Protection of pancreatic islets from oxidative cell death by a peripherally-active morphinan with increased drug safety

OBJECTIVE

Dextromethorphan (DXM) is a commonly used antitussive medication with positive effects in people with type 2 diabetes mellitus, since it increases glucose tolerance and protects pancreatic islets from cell death. However, its use as an antidiabetic medication is limited due to its central nervous side effects and potential use as a recreational drug. Therefore, we recently modified DXM chemically to reduce its blood-brain barrier (BBB) penetration and central side effects. However, our best compound interacted with the cardiac potassium channel hERG (human ether-à-go-go-related gene product) and the μ-opioid receptor (MOR). Thus, the goal of this study was to reduce the interaction of our compound with these targets, while maintaining its beneficial properties.

METHODS

Receptor and channel binding assays were conducted to evaluate the drug safety of our DXM derivative. Pancreatic islets were used to investigate the effect of the compound on insulin secretion and islet cell survival. Via liquor collection from the brain and a behavioral assay, we analyzed the BBB permeability. By performing intraperitoneal and oral glucose tolerance tests as well as pharmacokinetic analyses, the antidiabetic potential and elimination half-life were investigated, respectively. To analyze the islet cell-protective effect, we used fluorescence microscopy as well as flow cytometric analyses.

RESULTS

Here, we report the design and synthesis of an optimized, orally available BBB-impermeable DXM derivative with lesser binding to hERG and MOR than previous ones. We also show that the new compound substantially enhances glucose-stimulated insulin secretion (GSIS) from mouse and human islets and glucose tolerance in mice as well as protects pancreatic islets from cell death induced by reactive oxygen species and that it amplifies the effects of tirzepatide on GSIS and islet cell viability.

CONCLUSIONS

We succeeded to design and synthesize a novel morphinan derivative that is BBB-impermeable, glucose-lowering and islet cell-protective and has good drug safety despite its morphinan and imidazole structures.

Synthesis of Tetrasubstituted Nitroalkenes and Preliminary Studies of Their Enantioselective Organocatalytic Reduction

Starting from commercially available ketones, a reproducible and reliable strategy for the synthesis of tetrasubstituted nitroalkenes was successfully developed, using a two-step procedure; the HWE olefination of the ketone to form the corresponding α,β-unsaturated esters is followed by a nitration reaction to introduce the nitro group in the α position of the ester group. The enantioselective organocatalytic reduction of these compounds has also been preliminarily studied, to access the functionalized enantioenriched nitroalkanes, which are useful starting materials for further synthetic elaborations. The absolute configuration of the reduction product was established by chemical correlation of the chiral nitroalkane with a known product; preliminary DFT calculations were also conducted to rationalize the stereochemical outcome of the organocatalytic enantioselective reduction.

cleAR: an interoperable architecture for multi-user AR-based school curricula

Although there are some experiences that demonstrate the validity of the use of augmented reality in schools to help students understand and retain complex concepts, augmented reality has not been widely adopted in the education sector yet. This is in part because it is hard to use augmented reality applications in collaborative learning scenarios and to integrate them in the existing school curricula. In this work, we present an interoperable architecture that simplifies the creation of augmented reality applications, enables multi-user student collaboration and provides advanced mechanisms for data analysis and visualization. A review of the literature together with a survey answered by 47 primary and secondary school teachers allowed us to identify the design objectives of cleAR, an architecture for augmented reality-based collaborative educational applications. cleAR has been validated through the development of three proofs of concept. cleAR provides a more mature technological ecosystem that will foster the emergence of augmented reality applications for education and their inclusion in existing school programs.

