Resistance to apoptosis in complicated Crohn's disease: Relevance in ileal fibrosis

BACKGROUND AND AIMS

The stiffening of the extracellular matrix, and changes in its cellular and molecular composition, have been reported in the pathogenesis of fibrosis. We analyze the mechanisms that perpetuate ileal fibrosis in surgical resections of complicated Crohn's disease patients.

METHODS

Ileal resections were obtained from affected and non-affected tissue of stenotic or penetrating Crohn's disease behavior. Ilea from non-IBD patients were used as control tissue. All samples underwent RNA sequencing. Human small intestinal fibroblasts were treated for 48 h with IL-1β, TFGβ1, PDGFB or TNF-α. Resistance to apoptosis was analysed by RT-PCR, western blot and immunohistochemistry in ileal tissue and by RT-PCR and FACS in cultured cells.

RESULTS

Growth factor-driven signaling pathways and increased RAS GTPase activity were up-regulated in affected ilea in which we found expression of both the antiapoptotic molecule MCL1 and the transcription factor ETS1 in submucosal fibroblasts, and a senescence-associated secretory phenotype. In cultured intestinal fibroblasts, PDGFB induced an ETS1-mediated resistance to apoptosis that was associated with the induction of both of TGFB1 and IL1B, a cytokine that replicated the expression of SASP detected in ileal tissue. ETS1 drove fibroblast polarization between inflammatory and fibrogenic phenotypes in IL1β-treated cells.

CONCLUSIONS

Our data show resistance to apoptosis in complicated ileal CD, and demonstrate that PDGFB induce an ETS1-mediated resistance to apoptosis associated with an inflammatory and fibrogenic pattern of expression in intestinal fibroblasts. Results point to PDGFRB, IL1R1 or MCL1 as potential targets against ileal fibrosis.

Prevalence and risk factors of gestational diabetes in the health region of Lleida: a retrospective observational cohort study

BACKGROUND

Diabetes is a very common metabolic condition during pregnancy. The number of cases increases with age and obesity. The prevalence of pre-gestational diabetes and gestational diabetes (GD) differs between different ethnic groups.

OBJECTIVE

The aim of the study was to analyse the prevalence of pre-gestational diabetes and GD in the health region of Lleida. We also studied the GD risk factors during pregnancy according to the country of origin of the pregnant woman.

METHODS

We performed a retrospective observational cohort study among pregnant women between 2012 and 2018 in the health region of Lleida. A multivariate model was performed with the different variables analysed by calculating the regression coefficient and its 95% confidence interval (CI).

RESULTS

In our sample of 17,177 pregnant women, we observed a prevalence of pre-gestational diabetes and GD of 8.2% and 6.5%, respectively. We found a relationship of gestational diabetes with different factors: age, with 6.8% in 30-34 year-old women and 11.3% in women over 35 (OR 1.78 and 3.29, respectively); overweight, with 8.29% (OR 1.89); and obesity, with 12.9% (OR 3.15). Finally, women from Asia and the Middle East and the Maghreb had a higher risk of diabetes, with 12.2% (OR 2.1) and 9.91% (OR 1.3), respectively, and Sub-Saharan women had a lower risk of it 6.07% (OR 0.71).

CONCLUSIONS

GD has different risk factors, such as age, overweight, and obesity. Non-related conditions include hypothyroidism, arterial hypertension, and dyslipidaemia. Finally, pregnant women from the Maghreb, and Asia and the Middle East, are at higher risk of developing diabetes during pregnancy; meanwhile, Sub-Saharan origin is protector factor.

Implication of caveolae in the pathophysiology of human acute myocardial infarction: a histological study

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work has been funded by “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER” (Exp. PI20/00637) as well as by “Generalitat Valenciana” (Exp. PROMETEO/2021/008).

Introduction

Caveolae are lipid invaginations present in the membrane of most mammalian cells. They are mainly made up of three proteins: caveolin (Cav)-1, 2, and 3 and are involved in signal transduction and ion channels. Since caveolae regulate different signalling pathways to promote cardiac protection, the aim of this study is to compare the expression of Cav-1, 2, and 3 in the human myocardium of control subjects and in patients with myocardial infarction (MI).

Materials

Myocardial samples from human autopsies of 4 controls and 4 MI patients with more than 6 months of evolution were isolated. The infarction and control area were identified by haematoxylin-eosin and Masson’s trichromic stainings. The presence of Cav-1, 2 and 3 was detected by immunochemistry. Afterwards, 5 photographs were taken for each antibody and sample and the presence of each protein was morphometrically quantified using the image analyzer Image-Pro Plus. These results were also corroborated by immunofluorescence.

Results

A constitutive presence of Cav-1, 2, and 3 was observed in the myocardium of control patients, being Cav-1 and 3 higher expressed than Cav-2. Cav-2 and 3 were mainly found in cardiomyocytes, while Cav-1 was detected not only in cardiac muscle cells but also in endothelial cells. Comparing caveolae expression between the peri-infarct region of MI patients and controls, a significant reduction in the expression of the three proteins was observed by immunochemistry. Indeed, the decrease in Cav-2 and 3 could be also detected by immunofluorescence. Lastly, Cav-1 was more expressed in cardiomyocytes than in endothelial cells, but unlike muscle cells, its expression was not diminished after MI.

