The stigma of intellectual disability in Spain: a nationally representative survey

BACKGROUND

Stigma towards people with intellectual disability affects various aspects of their lives, including access to employment, housing, health and social care services. Furthermore, this stigma reduces their social opportunities and is even reflected in laws that diminish their autonomy. Due to the practical significance of this issue, the aim of this research is to explore for the first time the social stigma associated with intellectual disability in a representative sample of the Spanish population.

METHOD

A cross-sectional quantitative descriptive study was conducted, involving a representative sample of the population (N = 2746). The study includes descriptive analyses and hierarchical regressions to examine various dimensions of stigma, such as attitudes, attributions, and intentions of social distance.

RESULTS

Medium levels of stigma are found regarding attitudes and attributions towards people with intellectual disability, while levels are medium-low concerning the intention of social distance. The most reliable indicators of stigma across its various dimensions encompass attitudes, attributions, and the intention of social distance. Factors that contribute to lower stigma include knowing someone with an intellectual disability, being willing to discuss intellectual disability with an acquaintance who has it and having a progressive political ideology. People with intellectual disability show more negative attributions towards themselves. Living with a person with an intellectual disability is another predictor of more stigmatising attitudes, but less intention of social distance. Results are mixed regarding age, gender, and educational level.

CONCLUSION

Combating the stigmatisation of people with intellectual disabilities must include comprehensive actions to address attitudes, attributions and behavioural intentions. Public policies, such as national campaigns and programmes, should include contact with and open conversations about intellectual disability, and sensitivity to sociodemographic variables.

Executive summary of the consensus document on the management of perioperative anemia in Spain

Perioperative anemia is an independent risk factor for postoperative morbidity and mortality. However, conceptual, logistical and administrative barriers persist that hinder the widespread implementation of protocols for their management. The project coordinator convened a multidisciplinary group of 8 experienced professionals to develop perioperative anemia management algorithms, based on a series of key points (KPs) related to its prevalence, consequences, diagnosis and treatment. These KPs were assessed using a 5-point Likert scale, from "strongly disagree [1]" to "strongly agree [5]". For each KP, consensus was reached when receiving a score of 4 or 5 from at least 7 participants (>75%). Based on the 36 KPs agreed upon, diagnostic-therapeutic algorithms were developed that we believe can facilitate the implementation of programs for early identification and adequate management of perioperative anemia, adapted to the characteristics of the different institutions in our country.

Gut microbiota facilitate chronic spontaneous urticaria

Chronic spontaneous urticaria (CSU) comes with gut dysbiosis, but its relevance remains elusive. Here we use metagenomics sequencing and short-chain fatty acids metabolomics and assess the effects of human CSU fecal microbial transplantation, Klebsiella pneumoniae, Roseburia hominis, and metabolites in vivo. CSU gut microbiota displays low diversity and short-chain fatty acids production, but high gut Klebsiella pneumoniae levels, negatively correlates with blood short-chain fatty acids levels and links to high disease activity. Blood lipopolysaccharide levels are elevated, link to rapid disease relapse, and high gut levels of conditional pathogenic bacteria. CSU microbiome transfer and Klebsiella pneumoniae transplantation facilitate IgE-mediated mast cell(MC)-driven skin inflammatory responses and increase intestinal permeability and blood lipopolysaccharide accumulation in recipient mice. Transplantation of Roseburia hominis and caproate administration protect recipient mice from MC-driven skin inflammation. Here, we show gut microbiome alterations, in CSU, may reduce short-chain fatty acids and increase lipopolysaccharide levels, respectively, and facilitate MC-driven skin inflammation.

[Mastocytosis-a frequently unrecognized disease]

Mastocytosis is a rare disease characterized by clonal expansion and accumulation of mast cells (MC) in various organs. Mastocytosis results from an activating mutation of the KIT surface receptor leading to an increased proliferation of MC. There are significant differences between children and adult patients with mastocytosis. Children mainly present the cutaneous form, whereas adults more often exhibit the systemic form of mastocytosis. Patients with mastocytosis may be asymptomatic or affected by a variety of symptoms. Treatment is primarily supportive and aims at symptom control. New approved targeted therapies such as midostaurin and avapritinib changed the treatment paradigm in advanced forms of the disease, and next-generation inhibitors currently in clinical trials are expected in the near future.

Generation of a novel three-dimensional scaffold-based model of the bovine endometrium

Bovine in vitro endometrial models that resemble tissue function in vivo are needed to study infertility, long-term uterine alterations induced by pathogens and impact of endocrine disruptor chemicals on reproductive function and other reproductive system complications that cause high economic losses in livestock species. The present study aimed to generate an innovative, reproducible, and functional 3D scaffold-based model of the bovine endometrium structurally robust for long term-culture. We developed a multicellular model containing both endometrial epithelial and stromal cells. Epithelial cells organized to form a luminal-like epithelial layer on the surface of the scaffold. Stromal cells produced their own extracellular matrix forming a stable subepithelial compartment that physiologically resembles the normal endometrium. Both cell types released prostaglandin E2 and prostaglandin F2α following a treatment with oxytocin and arachidonic acid. Additionally signal pathways mediating oxytocin and arachidonic acid stimulation of prostaglandin synthesis were analyzed by real time PCR (RT-PCR). Oxytocin receptor (OXTR), prostaglandin E2 receptor 2 (EP2), prostaglandin E2 receptor 4 (EP4), prostaglandin F receptor (PTGFR), prostaglandin E synthase (PTGES), PGF-synthase (PGFS) and prostaglandin-endoperoxide synthase 2 (COX-2) expression was detected in both control and treatment groups, however, only significant changes in abundance of OXTR mRNA transcripts were found. The results obtained by this study are a step forward in bovine in vitro culture technology. This 3D scaffold-based model provides a platform to study regulatory mechanisms involved in endometrial physiology and can set the basis for a broader tool for designing and testing novel therapeutic strategies for recurrent uterine pathologies.

Association of HER2DX with pathological complete response and survival outcomes in HER2-positive breast cancer

BACKGROUND

The HER2DX genomic test predicts pathological complete response (pCR) and survival outcome in early-stage HER2-positive (HER2+) breast cancer. Here, we evaluated the association of HER2DX scores with (i) pCR according to hormone receptor status and various treatment regimens, and (ii) survival outcome according to pCR status.

MATERIALS AND METHODS

Seven neoadjuvant cohorts with HER2DX and clinical individual patient data were evaluated (DAPHNe, GOM-HGUGM-2018-05, CALGB-40601, ISPY-2, BiOnHER, NEOHER and PAMELA). All patients were treated with neoadjuvant trastuzumab (n = 765) in combination with pertuzumab (n = 328), lapatinib (n = 187) or without a second anti-HER2 drug (n = 250). Event-free survival (EFS) and overall survival (OS) outcomes were available in a combined series of 268 patients (i.e. NEOHER and PAMELA) with a pCR (n = 118) and without a pCR (n = 150). Cox models were adjusted to evaluate whether HER2DX can identify patients with low or high risk beyond pCR status.

RESULTS

HER2DX pCR score was significantly associated with pCR in all patients [odds ratio (OR) per 10-unit increase = 1.59, 95% confidence interval 1.43-1.77; area under the ROC curve = 0.75], with or without dual HER2 blockade. A statistically significant increase in pCR rate due to dual HER2 blockade over trastuzumab-only was observed in HER2DX pCR-high tumors treated with chemotherapy (OR = 2.36 (1.09-5.42). A statistically significant increase in pCR rate due to multi-agent chemotherapy over a single taxane was observed in HER2DX pCR-medium tumors treated with dual HER2 blockade (OR = 3.11, 1.54-6.49). The pCR rates in HER2DX pCR-low tumors were ≤30.0% regardless of treatment administered. After adjusting by pCR status, patients identified as HER2DX low-risk had better EFS (P < 0.001) and OS (P = 0.006) compared with patients with HER2DX high-risk.

CONCLUSIONS

HER2DX pCR score and risk score might help identify ideal candidates to receive neoadjuvant dual HER2 blockade in combination with a single taxane in early-stage HER2+ breast cancer.