Periodontitis and COVID-19: Biological Mechanisms and Meta-analyses of Epidemiological Evidence

Since the beginning of 2020, the entire global health care system has been severely challenged by the outbreak of coronavirus 2019 disease (COVID-19). Robust evidence has demonstrated a more severe course of COVID-19 in the presence of several comorbidities, such as cardiovascular diseases, diabetes mellitus, and obesity. Here, we critically appraise the recent research discoveries linking periodontitis to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to severe COVID-19, with a special focus on the associated biological mechanisms and the available epidemiological evidence. SARS-CoV-2 main receptors and coreceptors (ACE2, TMPRSS2, furin, CD147) are overexpressed in periodontal tissues of periodontitis patients, with inflammation, periodontal pathogens, and damage-induced pyroptosis triggering a positive feedback loop. However, meta-analyses of epidemiological studies only indicated a nonstatistically significant tendency for an increased risk of SARS-CoV-2 infection in subjects with periodontitis (odds ratio [OR] = 1.69; 95% CI, 0.91-3.13, P = 0.09). Furthermore, periodontitis may worsen clinical COVID-19 courses through multiple direct and indirect pathways, including damage to lower airways due to aspiration of periodontal pathogens, exacerbation of the cytokine storm via the low-grade chronic systemic inflammation, and SARS-CoV-2 dissemination through the ulcerated gingival epithelium with consequent induced pulmonary vessels vasculopathy. Indeed, meta-analyses of epidemiological studies indicated that periodontitis subjects are more likely to experience a more severe course of COVID-19. Specifically, periodontitis was associated with a 4-fold increased odds of hospitalization (OR = 4.72; 95% CI, 1.11-20.03, P = 0.04), 6-fold of requiring assisted ventilation (OR = 6.24; 95% CI, 2.78-14.02, P = 0.00), and more than 7-fold of death due to COVID-19 complications (OR = 7.51; 95% CI, 2.16-26.10, P = 0.00). The breakthrough analyzed here emphasizes the relevance of the mouth-systemic connection as a target to mitigate the current COVID-19 emergency and the future predicted coronavirus pandemics.

Enantioselective Organophotocatalytic Telescoped Synthesis of a Chiral Privileged Active Pharmaceutical Ingredient

The continuous flow, enantioselective, organophotoredox catalytic asymmetric alkylation of aldehydes was studied, by using a homemade, custom‐designed photoreactor for reactions under cryogenic conditions. Going from microfluidic conditions up to a 10 mL mesofluidic reactor, an increase of productivity by almost 18000 % compared to the batch reaction was demonstrated. Finally, for the first time, a stereoselective photoredox organocatalytic continuous flow reaction in a fully telescoped process for an active pharmaceutical ingredient (API)synthesis was successfully achieved. The final process consists of four units of operation: visible light‐driven asymmetric catalytic benzylation under continuous flow, inline continuous work‐up, neutralisation and a final oxidative amidation step afforded the pharmaceutically active molecule in 95 % e.e.

POS0374 MONITORING CHRONIC INFLAMMATORY MUSCULOSKELETAL DISEASES WITH A PRECISION DIGITAL COMPANION PLATFORM(TM)–RESULTS OF THE DIGIREUMA FEASIBILITY STUDY

Background

Patients with rheumatic and musculoskeletal diseases (RMDs) require a tailored follow-up that is limited by the capacity of healthcare professionals. Innovative tools need to be implemented effectively in the clinical care of patients with RMDs.

Objectives

To test the feasibility of a Precision Digital Companion Platform™ for real-time monitoring of disease outcomes in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA).

Methods

Digireuma was a prospective study including patients with RA and SpA, using the digital Precision Digital Companion Platform, Adhera for Rheumatology (ISRCTN11896540). During a follow-up of 3 months, patients were asked to report disease specific electronic patient reported outcomes (ePROs) on a regular basis in the mobile solution. Two rheumatologists monitored these ePROs and, patients were contacted for online or face-to-face interventions when deemed necessary by clinicians (Figure 1). Assessment measures included patient global assessment (PGA) of disease activity, tender joint count (TJC), swollen joint count (SJC), Health Assessment Questionnaire (HAQ) and pain visual analogue scale (VAS), for patients with RA; VAS, PGA, TJC, SJC, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) and ASAS Health Index (ASAS-HI), for patients with SpA. In addition, flares, changes in medication and recent infections were asked. Usability of the digital solution was measured by the Net-Promoter Score (NPS).

Figure 1.