Conclusions

The presence of caveolin decreases in the myocardial tissue after MI. Further studies are needed to confirm the cardioprotective role of caveolae post-AMI and their use as potential therapeutic target.

Morphometric, histological and immunohistochemical study of the His bundle in humans and other animal species

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER” (grant numbers PI20/00637 and CIBERCV16/11/00486) and Conselleria de Educación – Generalitat Valenciana (PROMETEO/2021/008).

Introduction

The His bundle is responsible for transmitting the electrical impulse from the atria to the ventricles where it connects with the Purkinje cells in both normal and abnormal hearts. The aim of this study was to perform a morphometric analysis of His bundle characteristics of in humans, dogs, horses and pigs and compare them in these studied species.

Methods

We analyzed five hearts of human male adults, five male pig hearts, five hearts from male horses and five hearts of male dogs. Histological sections of 5 μm thickness were obtained and stained with hematoxylin–eosin and Masson’s trichrome; the desmin and periodic acid–Schiff methods were also used for precise identification of cells.

Results

The His bundle was found to be longer in horses (2.85 ± 1.02 mm) and pigs (1.77 ± 0.9 mm) than in dogs (1.53 ± 0.8 mm) or humans, in which it was shortest (1.06 ± 0.6 mm). The area and diameters in His bundle cells, were significantly larger in pigs and horses than in humans (p < 0.001) or dogs (p < 0.001). We found two organizational patterns of His bundle components: group I, with large cells and a high amount of collagen fibers in ungulates (pigs and horses); and group II, with smaller cells and lower abundance of collagen fibers in humans and dogs.

Conclusions

Determining morphometrically cell size variations in the His bundle allows us not only to identify this bundle by histological or anatomical location but also to differentiate these cells from others such as nodal or Purkinje cells. Our analysis revealed that His bundle cells have discrete identities based on their morphometric and histological characteristics.

Post-stroke mania

Introduction

Approximately one-third of stroke survivors develop poststroke depression. Post-stroke mania is relatively rare, with a prevalence of less than 2%. One review of case reports of late-onset mania in 2015 demonstrated that 51% of the patients had established vascular risk factors. In 28% of cases, the treatment of underlying organic cause contributed to successful remission of the manic episode.

Objectives

For this review, we aimed to compile published case reports from the past 20 years to review late-onset mania as one of the neuropsychiatric outcomes of stroke and its management.

Methods

literature search on Pubmed, PsychInfo, and Embase utilizing keywords combinations: Bipolar, Manic, Mania, Secondary, Stroke, Poststroke, Post-stroke, Elderly, Old, Late onset, Late-onset, Lateonset, Hemisphere, Brain, Vascular, Infarction.

Results

Among the 17 case reports, the age of onset of manic episode ranged from 47 to 86 with a mean of 67 years. Of the 17 cases, the right hemisphere was the most frequently affected (14/17, 82%), with cerebrovascular lesion involving the left hemisphere in 3 cases (17.6%).

Conclusions

Clinicians should consider mania secondary to an organic cause in patients presenting with focal or soft neurological signs or symptoms, manic episode with atypical symptoms such as visual or olfactory hallucinations, altered mental status, disorientation, impairment in memory or cognition, unusual age of onset for bipolar disorder, or unusual illness course such as single episode of mania or poor response to psychopharmacologic treatment. Some reviews suggest combination of mood stabilizers and second-generation antipsychotics. Benzodiazepines recommended as an adjunctive drug for acute management such as agitation, aggressive behavior or disinhibition.

Disclosure

No significant relationships.

Methodological approach to spatial analysis of agricultural pest dispersal in olive landscapes

The effectiveness of a Geographical Information Systems cost-distance tool for detecting landscape permeability in relation to the movement of pests in olive landscapes was established. The simplification of agricultural systems is linked to an increased incidence of pests on crops. Therefore, it is important to understand the impact of different land uses surrounding olive groves on pests. In this work, we analysed the effect of the structure of the olive landscape on the movement of two main olive pests-the olive fruit fly, Bactrocera oleae (Rossi) (Diptera: Tephritidae) and the olive moth, Prays oleae (Bernard) (Lepidopetera: Praydidae). We applied linear mixed effects models to analyse the relationship between pest abundance and cost-distance, using different hypotheses to evaluate those land uses that are favourable or unfavourable for the movement of these pests. The results show that this methodology is effective in detecting possible unfavourable land uses with a barrier effect, such as woodland and artificial land uses, and favourable land uses with a corridor effect such as olive groves. Whether other land uses, such as scrubland or riverbanks, act as a barrier or corridor depends on the pest and its life cycle stage. The effect that different land uses have in maintaining low levels of pest populations and ensuring the long-term sustainability of these agricultural systems are discussed. The implications of landscape permeability for the physical structure of the landscape and the dispersal of organisms, and the potential of that landscape to impact the continuous flow of natural processes are also addressed.

Adherence to treatment for hypothyroidism in pregnancy and relationship with thyrotropin control: a retrospective observational cohort study

Background

Hypothyroidism is the second most common endocrinological disease during pregnancy, with percentages that can range between 3.2 and 5.5%. A good maternal and foetal health outcome depends on thyroid hormone replacement therapy. The goal of such therapy is to maintain thyrotropin (TSH) in a range that is specific for pregnant women and varies between the trimesters of pregnancy. In our study, we wanted to analyse the adherence to hypothyroidism treatment among pregnant women and to evaluate the degree of control of the disease.

