Computer anthropomorphisation in a socio-economic dilemma

In the study of human behaviour, non-social targets are often used as a control for human-to-human interactions. However, the concept of anthropomorphisation suggests that human-like qualities can be attributed to non-human objects. This can prove problematic in psychological experiments, as computers are often used as non-social targets. Here, we assessed the degree of computer anthropomorphisation in a sequential and iterated prisoner's dilemma. Participants (N = 41) faced three opponents in the prisoner's dilemma paradigm-a human, a computer, and a roulette-all represented by images presented at the commencement of each round. Cooperation choice frequencies and transition probabilities were estimated within subjects, in rounds against each opponent. We found that participants anthropomorphised the computer opponent to a high degree, while the same was not found for the roulette (i.e. no cooperation choice difference vs human opponents; p = .99). The difference in participants' behaviour towards the computer vs the roulette was further potentiated by the precedent roulette round, in terms of both cooperation choice (61%, p = .007) and cooperation probability after reciprocated defection (79%, p = .007). This suggests that there could be a considerable anthropomorphisation bias towards computer opponents in social games, even for those without a human-like appearance. Conversely, a roulette may be a preferable non-social control when the opponent's abilities are not explicit or familiar.

Generation and validation of a classification model to diagnose familial hypercholesterolaemia in adults

BACKGROUND AND AIMS

The early diagnosis of familial hypercholesterolaemia is associated with a significant reduction in cardiovascular disease (CVD) risk. While the recent use of statistical and machine learning algorithms has shown promising results in comparison with traditional clinical criteria, when applied to screening of potential FH cases in large cohorts, most studies in this field are developed using a single cohort of patients, which may hamper the application of such algorithms to other populations. In the current study, a logistic regression (LR) based algorithm was developed combining observations from three different national FH cohorts, from Portugal, Brazil and Sweden. Independent samples from these cohorts were then used to test the model, as well as an external dataset from Italy.

METHODS

The area under the receiver operating characteristics (AUROC) and precision-recall (AUPRC) curves was used to assess the discriminatory ability among the different samples. Comparisons between the LR model and Dutch Lipid Clinic Network (DLCN) clinical criteria were performed by means of McNemar tests, and by the calculation of several operating characteristics.

RESULTS

AUROC and AUPRC values were generally higher for all testing sets when compared to the training set. Compared with DLCN criteria, a significantly higher number of correctly classified observations were identified for the Brazilian (p < 0.01), Swedish (p < 0.01), and Italian testing sets (p < 0.01). Higher accuracy (Acc), G mean and F1 score values were also observed for all testing sets.

CONCLUSIONS

Compared to DLCN criteria, the LR model revealed improved ability to correctly classify observations, and was able to retain a similar number of FH cases, with less false positive retention. Generalization of the LR model was very good across all testing samples, suggesting it can be an effective screening tool if applied to different populations.

Clinical Validation of a Size-Based Microfluidic Device for Circulating Tumor Cell Isolation and Analysis in Renal Cell Carcinoma

Renal cell carcinoma (RCC) presents as metastatic disease in one third of cases. Research on circulating tumor cells (CTCs) and liquid biopsies is improving the understanding of RCC biology and metastases formation. However, a standardized, sensitive, specific, and cost-effective CTC detection technique is lacking. The use of platforms solely relying on epithelial markers is inappropriate in RCC due to the frequent epithelial-mesenchymal transition that CTCs undergo. This study aimed to test and clinically validate RUBYchip™, a microfluidic label-free CTC detection platform, in RCC patients. The average CTC capture efficiency of the device was 74.9% in spiking experiments using three different RCC cell lines. Clinical validation was performed in a cohort of 18 patients, eight non-metastatic (M0), five metastatic treatment-naïve (M1TN), and five metastatic progressing-under-treatment (M1TP). An average CTC detection rate of 77.8% was found and the average (range) total CTC count was 6.4 (0-27), 101.8 (0-255), and 3.2 (0-10), and the average mesenchymal CTC count (both single and clustered cells) was zero, 97.6 (0-255), and 0.2 (0-1) for M0, M1TN, and M1TP, respectively. CTC clusters were detected in 25% and 60% of M0 and M1TN patients, respectively. These results show that RUBYchip™ is an effective CTC detection platform in RCC.

Association of the practice of contact sports with the development of amyotrophic lateral sclerosis

Objectives: High-intensity physical activity and sports prone to repetitive injuries of the cervical spine and head (when associated with vigorous practice) have been suggested as possible risk factors for amyotrophic lateral sclerosis (ALS). Our objective was to evaluate the relationship between the practice of contact sports (boxing, hockey, football, rugby) and ALS. Methods: The study included 2247 individuals, 1326 patients and 921 controls from several European countries. Analysis of the effect of contact sports on ALS was conducted in male participants only, as very few women practiced contact sports. Logistic regression models were used with the response variable as the presence or absence of ALS, with α = 0.05 significance level. Results: A relationship between the practice of contact sports and ALS was found, with those practicing contact sports having 76% higher odds of an ALS diagnosis (OR = 1.76, p = 0.001). In addition, univariate analyses for age (higher risk for older people, p < 0.001), smoking status (higher risk for ex-smokers, p = 0.022) and tobacco exposure (higher risk for more exposure, p = 0.038) also indicated that these variables are risk factors for ALS. In multivariate models, in addition to age, the interaction term between practice of contact sports and tobacco exposure was still significant (p = 0.03). Conclusions: This is one of the largest studies on the role of contact sport in ALS development. Our results support the existence of a relationship between the practice of sports with repetitive trauma at the level of the cervical spine and head, and ALS. This risk appears to be enhanced by tobacco exposure.