Digital monitoring in the study powered by Adhera for Rheumatology. Screenshots in top depict the mobile interface (left) and clinical web application (right)

Results

Forty-six patients were recruited of whom 22 had RA and 24 SpA. Mean age was 48 ± 12 and 42 ± 9 years in the RA and SpA groups, respectively. 18/22 (82%) patients with RA and 9/24 (38%) with SpA were female. Among the total included patients, 41 (89%) completed the onboarding (18/22 (82%) RA, 23/24 (96%) SpA) and 37 (80%) submitted at least one entry. In the RA group who completed the onboarding (n=18) there were a total of 4019 total interactions (2178 questionnaire items, 648 accesses to educational units, 105 quizzes, 1088 rated messages), while patients with SpA (n=23) had a total of 3160 interactions (1637 questionnaire items, 684 accesses to educational units, 77 quizzes, 762 rated messages). ePROs measurements completion rates for RA and SpA patients that completed any data during follow-up are shown in Table 1. Patients with RA completed a median of 9.5 ePROs during follow-up, whereas patients with SpA completed a median of 3. Regarding alerts, 15 patients generated a total of 26 alerts, of which 24 were flares (10 RA, 14 SpA) and 2 were problems with the medication (1 RA, 1 SpA). 18 (69%) of the alerts were managed remotely, 5 (19%) required a face-to-face intervention and in 3 (12%) patients did not respond before the consultation. Regarding usability and patient satisfaction, 14 patients provided feedback. According to the NPS, 9/14 were considered promoters, 4/14 passives and 1/14 detractor. The overall rating of these 14 patients for the app was 4.3 out of 5 stars.

Table 1.

Onboarded patient engagement with regards to e-PROs

Rheumatoid Arthritis (n=18)PGATJCSJCVASHAQTotalePROs completed1.5 (0.25, 3)2 (0.25, 3)2 (0.25, 3)2 (0, 3)2 (1, 3)9.5 (4.3, 15.8)Patients with ≥ 1 entry13 (72.2)13 (72.2)13 (72.2)12 (66.7)16 (88.9)16 (88.9)Spondyloarthritis (n=23)PGATJCSJCBASDAIASAS-HITotalePROs completed1 (0,3)1 (0,3)1 (0,3)1 (0,2)1 (0,2)3 (1, 12)Patients with ≥ 1 entry16 (69.5)16 (69.5)16 (69.5)14 (60.8)14 (60.8)21 (91.3)

Follow-up period was 3 months. Results are expressed in median (Q1, Q3) and n (%)

Conclusion

This study shows that the use of a digital health solution is feasible in clinical practice. Based on these preliminary results, the next step will be to further implement the Precision Digital Companion Platform, Adhera for Rheumatology, in a multicentric setting to analyze the added value for monitoring patients.

Acknowledgements

This study was funded with an unrestricted grant from Abbvie.

Disclosure of Interests

Diego Benavent Speakers bureau: Jannsen, Roche, Grant/research support from: Novartis, Abbvie, Francisco J. Núñez-Benjumea Employee of: AdheraHealth Inc, Luis Fernández-Luque Employee of: AdheraHealth Inc, Victoria Navarro-Compán Speakers bureau: AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB Pharma, Grant/research support from: AbbVie and Novartis, María Sanz: None declared, Enrique Calvo Aranda Speakers bureau: Abbvie, LETICIA LOJO: None declared, Alejandro Balsa Speakers bureau: Pfizer, Abbvie, Lilly, Galapagos, BMS, Sandoz, Nordic Pharma, Gebro, Roche, Sanofi, UCB, Consultant of: Pfizer, Abbvie, Lilly, Galapagos, BMS, Nordic Pharma, Sanofi, UCB, Grant/research support from: Pfizer, Abbvie, BMS, Nordic Pharma, Gebro, Roche, UCB, Chamaida Plasencia Speakers bureau: Pfizer, Abbvie, Lilly, Sandoz, Sanofi, Biogen, Roche, Novartis, Grant/research support from: Pfizer y Abbvie

AB0376 DIFFERENCES IN IMMUNOGLOBULIN LEVELS IN PATIENTS WITH ANCA-ASSOCIATED VASCULITIS AND RHEUMATOID ARTHRITIS TREATED WITH RITUXIMAB

Background

Hypogammaglobulinemia (HGGS) is one of the adverse effects of Rituximab (RTX), a chimeric monoclonal antibody directed against the CD20 receptor, frequently observed in ANCA-associated vasculitis (AAV) patients.