Methods

We performed a retrospective observational cohort study in pregnant women between 2012 and 2018 in the Lleida health region. Therapeutic adherence was analysed by the proportion of days covered (PDC). The relationship with other variables was assessed using the regression coefficients and their 95% confidence interval (CI).

Results

We examined a sample of 17,281 women, representing more than 92% of the pregnant women in the Lleida health region in the period analysed. Among this sample, the mean prevalence of hypothyroidism was 6.52% (0.07% clinical and 6.45% subclinical). 3.3% of the 17,281 pregnant women were treated. Among them, the mean adherence score was 79.6 ± 22.2. Of these, 54% presented high adherence. The latter had a higher mean age and better TSH control, in comparison to the ones showing low adherence.

Conclusions

Half of the treated patients had good adherence to treatment and a better TSH control, in comparison to the others. Most of them achieved a good control at the third trimester of pregnancy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04483-8.

Fire ignition patterns to manage prescribed fire behavior: Application to Mediterranean pine forests

Climate change and the accumulation of surface fuel are leading to global changes in the occurrence of increasingly severe fires. In light of current budgetary constraints, prescribed fire can be a very cost-efficient tool for both reducing wildfire hazards and managing fire-prone landscapes. However, despite its widespread use in some countries, social and administrative constraints arise when applied at the European or larger scales. Science-based knowledge concerning fire behavior, fuel load reduction, and tree impacts is required to support the use of prescribed fire. Spatial ignition patterns can increase or decrease the spread rate, flame length, and flame residence time according to the objectives of a prescribed fire. This work aims to analyze fire behavior using different fire ignition patterns (strip-heading fire, flanking fire, and spot-heading fire) and meteorological and fuel conditions. Seventy-seven observations or sampling units using twenty-three prescribed fires were established for fire monitoring. Non-linear models based on environmental variables were fitted for the spread rate and flame length. Our study proposes a novel way of sharing scientific knowledge in relation to the most common distances between ignition lines and ignition points used in the southern Iberian Peninsula. The spread rate and flame length can be increased in strip-heading fire, by more than 3.5-fold and more than 1.95-fold, respectively, by modifying only the distance between ignition lines. Flanking fire could lead to a decrease in the spread rate by approximately half. Although spot-heading fire can reduce the spread rate by more than 78% and flame length by more than 41%, the highest distances between points could increase the flame residence time by 39-132%. This research seeks to achieve a trade-off between fire intensity and the impacts of fire on trees, soil, and surface roots.

[Incidence of severe exacerbation in patients diagnosed with diabetes and chronic obstructive pulmonary disease: Cohort study]

Objetivo

Estimar en una cohorte de pacientes diagnosticados de EPOC y diabetes la incidencia de hospitalizaciones por exacerbación grave de la EPOC y sus factores asociados.

Diseño

Estudio prospectivo de cohorte.

Emplazamiento

Centros de Atención Primaria de Lleida ciudad (en total 7 centros).

Participantes

Se estudiaron 761 pacientes codiagnosticados de EPOC y diabetes. Los criterios de inclusión fueron pacientes de ambos sexos, igual o mayores de 40 años, residentes en el área geográfica de Lleida ciudad, con el diagnóstico de EPOC según los criterios de la guía GOLD, con espirometría reciente y una fracción FEV₁/FVC < 0,7; diagnosticados de DM2 según la guía de la International Diabetes Federation. Los criterios de exclusión fueron padecer alguna enfermedad física o psíquica grave.

Mediciones principales

Las variables del estudio fueron: el sexo, la edad, su área básica de salud en Lleida, índice de masa corporal, perímetro de cintura, hábito tabáquico y enólico, hipertensión arterial, insuficiencia cardiaca, insuficiencia renal crónica, FEV₁, FEV₁/FVC, categorización GOLD, HbA1c. Se registró la vacuna antigripal y antineumocócica. La variable dependiente fue la exacerbación grave. En el análisis estadístico la asociación de la variable dependiente con las variables independientes se determinó mediante el cálculo de la hazard ratio (HR) con el intervalo de confianza del 95%. La HR se estimó de forma ajustada mediante modelos de regresión de Cox no condicional.

Resultados

La incidencia de hospitalización por exacerbación grave de la EPOC fue del 9,98%; se objetivó un aumento del riesgo de exacerbación grave en pacientes diagnosticados de insuficiencia cardiaca (HR = 2,27; p = 0,002), y con una menor fracción de FEV₁/FVC. La vacuna antigripal y antineumocócica presentaron un papel protector débil sin ser estadísticamente significativa.

Conclusión

Se documenta una incidencia de exacerbaciones elevada en los pacientes codiagnosticados de EPOC y DM2. La insuficiencia cardiaca y una menor fracción FEV₁/FVC podrían aumentar el riesgo de exacerbación.

Clinico-epidemiological characteristics of men and women with a new diagnosis of chronic obstructive pulmonary disease: a database (SIDIAP) study

BACKGROUND

The risk of developing Chronic Obstructive Pulmonary Disease (COPD), the associated comorbidities and response to bronchodilators might differ in men and women. The objective of this study was to determine the prevalence of COPD and the clinic-epidemiological characteristics of primary care patients with COPD according to gender.