Virus-infected mast cells activate virus-specific CD8+ T cells

Efficient anti-viral responses of CD8+ T cells require signals that promote their effector cell differentiation, that are mainly provided by dendritic cells (DCs). Mast cells (MCs) are key drivers of DC maturation, but also influence their migration and antigen presenting properties and therefore indirectly mediate CD8+ T cell activation. MCs initiate innate immune responses at pathogen entry sites, promote the development of adaptive immune responses after infection, and release mediators including chemokines that recruit and activate immune cells including T cells during viral infections. However, whether MCs can directly activate virus-specific CD8+ T cells remains largely unknown. Here, we used an in vitro viral infection model with lymphocytic choriomeningitis virus (LCMV)-infected MCs or DCs co-cultured with either LCMV-specific CD8+ T cells or with WT (unspecific) CD8+ T cells. Similar to LCMV-infected DCs, LCMV-infected MCs clustered with virus-specific CD8+ T cells and induced their activation and production of antiviral cytokines. In addition, the co-stimulatory molecules CD86 and OX40L, but not CD80, were upregulated on MCs and an increased production of IL-6 and type I interferons after LCMV infection was shown. Our findings suggest that MCs can promote CD8+ T cell activation during viral infections. MC-mediated CD8+ T cell activation might be especially important within infected tissues where direct cellular interaction can take place. A better understanding of anti-viral functions of MCs may help developing new strategies to better treat viral infections.

How Infection and Vaccination Are Linked to Acute and Chronic Urticaria: A Special Focus on COVID-19

Since more than a century ago, there has been awareness of the connection between viral infections and the onset and exacerbation of urticaria. Our knowledge about the role of viral infection and vaccination in acute and chronic urticaria improved as a result of the COVID-19 pandemic but it has also highlighted knowledge gaps. Viral infections, especially respiratory tract infections like COVID-19, can trigger the onset of acute urticaria (AU) and the exacerbation of chronic urticaria (CU). Less frequently, vaccination against viruses including SARS-CoV-2 can also lead to new onset urticaria as well as worsening of CU in minority. Here, with a particular focus on COVID-19, we review what is known about the role of viral infections and vaccinations as triggers and causes of acute and chronic urticaria. We also discuss possible mechanistic pathways and outline the unmet needs in our knowledge. Although the underlying mechanisms are not clearly understood, it is believed that viral signals, medications, and stress can activate skin mast cells (MCs). Further studies are needed to fully understand the relevance of viral infections and vaccinations in acute and chronic urticaria and to better clarify causal pathways.

Prognostic value of intrinsic subtypes in hormone-receptor-positive metastatic breast cancer: systematic review and meta-analysis

BACKGROUND

In hormone receptor-positive (HoR+) breast cancer (BC), gene expression analysis identifies luminal A (LumA), luminal B (LumB), human epidermal growth factor receptor 2 (HER2)-enriched (HER2-E), basal-like (BL) intrinsic subtypes and a normal-like group. This classification has an established prognostic value in early-stage HoR+ BC. Here, we carried out a trial-level meta-analysis to determine the prognostic ability of subtypes in metastatic BC (MBC).

MATERIALS AND METHODS

We systematically reviewed all the available prospective phase II/III trials in HoR+ MBC where subtype was assessed. The primary endpoint was progression-free survival (PFS)/time to progression (TTP) of the LumA subtype compared to non-LumA. Secondary endpoints were PFS/TTP of each individual subtype, according to treatment, menopausal and HER2 status and overall survival (OS). The random-effect model was applied, and heterogeneity assessed through Cochran's Q and I². Threshold for significance was set at P < 0.05. The study was registered in PROSPERO (ID: CRD42021255769).

RESULTS

Seven studies were included (2536 patients). Non-LumA represented 55.2% and was associated with worse PFS/TTP than LumA [hazard ratio (HR) 1.77, P < 0.001, I² = 61%], independently of clinical HER2 status [P_{subgroup difference} (P_sub) = 0.16], systemic treatment (P_sub = 0.96) and menopausal status (P_sub = 0.12). Non-LumA tumors also showed worse OS (HR 2.00, P < 0.001, I² = 65%), with significantly different outcomes for LumB (PFS/TTP HR 1.46; OS HR 1.41), HER2-E (PFS/TTP HR 2.39; OS HR 2.08) and BL (PFS/TTP HR 2.67; OS HR 3.26), separately (PFS/TTP P_sub = 0.01; OS P_sub = 0.005). Sensitivity analyses supported the main result. No publication bias was observed.

CONCLUSIONS

In HoR+ MBC, non-LumA disease is associated with poorer PFS/TTP and OS than LumA, independently of HER2, treatment and menopausal status. Future trials in HoR+ MBC should consider this clinically relevant biological classification.

Carbon footprint, economic benefits and sustainable fishing: Lessons for the future from the Western Mediterranean

Ensuring an economically viable, sustainable and low CO₂ emission extractive fishery is critical in order to achieve the life below water UN sustainable development goals and the climate change commitments of Paris agreement. This challenge is even more relevant in the most overexploited region of the world: The Mediterranean Sea. Here, we use the socio-ecological system of the Spanish Mediterranean commercial fisheries (Northern Alboran Sea, Northern Spain and the Balearic Islands) to develop an integrative impact assessment, including detailed socio-economic, ecosystem indices of the trophic structure of extractive fishery and CO₂ emission analyses combining different gear, vessel size classes as well as a wide range estimation of carbon release from the seafloor by bottom trawling. Northern Alboran Sea preferentially requires reduction in purse seine fishery while in Northern Spain bottom trawling should be reduced first to reach sustainable exploitation. Fuel CO₂ footprint of purse seine and bottom trawling are among the lowest footprints of animal protein production, but considering sweeping released CO₂ from the seafloor the bottom trawling footprint becomes the animal protein production with the highest footprint. Moreover, the lowest bottom released CO₂ estimation overrides 2.7-10 times the CO₂ buried in the seafloor through the biological pump in trawled areas potentially turning the continental shelf from a CO₂ sink to a CO₂ source. Net profit per fuel derived CO₂ emission for all fleets is lower than 1€ kgCO₂^-1, being lowest for large bottom trawler (0.025 € kgCO₂^-1). Thus, urgent mitigation and adaptation measures are necessary to obtain sustainable fishery in terms of net profit, sustainable seafood extraction and CO₂ emission reduction. Our study provides scientific bases to develop these measures such as the restriction of harmful fishing gear in carbon rich river influenced areas, reduction of bottom contact of the fishing gear, favouring purse seine fishery and smaller bottom trawlers.

Eating Increases and Exercise Decreases Disease Activity in Patients With Symptomatic Dermographism

BACKGROUND

Eating can increase disease activity in patients with symptomatic dermographism , the most common subtype of chronic inducible urticaria, but it is unclear how common this is. The effects of exercising on symptomatic dermographism disease activity have also not yet been determined.

OBJECTIVE

To assess the impact of exercise and nonspecific carbohydrate-rich food intake on the severity and intensity of symptomatic dermographism after exercise and nonspecific carbohydrate-rich food intake.

METHODS

We assessed disease activity by FricTest provocation testing in 75 symptomatic dermographism patients before and after eating, exercising, or both. We determined the rates of food-dependent (FD) symptomatic dermographism and food-exacerbated (FE) symptomatic dermographism. By comparing post- and pre-exercise FricTest scores, we identified complete responders: that is, patients with a negative FricTest response after exercising and partial responders. Finally, we evaluated whether exercise protects patients with FD-symptomatic dermographism or FE-symptomatic dermographism from eating-induced worsening of symptomatic dermographism.

RESULTS

Of 64 symptomatic dermographism patients, eight had FD-symptomatic dermographism (13%), 42 had FE-symptomatic dermographism (66%), and 14 patients showed no negative impact of eating on disease activity (21%). Physical exercise reduced FricTest skin provocation test responses in 83% of 58 patients. Exercising protected patients with FD/FE-symptomatic dermographism from worsening of symptomatic dermographism owing to eating in half of cases, with higher rates for exercise after eating (67%) compared with exercise before eating (35%).