Objectives

To study the characteristics of patients with AAV on RTX treatment and to analyze the factors associated with HGGS, as well as to compare them with patients with rheumatoid arthritis (RA) on the same treatment.

Methods

Retrospective descriptive study of patients with a diagnosis of AAV or RA treated with RTX who had immunoglobulin levels prior to treatment and after each cycle were included. Demographic, clinical and analytical variables were analyzed. Patients who developed HGGS versus those who did not were compared using Student’s t and Mann-Whitney U for continuous variables and chi-square for categorical variables.

Results

Ninety-five patients were included, 19 (20%) with AAV and 76 (80%) with RA. Of the 34 (35.8%) who developed HGGS, 19 had RA (25%) and 15 AAV (79%) (p<0.001). The 6 patients who presented with severe HGGS (IgG<500) belonged to the AAV group.

The overall sample was divided into patients with HGGS and patients without (Table 1). Significant differences were obtained in relation to diagnosis (p<0.001), age at diagnosis and at the start of treatment, being higher in patients with HGGS (p 0.005 and p 0.001) and years of disease evolution (p 0.036). Patients with HGGS had a lower mean baseline IgG (p<0.001). The HGGS group had more severe infections (infections requiring admission) (p 0.005) and the time from RTX administration to the development of infection was shorter in this group (p 0.017). The frequency of abdominal infection was higher in the HGGS group (p 0.050), and there were no significant differences with the other types of infection.

Table 1.Total sample (n= 95)HGGS IgG (n= 34)No HGGS IgG (n= 61)PWomen n/N(%)70/95(73.7)23/34(67.6)47/61(77)0.318Age (m±SD)64±1268±1062±120.005Age at start of treatment (m±SD)57±1262±1054±120.001Years of evolution (m±SD)11±98±912±100.036RA n/N(%)76/95(80)19/34(55.9)57/61(93.4)<0.001AAV n/N(%)19/95(20)15/34(44.1)4/61(6.6)<0.001Glomerular filtration rate <60 n/N(%)7/91(7.7)4/34(11.8)3/61(4.9)0.164GCS AD in the previous year (m±SD)2918±31023265±30502690±31550.238GC AD during treatment (m±SD)4656±177132889±27785576±217750.271Total GC AD (m±SD)56411±326716117050±4841865879±60890.159CFM AD (m±SD)0.51±2.251.1±3.10.2±1.50.032Baseline IgG (m±SD)1107±340933±3461203±297<0.001Infection n/N(%)58/95(61.1)23/34(67.6)35/61(57.3)0.325Severe infection n/N(%)19/95(20)12/34(35.3)7/61(11.5)0.005Time to infection (months)(m±SD)43±4330±3657±450.017Exitus n/N(%)8/95(8.4)2/34(5.9)6/61(9.9)0.270

Conclusion

A significantly higher percentage of HGGS is observed in patients with AAV treated with RTX compared to patients with RA. The development of HGGS seems to be influenced by age at diagnosis and at the start of treatment, years of disease evolution and low levels of IgGs prior to the start of treatment. In addition, there is a higher frequency of severe infections in the HGGS group. Studies with larger sample sizes are needed to confirm these results.

References

[1]Roberts DM, Jones RB, Smith RM, Alberici F, Kumaratne DS, Burns S, Jayne DR. Rituximab-associated hypogammaglobulinemia: incidence, predictors and outcomes in patients with multi-system autoimmune disease. J Autoimmun. 2015 Feb;57:60-5. doi: 10.1016/j.jaut.2014.11.009.

Disclosure of Interests

None declared

AB1396 MULTICENTER QUALITATIVE STUDY ON THE EXPERIENCE OF USE OF BIOLOGIC AND TARGETED SYNTHETIC DISEASE-MODIFYING DRUGS IN PATIENTS WITH RHEUMATIC DISEASES. WHAT DO OUR PATIENTS THINK?

