstrate that pig farming in large land pens is the best strategy for sustainable family pig breeding in Uvéa Islands and therefore in similar small tropical islands.

A mechanistic and kinetic study of the heterogeneous degradation of chlorpyrifos and chlorpyrifos oxon under the influence of atmospheric oxidants: ozone and OH-radicals

Chlorpyrifos in the heterogeneous phase of the atmosphere is quickly removed by reaction with OH radicals (∼2 day) whereas its degradation product, chlorpyrifos oxon is more persistent.

Radiosensitization by histone deacetylase inhibition in an osteosarcoma mouse model

BACKGROUND

Osteosarcomas (OS) are highly malignant and radioresistant tumors. Histone deacetylase inhibitors (HDACi) constitute a novel class of anticancer agents. We sought to investigate the effect of combined treatment with suberoylanilide hydroxamic acid (SAHA) and radiotherapy in OS in vivo.

METHODS

Clonogenic survival of human OS cell lines as well as tumor growth delay of OS xenografts were tested after treatment with either vehicle, radiotherapy (XRT), SAHA, or XRT and SAHA. Tumor proliferation, necrosis, microvascular density, apoptosis, and p53/p21 were monitored by immunohistochemistry. The CD95 pathway was performed by flow cytometry, caspase (3/7/8) activity measurements, and functional inhibition of CD95 death signaling.

RESULTS

Combined treatment with SAHA and XRT markedly reduced the surviving fraction of OS cells as compared to XRT alone. Likewise, dual therapy significantly inhibited OS tumor growth in vivo as compared to XRT alone, reflected by reduced tumor proliferation, impaired angiogenesis, and increased apoptosis. Addition of HDACi to XRT led to elevated p53, p21, CD95, and CD95L expression. Inhibition of CD95 signaling reduced HDACi- and XRT-induced apoptosis.

CONCLUSION

Our data show that HDACi increases the radiosensitivity of osteosarcoma cells at least in part via ligand-induced apoptosis. HDACi thus emerge as potentially useful treatment components of OS.

Imaging and elemental mapping of biological specimens with a dual-EDS dedicated scanning transmission electron microscope

A dedicated analytical scanning transmission electron microscope (STEM) with dual energy dispersive spectroscopy (EDS) detectors has been designed for complementary high performance imaging as well as high sensitivity elemental analysis and mapping of biological structures. The performance of this new design, based on a Hitachi HD-2300A model, was evaluated using a variety of biological specimens. With three imaging detectors, both the surface and internal structure of cells can be examined simultaneously. The whole-cell elemental mapping, especially of heavier metal species that have low cross-section for electron energy loss spectroscopy (EELS), can be faithfully obtained. Optimization of STEM imaging conditions is applied to thick sections as well as thin sections of biological cells under low-dose conditions at room and cryogenic temperatures. Such multimodal capabilities applied to soft/biological structures usher a new era for analytical studies in biological systems.

A Quantum Cascade Laser Absorption Spectrometer devoted to the in situ measurement of atmospheric N2O and CH4 emission fluxes

This paper describes a Quantum Cascade Laser Absorption Spectrometer, called "QCLAS" that was developed to monitor in situ greenhouse gases like N2O and CH4, at high temporal resolution and with a high accuracy. The design of the laser sensor is reported as well as its performances in terms of precision error and field deployment capabilities. Finally, to demonstrate the efficiency and the robustness of QCLAS and its suitability for gas emission monitoring and for the determination of fluxes, we report the results from a field campaign, that took place in the Wallis and Futuna Islands in 2011, to investigate the impact of environmental intensive pig farming.

The Dark Side:Stigma in purpose-built senior environments

This paper focuses on stigma in collective living environments for older adults, specifically multi-level campuses. We contrast two design profiles, a purpose-built campus which opened in 1997, and an older setting that grew by accretion over decades. Purpose-built housing is used as originally intended, designed, and constructed; housing built by accretion has been modified over time to meet changing needs and uses. The separation by care levels in both sites is reflected in their cultures as residents and staff relate to physical levels of care through a vocabulary of fear and stigma. Residents of the independent living building on the purpose-built campus refer to the assisted living building, accessed only through a second floor link, as "the other side" or "the dark side." In this setting we observe stigma assigned to a place in the built environment. By contrast, in the older setting built by accretion over the last century, levels of care feature a less-structured clustering of independent living and assisted living, and common areas were shared by residents from multiple care levels. We have observed less stigma associated with levels of care in this older building. Grounding our analysis in data drawn from ongoing ethnographic research, we focus on the built environment as it relates to stigma in the social environment. The paper concludes with a discussion of the importance and pervasiveness of stigma in senior environments.

Effect of vitamin E on reperfusion injuries during reconstructive vascular operations on lower limbs

INTRODUCTION

The challenge against reperfusion injury and tissue oxidative stress, especially in vascular surgical interventions has an essential importance to reach the optimal clinical result. Numerous experimental attempts have proved the positive antioxidant effect of vitamin E in both chronic and acute phase models. In our study we monitored the effect of continuous preoperative treatment with vitamin E, on oxidative stress and tissue inflammation reactions developed after reconstructive operations.

PATIENTS AND METHODS

32 patients have been involved in a randomized, prospective study, all suffering from AFS occlusion proved by angiography, and all undergone supragenual reconstruction. Duration of ischemia and amount of tissues under vascular clamping were almost the same in all patients. In the group treated with E-vitamin, we administered 1 x 200 mg of vitamin E p/o from the preoperative day till the 7th post operative day. Patients of the second group did not receive vitamin E.

MATERIALS AND METHODS

Peripheral blood samples were collected immediately before operation and at the end of the second reperfusion hour (early reperfusion period). Late reperfusion period has been monitored by analyzing blood samples taken at 24th hour and 7th day next to the operative ischemia. Among oxidative stress parameters, direct measurement of reactive oxygen intermediator (ROI) and determination of antioxidant state (GSH, Total-SH group, SOD) have been performed. Malondialdehyde was chosen as marker for lipidperoxidation. Inflammation reactions were monitored up on expression of adhesion molecules (CD11a and CD18). We also controlled the oscillation of myeloperoxidase (MPO) activity.

RESULTS

Our study has proved that preoperative (from the preoperative day till the 7th post operative day) administration of 200 mg vitamin E could reduce the level of oxidative stress developed after ischemic-reperfusion insult (lipidproxidation, antioxidant enzymes). According to our results, the prooxidant-antioxidant imbalance also diminished in the group with E-vitamin treatment. We proved that elective administration of vitamin E could decrease the WBC activity (MPO activity, free radicals production, expression of adhesion molecules) and its consequential local inflammation process, during early reperfusion.