CONCLUSIONS

Our study shows that eating often worsen symptomatic dermographism symptoms, and exercise often improves it. Our findings might aid patients in controlling symptoms better.

Effect of high hydrostatic pressure processing on the rennet coagulation kinetics and physicochemical properties of sheep milk rennet-induced gels

The effects of high hydrostatic pressure on the constituents and coagulation ability and their effect on cheese production of sheep milk have not been studied in detail. The objective of this work was to evaluate the effect of high hydrostatic pressure processing on the coagulation kinetics and physicochemical properties of sheep milk and to explore how such treatment could improve the cheesemaking process. Five batches of milk were tested: 1 untreated control batch and 4 batches each subjected to a different pressure (150, 300, 450, or 600 MPa) for 5 min at 10°C. As treatment pressure increased, values of electrical conductivity and oxidation-reduction potential were found to decrease. However, no significant reduction in pH was recorded. Treatment pressures >300 MPa produced milk with lower lightness (luminosity) and a more yellow and green hue. Pressures >150 MPa resulted in micellar fragmentation, as well as significant increases in particle size, viscosity, and water-holding capacity as a consequence of the denaturing of soluble proteins. High-pressure treatments increased the solubility of colloidal calcium phosphate, leading to a considerable increase in the concentration of minerals in the serum phase. The highest concentrations of calcium and phosphorus in the rennet whey of milk were reached at 300 MPa. Curd coagulation time was reduced by 28% at pressures >300 MPa, and an increase in the curd firming rate was observed. As treatment pressure increased to 450 MPa, the firmness, elasticity, and the percentage creep recovery of gels increased, whereas values of compliance and fracture strain were reduced. Thus, we can conclude that 300 MPa is the optimum treatment pressure for milk intended for cheesemaking by enzymatic coagulation. This pressure produced milk with optimal coagulation kinetics and water-holding properties with the least loss of fat and protein to the whey.

Gut Microbiome Composition in Patients with Chronic Urticaria: A Review of Current Evidence and Data

Recent studies have linked gut microorganism composition and chronic urticaria (CU); however, the underlying mechanisms responsible for this connection are unknown. Since the human immune system is in homeostasis with microbiota, and the composition of the microbiome regulates the development and function of the immune system, it is likely that an alteration of microbiota components (a dysbiosis) could influence the course of chronic spontaneous urticaria (CSU), including disease severity, patient quality of life and treatment outcome. To date, several studies have identified changes in the gut microbiota composition of patients with CSU, though only a few have exhibited metabolic abnormalities associated with gut dysbiosis. The studies on CSU patients predominantly showed that the relative abundance of beneficial bacteria was decreased (Firmicutes and Bacteroides), while that of opportunistic bacteria was increased (Enterobacteria and Proteobacteria). In addition, serum metabolome analysis revealed that gut microbiota-associated alterations in unsaturated fatty acids and the butanoate metabolism pathway may play a role in CSU. These findings are potentially associated with inflammation mediated by the imbalance of Th1/Th2/Th17 cytokines, which might contribute to CSU pathogenesis. Further research in this field could improve clinical, diagnostic, and therapeutic approaches to patients with CSU. By applying new knowledge on gut microbial communities and metabolomics, future CSU therapies could modify the microbiota composition using agents such as probiotics or other similar agents, which, in combination with current standard therapies, could hopefully lead to a reduction in symptoms and an improved quality of life for CSU patients.

SNP discovery and association study for growth, fatness and meat quality traits in Iberian crossbred pigs

Iberian pigs and its crosses are produced to obtain high-quality meat products. The objective of this work was to evaluate a wide panel of DNA markers, selected by biological and functional criteria, for association with traits related to muscle growth, fatness, meat quality and metabolism. We used 18 crossbred Iberian pigs with divergent postnatal growth patterns for whole genome sequencing and SNP discovery, with over 13 million variants being detected. We selected 1023 missense SNPs located on annotated genes and showing different allele frequencies between pigs with makerdly different growth patterns. We complemented this panel with 192 candidate SNPs obtained from literature mining and from muscle RNAseq data. The selected markers were genotyped in 480 Iberian × Duroc pigs from a commercial population, in which phenotypes were obtained, and an association study was performed for the 1005 successfully genotyped SNPs showing segregation. The results confirmed the effects of several known SNPs in candidate genes (such as LEPR, ACACA, FTO, LIPE or SCD on fatness, growth and fatty acid composition) and also disclosed interesting effects of new SNPs in less known genes such as LRIG3, DENND1B, SOWAHB, EPHX1 or NFE2L2 affecting body weight, average daily gain and adiposity at different ages, or KRT10, NLE1, KCNH2 or AHNAK affecting fatness and FA composition. The results provide a valuable basis for future implementation of marker-assisted selection strategies in swine and contribute to a better understanding of the genetic architecture of relevant traits.

Unravelling the drivers of variability in body condition and reproduction of the European sardine along the Atlantic-Mediterranean transition

Body condition and reproduction data are broadly used to assess the health status of fish because of its implications for recruitment and ecosystem structure. Sardina pilchardus is a small pelagic distributed throughout both Mediterranean and Eastern Atlantic. Seasonal trend analysis of energy storage and reproduction was carried out in sardines from two areas along the Atlantic-Mediterranean transition: Southern Portugal-Gulf of Cádiz (POR-GC) (Atlantic Ocean) and Alboran Sea (Alb) (Mediterranean Sea) from 2019 to 2021. Energetic condition was estimated using tissue and mesenteric fat content, hepatosomatic index (HSI), and the relative condition factor (Kn). Sex, reproductive developmental stage, and gonadosomatic index (GSI) were also obtained. In addition, the oceanographic and meteorological characteristics of the areas were analysed. Results showed that seasonal Kn, tissue and mesenteric fat content, and HSI values of POR-GC specimens exceeded Alb's with summer arrival, period in which sardine acquires reserves to allocate them to reproduction. These differences could be associated to greater productivity of the former area mainly due to rivers discharges and trade winds intensification during summer (from July to September). Furthermore, gonad maturation of POR-GC stock occurred before the Alb. However, no spawning capable individuals were identified until February in POR-GC. In contrast, in Alb it was observed a remarkable fraction of spawning capable and active spawner individuals in October. We hypothesized the migration of mature individuals from POR-GC to the spawning areas located in the Alb. Seasonal genetic population studies are required to untangle it and reliably evaluate the environmental effect on the stocks.

P-796 Intraovarian injection of plasma rich in growth factors improves ovarian reserve and reproductive outcomes in women with diminished ovarian reserve

Study question

Does Plasma rich in growth factors (PRGF) ovarian injection increase the ovarian reserve biomarkers in women with diminished ovarian reserve?

Summary answer

PRGF injection increased Antimüllerian hormone (AMH) levels and antral follicular count (AFC) since the first follow-up after treatment allowing the initiation of ovarian stimulation cycles.

What is known already

Several techniques based on in vitro activation, ovarian fragmentation and stem cell ovarian transplantation have been proposed to reactivate ovarian function and increase IVF success in women with premature ovarian insufficiency and poor ovarian response. However, less invasive and feasible approaches are still required for those patients where egg donation is the only practical option.

Platelet rich plasma (PRP) and PRGF contain a high concentration of platelets, which carry more than 800 types of proteins, cytokines, hormones, and chemoattractants. Indeed, intraovarian PRP injection has recently been used in different case series and cohort studies of POI women with encouraging results.

Study design, size, duration

Retrospective study with 104 women aging 23-45 years who received a PRGF intraovarian injection (REGENERA-Ovario) was conducted between 2020 and 2021 at IVIRMA Alicante (Spain). Study was approved by the IRB committee of La Fe University Hospital (2112-FIVI-109-SH).

Participants/materials, setting, methods

Patients underwent a PRGF injection (Endoret kit; B.T.I. Biotechnology Institute S.L, Spain) in both ovaries and a follow up of ovarian reserve biomarkers (AFC, AMH) and follicle stimulating hormone (FSH) to evaluate follicular reactivation seeking IVF or spontaneous pregnancy. The follow up visits ranged from 1 to 5 months and were developed on a monthly basis after treatment or after menses recovery in POI. Study variables were compared to basal levels with a paired t-test.