Background

The development of targeted biologic (bDMARDs) and targeted synthetic disease-modifying drugs (tsDMARDS) has made a substantial change in the control of our patients, and has allowed an increasing number of patients to achieve clinical remission.

Objectives

To gain understanding of patients’ experiences of starting treatment with b/tsDMARDs, and explore their attitudes in order to improve the doctor-patient relationship, adherence to treatment, compliance, and knowledge about the experience of using b/tsDMARDs.

Methods

A qualitative study was carried out. A consecutive sample of 130 patients attended in the rheumatology units of four Madrid hospitals, from August 29th, 2021 to January 21st, 2022 completed a questionnaire that consisted of 31 questions, a subsequent qualitative analysis of discourse and content through focus groups with patients was carried out. Descriptive statistical analysis was performed. Chi-squared tests were applied to explore the dependency relationship between the different qualitative variables.

Results

One hundred and thirty questionnaires were collected (see general characteristics in the Table 1).

Table 1.

Baseline demographics.

Sex, n (%)96 female (73.85%), 34 male (26.15%)Age, years, mean (SD)51,62±12.31 yearsEthnicity/race, n(%)74.6% White or Caucasian22.3% Hispanic or Latino2.3% Asiatic0.8% Black or African AmericanDiagnosis, (%)42.4% rheumatoid arthritis25.3% axial spondyloarthritis10% psoriatic arthritis6.9% connective tissue diseases15.4 % otherTime since diagnosis (years), mean (SD)14,7 years (+/-11,43)Time since initiation of treatment with b/tsDMARDs (years), mean (SD)5,84 years (+/-4,28)

Most of the patients (68.46%) felt hope when they were informed that they were going to start treatment with b/tsDMARDs, 26.9% relief, 22.3% happiness and 27.7% fear and concern. 76% of the patients received information about why the treatment was modified, the advantages of b/tsDMARDs (60%), their mechanism of action (48.5%) and the precautions to be aware of (38.5 %). Fifty-two percent of the respondents searched for additional information on their own, with the most used sources being from internet search engines (34.2%), the corresponding drug insert (22.8%) and the page of the Spanish Society of Rheumatology (23.7%).

60% of the respondents were informed about the possible risks associated with the treatment, 49.4% reported being more concerned when they contracted an infection. Most of the patients were recommended to receive influenza (81.5%) and pneumococcal (69.2%) vaccination, of which 74.6% and 54.6% received those respectively. A statistically significant dependence was observed between the recommendation of the vaccine and vaccination, since most (91,5%) of those who received the recommendation were vaccinated (p<0.001). Most of the respondents kept their scheduled appointments (87.3%) and never forgot to take their medication (37.04%).

51% of the patients reported that with b/tsDMARDs they had experienced “considerable improvement”, 38.5% indicated that “their life has changed”, 10% reported little or no improvement. It was observed that men reported a maximum degree of improvement with a significantly higher frequency than women (77% vs 37% respectively), OR 5.79 (p <0.009, IC 95% 1.42, 23.67). To the question “In which aspects have you noticed the greatest changes?” the respondents answered: reduction in outbreaks of the disease (67%), emotional improvement (38.6%) and regaining work activity (31.8%).

Conclusion

In our setting, education programs inform patients adequately, but it seems necessary to make a greater emphasis on therapeutic compliance, providing more safety information, and compliance to recommended vaccinations.

References

[1]Arkell P, et al. Patient experiences, attitudes and expectations towards receiving information about anti-TNF medication—“it could give me two heads and I’d still try it!” BMC Musculoskelet Disord. 2013;10:165. doi: 10.1186/1471-2474-14-165

Disclosure of Interests

None declared

Implementing a Rapid Response System in a tertiary-care hospital. A cost-effectiveness study

PURPOSE

The occurrence of adverse events (AE) in hospitalized patients substancially increases the risk of disability or death, having a major negative clinical and economic impact on public health. For early identification of patients at risk and to establish preventive measures, different healthcare systems have implemented rapid response systems (RRS). The aim of this study was to carry out a cost-effectiveness analysis of implementing a RRS in a tertiary-care hospital.