Comparative study on the performance of different classification algorithms, combined with pre- and post-processing techniques to handle imbalanced data, in the diagnosis of adult patients with familial hypercholesterolemia

Familial Hypercholesterolemia (FH) is an inherited disorder of cholesterol metabolism. Current criteria for FH diagnosis, like Simon Broome (SB) criteria, lead to high false positive rates. The aim of this work was to explore alternative classification procedures for FH diagnosis, based on different biological and biochemical indicators. For this purpose, logistic regression (LR), naive Bayes classifier (NB), random forest (RF) and extreme gradient boosting (XGB) algorithms were combined with Synthetic Minority Oversampling Technique (SMOTE), or threshold adjustment by maximizing Youden index (YI), and compared. Data was tested through a 10 × 10 repeated k-fold cross validation design. The LR model presented an overall better performance, as assessed by the areas under the receiver operating characteristics (AUROC) and precision-recall (AUPRC) curves, and several operating characteristics (OC), regardless of the strategy to cope with class imbalance. When adopting either data processing technique, significantly higher accuracy (Acc), G-mean and F₁ score values were found for all classification algorithms, compared to SB criteria (p < 0.01), revealing a more balanced predictive ability for both classes, and higher effectiveness in classifying FH patients. Adjustment of the cut-off values through pre or post-processing methods revealed a considerable gain in sensitivity (Sens) values (p < 0.01). Although the performance of pre and post-processing strategies was similar, SMOTE does not cause model’s parameters to loose interpretability. These results suggest a LR model combined with SMOTE can be an optimal approach to be used as a widespread screening tool.

AB1552-HPR HEALTH PERCEPTION OF PATIENTS WITH FIBROMYALGIA IN BRAZIL

Background

Fibromyalgia is a rheumatologic syndrome characterized by chronic pain and symptoms such as fatigue, morning stiffness, sleep disturbances and depression. Health perception is a global assessment of health based on an analysis of the objective and also subjective aspects of each person. Health self-assessment is increasingly researched and shows the health status of the population, considering the individual’s personal perspective and that this information can be useful to propose health promotion strategies.

Objectives

To identify the health perception of patients with fibromyalgia who live in Brazil.

Methods

This is a cross-sectional study that was carried out in Brazil in 2021. They were invited to participate in the research. Individuals with fibromyalgia were invited to participate in the study through the Brazilian Association of Fibromyalgia Patients (ABRAFIBRO) in August 2021. The invitation was sent via email to all people registered with this association in the country. Self-perception of health was questioned through the following response options: bad, fair, good or very good. Data were analyzed using descriptive statistics.

Results

The study consisted of 243 people with fibromyalgia living in different states of Brazil. Most were female (97.5%), married or living with a partner (63.7%), of white race/color (58%), receiving 1 to 2 minimum wages (60.4%), with complete higher education (46.5%) and who administer more than 2 medications per day (65.8%). Regarding the perception of health, the majority reported that their health was regular (42.4%), followed by bad (38.3%), good (16%) and very good (3.3%).

Conclusion

The most prevalent health perception in people with fibromyalgia in Brazil was: “regular”, followed by “bad”, “good” and “very good”. In view of the findings of this study, measures to control and prevent health risks in people with fibromyalgia become necessary. In order to implement policies to promote a healthy life for this population, it is necessary to know the determinants of these indicators of self-reported health morbidity in Brazil. It is also suggested that the results of this investigation be monitored by periodic population-based surveys, in order to verify the determination of the observed associations, being able, in the future, to detect an association with other variables. In addition, these data can guide and evaluate education and health promotion strategies in fibromyalgia.

References

[1]Antunes M, Schmitt A, Marques AP. Ab0912-hpr Amigos de Fibro (Fibro Friends): educational program to promote the health of people with fibromyalgia in Brazil. 2021; Annals of the Rheumatic Diseases 2021;80:1478.

[2]Antunes MD, Couto LA, Bertolini SMMG, Rocha Loures FCN, Schmitt ACB, Marques AP. of interdisciplinary health education programs for individuals with fibromyalgia: A systematic review. Journal of Education and Health Promotion. 2021;10(64):1-8. Doi: https://dx.doi.org/10.4103%2Fjehp.jehp_592_20.

[3]García-Ríos MC, Navarro-Ledesma S, Tapia-Haro RM, Toledano-Moreno S, Casas-Barragán A, Correa-Rodríguez M, et al. Effectiveness of health education in patients with fibromyalgia: a systematic review. European Journal of Physical and Rehabilitation Medicine. 2019;55(2):301–13, 2019. Doi: https://doi.org/10.23736/S1973-9087.19.05524-2

Acknowledgements

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001

Disclosure of Interests

None declared

AB1539-HPR AMIGOS DE FIBRO (FIBRO FRIENDS): VALIDATION OF AN EDUCATIONAL E-BOOK TO PROMOTE THE HEALTH OF PEOPLE LIVING WITH FIBROMYALGIA IN BRAZIL

Background

In the optimal treatment of fibromyalgia, international recommendations highlight non-pharmacological treatment as the key to success. Health education is one of the main tools to promote the health of patients with fibromyalgia. Educational strategies are essential for the care of patients with fibromyalgia.

Objectives

Develop and validate an e-book to promote the health of people with fibromyalgia who live in Brazil.

Methods

This is a methodological study, initially, through a bibliographic survey, the available publications on the subject were analyzed. Then, this knowledge was used to build the theoretical content addressed and the art and layout of the e-book was elaborated. Finally, the validation of the constructed material was carried out with three groups of specialists: content specialists (n=23), technicians (n=23) and design specialists (n=23). In addition, it was also decided to validate the e-book with individuals who have fibromyalgia (n=45. The e-book was evaluated by specific instruments through the Delphi technique. The data were analyzed, and the reliability was evaluated by the Alpha of Cronbach (αC) and agreement, using the Content Validity Index (CVI).

Results

In the global evaluation, all the judges agreed with the items evaluated in the e-book, presented a considerable minimum of the CVI, being: content (0.79), technical (0.89), design (0.92), and target audience (0.97). Regarding reliability, all groups also had an αC within the acceptable range: content (0.960), technical (0.963), design (0.977), and target audience (1.08).

Conclusion

E-book was prepared and validated in terms of content and relevance, and can be used in Brazil to promote the health of individuals with fibromyalgia, mainly as a complement to treatments already carried out for fibromyalgia. In the future, this e-book may be translated and adapted into new languages.

References

[1]Antunes M, Schmitt A, Marques AP. Ab0912-hpr Amigos de Fibro (Fibro Friends): educational program to promote the health of people with fibromyalgia in Brazil. 2021; Annals of the Rheumatic Diseases 2021;80:1478.

[2]Antunes MD, Couto LA, Bertolini SMMG, Rocha Loures FCN, Schmitt ACB, Marques AP. of interdisciplinary health education programs for individuals with fibromyalgia: A systematic review. Journal of Education and Health Promotion. 2021;10(64):1-8. Doi: https://dx.doi.org/10.4103%2Fjehp.jehp_592_20.