Main results and the role of chance

Overall, 104 women (age: 38.7±2.0 years; BMI: 22.1±2.9) with diminished ovarian reserves underwent a PRGF intraovarian injection (3.3±0.8ml PRGF/each ovary). Prior to treatment, our cohort was characterized high serum FSH (21.8±4.1mIU/mL), low AMH levels (0.25±0.37ng/ml), and an ovarian volume of 6.3±2.3cm3.

Eighty-eight of them fulfilled the 1st follow up visit and showed an increase of serum AMH (0.25±0.37ng/ml vs. 0.32±0.36ng/ml, p = 0.008), and AFC in both ovaries (2.1±1.9 vs. 3.2±2.4, p &lt; 0.0001) compared to basal levels, achieving ovarian reactivation in 55.9% of them and IVF cycle initiation in 19.3%. These improvements were higher 2 months after treatment (55 patients), with increased antral follicles (AFC-2: 2.9±2.5, p = 0.0001) and ovarian activation in 58.2%, and IVF start in 43.9% of patients. Similar results were observed during the 3rd follow up accomplished by 30 women and lasted until the 5th visit (n = 8), although the reduced patient number at this point.

A total of 44 IVF cycles were started and oocyte pick-up was successfully developed in 72.7% of them with a mean number of 3.3±4.2MII oocytes, 1.8±2.1 fertilized oocytes and 1.5±2.0 embryos per cycle. Indeed, 6 pregnancies were obtained during this period, 2 of them after embryo transfer and 4 by natural conception.

Limitations, reasons for caution

Our results are encouraging but a large cohort of patients with a longer follow up period is needed to establish the efficacy and duration of the PRGF positive ovarian effects. Moreover, a proper comparison with a control group with the same characteristics and no PRGF intervention is still required.

Wider implications of the findings

PRGF intraovarian injection reactivates follicle growth and allows IVF cycle initiation and embryo generation in a poor prognosis population of patients with diminished ovarian reserve. The effects persisted for several months after treatment.

Trial registration number

2112-FIVI-109-SH

P-341 The effect of endometriosis on implantation success after single embryo transfer of a high-quality euploid blastocyst

Study question

Does endometriosis limit the embryo competence to implant in patients undergoing transfer of a single high-quality euploid blastocyst?

Summary answer

Although implantation competence of euploid blastocysts after deferred single-embryo transfers (SET) decreases in endometriosis patients, the effect is not observed when high-quality embryos are transferred.

What is known already

Endometriosis, a frequent gynecological disease, is often associated with female infertility and worse IVF clinical outcomes. Multiple factors may be involved in the subfertility of those patients. Although both defective embryo and altered endometrial receptivity may compromise implantation, evidences suggest a major role of embryo in the endometriosis impaired reproductive outcomes. However, few studies examine implantation after transfer of high-quality euploid embryos. Two studies on this issue suggested that endometriosis does not impact on pregnancy rates but either the embryo morphology was not considered, or a small sample size was used even including transfers with more than one single embryo.

Study design, size, duration

Retrospective multicenter cohort study on the competence of euploid embryos from patients with endometriosis (n = 277) compared with disease-free control women (n = 4677). Implantation and other clinical outcomes (positive pregnancy test, live birth: LB, miscarriages) were examined after SET to ascertain the effect of endometriosis on embryo competence. Results were firstly analyzed in single transferred embryos with any morphological graduation but also when only single high-quality blastocyst (A+B according ASEBIR embryo grading) were transferred.

Participants/materials, setting, methods

Our study involved women aged 18-42 years old undergoing IVF after preimplantation genetic testing for aneuploidies (PGT-A) in IVIRMA Clinics between 2012 and 2019. Severe male factors and patients with altered karyotype or chromosomopathies in previous embryos or pregnancies were excluded. Presence of endometriosis was revealed at the time of surgery or after pelvic ultrasound or NMR. Chi-square test for categorical variables or Student’s-test for quantitative variables were used to assess the statistical significance (P &lt; 0.05).

Main results and the role of chance

A total of 394 euploid blastocyst from endometriosis patients were included in the analysis while 6581 belonged to the control group. Up to 91.5 % were transferred after vitrification-warming in a deferred cycle (338 and 6043 in endometriosis and control groups) while the rest were transferred in the same cycle of embryo biopsy or even the oocyte retrieval. Among the frozen-transferred blastocysts, 76.85% and 74.93% from endometriosis and control women were high-quality embryos on the day of transfer (p = 0.51). Data showed slight but not significant differences in the positive pregnancy test (57.76% vs. 61.37%) and implantation outcomes (49.11% vs. 53.74%) between endometriosis and control group when both frozen and fresh SET were considered. Focusing on deferred SET of euploid blastocysts with any ASEBIR grade, both the proportion of positive test (56.08% vs. 61.82%; p = 0.04) and implanted blastocyst (47.77% vs. 54.34%, p = 0.02) were significantly lower in endometriosis than in the control group. However, they did result in similar amounts of LB (39.14% vs. 43.39%; p = 0.15). Moreover, when the top-quality embryos were examined, none of the clinical outcomes after deferred SET of euploid blastocysts where significantly different between endometriosis and control group (implantation: 50.88% vs. 57.43%; LB: 41.55% vs. 45.60%; p &gt; 0.05).

Limitations, reasons for caution

Results should be interpreted with caution due to the retrospective nature of the study. Although groups were as homogeneous as possible, multivariate regression models to avoid confounding factors are still pending. Reproductive outcomes only after fresh SET or considering to the severity of the disease have not been evaluated yet.

Wider implications of the findings

Although further research is required to surely state no association between endometriosis and embryo reproductive competence, our results suggest a similar pregnancy prognosis in women with or without endometriosis when a high-quality euploid blastocyst is available for transfer. Future prospective studies should take into consideration the quality of the embryo.

Trial registration number

Not applicable

Autoimmune chronic spontaneous urticaria

Chronic spontaneous urticaria (CSU) is a debilitating mast cell-driven disease characterized by recurrent wheals and/or angioedema. Substantial progress has been made in dissecting the 2 main autoimmune mechanisms that drive the pathogenesis of CSU. Type I autoimmune (autoallergic) CSU is associated with IgE antibodies against autoantigens, for example, thyroid peroxidase and IL-24. Type IIb autoimmune CSU is mediated by autoantibodies that activate mast cells, for example, via IgE and FcεRI, and is present in less than 10% of patients with CSU when strict criteria are used, that is, triple positivity of autologous serum skin test, immunoassays for IgG autoantibodies, and basophil activation tests. A subpopulation of patients with CSU has both types. Type IIb autoimmune CSU is characterized by higher disease severity, concomitant autoimmune diseases, low levels of total IgE, elevated levels of IgG-anti-thyroid peroxidase, basopenia, eosinopenia, poor response to antihistamines and to omalizumab, and a good response to cyclosporine. Novel targeted therapies for CSU are under development such as ligelizumab, an anti-IgE, fenebrutinib and remibrutinib, Bruton's tyrosine kinase inhibitors, and dupilumab, an anti-IL-4Rα. Further studies should investigate the overlap between autoallergic and type IIb autoimmune CSU, optimize the diagnosis of both autoimmune endotypes using easy-to-perform, noninvasive, and inexpensive markers, and assess differences in response to therapy.

AB0560 CLINICAL, SEROLOGICAL AND IMAGING CHARACTERISTICS OF LATIN AMERICAN PATIENTS WITH LUPUS MYOCARDITIS: A CASE-CONTROL STUDY

Background

Lupus myocarditis (LM) is an uncommon manifestation of systemic lupus erythematosus (SLE),

with a prevalence of 9% that tends to be lower in recent studies; it can range from subclinical to life-threatening manifestations (1). The clinical and immunological characteristics of LM have not been established in Latin American patients.

Objectives

To determine the clinical, serological, and imaging characteristics of patients with LM.

Methods

We conducted a single-center, case-control study that enrolled hospitalized patients between 2012 and 2020 in Colombia. Fifteen LM patients (cases) were matched by age and sex with thirty non-LM patients (controls). Descriptive, comparative, and logistic regression analyses were performed.