METHODS

We included all the patients admitted to Hospital Clínic de Barcelona from 1 to 2016 to 31 December 2016. The cost-effectiveness analysis was summarized as the incremental cost-effectiveness ratio (incremental cost divided by the incremental effectiveness of the two alternatives, RRS versus non-RRS). The effectiveness of the RRS, defined as improvements in health outcomes (AE, cardiopulmonary arrest and mortality), was obtained from the literature and applied to the included patient cohort. A budget impact analysis on the implementation of the RRS from a hospital perspective was performed over a 5-year time horizon.

RESULTS

42,409 patients were included, and 448 (1.05%) had severe AE requiring ICU admission. The cost-effectiveness analysis showed an incremental cost (savings) of EUR - 1,471,101 of RRS versus the non-RRS. The budgetary impact showed a cost reduction of EUR 896,762.00 in the first year and EUR 1,588,579.00 from the second to the fifth year.

CONCLUSIONS

The present analysis shows the RRS as a dominant, less costly and more effective structure compared to the non-RRS.

Peripherally active dextromethorphan derivatives lower blood glucose levels by targeting pancreatic islets

Dextromethorphan (DXM) acts as cough suppressant via its central action. Cell-protective effects of this drug have been reported in peripheral tissues, making DXM potentially useful for treatment of several common human diseases, such as type 2 diabetes mellitus (T2DM). Pancreatic islets are among the peripheral tissues that positively respond to DXM, and anti-diabetic effects of DXM were observed in two placebo-controlled, randomized clinical trials in humans with T2DM. Since these effects were associated with central side effects, we here developed chemical derivatives of DXM that pass the blood-brain barrier to a significantly lower extent than the original drug. We show that basic nitrogen-containing residues block central adverse events of DXM without reducing its anti-diabetic effects, including the protection of human pancreatic islets from cell death. These results show how to chemically modify DXM, and possibly other morphinans, as to exclude central side effects, while targeting peripheral tissues, such as pancreatic islets.

[Prognosis of in hospital nonagenarians with acute kidney injury]

BACKGROUND

There has been little in the way of study of nonagenarians with acute kidney injury (AKI, defined in lines with KDIGO guidelines), but the rise in their life expectancy makes further study of this population necessary. The aim of this study is to assess mortality in nonagenarians with AKI during hospitalization.

METHODS

In this retrospective study, patients with AKI during hospitalization between 2013-2014 were included. At baseline, epidemiological variables, comorbidities and treatments were collected. Analytics and mortality were studied during hospitalisation. Univariate analysis was carried out to evaluate mortality-associated variables. A logistic regres-sion analysis was carried out to demonstrate independent predictors for mortality.

RESULTS

Two hundred and sixty-four nonagenarian patients were included. Mean age was 93±3 years, 73 (27.7?%) of whom were men. During hospitalization, 79 patients (29.9?%) died. Comorbidities related to mortality were history of heart failure (p?=?0.018), diastolic dysfunction (p?<?0.042) and higher dependence according to the modified Barthel index (p?=?0.003). The clinical variables related to mortality at hospital admission were lower systolic (p?=?0.016) and diastolic blood pressure (p?=?0.013), higher white blood cell count (p?=?0.003), greater severity of AKI (p?=?0.003) and L-?lactic (p?=?0.005). In an adjusted multivariate analysis, history of heart failure (OR?=?2.31, 95%CI: 1.07-5.00, p?=?0.036), depend-ence according to the Barthel index (OR?=?0.80, 95%CI: 0.67-0.97, p?=?0.016) and L-?lactic acid (OR?=?1.31, 95%IC: 1.06-1.61, p?=?0.005) were independent predictors of mortality.

CONCLUSION

Heart failure, dependence according to the Barthel index and L-?lactic acid at admission are independent predictors of mortality in nonagenarians hospitalized with AKI.