[3]García-Ríos MC, Navarro-Ledesma S, Tapia-Haro RM, Toledano-Moreno S, Casas-Barragán A, Correa-Rodríguez M, et al. Effectiveness of health education in patients with fibromyalgia: a systematic review. European Journal of Physical and Rehabilitation Medicine. 2019;55(2):301–13, 2019. Doi: https://doi.org/10.23736/S1973-9087.19.05524-2

Acknowledgements

This study was financed in part by the Coordenação de

Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001

Disclosure of Interests

None declared

AB1538-HPR AMIGOS DE FIBRO (FIBRO FRIENDS): VALIDATION OF AN EDUCATIONAL PROGRAM TO PROMOTE THE HEALTH OF PATIENTS WITH FIBROMYALGIA IN BRAZIL

Background

Health education is a very important tool in the treatment of people with fibromyalgia. Health education acts as an excellent non-pharmacological treatment to promote health in fibromyalgia.

Objectives

To validate a multidisciplinary educational program to promote the health of people with fibromyalgia in Brazil, called Amigos de Fibro.

Methods

This is a methodological research with 45 individuals with fibromyalgia (target audience) and 23 health professionals (expert judges). Both groups used an instrument to assess the objectives, themes and proposed actions, relevance, writing style and structure of the program using the Delphi technique. The Content Validity Index (CVI) ≥ 0.78 and Kappa Coefficient ≥ 0.61 were used to analyze and validate the data.

Results

All items evaluated in both groups had a considerable minimum CVI and Kappa Coefficient to be valid. In the global assessment of Amigos de Fibro, the CVI of the target audience judges was 0.95, while the expert judges presented a value of 0.90. The Kappa Coefficient of the target audience judges was 0.85 and that of the expert judges was 0.90. Therefore, the instrument proved to be validated.

Conclusion

Amigos de Fibro was considered valid for its content and internal consistency, therefore, valid to be used by health professionals with the target audience in Primary Health Care in Brazil, allowing them to act as promoters of their health.

References

[1]Antunes MD, Couto LA, Bertolini SMMG, Rocha Loures FCN, Schmitt ACB, Marques AP. of interdisciplinary health education programs for individuals with fibromyalgia: A systematic review. Journal of Education and Health Promotion. 2021;10(64):1-8. Doi: https://dx.doi.org/10.4103%2Fjehp.jehp_592_20

[2]Antunes M, Schmitt A, Marques AP. Ab0912-hpr Amigos de Fibro (Fibro Friends): educational program to promote the health of people with fibromyalgia in Brazil. 2021; Annals of the Rheumatic Diseases 2021;80:1478.

[3]García-Ríos MC, Navarro-Ledesma S, Tapia-Haro RM, Toledano-Moreno S, Casas-Barragán A, Correa-Rodríguez M, et al. Effectiveness of health education in patients with fibromyalgia: a systematic review. European Journal of Physical and Rehabilitation Medicine. 2019;55(2):301–13, 2019. Doi: https://doi.org/10.23736/S1973-9087.19.05524-2

Acknowledgements

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001

Disclosure of Interests

None declared

Performance comparison of different classification algorithms applied to the diagnosis of familial hypercholesterolemia in paediatric subjects

Familial Hypercholesterolemia (FH) is an inherited disorder of lipid metabolism, characterized by increased low density lipoprotein cholesterol (LDLc) levels. The main purpose of the current work was to explore alternative classification methods to traditional clinical criteria for FH diagnosis, based on several biochemical and biological indicators. Logistic regression (LR), decision tree (DT), random forest (RF) and naive Bayes (NB) algorithms were developed for this purpose, and thresholds were optimized by maximization of Youden index (YI). All models presented similar accuracy (Acc), specificity (Spec) and positive predictive values (PPV). Sensitivity (Sens) and G-mean values were significantly higher in LR and RF models, compared to the DT. When compared to Simon Broome (SB) biochemical criteria for FH diagnosis, all models presented significantly higher Acc, Spec and G-mean values (p < 0.01), and lower negative predictive value (NPV, p < 0.05). Moreover, LR and RF models presented comparable Sens values. Adjustment of the cut-off point by maximizing YI significantly increased Sens values, with no significant loss in Acc. The obtained results suggest such classification algorithms can be a viable alternative to be used as a widespread screening method. An online application has been developed to assess the performance of the LR model in a wider population.

Temporal Dynamics of Intranasal Oxytocin in Human Brain Electrophysiology

Oxytocin (OT) is a key modulator of human social cognition, popular in behavioral neuroscience. To adequately design and interpret intranasal OT (IN-OT) research, it is crucial to know for how long it affects human brain function once administered. However, this has been mostly deduced from peripheral body fluids studies, or uncommonly used dosages. We aimed to characterize IN-OT’s effects on human brain function using resting-state EEG microstates across a typical experimental session duration. Nineteen healthy males participated in a double-blind, placebo-controlled, within-subject, cross-over design of 24 IU of IN-OT in 12-min windows 15 min-to-1 h 42min after administration. We observed IN-OT effects on all microstates, across the observation span. During eyes-closed, IN-OT increased duration and contribution of A and contribution and occurrence of D, decreased duration and contribution of B and C; and increased transition probability C-to-B and C-to-D. In eyes-open, it increased A-to-C and A-to-D. As microstates A and D have been related to phonological auditory and attentional networks, respectively, we posit IN-OT may tune the brain for reception of external stimuli, particularly of social nature—tentatively supporting current neurocognitive hypotheses of OT. Moreover, we contrast our overall results against a comprehensive literature review of IN-OT time-course effects in the brain, highlighting comparability issues.

Volatile Profile of Portuguese Monofloral Honeys: Significance in Botanical Origin Determination

The volatile profiles of 51 samples from 12 monofloral-labelled Portuguese honey types were assessed. Honeys of bell heather, carob tree, chestnut, eucalyptus, incense, lavender, orange, rape, raspberry, rosemary, sunflower and strawberry tree were collected from several regions from mainland Portugal and from the Azores Islands. When available, the corresponding flower volatiles were comparatively evaluated. Honey volatiles were isolated using two different extraction methods, solid-phase microextraction (SPME) and hydrodistillation (HD), with HD proving to be more effective in the number of volatiles extracted. Agglomerative cluster analysis of honey HD volatiles evidenced two main clusters, one of which had nine sub-clusters. Components grouped by biosynthetic pathway defined alkanes and fatty acids as dominant, namely n-nonadecane, n-heneicosane, n-tricosane and n-pentacosane and palmitic, linoleic and oleic acids. Oxygen-containing monoterpenes, such as cis- and trans-linalool oxide (furanoid), hotrienol and the apocarotenoid α-isophorone, were also present in lower amounts. Aromatic amino acid derivatives were also identified, namely benzene acetaldehyde and 3,4,5-trimethylphenol. Fully grown classification tree analysis allowed the identification of the most relevant volatiles for discriminating the different honey types. Twelve volatile compounds were enough to fully discriminate eleven honey types (92%) according to the botanical origin.