Results

Patients with LM were mostly females (93.3%) with a mean age of 28.2 years. The major affected clinical domains associated was renal (80%). Myocardial involvement occurred after SLE diagnosis with a mean of 5.1 years. Dyspnea (73.3%) was the main clinical manifestation. Troponin was high in 92.3% and echocardiographic findings included decreased left ventricular ejection fraction (LVEF) in the 60% of cases (mean 40%), diastolic dysfunction (61.5%), left ventricular dilatation (53.3%) and global hypokinesia 35.7%. The most common valvulopathy was mild mitral regurgitation. Nine LM patients underwent cardiac magnetic resonance. In this modality, mean LVEF was 38%, increased regional intensity on T2-weighted images, increased myocardial potentiation ratio on T1, and non-ischemic enhancement (mainly epicardial) was presented on 85.7%, 60%, and 57.1%, respectively. All patients received glucocorticoids and cyclophosphamide. Comparisons of the demographic, clinical, serological between LM and non-LM groups are shown in Table 1.

Table 1.

Demographic, clinical and serological characteristics.

VariableLM (n=15)Non-LMP-valueFemale93.3%100%0.333Age SLE24.9 (SD 12)28.3 (SD 13.9)0.515Clinical domainsCutaneous46.7%90%0.003Articular60%76.7%0.245Hematological60%83.3%0.086Serosal53.3%36.7%0.227Renal80%76.7%0.560Neuropsyquiatric6.7%26.7%0.115Vascular13.3%50%0.017PCR mg/dL10.1 (SD 9.3)2.8 (SD 4.6)0.0004Erythrocyte sedimentation rate mm/H52.9 (SD 25.7)43.9 (SD 32.9)0.267Creatinine mg/dL1.4 (SD 0.9)1.9 (SD 2.5)0.294C3 mg/dL57.4 (SD 22.4)86.2 (SD 29.9)0.002C4 mg/dL9.6 (SD 8.3)16.4 (SD 9.3)0.009Anti-dsDNA86.7%52.4%0.034SLEDAI score14.7 (SD 5.7)6.8 (SD 7.6)0.0003

SD: Standard deviation

Bivariate logistic regression showed that LM was independently associated with anti-dsDNA (OR 1.17, IC 1.04 – 1.31, p= 0.004), higher SLEDAI score (OR 1.17, IC 1.04 – 1.31, p=0,006), higher RCP (OR 1.21, IC 1.04 – 1.4, p=0.013), lower C3 (OR 0.96, IC 0.93 – 0.98, p:0,06) and lower C4 (OR 0.90 IC 0.82 – 0.99 P=0,036), highlighting its relationship with disease activity.

Conclusion

LM is a potentially severe manifestation and occurs in patients with higher disease activity, as was evidenced in the present study by low complement, anti-dsDNA and SLEDAI score. In the proper clinical context, noninvasive diagnostic tests should detect myocardial involvement in SLE.

References

[1]du Toit, Riette et al. “Outcome of clinical and subclinical myocardial injury in systemic lupus erythematosus - A prospective cohort study.” Lupus vol. 30,2 (2021): 256-268. doi:10.1177/0961203320976960

Disclosure of Interests

None declared

COVID-19 L·OVE repository is highly comprehensive and can be used as a single source for COVID-19 studies

Background and Objective

The coronavirus disease 2019 Living OVerview of Evidence (COVID-19 L·OVE) is a public repository and classification platform for COVID-19 articles. The repository contains more than 430,000 articles as of September 20, 2021 and intends to provide a one-stop shop for COVID-19 evidence. Considering that systematic reviews conduct high-quality searches, this study assesses the comprehensiveness and currency of the repository against the total number of studies in a representative sample of COVID-19 systematic reviews.

Methods

Our sample was generated from all the studies included in the systematic reviews of COVID-19 published during April 2021. We estimated the comprehensiveness of COVID-19 L·OVE repository by determining how many of the individual studies in the sample were included in the COVID-19 L·OVE repository. We estimated the currency as the percentage of studies that was available in the COVID-19 L·OVE repository at the time the systematic reviews conducted their own search.

Results

We identified 83 eligible systematic reviews that included 2,132 studies. COVID-19 L·OVE had an overall comprehensiveness of 99.67% (2,125/2,132). The overall currency of the repository, that is, the proportion of articles that would have been obtained if the search of the reviews was conducted in COVID-19 L·OVE instead of searching the original sources, was 96.48% (2,057/2,132). Both the comprehensiveness and the currency were 100% for randomized trials (82/82).

Conclusion

The COVID-19 L·OVE repository is highly comprehensive and current. Using this repository instead of traditional manual searches in multiple databases can save a great amount of work to people conducting systematic reviews and would improve the comprehensiveness and timeliness of evidence syntheses. This tool is particularly important for supporting living evidence synthesis processes.

Page kidney after pediatric kidney transplantation: a case report

INTRODUCTION

Page kidney (PK) is a rare condition caused by parenchymal compression due to a subcapsular hematoma. Irreversible damage of the graft may occur if this condition is not recognized and treated properly.

CLINICAL CASE

We describe the case of a 16-year-old man with chronic renal failure secondary to corticosteroid-resistant nephrotic syndrome (CRNS) caused by NPHS2 mutations. The patient underwent a 5th fifth living-related KT. The graft was placed intraperitoneally and reperfused well without complications. On the 4th postoperative day his labs demonstrated raising creatinine associated with refractory hypertension, gross hematuria and anemia. Urgent ultrasound revealed a subcapsular hematoma with signs of parenchymal compression. PK phenomenon was suspected and urgent surgical intervention decided.

COMMENTS

PK is a rare but an emergence potentially treatable and reversible complication after pediatric KT. Early diagnosis based on clinical suspicion and suggestive imaging are the key points for a favorable outcome.

Consequences of a low protein diet on the liver and longissimus dorsi transcriptome of Duroc × Iberian crossbred pigs

Low protein diets supplied during the growing period of pigs can diminish their growth rate and increase the intramuscular fat (IMF) content which affects the sensorial and technological characteristics of the products. In the present study, the effects of a low protein diet supplied during the growing period of Duroc × Iberian crossbred pigs on several phenotypic traits and on liver and longissimus dorsi transcriptome were analysed at the beginning (EARLY) and at the end (LATE) of the growing period. Two experimental groups of 10 crossbred pigs each were fed two isocaloric diets with different protein content: control diet (C) with 16.5% protein and 0.8% lysine and low protein diet (LP) with 11% CP and 0.6% lysine. Animals fed LP diet have a slower growth than those fed C diet, but no effect of LP diet was observed on the IMF content. The transcriptomes of liver and longissimus dorsi were characterised and quantified through RNA-sequencing (RNA-seq). In liver, 134 and 480 differentially expressed annotated genes and new isoforms (DEGs) were detected between C and LP diets for EARLY and LATE animals, respectively. In muscle, 128 and 68 DEGs were detected at EARLY and LATE time-points. Functional interpretation revealed that LP diet may inhibit immune system molecules and processes in both tissues at EARLY stage. In liver, the DEGs mainly affect lipid and cholesterol metabolic processes, while in muscle, the expression changes would be involved in growth, development and meat quality. In conclusion, a low protein diet supplied during the growing period seems to slow down the growth of Duroc × Iberian crossbred pigs, but it also seems to affect multiple biological processes that could compromise the immune system of Duroc × Iberian crossbred pigs. Therefore, these results question the adequacy of this type of regime in Duroc × Iberian pigs that must be studied in greater depth before being implemented.

Food-dependent and food-exacerbated symptomatic dermographism: New variants of symptomatic dermographism

BACKGROUND

Symptomatic dermographism (SD) is the most common form of chronic inducible urticaria. The criterion standard for diagnosing SD and disease activity assessment in SD is provocation testing. As of now, if and what cofactors have an impact on provocation test results is unknown.

OBJECTIVE

We sought to determine whether the induction of signs and symptoms of SD is affected by the intake of food.