A phase I trial of selinexor plus FLAG-Ida for the treatment of refractory/relapsed adult acute myeloid leukemia patients

Prognosis for relapsed or refractory (R/R) acute myeloid leukemia (AML) despite salvage therapy is dismal. This phase I dose-escalation trial assessed the safety and preliminary clinical activity of selinexor, an oral exportin-1 (XPO1) inhibitor, in combination with FLAG-Ida in younger R/R AML patients. The aim was to find the recommended phase 2 dose (RP2D) and maximum tolerated dose (MTD). Fourteen patients were included, and selinexor dosage was 60 mg (3 patients), 80 mg (3 patients), and 100 mg (7 patients) weekly. No dose-limiting toxicities were reported. Grade ≥3 non-hematologic adverse events (AEs) occurred in 78.6% of patients. Two patients were non MTD evaluable due to early death, and overall, 3 out of 14 patients (21.4%) had fatal AEs. Five out of 12 (42%) response and MTD evaluable patients achieved a complete remission (CR; n=4) or CR with incomplete hematologic recovery (CRi, n=1), and 4 patients (33%) subsequently underwent allogeneic transplantation. The median overall survival (OS) and event-free survival (EFS) were 6.0 (range 0.9-19.3) and 1.1 months (range 0.7-19.3), respectively. Using selinexor 100 mg/weekly, CR/CRi rate of 66.7%, OS 13.6 months (range, 1.6-19.3), and EFS 10.6 months (range, 0.9-19.3). At last follow-up, 3 patients were alive. Selinexor 100 mg/weekly with FLAG-Ida combination in R/R AML showed acceptable tolerability and efficacy, establishing the RP2D of this regimen in future clinical trials. ClinicalTrials.gov Identifier: NCT03661515.

Multiphoton Excitation Fluorescence Microscopy and Spectroscopic Multianalytical Approach for Characterization of Historical Glass Grisailles

The preservation of the integrity of artworks and cultural heritage items during characterization and conservation operations is of high priority, therefore, the application of non-invasive techniques is commonly suggested and recommended. Nonlinear optical microscopies (NLOM), based on the use of tightly focused pulsed femtosecond lasers, are emerging techniques for structural and chemical analysis of heritage objects with micrometric lateral and axial resolution. The results obtained with a set of optical and spectroscopic techniques for the chemical and physical characterization of grisaille paint layers on historical stained glasses, from different chronologies and provenance in Spain, are presented in this work. Optical behaviour and chemical composition were investigated by NLOM, using a laboratory set-up in the modality of Multi-Photon Excitation Fluorescence (MPEF), and by a multi-analytical combination of Field Emission Scanning Electron Microscopy-Energy Dispersive X-ray Spectrometry (FESEM-EDS), Laser Induced Breakdown Spectrosocopy (LIBS) and Laser Induced Fluorescence (LIF). Thicknesses values of the historical grisaille paint layers measured with MPEF were compared with those retrieved through FESEM, showing significant consistency and agreement. Under proper conditions, analysis via MPEF microscopy avoids the photochemical and physical damage to the examined materials, thus ensuring their preservation. This approach paves the way for future in-situ, non-invasive stratigraphic investigations on cultural heritage objects.

Hard tissue volumetric and soft tissue contour linear changes at implants with different surface characteristics after experimentally induced peri-implantitis: an experimental in vivo investigation

OBJECTIVE

To evaluate the hard tissue volumetric and soft tissue contour linear changes in implants with two different implant surface characteristics after a ligature-induced peri-implantitis.

MATERIAL AND METHODS

In eight beagle dogs, implants with the same size and diameter but distinct surface characteristics were placed in the healed mandibular sites. Test implants had an external monolayer of multi-phosphonate molecules (B+), while control implants were identical but without the phosphonate-rich surface. Once the implants were osseointegrated, oral hygiene was interrupted and peri-implantitis was induced by placing subgingival ligatures. After 16 weeks, the ligatures were removed and peri-implantitis progressed spontaneously. Bone to implant contact (BIC) and bone loss (BL) were assessed three-dimensionally with Micro-Ct (μCT). Dental casts were optically scanned and the obtained digitalized standard tessellation language (STL) images were used to assess the soft tissue vertical and horizontal contour linear changes.