METHODS

This is a cross-sectional study using electronic healthcare records Catalonia (Spain), during the 01/01/2012-31/12/2017 period. Patients from the SIDIAP database (System for the Development of Research in Primary Care) were included (5,800,000 patients registered in 279 primary care health centres). Clinic-demographic characteristics, comorbidities and blood tests results were collected for each patient. Adjusted OR (ORa) with logistic regression methods were used to determine variables associated with men and women.

RESULTS

From an initial sample of 800,899 people, 24,135 (3%) were considered COPD patients, and 22.9%were women. The most common risk factors in women were bronchiectasis (ORa = 20.5, SD = 19.5-21.6), age > 71 years (ORa = 18.8; SD = 17.3-20.5), cor pulmonale (ORa = 5.2; SD = 4.3-6.7) and lung cancer (ORa = 3.6, SD = 3.2-4.0). Men and women presented the same comorbidities, though the strength of association was different for each gender.

CONCLUSIONS

Patients suffering high comorbidity rates. Comorbidities are similar in men and women, although the strength of association varies according to gender. Women are more susceptible to the harmful effects of smoking and present a higher proportion of bronchiectasis and OSAS.

Re-establishment of the epigenetic state and rescue of kinome deregulation in Ts65Dn mice upon treatment with green tea extract and environmental enrichment

Down syndrome (DS) is the main genetic cause of intellectual disability due to triplication of human chromosome 21 (HSA21). Although there is no treatment for intellectual disability, environmental enrichment (EE) and the administration of green tea extracts containing epigallocatechin-3-gallate (EGCG) improve cognition in mouse models and individuals with DS. Using proteome, and phosphoproteome analysis in the hippocampi of a DS mouse model (Ts65Dn), we investigated the possible mechanisms underlying the effects of green tea extracts, EE and their combination. Our results revealed disturbances in cognitive-related (synaptic proteins, neuronal projection, neuron development, microtubule), GTPase/kinase activity and chromatin proteins. Green tea extracts, EE, and their combination restored more than 70% of the phosphoprotein deregulation in Ts65Dn, and induced possible compensatory effects. Our downstream analyses indicate that re-establishment of a proper epigenetic state and rescue of the kinome deregulation may contribute to the cognitive rescue induced by green tea extracts.

Compliance with the guidelines on recommended immunization schedule in patients with inflammatory bowel disease: implications on public health policies

BACKGROUND

Patients with inflammatory bowel disease (IBD) have a higher risk of developing opportunistic infections due to either the disease itself or to treatment with immunosuppressants. This risk can be reduced through vaccination. The aim of this study was to determine the prevalence of compliance with the guidelines on recommended immunization schedule in patients with IBD in the health district of Lleida, Spain.

METHODS

Descriptive, cross-sectional, retrospective study of data at December 31, 2016. The reference population was formed by adults with a clinical diagnosis of IBD. The dependent variable was "compliance with the guidelines on recommended immunization schedule". Variables were sex, age, residence, diagnosis, vaccination against measles, mumps, rubella, varicella, tetanus-diphtheria, influenza, pneumococcus, meningococcus C, hepatitis B, and hepatitis A. Data were obtained from electronic medical records. For the data analysis, mean (standard deviation), prevalence with 95% confidence intervals, χ² test and Mann-Whitney test were used.

RESULTS

Compliance did not exceed 65% for any of vaccines analysed in the 1722 studied patients with ulcerative colitis or Crohn's disease. Significant differences across age groups were found in compliance for measles, mumps, rubella, varicella, tetanus, diphtheria and influenza in both ulcerative colitis and Crohn's disease and for meningococcus C and hepatitis A exclusively in ulcerative colitis.

CONCLUSIONS

Compliance in patients with IBD is low. Thus, prevention of immunopreventable diseases or their complications is not maximized in this kind of patients. Greater awareness of how vaccines can reduce the risk of vaccine-preventable infections is needed among both patients and healthcare professionals.

Adequacy of the special category antibiotics prescriptions in the Emergency Department of a third level urban Hospital

Objetivo

Material y métodos

Resultados

Conclusiones

Diabetes as a risk factor for severe exacerbation and death in patients with COPD: a prospective cohort study

Background

Type 2 diabetes comorbidity is common in patients with COPD. One of the most frequent causes of hospital admission in patients with COPD are exacerbations.

Methods

Prospective cohort study, which included 512 patients with COPD recruited in a primary care centre in Mollerussa (Lleida, Spain). Inclusion criteria were: patients &gt;40 years of age with COPD according to the Global Initiative for Chronic Obstructive Lung Disease. Variables collected were as follows: age, gender, civil status, education level, smoking habit, severity (Global Initiative for Chronic Obstructive Lung Disease), comorbidities (Charlson), history of severe exacerbations, dyspnoea (mMRC), BODEx, EuroQol 5 D and depression (HAD). Logistic regression was used to determine the association of diabetes with risk of hospital admission and death.

Results

Prevalence of diabetes was 25.8%. During the second year of follow up, 18.2% of patients with COPD and diabetes were admitted for exacerbation, in comparison with 8.9% non-diabetic COPD patients. The variables associated with hospital admission were diabetes (ORa=1.54); gender (men, ORa=1.93); age (ORa=1.02); number of hospital admissions during the previous year: 1 (ORa=2.83) or more than one admission (ORa=4.08); EuroQol 5 D (ORa=0.76) and BODEx (ORa=1.24). With the exclusion of BODEx, all these variables were associated with a higher risk of death.