AB0878-HPR EFFECT OF AQUATIC PHYSIOTHERAPY ON PAIN AND QUALITY OF LIFE IN ELDERLY WOMEN WITH FIBROMYALGIA

Background:

Fibromyalgia is defined as a chronic non-articular rheumatic disease, characterized by generalized, diffuse bilateral pain and the presence of tender points in specific anatomical regions. Its symptoms are characterized by a very varied picture and the etiology is considered multifactorial. Today, with difficult treatment, fibromyalgia has been a major challenge for healthcare professionals. Aquatic physiotherapy is currently one of the most commonly used forms of intervention in the management of fibromyalgia, and for this reason it has been used in interdisciplinary rehabilitation programs to promote health.

Objectives:

To evaluate the effects of aquatic physiotherapy on pain and quality of life in patients with fibromyalgia.

Methods:

This is an interventional, quasi-experimental study carried out at the Physiotherapy School Clinic of Universidade Cesumar in the city of Maringá, PR, Brazil. The study was approved by the Human Research Ethics Committee of Unicesumar under opinion No. 1,025,567. Participated in the study, elderly women aged 60 years, with clinical diagnosis of fibromyalgia. To assess the quality of life, the Medical Outcomes Study 36 - Item Short-Form Health Survey (SF-36) instrument was used and to verify the intensity of the pain, the Visual Analogue Scale was used. The aquatic physiotherapy intervention protocol was to perform 10 Watsu sessions, performed twice a week, lasting 40 minutes each. To perform the Watsu method, the following steps of the technique were followed: before starting, opening, delivering the water, dancing the breath in the water, breathing balance and to finish releasing the spine. For data analysis, the Shapiro-Wilk test was initially applied to verify the normality of the variables under study. As the data presented a normal distribution, mean, standard deviation, minimum and maximum were used to characterize the results. To compare the initial and final variables, the dependent student t test was used. The significance adopted was p <0.05.

Results:

The study included 17 elderly women with a mean age of 67.5 ± 4.7 years. When comparing the evaluation and the reassessment, a statistically significant improvement was evidenced in the domains of quality of life: functional capacity (p=0.00445), limitation due to physical aspects (p=0.01347), pain (p=0.00861), vitality (p=0.00044), limitation due to emotional aspects (p=0.02019), mental health (p=0.00748). The domains that did not show statistical increase were the general health status (p=0.30663) and the social aspects (p=0.05037). The pain, on the other hand, was statistically less after the intervention (p=0.00059).

Conclusion:

Aquatic physical therapy provided benefits in reducing pain and improving the quality of life of elderly women with fibromyalgia. It is important to encourage individuals with fibromyalgia to perform non-pharmacological interventions, such as aquatic physiotherapy, to promote their health and quality of life.

References:

[1]Oliveira DV, Ferreira AAM, Oliveira DCD, Leme DEDC, Antunes MD, Nascimento Júnior JRAD. Association of the practice of physical activity and of health status on the quality of life of women with fibromyalgia. Journal of Physical Education. 2019;30(1): e3027. https://doi.org/10.4025/jphyseduc.v30i1.3027.

[2]Antunes MD, Vertuan MP. Miquilin A, Leme DEC, Morales RC, Oliveira DV. Efeitos do Watsu na qualidade de vida e quadro doloroso de idosas com fibromialgia. ConScientiae Saúde. 2016;15(4), 636-641. https://doi.org/10.5585/conssaude.v15n4.6756.

[3]Antunes M, Ferreira A, Oliveira D, Júnior JN, Bertolini S, Marques AP. There is association between the level of physical activity and quality of life of women with fibromyalgia?. Annals of rheumatic diseases. 2019;78(2)650-1. http://dx.doi.org/10.1136/annrheumdis-2019-eular.2835.

Acknowledgements:

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001.

Disclosure of Interests:

None declared

AB0912-HPR AMIGOS DE FIBRO (FIBRO FRIENDS): EDUCATIONAL PROGRAM TO PROMOTE THE HEALTH OF PEOPLE WITH FIBROMYALGIA IN BRAZIL

Background:

Health education is pointed out as the front line in non-pharmacological approaches in fibromyalgia.

Objectives:

To develop an interdisciplinary educational program to promote the health of individuals with fibromyalgia in Brazil.

Methods:

This is a qualitative study, through a focus group, carried out in a Basic Health Unit in the city of São Paulo, SP. The guiding questions were about the needs and demands exposed by patients with fibromyalgia and health professionals who work in primary health care. 12 individuals with fibromyalgia and 10 health professionals participated. The data were analyzed using the content analysis method proposed by Bardin, specifically the thematic content analysis.

Results:

Amigos de Fibro (Fibro Friends) should be conducted through lectures, dynamics and conversation circles. The educational program must include 15 meetings with weekly frequency. The meetings are: 1st to present the program and socialization activities. 2nd: Doctor presents the concepts of fibromyalgia. 3rd: Nurse informs about practices and environments that favor self-care. 4th: Social Worker shows the importance of support. 5th: Physiotherapist shows the main body practices and physical activity. 6th: Nutritionist presents an adequate and healthy diet. 7: Psychologist shows mental health practices. 8th: Pharmacist informs about medicines. 9, 11 and 13: participants perform activities at home. 10: Naturologist presents integrative and complementary practices. 12th: Occupational Therapist encourages methods to save energy. Day 14: Speech therapist helps in the quality of sleep. 15: closing activity.

Conclusion:

Amigos de Fibro is a program that presents interdisciplinary educational information for individuals with fibromyalgia, being considered a trend of care for the future. The next step is to conduct a clinical trial to verify the effect of this intervention and then implement it in the health service in Brazil. Fibro Friends was created from the conjunct action of patients and healthcare professionals, it can be an effective educational tool to be implemented at primary health attention centers, promoting the self-care, life quality and the promotion of health in individuals with Fibromyalgia. Fibro Friends is an excellent tool for patient education and counseling in Brazil.