METHODS

We performed standardized skin provocation testing with a dermographometer (FricTest) before and after the intake of food. Patients were off antihistamine treatment for at least 3 days before testing. In total, 17 patients were tested after not having eaten for at least 4 hours (preprandial) on one volar forearm and 60 minutes after a carbohydrate-rich meal (postprandial) on the other. FricTest responses (wheals, itch) at trigger thresholds were assessed at 5 and 30 seconds as well as at 1, 2, 5, and 10 minutes.

RESULTS

We identified 7 patients with SD who showed faster onset of FricTest-induced whealing and/or lower trigger thresholds after the intake of food, that is, food-exacerbated SD. In 5 other patients, FricTest provocation testing resulted in a positive response only after the intake of food, but not before. Three of these 5 patients with food-dependent SD had comorbid chronic spontaneous urticaria and 1 had cholinergic urticaria.

CONCLUSIONS

We describe 2 previously unknown subtypes of SD, food-exacerbated SD and food-dependent SD. The prevalence and underlying pathomechanisms of food-exacerbated SD and food-dependent SD need to be investigated, and the impact of food intake on other forms of chronic inducible urticaria should be explored.

Mast Cells Modulate Antigen-Specific CD8+ T Cell Activation During LCMV Infection

Mast cells (MCs), strategically localized at mucosal surfaces, provide first-line defense against pathogens and shape innate and adaptive immune responses. Recent studies have shown that MCs are involved in pathogenic responses to several viruses including herpes simplex viruses, dengue virus, vaccinia virus and influenza virus. However, the underlying mechanisms of MCs in the activation of CD8+ T cells during viral infections are not fully understood. Therefore, we investigate the role of MCs in the development of virus-specific CD8+ T cell responses using the well-characterized murine lymphocytic choriomeningitis virus (LCMV) model and the transgenic MasTRECK mice that contain the human diphtheria toxin receptor as an inducible MC-deficient model. Here, we report that MCs are essential for the activation and expansion of virus-specific CD8+ T cells. After MC depletion and subsequent intradermal LCMV infection, the CD8 + T cell effector phenotype and antiviral cytokine production were impaired at the peak of infection (day 8 p.i.). Importantly, MC-deficient mice were unable to control the infection and exhibited significantly higher viral loads in the spleen and in the ear draining lymph nodes compared to that of wild type control mice. In the absence of MCs, dendritic cell (DC) activation was impaired upon LCMV infection. In addition, type-I interferon (IFN) levels in the serum and in the spleen of MC-deficient mice were reduced during the first days of infection. Interestingly, depletion of MCs after intradermal LCMV infection did not impair virus-specific CD8+ T cell expansion, activation or antiviral cytokine production. In summary, our results indicate that MCs play a pivotal role in the activation and antiviral functions of CD8+ T cells through proper DC activation. A better understanding of the impact of MCs on CD8+ T cell responses is mandatory to improve antiviral immune responses.

POS0770 DIFFERENTIAL CLINICAL PRESENTATION BETWEEN SLE RUPHUS PATIENTS AND SLE NON-RHUPUS PATIENTS: A CASE-CONTROL STUDY

Background:

Rhupus is a term that describe the coexistence of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Rhupus patients have symmetrical, erosive arthritis, characteristic SLE manifestations and an array of autoantibodies including rheumatoid factor (RF), anti-cyclic citrullinated peptides (anti-CCP), anti-dsDNA, and anti-Sm.1 Joint involvement is common in SLE patients (90%), but only 1% to 9,7% have rhupus.2 Due to its low prevalence, there is still a lack of evidence on its presentation and differences with other SLE patients without rhupus.

Objectives:

To examine the rhupus prevalence and to compare the clinical and serological characteristics between rhupus, and non-rhupus SLE patients (SLE with arthritis (SLEa), and SLE without arthritis (SLEwa)).

Methods:

We performed a case-control study. Rhupus patients (cases) were matched 1:1 with non-rhupus SLE patients (controls). Descriptive statistics were calculated and rhupus, SLEa, and SLEwa were compared.

Results:

A total of 72 patients were included, 24 patients in each group; most were female (87.5%). The median age at rhupus onset was 36.5 years (IQR 30-42.5). RA preceded rhupus in half of the patients, 29% were initially diagnosed as SLE, and 21% were initially diagnosed as rhupus. The median duration of RA was 66 months (IQR 30-144).

In the descriptive analysis of rhupus patients, the most affected joints were the proximal interphalangeal and metacarpophalangeal joints (87.5%), followed by the wrists (79.1%). Regarding immunological findings, RF and anti-CCP were positive in 87.5% and 50% of the patients, respectively. As to radiographic findings, the median number of erosions in the hands and wrists was 2 (IQR 0-5) and the median number of joints with narrowed joint space was 7 (IQR: 1.5 - 13.5). In terms of treatment, 95.8% received corticosteroids (median 10 mg/day), 91.6% antimalarials, 79.1% methotrexate, 41.6% leflunomide, and 25.0% rituximab.

Patients with rhupus were older and had less renal and hematological involvement than patients with SLEa and SLEwa. SLEa patients had higher seropositivity for anti-RNP and anti-Sm, higher neurological involvement, and higher SLEDAI-2K scores than rhupus patients. Comparisons of other clinical and serological variables between SLE rhupus and non-ruphus patients are shown in table 1 and figure 1.

Table 1.

Clinical and serological manifestations in rhupus, articular SLE, and non-articular SLE

VariablesRHUPUSM (IQR)SLE with arthritisM (IQR)SLE without arthritisM (IQR)P value RHUPUS vs. SLE with arthritisp value RHUPUSvs. SLE without arthritisAge (years) M (IQR)40 (31.5 – 49)29 (21.5 – 45)33 (19.5 – 37.5)0.0430.013CPR M (IQR)2.3 (1– 8.5)1.6 (0.3– 3.6)0.9 (0.2– 2.5)0.3370.032Positive anti-RNP N (%)7 (29.1%)14 (58.3%)7 (29.1%)0.0421.000Positive anti-Sm N (%)5 (20.8%)15 (62.5%)6 (25%)0.0030.500SLEDAI – 2K score M (IQR)4.5 (1 – 7)9 (2 – 18)7 (3.5 – 15)0.0450.082Figure 1.

Differences in the frequencies of organic alterations. w/o: without.

Conclusion:

Patients with rhupus were older and had lower SLEDAI-2K scores compared with those non-rhupus. Furthermore, renal, neurological, and hematological manifestations were more common in non-rhupus patients than in rhupus patients.

References:

[1]Antonini L, et al. Rhupus: a systematic literature review. Autoimmun Rev. 2020;19(9):102612.

[2]Tani C, et al. Rhupus syndrome: Assessment of its prevalence and its clinical and instrumental characteristics in a prospective cohort of 103 SLE patients. Autoimmun Rev. 2013; 12:537–41.

Disclosure of Interests:

None declared

Mental health consequences of the Covid-19 outbreak in Spain. A longitudinal study of the alarm situation and return to the new normality

AIMS

The objective is to conduct a longitudinal analysis of the effects of the pandemic and alarm situation on the mental health of the general population at three points in time: two weeks after beginning the confinement, after a month, and after two months, when the lockdown was lifted and the country returned to the new normality.

METHODS

The evaluations were carried out by means of an online survey, with a sample of 3480 persons in the first data collection and 1041 and 569 persons in the successive evaluation periods. The presence of depressive symptoms, anxiety and posttraumatic stress disorder (PTSD) was evaluated by means of screening tests. Sociodemographic data, Covid-19 variables, loneliness, psychological well-being, social support, discrimination and a sense of belonging, were collected.

RESULTS

Depressive symptoms increased significantly throughout the confinement, decreasing at the last assessment but not dropping to previous levels. In anxiety, there are no significant changes between the three evaluations, but a downward trend can be seen over time. Regarding the symptomatology of PTSD, a downward trend is observed throughout the three evaluations, with significantly lower scores between the first and third assessments. The different regression models developed reveal the importance of perceived loneliness and spiritual well-being as the main predictors of mental health, as well as the importance of the lower age for depression and the female gender for anxiety and PSTD.

CONCLUSIONS

This research shows that the pandemic has had a negative impact on our mental health, which still does not seem to be at pre-crisis levels, although it has improved as the emergency situation subsides. These results underline the importance of paying greater attention to mental health, and reveal key variables such as spiritual well-being and perceived loneliness in which to intervene from different care services, as well as younger people and women as vulnerable groups on which to focus more attention.