Conclusion

Prevalence of diabetes is high in patients suffering from COPD. COPD patients with diabetes are at higher risk of severe exacerbation and death. The suggested predictive model could identify patients at higher risk so that adequate preventive and therapeutic measures can be implemented.

Are Obesity Indices Useful for Detecting Subclinical Atheromatosis in a Middle-Aged Population?

OBJECTIVE

There is a close relationship between excess adiposity and cardiovascular disease. Although body mass index (BMI) is the most used approach to estimate excess weight, other anthropometric indices have been developed to measure total body and abdominal adiposity. Here, our objective was to assess the usefulness of these anthropometric indices to detect subclinical atheromatous disease.

METHODS

A cross-sectional study with 6,809 middle-aged subjects (mean age, 57 [53-63] years) with low to moderate cardiovascular risk from the ILERVAS project. Measures of total body fat (BMI, Clínica Universidad de Navarra - Body Adiposity Estimator [CUN-BAE], and Deurenberg's formula) and central adiposity (waist and neck circumferences, conicity index, waist-to-height ratio, Bonora's equation, the A body adiposity index, and body roundness index) were performed in all participants. Bilateral carotid and femoral ultrasound vascular studies allowed the identification of subjects with plaque. -Results: All measured indices were significantly higher in males with subclinical carotid or femoral plaques (p ≤ 0.021 for all). Also, a positive and significant correlation between all indices and the number of affected territories was found (p ≤ 0.013 for all). From the ROC analysis, all measurements identified patients with asymptomatic atheromatosis but none of them helped make clinical decisions. Regarding females, the results were less conclusive.

CONCLUSION

Obesity indices are related to subclinical atheromatosis, especially in men, in a large cohort of middle-aged subjects. However, the indices could not detect the presence of arterial plaque, so, when used in isolation, are unlikely to be decisive.

High prevalence of asymptomatic COVID-19 in hemodialysis. Daily learning during first month of COVID-19 pandemic☆

Dialysis patients are a risk group for SARS-CoV2 infection and possibly further complications, but we have little information. The aim of this paper is to describe the experience of the first month of the SARS-Cov2 pandemic in a hospital haemodialysis (HD) unit serving the district of Madrid with the second highest incidence of COVID19 (almost 1000 patients in 100,000 h). In the form of a diary, we present the actions undertaken, the incidence of COVID19 in patients and health staff, some clinical characteristics and the results of screening all the patients in the unit.

We started with 90 patients on HD: 37 (41.1%) had COVID19, of whom 17 (45.9%) were diagnosed through symptoms detected in triage or during the session, and 15 (40.5%) through subsequent screening of those who, until that time, had not undergone SARS-CoV2 PCR testing. Fever was the most frequent symptom, 50% had lymphopenia and 18.4% <95% O₂ saturation. Sixteen (43.2%) patients required hospital admission and 6 (16.2%) died. We found a cluster of infection per shift and also among those using public transport. In terms of staff, of the 44 people involved, 15 (34%) had compatible symptoms, 4 (9%) were confirmed as SARS-Cov2 PCR cases by occupational health, 9 (20%) required some period of sick leave, temporary disability to work (ILT), and 5 were considered likely cases.

Conclusions

We detected a high prevalence of COVID19 with a high percentage detected by screening; hence the need for proactive diagnosis to stop the pandemic. Most cases are managed as outpatients, however severe symptoms are also appearing and mortality to date is 16.2%. In terms of staff, 20% have required sick leave in relation to COVID19.

P1013Biannular atrial flutter: clinical and electrophysiological characterization by activation and entrainment

Introduction

re-entry mechanisms around mitral and tricuspid annuli are frequent causes of left and right atrial flutter (AFt) respectively in patients with ipsilateral atrial pathology. However, clinical and electrophysiological characteristics of other types of atrial re-entries that could involve both AV annuli are less known.

Purpose

characterize biannular atrial flutters.

Methods

4 patients with AFt were submitted for ablation (aged 30, 31, 58 and 61 yo; 2 females). All had a cardiac congenital disease with a prior surgical procedure: 3 atrial septal defects (ASD) with surgical repair and 1 with transposition of the great arteries (TGA) with Senning repair. The AFt had a cycle length (CL) of 290, 315, 330 y 340 ms respectively and 1:1 AV conduction in 3 of them. For the electrophysiological study, a multipolar catheter (20 or 24 poles) was placed in the right atrium (RA) in every patient, showing counterclockwise and clockwise activation in 1 and 3 patients, respectively. Coronary sinus (CS) activation was proximal to distal in one patient and distal to proximal in the other 2. No CS activation could be obtained in the patient with Senning repair.

Results

each AFt was mapped by entrainment from different sites of the RA, showing post-pacing intervals (PPI) similar to the CL of the AFt around the tricuspid annulus in all of them and also from proximal and distal CS in the 3 patients with ASD. Access to the native left atrium (LA) was achieved in the patient with Senning repair, showing PPIs around the mitral annulus that were similar to the LC of the tachycardia. In 2 patients the attempt to get to the LA through the interatrial septum (IAS) could not be achieved and was unattempted in the other one. Recordings and PPIs of the LA roof were obtained from the right branch of the pulmonary artery in 2 patients. Counterclockwise AFt and clockwise AFt by single biannular perimitrotricuspid rotation in 1 and 3 patients respectively. The AFt was ended and no reinduction was possible after radiofrequency application that achieved cavotricuspid isthmus block in all of the patients.