References:

[1]Antunes M, Ferreira A, Oliveira D, Júnior JN, Bertolini S, Marques AP. There is association between the level of physical activity and quality of life of women with fibromyalgia?. Annals of rheumatic diseases. 2019;78(2)650-1. http://dx.doi.org/10.1136/annrheumdis-2019-eular.2835.

[2]García-Ríos MC, Navarro-Ledesma S, Tapia-Haro RM, Toledano-Moreno S, Casas-Barragán A, Correa-Rodríguez M et al. Effectiveness of health education in patients with fibromyalgia: a systematic review. European Journal of Physical and Rehabilitation Medicine. 2019;55(2):301-13. https://doi.org/10.23736/S1973-9087.19.05524-2.

[3]Oliveira DV, Ferreira AAM, Oliveira DCD, Leme DEDC, Antunes MD, Nascimento Júnior JRAD. Association of the practice of physical activity and of health status on the quality of life of women with fibromyalgia. Journal of Physical Education. 2019;30(1): e3027. https://doi.org/10.4025/jphyseduc.v30i1.3027.

[4]Stuifbergen AK, Blozis SA, Becker H, Phillips L, Timmerman G, Kullberg V, et al. A randomized controlled trial of a wellness intervention for women with fibromyalgia syndrome. Clinical Rehabilitation. 2010;24(4):305-18. https://doi.org/10.1177/0269215509343247.

Acknowledgements:

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001.

Disclosure of Interests:

None declared

The familial hypercholesterolaemia phenotype: Monogenic familial hypercholesterolaemia, polygenic hypercholesterolaemia and other causes

Familial hypercholesterolaemia (FH) is a monogenic disorder characterised by high low-density lipoprotein cholesterol (LDL-C) concentrations and increased cardiovascular risk. However, in clinically defined FH cohorts worldwide, an FH-causing variant is only found in 40%-50% of the cases. The aim of this work was to characterise the genetic cause of the FH phenotype in Portuguese clinical FH patients. Between 1999 and 2017, 731 index patients (311 children and 420 adults) who met the Simon Broome diagnostic criteria had been referred to our laboratory. LDLR, APOB, PCSK9, APOE, LIPA, LDLRAP1, ABCG5/8 genes were analysed by polymerase chain reaction amplification and Sanger sequencing. The 6-SNP LDL-C genetic risk score (GRS) for polygenic hypercholesterolaemia was validated in the Portuguese population and cases with a GRS over the 25th percentile were considered to have a high likelihood of polygenic hypercholesterolaemia. An FH-causing mutation was found in 39% of patients (94% in LDLR, 5% APOB and 1% PCSK9), while at least 29% have polygenic hypercholesterolaemia and 1% have other lipid disorders. A genetic cause for the FH phenotype was found in 503 patients (69%). All known causes of the FH phenotype should be investigated in FH cohorts to ensure accurate diagnosis and appropriate management.

Redox-Oligomeric State of Peroxiredoxin-2 and Glyceraldehyde-3-Phosphate Dehydrogenase in Obstructive Sleep Apnea Red Blood Cells under Positive Airway Pressure Therapy

In this study, we examined the effect of six months of positive airway pressure (PAP) therapy on Obstructive Sleep Apnea (OSA) red blood cell (RBC) proteome by two dimensional difference gel electrophoresis (2D-DIGE) - based proteomics followed by Western blotting (WB) validation. The discovered dysregulated proteins/proteoforms are associated with cell death, H2O2 catabolic/metabolic process, stress response, and protein oligomerization. Validation by nonreducing WB was performed for peroxiredoxin-2 (PRDX2) and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) by using antibodies against the sulfinylated/sulfonylated cysteine of these proteins to better evaluate their redox-oligomeric states under OSA and/or in response to PAP therapy. The results indicated that the redox-oligomeric state of GAPDH and PRDX2 involving overoxidation by sulfinic/sulfonic acids were differentially modulated in OSA RBC, which might be compromising RBC homeostasis. PAP therapy by restoring this modulation induced a higher oligomerization of overoxidized GAPDH and PRDX2 in some patients that could be associated with eryptosis and the chaperone "gain" of function, respectively. This varied response following PAP may result from the complex interplay between OSA and OSA metabolic comorbidity. Hence, information on the redox status of PRDX2 and GAPDH in RBC will help to better recognize OSA subtypes and predict the therapeutic response in these patients. GAPDH monomer combined with body mass index (BMI) and PRDX2 S-S dimer combined with homeostatic model assessment for insulin resistance (HOMA-IR) showed to be very promising biomarkers to predict OSA and OSA severity, respectively.

Oxytocin and vasopressin modulation of prisoner's dilemma strategies

BACKGROUND

The neuropeptides oxytocin and vasopressin have been repeatedly implicated in social decision making by enhancing social salience and, generally, cooperation. The iterated and sequential version of the prisoner's dilemma (PD) game is a social dilemma paradigm eliciting strategies of cooperation versus competition.

AIMS

We aimed to characterise the role of PD players' sex, game partner type (computer vs. human) and oxytocin or vasopressin inhalation on the player's strategy preference.

METHODS

Participants (153 men; 151 women) were randomised to intranasal 24 IU oxytocin, 20 IU vasopressin or placebo, double-blind, and played the PD. We examined main and interactive effects of sex, drug and partner type on strategy preference.

RESULTS

We found a pervasive preference for a tit-for-tat strategy (i.e. general sensitivity to the partner's choices) over unconditional cooperation, particularly when against a human rather than a computer partner. Oxytocin doubled this sensitivity in women (i.e. the preference for tit-for-tat over unconditional cooperation strategies) when playing against computers, which suggests a tendency to anthropomorphise them, and doubled women's unconditional cooperation preference when playing against humans. Vasopressin doubled sensitivity to the partner's previous choices (i.e. for tit-for-tat over unconditional cooperation) across sexes and partner types.

CONCLUSIONS

These findings suggest that women may be more sensitive to oxytocin's social effects of anthropomorphism of non-humans and of unconditional cooperation with humans, which may be consistent with evolutionary pressures for maternal care, and that vasopressin, irrespective of sex and partner type, may be generally sensitising humans to others' behaviour.

A statistical model to identify determinants of glycemic control in patients with type 2 diabetes with different pharmacotherapeutic profiles

AIM

To develop a statistical model to identify determinants of glycemic control.

MATERIALS AND METHODS

A database was extracted from patients' records with at least one glycated hemoglobin (HbA1c) analysis and with antidiabetic therapy established and stabilized. A logistic regression model was designed to identify the statistical significance of factors associated with glycemic control.