Reprogramming Intestinal Epithelial Cell Polarity by Interleukin-22

Background: Interleukin-22 (IL-22) impacts the integrity of intestinal epithelia and has been associated with the development of colitis-associated cancer and inflammatory bowel diseases (IBD). Previous data suggest that IL-22 protects the mucosal barrier and promotes wound healing and barrier defect. We hypothesized, that IL-22 modulates cell polarity of intestinal epithelial cells (IECs) acting on tight junction assembly. The aim of the study was to investigate IL-22-dependent mechanisms in the reprogramming of intestinal epithelia.

Methods: IECs were exposed to IL-22 at various concentrations. IECs in Matrigel® were grown to 3-dimensional cysts in the presence or absence of IL-22 and morphology and expression of polarity proteins were analyzed by confocal microscopy. Epithelial cell barrier (TER and sandwich assay) and TJ assembly analysis (calcium-switch assay) were performed. TJ and cell polarity protein expression were assessed by western blotting and confocal microscopy. Cell migration and invasion assays were performed. Induction of epithelial-mesenchymal transition (EMT) was assessed by RT-qPCR analysis and western blotting. Signaling pathway analyses were performed by phosphoblotting and functional assays after blocking STAT3 and ERK signaling pathways. Using the toxoplasma-model of terminal ileitis, IL-22-knock-out mice were compared to wild-type littermates, analyzed for barrier function using one-path-impedance-analysis and macromolecular flux (H3-mannitol, Ussing-chambers).

Results: IECs exhibited a barrier defect after IL-22 exposure. TJ protein distribution and expression were severely impaired. Delayed recovery in the calcium-switch assay was observed suggesting a defect in TJ assembly. Analyzing the 3D-cyst model, IL-22 induced multi-lumen and aberrant cysts, and altered the localization of cell polarity proteins. Cell migration and invasion was caused by IL-22 as well as induction of EMT. Interestingly, only inhibition of the MAPK pathway, rescued the TJal barrier defect, while blocking STAT3 was relevant for cell survival. In addition, ileal mucosa of IL-22 deficient mice was protected from the barrier defect seen in Toxoplasma gondii-induced ileitis in wild type mice shown by significantly higher Re values and correspondingly lower macromolecule fluxes.

Conclusion: IL-22 impairs intestinal epithelial cell barrier by inducing EMT, causing defects in epithelial cell polarity and increasing cell motility and cell invasion. IL-22 modulates TJ protein expression and mediates tight junctional (TJal) barrier defects via ERK pathway.

Immune microenvironment characterisation and dynamics during anti-HER2-based neoadjuvant treatment in HER2-positive breast cancer

Despite their recognised role in HER2-positive (HER2+) breast cancer (BC), the composition, localisation and functional orientation of immune cells within tumour microenvironment, as well as its dynamics during anti-HER2 treatment, is largely unknown. We here investigate changes in tumour-immune contexture, as assessed by stromal tumour-infiltrating lymphocytes (sTILs) and by multiplexed spatial cellular phenotyping, during treatment with lapatinib-trastuzumab in HER2+ BC patients (PAMELA trial). Moreover, we evaluate the relationship of tumour-immune contexture with hormone receptor status, intrinsic subtype and immune-related gene expression. sTIL levels increase after 2 weeks of HER2 blockade in HR-negative disease and HER2-enriched subtype. This is linked to a concomitant increase in cell density of all four immune subpopulations (CD3+, CD4+, CD8+, Foxp3+). Moreover, immune contexture analysis showed that immune cells spatially interacting with tumour cells have the strongest association with response to anti-HER2 treatment. Subsequently, sTILs consistently decrease at the surgery in patients achieving pathologic complete response, whereas most residual tumours at surgery remain inflamed, possibly reflecting a progressive loss of function of T cells. Understanding the features of the resulting tumour immunosuppressive microenvironment has crucial implications for the design of new strategies to de-escalate or escalate systemic therapy in early-stage HER2+ BC.

Th2 cells lacking T-bet suppress naive and memory T cell responses via IL-10

Exacerbated immune responses and loss of self-tolerance lead to the development of autoimmunity and immunopathology. Novel therapies to target autoreactive T cells are still needed. Here, we report that Th2-polarized T cells lacking the transcription factor T-bet harbor strong immunomodulatory potential and suppress antigen-specific CD8+ T cells via IL-10. Tbx21-/- Th2 cells protected mice against virus-induced type 1 diabetes development and suppressed not only naive but also memory CD8+ T cell responses. IL-10-producing, but not IL-10-deficient Tbx21-/- Th2 cells down-regulated costimulatory molecules on dendritic cells and reduced their IL-12 production after lymphocytic choriomeningitis virus infection. Impaired dendritic cell activation hindered effector and cytotoxic CD8+ T cell development after infection. These findings indicate that Tbx21-/- Th2 cells strongly suppress proinflammatory responses of naive and memory T cells via IL-10. Thus, in vivo IL-10-secreting Th2 cells could harbor a therapeutic potential for the treatment of T cell-mediated inflammatory disorders.

Runs of homozygosity provide a genome landscape picture of inbreeding and genetic history of European autochthonous and commercial pig breeds

ROHs are long stretches of DNA homozygous at each polymorphic position. The proportion of genome covered by ROHs and their length are indicators of the level and origin of inbreeding. Frequent common ROHs within the same population define ROH islands and indicate hotspots of selection. In this work, we investigated ROHs in a total of 1131 pigs from 20 European local pig breeds and in three cosmopolitan breeds, genotyped with the GGP Porcine HD Genomic Profiler. plink software was used to identify ROHs. Size classes and genomic inbreeding parameters were evaluated. ROH islands were defined by evaluating different thresholds of homozygous SNP frequency. A functional overview of breed-specific ROH islands was obtained via over-representation analyses of GO biological processes. Mora Romagnola and Turopolje breeds had the largest proportions of genome covered with ROH (~1003 and ~955 Mb respectively), whereas Nero Siciliano and Sarda breeds had the lowest proportions (~207 and 247 Mb respectively). The highest proportion of long ROH (>16 Mb) was in Apulo-Calabrese, Mora Romagnola and Casertana. The largest number of ROH islands was identified in the Italian Landrace (n = 32), Cinta Senese (n = 26) and Lithuanian White Old Type (n = 22) breeds. Several ROH islands were in regions encompassing genes known to affect morphological traits. Comparative ROH structure analysis among breeds indicated the similar genetic structure of local breeds across Europe. This study contributed to understanding of the genetic history of the investigated pig breeds and provided information to manage these pig genetic resources.

Palbociclib in combination with endocrine therapy versus capecitabine in hormonal receptor-positive, human epidermal growth factor 2-negative, aromatase inhibitor-resistant metastatic breast cancer: a phase III randomised controlled trial-PEARL

BACKGROUND

Palbociclib plus endocrine therapy (ET) is the standard treatment of hormone receptor-positive and human epidermal growth factor receptor 2-negative, metastatic breast cancer (MBC). However, its efficacy has not been compared with that of chemotherapy in a phase III trial.

PATIENTS AND METHODS

PEARL is a multicentre, phase III randomised study in which patients with aromatase inhibitor (AI)-resistant MBC were included in two consecutive cohorts. In cohort 1, patients were randomised 1 : 1 to palbociclib plus exemestane or capecitabine. On discovering new evidence about estrogen receptor-1 (ESR1) mutations inducing resistance to AIs, the trial was amended to include cohort 2, in which patients were randomised 1 : 1 between palbociclib plus fulvestrant and capecitabine. The stratification criteria were disease site, prior sensitivity to ET, prior chemotherapy for MBC, and country of origin. Co-primary endpoints were progression-free survival (PFS) in cohort 2 and in wild-type ESR1 patients (cohort 1 + cohort 2). ESR1 hotspot mutations were analysed in baseline circulating tumour DNA.