Conclusions

reentry around both AV annuli is possible as a single loop, counterclockwise or clockwise, of simultaneous rotation as a clinical mechanism of Aft. This type of AFt seems to be associated to absence or severe damage in the IAS.

Skin Autofluorescence Measurement in Subclinical Atheromatous Disease: Results from the ILERVAS Project

Aim: Advanced glycation end-products (AGEs) have been involved in the atherogenic process in the high-risk population. The goal of this study was to demonstrate that AGEs are related to subclinical atheromatous disease in subjects with low to moderate vascular risk.

Methods: A cross-sectional study in which 2,568 non-diabetic subjects of both sexes without cardiovascular disease were included. Subcutaneous content of AGEs was assessed by skin autofluorescence (SAF) and subclinical atheromatous disease was measured by assessing the atheromatous plaque burden in carotid and femoral regions using ultrasonography. In addition, serum pentosidine, carboxymethyl-lysine (CML) and AGE receptors (RAGE) were assessed in a nested case-control study with 41 subjects without plaque and 41 individuals subjects with generalized disease.

Results: Patients with atheromatous plaque had a higher SAF than those with no plaque (1.9 [1.7 to 2.3] vs. 1.8 [1.6 to 2.1] arbitrary units (AU), p % 0.001). The SAF correlated with the total number of affected regions (r = 0.171, p < 0.001), increasing progressively from 1.8 [1.6 to 2.1] AU in those without atheromatous disease to 2.3 [1.9 to 2.7] AU in patients with ≥ 8 plaques (p < 0.001). A correlation was also observed between SAF and the total plaque area (r = 0.113, p < 0.001). The area under the Receiver Operating Characteristic curve was 0.65 (0.61 to 0.68) for identifying male subjects with atheromatous disease. The multivariable logistic regression model showed a significant and independent association between SAF and the presence of atheromatous disease. However, no significant differences in serum pentosidine, CML, and RAGE were observed.

Conclusions: Increased subcutaneous content of AGEs is associated with augmented atheromatous plaque burden. Our results suggest that SAF may provide clinically relevant information to the current strategies for the evaluation of cardiovascular risk, especially among the male population.

P863Morphometric analysis of the dynamic changes of the interstitium after reperfused myocardial infarction

Background

The interstitial space is mainly composed by cells, fibers and gels of polysaccharides, which act as a compression buffer against the stress placed on the extracellular matrix (ECM). After myocardial infarction (MI), heart has to withstand higher mechanical stress due to injured cardiomyocytes. ECM composition notably influences the mechanical properties of the myocardium and participates in left ventricular remodeling.

Purpose

To characterize the myocardial ECM changes from ischemia onset until late phases after coronary reperfusion in a swine model of reperfused MI.

Methods

MI was induced in swine by transient 90-min coronary occlusion using angioplasty balloons. One control group and three MI groups were defined: 1) without reperfusion, 2) 1-week, and 3) 1-month reperfusion (n=5, each). Myocardial samples from the infarcted area were isolated and histologically staining to evaluate the presence of collagen type I, collagen type III, elastic fibers, and proteinglycans. Moreover, the presence of laminin, fibronectin, and secreted protein, acidic and rich in cysteine (SPARC) was determined by immunohistochemistry. Five independent photographs for each group and each stain were taken and the presence of the different components of the interstitium was morphometrically quantified. Indeed, the mRNA levels of metalloproteinases (MMP), tissue inhibitors of metalloproteinases (TIMP), and transcription factors implicated in ECM remodeling were quantified.

Results

In the no-reperfusion group, an increase in fibronectin, laminin, and elastic fibers were observed, whereas no changes neither in the quantity nor in the organization of collagen-I and collagen-III fibers were detected. In the 1-week and 1-month reperfusion groups, an augmentation in the content of collagen-I, collagen-III, elastic fibers were found. These fibers displayed a more organized pattern compared to control tissue. The quantity of proteinglycans, laminin, fibronectin, and SPARC were also increased. These changes could be explained by a heightening in the mRNA expression of TIMP1, TIMP2, and TIMP3 from the ischemic period until chronic phases, whereas no changes were observed for TIMP4. MMP2 and MMP9 mRNA levels were boosted in late phases post-MI. When exploring the mRNA levels of transcription factors implicated in ECM remodeling, CTGF increased during the ischemic period, whereas TNF-α and TGF-β augmented after 1-week and 1-month post-reperfusion, respectively.

Conclusions

ECM remodeling starts after ischemia onset, probably aiming to protect cardiomyocytes from the ischemic damage. After reperfusion, the ECM evolves to constitute a fibrotic scar to maintain a proper cardiac function. These changes may be orchestrated by the fluctuation in genes specially implicated in ECM distribution. ECM changes might be accurately regulated since it could provoke an adverse left ventricular remodelling, consequently impairing patient prognosis.

Acknowledgement/Funding

This study was funded by “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER” (PIE15/00013, PI17/01836, and CIBERCV16/11

Lung function measurements in the prediabetes stage: data from the ILERVAS Project

AIMS

Patients with type 2 diabetes have been considered a susceptible group for pulmonary dysfunction. Our aim was to assess pulmonary function on the prediabetes stage.