RESULTS

Higher probability of success (HbA1c ≤8% [64 mmol/mol]) was found for those who were older in age, those who were men, and those with higher education levels. Increased values for the following variables were associated with the poorest glycemic control: number of years of T2DM since diagnosis, number of antidiabetic medicines, body mass index, low-density lipoprotein cholesterol, triglycerides, systolic blood pressure and number of diabetes consultations in the last twelve months. The following pharmacotherapeutic treatments were associated with glycemic control (in decreasing order of the results): oral antidiabetic drugs; oral antidiabetic drugs and insulin; insulin. Patients using metformin and a dipeptidyl peptidase-4 inhibitors have a higher probability of success than do patients using metformin and a sulfonylurea, and patients using insulin and metformin have a higher probability of success than do patients using insulin alone.

CONCLUSIONS

Sociodemographic, clinical and therapeutic parameters can strongly affect glycemic control. Studies based on real-life patient data provide important information on the development of more effective glycemic control.

Cybersecurity risk analysis in healthcare institutions

Introduction The growing digitization of businesses and its increasing dependence on Internet infrastructure has boosted the concerns related to data privacy and confidentiality. Healthcare institutions have been challenged with specific issues, namely the sensitivity of data, the specificity of networked equipment and the average information technology skills held by of healthcare professionals in Portugal.

Objectives To understand the relationship level established by healthcare professionals with the information security by assessing attitudes and behaviours in cybersecurity; to identify risks and actions that may be taken to enhance the healthcare professional’s cybersecurity awareness.

Methodology The study consists in translating, adjusting and applying two previously validated and published Likert-type response scales to assess health professionals' cybersecurity attitudes and behaviours in the Portuguese health environment. This is an observational, quantitative, cross-sectional and descriptive study in cybersecurity attitudes and behaviours in a healthcare institution in Portugal.

Results The sample was composed by 56 professionals, 71% women and 29% men, divided in four professional groups, where a mean (±SD) of 31.59 (±14.211) points was achieved for the cybersecurity risky behaviour (RScB) scale and 66.41 (±6,26) points for the cybersecurity and cybercrime in business attitudes scale (ATC-IB).

Conclusions There was no-significant statistical differences between the sociodemographic factors and the scores obtained on both scales. However, the points of the scales for the different domains evidences a statistical difference between ages, genders and professional groups by items, which are therefore important points for the development of future studies. The results showed a relationship between acquired behaviours and the attitudes of involvement with work and organizational commitment, establishing a bridge for the quantification in awareness.

AB1319-HPR EFFECT OF SEGMENTAL STABILIZATION AND PILATES ON CHRONIC NON-SPECIFIC LOW BACK PAIN: PILOT STUDY

Background:

Low back pain is an important health condition with major socioeconomic consequences and is associated with high costs for the health system, absenteeism at work and reduced functional performance. It is one of the most relevant health problems in the elderly, with point prevalence estimates higher than other musculoskeletal conditions.

Objectives:

To verify the effect of segmental stabilization versus the Pilates method in the elderly with chronic low back pain.

Methods:

The study included 9 elderly women with chronic low back pain randomized into two groups: Segmental Stabilization Group (SG n = 5; age 65.2 ± 4.32; Body Mass Index - BMI 29.99 ± 4.65) and Pilates Group (PG n = 4; age 67.75 ± 7.13; BMI 26.49 ± 4.06). Both groups underwent 16 individual sessions of 60 minutes twice a week and avaliated before and after 8 weeks. Pain was assessed using the Visual Analogue Pain Scale; functional disability, by Oswestry’s disability index; excessive fear of movement and physical activity, using the Tampa Kinesiophobia Scale; level of confidence in the balance for specific activities, on the Activity-Specific Balance Confidence (ABC) scale and; activation of the transverse muscle of the abdomen, by the pressure biofeedback unit Stabilizer of the Chatanooga brand. The allocation and evaluations of the participants were performed by a blind examiner. The data were analyzed using the Student’s t-test with the level of significance (p≤0.05).

Results:

The data show significant differences in the reduction of pain intensity (p= 0.022) and functional disability (p=0.023) only in SG and improvement in kinesiophobia (p=0.007) only in PG. The level of confidence in the balance for specific activities was better in the SG when compared to the PG (p=0.059). There was no difference in the activation of the transversus abdominis in both groups.

Conclusion:

The results indicate that the segmental stabilization was effective to improve pain and functional disability, Pilates to improve the degree of kinesiophobia and the SG obtained a better result when compared to the PG regarding the level of confidence in the balance for specific activities. Both techniques had a great effect on improving functional capacity and on the level of confidence in the balance for specific activities. It is suggested to carry out studies with a larger number of participants and follow-up evaluation to assess the long-term effects.

References:

[1]Boonstra AM, Preuper HRS, Reneman MF, Posthumus JB, Stewart RE. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. IJSR 2008; 3(2):165-9.

[2]Marques AP, Mendes YC, Taddei U, Pereira CAB, Assumpção A. Brazilian-Portuguese translation and cross cultural adaptation of the activities-specific balance confidence ABC) scale. Braz J Phys Ther 2013; 17(2): 170-8.

[3]Siqueira FB, Teixeira-Salmela LF, Magalhães LC. Análise das propriedades psicométricas da versão brasileira da escala tampa de cinesiofobia. Acta Orto Bras 2007; 15(1): 19-24.

[4]Viggato R, Alexandre NMC, Correa Filho HR. Development of a Braziliam Portuguese version of the Oswestry Disability Index: cross-cultural adaptation, reliability, and validity. Spine 2007; 32(4):481-6.

Acknowledgments:

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Disclosure of Interests:

None declared

Physiologically motivated detection of Atrial Fibrillation

Atrial Fibrillation (AF) is the most common arrhythmia and it is estimated to affect 33.5 million people worldwide. AF is associated with an increased risk of mortality and morbidity, such as heart failure and stroke and affects mostly older persons and persons with other conditions (e.g. heart failure and coronary artery disease). In order to prevent such life threatening and life quality reducing conditions it is essential to provide better algorithms, capable of being integrated in low-cost personalized health systems. This paper presents a new algorithm for AF detection, which is based on the analysis of the three physiological characteristics of AF: 1) Irregularity of heart rate and; 2) Absence of P-waves and 3) Presence of fibrillatory waves. Based on these characteristics several features were extracted from 12-lead electrocardiograms (ECG) and selected according to their discrimination ability. The classification between AF and non-AF episodes was performed using a Support Vector Machine (SVM) classification model. Our results show that the identification of the fibrillatory patterns, using the proposed features, extracted from the analysis of 12-lead ECG improves the performance of the algorithm to a sensitivity of 88.5% and specificity 92.9%, when compared to our previous single-channel approach, in the same database.