RESULTS

From March 2014 to July 2018, 296 and 305 patients were included in cohort 1 and cohort 2, respectively. Palbociclib plus ET was not superior to capecitabine in both cohort 2 [median PFS: 7.5 versus 10.0 months; adjusted hazard ratio (aHR): 1.13; 95% confidence interval (CI): 0.85-1.50] and wild-type ESR1 patients (median PFS: 8.0 versus 10.6 months; aHR: 1.11; 95% CI: 0.87-1.41). The most frequent grade 3-4 toxicities with palbociclib plus exemestane, palbociclib plus fulvestrant and capecitabine, respectively, were neutropenia (57.4%, 55.7% and 5.5%), hand/foot syndrome (0%, 0% and 23.5%), and diarrhoea (1.3%, 1.3% and 7.6%). Palbociclib plus ET offered better quality of life (aHR for time to deterioration of global health status: 0.67; 95% CI: 0.53-0.85).

CONCLUSIONS

There was no statistical superiority of palbociclib plus ET over capecitabine with respect to PFS in MBC patients resistant to AIs. Palbociclib plus ET showed a better safety profile and improved quality of life.

Metabolomic Profiling of Bos taurus Beef, Dairy, and Crossbred Cattle: A Between-Breeds Meta-Analysis

Cattle breeds may differ substantially in their metabolism. However, the metabolomes of dairy and beef cattle are not well-known. Knowledge of breed-specific metabolic features is essential for biomarker identification and to adopt specific nutritional strategies. The muscle hypertrophy (mh), a beef cattle phenotype present in Asturiana de los Valles (AV) but absent in Asturiana de la Montaña (AM) and Holsteins, may underlie such differences. We compared the plasma metabolomes of Holstein, AV, AM, and crossbred cattle recipients selected for meta-analysis within an embryo transfer (ET) program. Blood samples were collected on day 0 (oestrus) and day 7 (prior to ET) (N = 234 samples × 2 days). Nuclear magnetic resonance quantified N = 36 metabolites in plasma, and more metabolic differences between breeds were found on day 0 (N = 19 regulated metabolites) than on day 7 (N = 5). AV and AM largely differed from Holstein cattle (N = 55 and 35 enriched metabolic pathways, respectively); however, AV and AM differed in N = 6 enriched pathways. Metabolic activity was higher in AV than in Holstein cattle, as explained in part by the mh phenotype. The metabolomic characterization of breeds facilitates biomarker research and helps to define the healthy ranges of metabolite concentrations.

Patient blood management during the COVID-19 pandemic: a narrative review

As COVID-19 disease escalates globally, optimising patient outcome during this catastrophic healthcare crisis is the number one priority. The principles of patient blood management are fundamental strategies to improve patient outcomes and should be given high priority in this crisis situation. The aim of this expert review is to provide clinicians and healthcare authorities with information regarding how to apply established principles of patient blood management during the COVID-19 pandemic. In particular, this review considers the impact of the COVID-19 pandemic on blood supply and specifies important aspects of donor management. We discuss how preventative and control measures implemented during the COVID-19 crisis could affect the prevalence of anaemia, and highlight issues regarding the diagnosis and treatment of anaemia in patients requiring elective or emergency surgery. In addition, we review aspects related to patient blood management of critically ill patients with known or suspected COVID-19, and discuss important alterations of the coagulation system in patients hospitalised due to COVID-19. Finally, we address special considerations pertaining to supply-demand and cost-benefit issues of patient blood management during the COVID-19 pandemic.

Genome-wide detection of copy number variants in European autochthonous and commercial pig breeds by whole-genome sequencing of DNA pools identified breed-characterising copy number states

In this study, we identified copy number variants (CNVs) in 19 European autochthonous pig breeds and in two commercial breeds (Italian Large White and Italian Duroc) that represent important genetic resources for this species. The genome of 725 pigs was sequenced using a breed-specific DNA pooling approach (30-35 animals per pool) obtaining an average depth per pool of 42×. This approach maximised CNV discovery as well as the related copy number states characterising, on average, the analysed breeds. By mining more than 17.5 billion reads, we identified a total of 9592 CNVs (~683 CNVs per breed) and 3710 CNV regions (CNVRs; 1.15% of the reference pig genome), with an average of 77 CNVRs per breed that were considered as private. A few CNVRs were analysed in more detail, together with other information derived from sequencing data. For example, the CNVR encompassing the KIT gene was associated with coat colour phenotypes in the analysed breeds, confirming the role of the multiple copies in determining breed-specific coat colours. The CNVR covering the MSRB3 gene was associated with ear size in most breeds. The CNVRs affecting the ELOVL6 and ZNF622 genes were private features observed in the Lithuanian Indigenous Wattle and in the Turopolje pig breeds respectively. Overall, the genome variability unravelled here can explain part of the genetic diversity among breeds and might contribute to explain their origin, history and adaptation to a variety of production systems.

Development of a 64 SNV panel for breed authentication in Iberian pigs and their derived meat products

Spanish legislation regulates the labelling of Iberian pig meat and dry-cured products, which are labelled as "Ibérico" or "100% Ibérico" when they come from Duroc x Iberian crossbred or Iberian purebred pigs. Although the analytical authentication of breed origin is not mandatory, a genetic diagnostic tool is demanded by producers and consumers. We have designed a 64 Single Nucleotide Variant genotyping panel displaying extreme allelic frequencies between Duroc and Iberian purebred samples. Average proportions of Iberian alleles of 0.99, 0.01, 0.77 and 0.48 were estimated by admixture clustering analysis of known origin samples, for Iberian and Duroc purebred, 75% Iberian and 50% Iberian classes, respectively. A supervised analysis with 1419 samples showed some overlapping between contiguous classes, but the calculated degrees of separability ranged from 0.800 to 0.996, exceeding the threshold value (0.70) for considering suitable for prediction. Therefore, this panel is a useful genetic tool to infer purebred or crossbred Iberian origin of live animals, meat and dry-cured products.

Nuclear magnetic resonance analysis of female and male pre-hatching embryo metabolites at the embryo-maternal interface

INTRODUCTION

Bovine female and male embryos differentially release metabolites with signalling effects to culture media. However, it is unknown if the embryo-maternal interface (EMI) metabolome is modified by embryonic sex.

OBJECTIVE

To analyse using a combination of 1H NMR and a co-culture of endometrial cells the EMI.

RESULTS

Twenty-six metabolites were identified and quantified in the EMI, nine metabolites reflected the sex of the embryo rather than their presence.

CONCLUSIONS

1H NMR is sensitive enough to perform quantitative analysis of sex-induced differences in the EMI. These results may help to understand the embryo-maternal dialogue on the basis of embryonic sex.

Risk factors for major adverse cardiovascular events after osteoporotic hip fracture repair surgery

Osteoporotic hip fracture (OHF) is an increasingly frequent age-related pathology, which results in high rates of functional loss and mortality within the first year after surgery. This study assessed whether preoperative levels of brain natriuretic peptide (NT-proBNP) and troponin I were related to early occurrence (30d) of major adverse cardio-vascular events (MACE) after OHF repair surgery. During a 6-month period, perioperative clinical and analytical data from consecutive patients, without known history of cardiovascular disease and undergoing surgery for OHF repair at a single centre, were prospectively collected. MACE was defined as acute myocardial ischaemia or infarction, acute heart failure or cardiovascular death. amongst the 140 patients included, 23 (16.4%) developed postoperative MACE (MACE group) and 117 did not (Control group). Compared to those from control group, patients from MACE group were older, had poorer physical status (ASA III-IV), received preoperative red blood cell transfusion (RBCT) more frequently, presented with lower haemoglobin concentrations and higher NT-proBNP, creatinine and troponin I concentrations. Overall, RBCT requirements and 30d mortality rate were also higher in MACE group. However, in multivariate analysis, only preoperative RBCT, creatinine >1 mg/dL and NT-proBNP >450 pg/mL remained as independent preoperative risks factors for postoperative MACE, while 95% confidence intervals of odds ratios were wide. Though our findings require confirmation in a larger multicentre cohort, identifying risk factors for early postoperative MACE after OHF repair surgery, might facilitate assessing patients' risk prior to and following surgery, and targeting them the appropriate preventive and/or therapeutic interventions.