METHODS

Pulmonary function was assessed in 4,459 non-diabetic subjects, aged between 45 and 70 years, without cardiovascular disease or chronic pulmonary obstructive disease from the ongoing study ILERVAS. A "restrictive spirometric pattern", an "abnormal FEV1" and an "obstructive ventilatory defect" were assessed. Prediabetes was defined by glycosylated hemoglobin (HbA1c) between 5.7 and 6.4% according to the American Diabetes Association criteria.

RESULTS

Population was composed of 52.1% women, aged 57 [53;63] years, a BMI of 28.6 [25.8;31.8] kg/m², and with a prevalence of prediabetes of 29.9% (n = 1392). Subjects with prediabetes had lower forced vital capacity (FVC: 93 [82;105] vs. 96 [84;106], p < 0.001) and lower forced expired volume in the first second (FEV1: 94 [82;107] vs. 96 [84;108], p = 0.011), as well as a higher percentage of the restrictive spirometric pattern (16.5% vs. 13.6%, p = 0.015) and FEV1 < 80% (20.3% vs. 17.2%, p = 0.017) compared to non-prediabetes group. In the prediabetes group, HbA1c was negatively correlated with both pulmonary parameters (FVC: r = - 0.113, p < 0.001; FEV1: r = - 0.079, p = 0.003). The multivariable logistic regression model in the whole population showed that there was a significant and independent association between HbA1c with both restrictive spirometric pattern [OR = 1.42 (1.10-1.83), p = 0.008] and FEV1 < 80% [OR = 1.50 (1.19-1.90), p = 0.001].

CONCLUSIONS

The deleterious effect of type 2 diabetes on pulmonary function appears to be initiated in prediabetes, and it is related to metabolic control. TRIAL REGISTRATION CLINICALTRIALS.GOV: NCT03228459.

Trends and prediction of antimicrobial susceptibility in urinary bacteria isolated in European emergency departments: the EuroUTI 2010-2016 Study

Objectives

To assess recent trends in susceptibility to antibiotics among urinary isolates isolated in European emergency departments (EDs) and to identify isolates with a high (90% or more) predicted probability of susceptibility to fluoroquinolones or third-generation cephalosporins (3GCs).

Methods

In this cross-sectional study, we included urine cultures obtained from adult patients between 2010 and 2016 in 24 European EDs. Temporal trends were assessed using time-series analysis and multivariate logistic models. Multivariate logistic models were also used to predict susceptibility to fluoroquinolones or 3GCs from patient age and sex, year, month and ED.

Results

We included 88242 isolates. Time-series analysis found a significant increase in susceptibility to fluoroquinolones and no significant trend for susceptibility to 3GCs. Adjusting for patient age and sex, ED and organism, multivariate models showed that susceptibility to 3GCs decreased from 2014 to 2016, while susceptibility to fluoroquinolones increased in 2015 and 2016. Among isolates from 2016, multivariate models predicted high probability of susceptibility to fluoroquinolones in 11% of isolates (positive predictive value 91%) and a high probability of susceptibility to 3GCs in 35% of isolates (positive predictive value 94%).

Conclusions

Susceptibility of ED urinary isolates to fluoroquinolones increased from 2014, while susceptibility to 3GCs decreased from 2015. Predictive models identified isolates with a high probability of susceptibility to fluoroquinolones or 3GCs. The ability of such models to guide the empirical treatment of pyelonephritis in the ED remains to be determined.

Anatomy, immunohistochemistry, and numerical distribution of human splenic microvessels

The microvascular architecture of the spleen plays an important role in the immunological function of this organ. The different types of vessels are related to different reticular cells each with their own immunomodulatory functions. The present study describes an immunohistochemical and morphometric analysis of the various types of vessels in 21 human autopsy non-pathological splenic samples. On an area of 785,656.37 μm² for each sample, we classified and quantified the type and number of vascular structures, each according to their morphology and immunohistochemical profile, and obtained the ratios between them. The distribution of trabecular vessels and the characteristics of the venules are reviewed. In our material the so-called "cavernous perimarginal sinus" (anatomical structure previously described by Schmidt et al., 1988) was observed and interpreted as a curvilinear venule shaped by the follicle in contact with the trabecular vein. Our material comprised 261 trabeculae (containing 269 arterial sections and 508 venous sections), 30,621 CD34+ capillaries, 7739 CD271+ sheathed capillaries, 2588 CD169+ sheathed capillaries, and 31,124 CD8+ sinusoids. The total area (TA) (14,765,714.88 μm²) occupied by the sinusoidal sections of the 21 cases was much higher than the TA of the capillary sections (1,700,269.83 μm²). Similarly, the TA (651,985 μm²) occupied by the sections of the trabecular veins was much higher than the TA of the trabecular arteries (88,594 μm²). The total number of CD34+ capillaries and of sinusoids CD8+ was similar for the sum of the 21 cases, nevertheless there were large differences in each case. Statistically the hypothesis that the number of capillaries and sinusoids are present with the same frequency is discarded. In view of the absence of a numerical correlation between capillaries and sinusoids, we postulate that very possibly the arterial and the venous vascular trees are two anatomically independent structures separated by the splenic cords. We believe that this is the first work where splenic microvascularization is simultaneously approached from a morphometric and immunohistochemical point of view.