Correlations between resistance training-induced changes on phase angle and biochemical markers in older women

The main purpose of this study was to investigate the effects of 12 weeks of resistance training (RT) on phase angle (PhA), inflammatory and oxidative stress biomarkers, and to evaluate whether these RT-induced adaptations are related to PhA changes. Fifty-one older women (70.6 ± 5.1 years; 26.9 ± 4.2 kg/m² ) were randomly allocated into a training group (TG) that performed 12-week RT or a nonexercising control group (CG). The PhA (Xitron), body composition (DXA), and blood sample measurements (after a 12 hours fast) were performed before and after the intervention. The TG showed a significant (P < .05) increase in PhA (TG: +7.4±5.9% vs CG: -3.6 ± 8.8%), and interleukin-10 (IL-10; TG: +51.8 ± 71.1% vs CG: -46.6 ± 38.0%), and a decrease in tumor necrosis factor alpha (TNF-α; TG: -15.2 ± 11.1% vs CG: +6.9±17.7%), interleukin-6 (IL-6; TG: -17.9 ± 17.8% vs CG: +6.1 ± 24.8%), and C-reactive protein (CRP; TG: -24.1 ± 19.9% vs CG: +43.8 ± 31.1%). Moreover, TG upregulated catalase (TG: +11.4 ± 15.0% vs CG: -6.7 ± 10.2%). Changes in TNF-α (r = -.71), CRP (r = -.65), lower advanced oxidation protein products (r = -.55), and catalase (r = +.73) after RT were correlated with changes in PhA (P < .05). These results suggest that RT improves PhA, inflammatory and oxidative stress biomarkers, and the changes in inflammatory and oxidative damage markers are correlated with changes in PhA.

Proteostasis in epicardial versus subcutaneous adipose tissue in heart failure subjects with and without diabetes

BACKGROUND

Cardiovascular diseases (CVDs) are leading cause of death and primary cause of morbidity and mortality in diabetic population. Epicardial adipose tissue (EAT) covers the heart's surface and is a source of biomolecules regulating heart and blood vessel physiology. The protective activation of the unfolded protein response (UPR) and autophagy allows the cardiomyocyte reticular network to restore energy and/or nutrient homeostasis and to avoid cell death. However, an excessive or prolonged UPR activation can trigger cell death. UPR activation is an early event of diabetic cardiomyopathies and deregulated autophagy is associated with CVDs.

RESULTS

An upregulation of UPR markers (glucose-regulated protein 78 KDa, glucose-regulated protein 94 KDa, inositol-requiring enzyme 1α, protein kinase RNA-like ER kinase and CCAAT/-enhancer-binding protein homologous protein (CHOP) gene) in EAT compared to subcutaneous adipose tissue (SAT), was observed as well as the UPR-related apoptosis marker caspase-4/procaspase-4 ratio but not in CHOP protein levels. Additionally, levels of ubiquitin and ubiquitinated proteins were decreased in EAT. Moreover, upregulation of autophagy markers (5' adenosine monophosphate-activated protein kinase, mechanistic target of rapamycin, Beclin 1, microtubule-associated protein light chain 3-II, lysosome-associated membrane protein 2, and PTEN-induced putative kinase 1) was observed, as well as an increase in the apoptotic Bim but not the ratio between Bim and the anti-apoptotic Bcl-2 in EAT. Diabetic patients show alterations in UPR activation markers but not in autophagy or apoptosis markers.

CONCLUSION

UPR and autophagy are increased in EAT compared to SAT, opening doors to the identification of early biomarkers for cardiomyopathies and novel therapeutic targets.

Reproductive features of the swimming crab Callinectes danae(Crustacea, Portunoidea) on the subtropical coast of Brazil: a sampling outside the estuary

The life cycle of the crab Callinectes danae is estuarine-dependent, and studies on aspects of their biology should also cover marine areas. The present study investigated the sexual maturity, as well as habitat preference by adults in different gonadal stages, and the crabs' reproductive periodicity outside the estuary. Three bays on the subtropical southeastern coast of Brazil were sampled monthly for two years. For each bay, six transects were established, four of them parallel to the beach line (5, 10, 15 and 20 m depth), as well as one transect in an exposed area, and another sheltered from the action of waves. The results showed that the pattern of spatio-temporal distribution of adults C. danae was similar in three bays, although the highest abundance was found in Ubatumirim. Females with developed gonads/ovigerous females were found in greater abundance than females with rudimentary/developing gonads, mainly in deeper transects. Although the areas sampled have different environmental characteristics, the reproductive pattern of the species did not change, showing continuous reproduction throughout, with more abundance of reproductive females on spring and summer. Males reached maturity at larger sizes than females in all three bays.

Assessment of cardiovascular function from multi-Gaussian fitting of a finger photoplethysmogram

Monitoring of cardiovascular function on a beat-to-beat basis is fundamental for protecting patients in different settings including emergency medicine and interventional cardiology, but still faces technical challenges and several limitations. In the present study, we propose a new method for the extraction of cardiovascular performance surrogates from analysis of the photoplethysmographic (PPG) signal alone.We propose using a multi-Gaussian (MG) model consisting of five Gaussian functions to decompose the PPG pulses into its main physiological components. From the analysis of these components, we aim to extract estimators of the left ventricular ejection time, blood pressure and vascular tone changes. Using a multi-derivative analysis of the components related with the systolic ejection, we investigate which are the characteristic points that best define the left ventricular ejection time (LVET). Six LVET estimates were compared with the echocardiographic LVET in a database comprising 68 healthy and cardiovascular diseased volunteers. The best LVET estimate achieved a low absolute error (15.41   ±   13.66 ms), and a high correlation (ρ = 0.78) with the echocardiographic reference.To assess the potential use of the temporal and morphological characteristics of the proposed MG model components as surrogates for blood pressure and vascular tone, six parameters have been investigated: the stiffness index (SI), the T1_d and T1_2 (defined as the time span between the MG model forward and reflected waves), the reflection index (RI), the R1_d and the R1_2 (defined as their amplitude ratio). Their association to reference values of blood pressure and total peripheral resistance was investigated in 43 volunteers exhibiting hemodynamic instability. A good correlation was found between the majority of the extracted and reference parameters, with an exception to R1_2 (amplitude ratio between the main forward wave and the first reflection wave), which correlated low with all the reference parameters. The highest correlation ([Formula: see text] = 0.45) was found between T1_2 and the total peripheral resistance index (TPRI); while in the patients that experienced syncope, the highest agreement ([Formula: see text] = 0.57) was found between SI and systolic blood pressure (SBP) and mean blood pressure (MBP).In conclusion, the presented method for the extraction of surrogates of cardiovascular performance might improve patient monitoring and warrants further investigation.