Robust segmentation of retinal layers in optical coherence tomography images based on a multistage active contour model

Optical Coherence Tomography (OCT) constitutes an imaging technique that is increasing its popularity in the ophthalmology field, since it offers a more complete set of information about the main retinal structures. Hence, it offers detailed information about the eye fundus morphology, allowing the identification of many intraretinal pathological signs. For that reason, over the recent years, Computer-Aided Diagnosis (CAD) systems have spread to work with this image modality and analyze its information. A crucial step for the analysis of the retinal tissues implies the identification and delimitation of the different retinal layers. In this context, we present in this work a fully automatic method for the identification of the main retinal layers that delimits the retinal region. Thus, an active contour-based model was completely adapted and optimized to segment these main retinal boundaries. This fully automatic method uses the information of the horizontal placement of these retinal layers and their relative location over the analyzed images to restrict the search space, considering the presence of shadows that are normally generated by pathological or non-pathological artifacts. The validation process was done using the groundtruth of an expert ophthalmologist analyzing healthy as well as unhealthy patients with different degrees of diabetic retinopathy (without macular edema, with macular edema and with lesions in the photoreceptor layers). Quantitative results are in line with the state of the art of this domain, providing accurate segmentations of the retinal layers even when significative pathological alterations are present in the eye fundus. Therefore, the proposed method is robust enough to be used in complex environments, making it feasible for the ophthalmologists in their routine clinical practice.

Mental disorders in chronic obstructive pulmonary diseases

PURPOSE

Anxiety and depression are underdiagnosed in chronic obstructive pulmonary disease (COPD) patients. Few studies have tried to identify their association with hospitalization (severe exacerbation). The objective of this study was to determine whether the anxiety/depression was associated with severe exacerbation.

DESIGN AND METHODS

A prospective cohort study, based on a sample of 512 patients diagnosed with COPD originating from primary care in a rural area in Lleida (Spain) and monitored between November 1, 2012 and October 31, 2014. For each patient, variables of interest were recorded; they were administered the HADS (Hospital Anxiety and Depression Scale) test to determine the possible presence of anxiety/depression, and its association with severe exacerbation was analyzed using a logistic regression model.

FINDINGS

Initially, the prevalence of anxiety/depression was 15.6%. The incidence of global hospitalization in the first year was 8.2% and 11.3% in the second year. In patients with anxiety/depression, it increased to 17.5% in the first year and 18.8% in the second year. In the multivariate regression model, the diagnosis of anxiety/depression almost doubled the risk of hospitalization (OR = 1.94) (p < .041).

PRACTICE IMPLICATIONS

Anxiety and depression are associated with an increased risk of hospitalization. Intervention studies are needed to evaluate the effects of anxiety/depression in the hospitalization.

Prevalence of chronic obstructive pulmonary disease (COPD) not diagnosed in a population with cardiovascular risk factors

BACKGROUND AND OBJECTIVE

The magnitude of undiagnosed COPD in our population with cardiovascular risk factors (CVRF) is unknown. The objective of this study was to estimate the prevalence of undiagnosed COPD and its specific characteristics in a population with CVRF.

MATERIALS AND METHODS

Study the prevalence of COPD in patients with CVRF. Spirometry was performed between 01/01/2015 and 12/31/2016 and the percentage of patients with COPD, who had not previously been diagnosed, was determined. Each patient's variables of interest were recorded; the records of patients who had spirometry showing COPD were checked to confirm whether a diagnosis had been recorded or not. The association of undiagnosed COPD with different independent variables was determined with adjusted odds ratio (aOR) by non conditional logistic regression models.

RESULTS

2,295 patients with CVRF were studied. The overall prevalence of COPD was 14.5%. An underdiagnosis of 73.3% was observed. Newly diagnosed COPD vs. undiagnosed COPD showed to be higher in women (74.1% vs. 36.0%; P=.081), non-smokers (21.3% vs. 12.4%; P=.577), mild cases (GOLD1) (42.6% vs. 32.4%, P=.008) and cases with lower than average HbA1c (5.5% vs. 5.6%; P=.008) and uric acid (5.1mg/dL vs. 5.6mg/dL; P=.011). The variables associated with undiagnosed COPD were: women (aOR=1.27; 95%CI: 0.74-2.17; P=.383); age (aOR=0.94; 95%CI: 0.87-0.99; P=.018); smokers (smoker/non-smoker) (aOR=0.47; 95%CI: 0.22-1.01; P=.054) and HbA1c (%) (aOR=0.45; 95%CI: 0.23-0.88; P=.019).

CONCLUSIONS

The under-diagnosis of COPD is very high. The contact patients aged between 50 and 65 years-old who have CVRF with their health system should be reassessed, and they need to ask for a spirometry.

Combined abdomino-sacral laparoscopically assisted approach for retrorectal mass resection in a patient with Currarino's Syndrome - video vignette

A correct preoperative strategy is crucial when surgery is needed for retrorectal tumours (RRT).[1] Surgical approaches may be purely anterior-abdominal, posterior-sacrococcygeal or combined depending on the tumour's size and location.[2] We present the case of an 18-year-old female with Currarino Syndrome who underwent surgery by a combined abdominal laparoscopic-posterior Kraske approach for the resection of a large RRT. This article is protected by copyright. All rights reserved.