Prediction of Heart Failure Decompensation Events by Trend Analysis of Telemonitoring Data

This paper aims to assess the predictive value of physiological data daily collected in a telemonitoring study in the early detection of heart failure (HF) decompensation events. The main hypothesis is that physiological time series with similar progression (trends) may have prognostic value in future clinical states (decompensation or normal condition). The strategy is composed of two main steps: a trend similarity analysis and a predictive procedure. The similarity scheme combines the Haar wavelet decomposition, in which signals are represented as linear combinations of a set of orthogonal bases, with the Karhunen-Loève transform, that allows the selection of the reduced set of bases that capture the fundamental behavior of the time series. The prediction process assumes that future evolution of current condition can be inferred from the progression of past physiological time series. Therefore, founded on the trend similarity measure, a set of time series presenting a progression similar to the current condition is identified in the historical dataset, which is then employed, through a nearest neighbor approach, in the current prediction. The strategy is evaluated using physiological data resulting from the myHeart telemonitoring study, namely blood pressure, respiration rate, heart rate, and body weight collected from 41 patients (15 decompensation events and 26 normal conditions). The obtained results suggest, in general, that the physiological data have predictive value, and in particular, that the proposed scheme is particularly appropriate to address the early detection of HF decompensation.

Comparison of alternative mixture model methods to analyze bacterial CGH experiments with multi-genome arrays

BACKGROUND

Microarray-based comparative genomic hybridization (aCGH) is used for rapid comparison of genomes of different bacterial strains. The purpose is to evaluate the distribution of genes from sequenced bacterial strains (control) among unsequenced strains (test). We previously compared the use of single strain versus multiple strain control with arrays covering multiple genomes. The conclusion was that a multiple strain control promoted a better separation of signals between present and absent genes.

FINDINGS

We now extend our previous study by applying the Expectation-Maximization (EM) algorithm to fit a mixture model to the signal distribution in order to classify each gene as present or absent and by comparing different methods for analyzing aCGH data, using combinations of different control strain choices, two different statistical mixture models, with or without normalization, with or without logarithm transformation and with test-over-control or inverse signal ratio calculation. We also assessed the impact of replication on classification accuracy. Higher values of accuracy have been achieved using the ratio of control-over-test intensities, without logarithmic transformation and with a strain mix control. Normalization and the type of mixture model fitted by the EM algorithm did not have a significant impact on classification accuracy. Similarly, using the average of replicate arrays to perform the classification does not significantly improve the results.

CONCLUSIONS

Our work provides a guiding benchmark comparison of alternative methods to analyze aCGH results that can impact on the analysis of currently ongoing comparative genomic projects or in the re-analysis of published studies.

Multi-Gaussian fitting for the assessment of left ventricular ejection time from the photoplethysmogram

The Left ventricular ejection time (LVET) is one of the primary surrogates of the left ventricular contractility and stroke volume. Its continuous monitoring is considered to be a valuable hypovolumia prognostic parameter and an important risk predictor in cardiovascular diseases such as cardiac and light chain amyloidosis. In this paper, we present a novel methodology for the assessment of LVET based the Photoplethysmographic (PPG) waveform. We propose the use of Gaussian functions to model both systolic and diastolic phases of the PPG beat and consequently determine the onset and offset of the systolic ejection from the analysis of the systolic phase 3(rd) derivative. The results achieved by the proposed methodology were compared with the algorithm proposed by Chan et al. [1], revealing better estimation of LVET (15.84 ± 13.56 ms vs 23.01 ± 14.60 ms), and similar correlation with the echocardiographic reference (0.73 vs 0.75).

The novel object recognition memory: neurobiology, test procedure, and its modifications

Animal models of memory have been considered as the subject of many scientific publications at least since the beginning of the twentieth century. In humans, memory is often accessed through spoken or written language, while in animals, cognitive functions must be accessed through different kind of behaviors in many specific, experimental models of memory and learning. Among them, the novel object recognition test can be evaluated by the differences in the exploration time of novel and familiar objects. Its application is not limited to a field of research and enables that various issues can be studied, such as the memory and learning, the preference for novelty, the influence of different brain regions in the process of recognition, and even the study of different drugs and their effects. This paper describes the novel object recognition paradigms in animals, as a valuable measure of cognition. The purpose of this work was to review the neurobiology and methodological modifications of the test commonly used in behavioral pharmacology.

Complications of endomyocardial biopsy in heart transplant patients: a retrospective study of 2117 consecutive procedures

BACKGROUND

Endomyocardial biopsy (EMB) remains the gold standard for the diagnosis of graft rejection after heart transplantation (HT). Our purpose was to evaluate the rate of complications of this invasive procedure.

METHODS

This was a retrospective study of 175 patients, who were transplanted between November 2003 and October 2010 and survived more than 1 month after surgery. We evaluated the number of inconclusive EMB and described the incidence, nature, and subsequent management of several complications associated with this procedure.

RESULTS

Over a period of approximately 7 years, we performed 2217 EMB yielding 4972 specimens, namely, an average of 2.3 fragments per procedure. The majority of EMBs (95.3%) were performed by the femoral approach. Only 12 EMB (0.57%) were inconclusive. The overall complication rate was 0.71%. During puncture, one patient experienced a vasovagal reaction and another one, a femoral artery false aneurysm. During the biopsy, there was one case of cardiac perforation with tamponade, two cases of supraventricular tachycardia, and three atrioventricular conduction abnormalities. In 19 patients, histological analysis revealed chordal tissue, but only two patients developed mild tricuspid regurgitation. We observed five cases of coronary artery fistulae. The clinical outcomes were favorable in all cases.

CONCLUSION

EMB proved to be a suitable, safe method to monitor rejection after HT.