RESULTS

Reduction of the three-dimensional BIC percentage during the induction and progression phases of the experimental peri-implantitis was similar for both the experimental and control implants, without statistically significant differences between them. Soft tissue analysis revealed for both implant groups an increase in horizontal dimension after the induction of peri-implantitis, followed by a decrease after the spontaneous progression period. In the vertical dimension, a soft tissue dehiscence was observed in both groups, being more pronounced at the buccal aspect.

CONCLUSIONS

The added phosphonate-rich surface did not provide a more resistant environment against experimental peri-implantitis, when assessed by the changes in bone volume and soft tissue contours.

CLINICAL RELEVANCE

Ligature-induced peri-implantitis is a validated model to study the tissue changes occurring during peri-implantitis. It was hypothesized that a stronger osseointegration mediated by the chemical bond of a phosphonate-rich implant surface would develop an environment more resistant to the inflammatory changes occurring after experimental peri-implantitis. These results, however, indicate that the hard and soft tissue destructive changes occurring at both the induction and progression phases of experimental peri-implantitis were not influenced by the quality of osseointegration.

Antimicrobial effect of nanostructured membranes for guided tissue regeneration: an in vitro study

OBJECTIVE

The purpose of this in vitro study was to evaluate the antibacterial effect of a novel non-resorbable, bioactive polymeric nanostructured membrane (NMs), when doped with zinc, calcium and doxycycline.

METHODS

A validated in vitro subgingival biofilm model with six bacterial species (Streptococcus oralis, Actinomyces naeslundii, Veillonela parvula, Fusobacterium nucleatum, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans) was used. The experimental NMs, with and without being doped with doxycycline, calcium and zinc, were placed on hydroxyapatite (HA) discs. As positive control membranes, commercially available dense polytetrafluoroethylene (d-PTFE) membranes were used and, as negative controls, the HA discs without any membrane. The experimental, positive and negative control discs were exposed to a mixed bacterial suspension, at 37 °C under anaerobic conditions, during 12, 24, 48 and 72 h. The resulting biofilms were analyzed through scanning electron microscopy (SEM), to study their structure, and by quantitative polymerase chain reaction (qPCR), to assess the bacterial load, expressed as colony forming units (CFU) per mL. Differences between experimental and control groups were evaluated with the general linear model and the Bonferroni adjustment.

RESULTS

As shown by SEM, all membrane groups, except the NMs with doxycycline, resulted in structured biofilms from 12-72 hours. Similarly, only the membranes loaded with doxycycline demonstrated a significant reduction in bacterial load during biofilm development, when compared with the control groups (p < 0.001).

SIGNIFICANCE

Doxycycline-doped nanostructured membranes have an impact on biofilm growth dynamics by significant reducing the bacterial load.

Risk factors related to oral candidiasis in patients with primary Sjögren's syndrome

BACKGROUND

Candidiasis is the most frequent mycotic infection of the oral cavity. The aim of this study was to investigate the presence of clinical oral candidiasis and Candida albicans yeast in a population diagnosed of primary Sjögren's syndrome (pSS) and to study the possible factors associated with this infection.

MATERIAL AND METHODS

An observational cross-sectional study was conducted in 61 pSS patients (60 women, 1 man, mean age 57.64±13.52) where patient based information (demographic and medical, tobacco and alcohol consumption history), intraoral parameters (presence of dentures, clinical signs of candidiasis), salivary analytical information (number of Candida albicans as colony-forming units per millilitre (CFU/mL), salivary pH levels, unstimulated whole saliva (UWS) and stimulated whole saliva (SWS) were collected.

RESULTS

13.1% of pSS patients presented oral signs of candidiasis. Denture stomatitis and angular cheilitis were the most common lesions. 87.5% of patients with clinical candidiasis presented reduced pH levels and salivary flow in both UWS and SWS. A significant statistical negative correlation was found between CFU/mL of Candida albicans and levels of UWS and SWS. A negative correlation was found between pH levels and CFU/mL, although not statistically significant.

CONCLUSIONS

A reduced salivary flow may predispose pSS patients to Candida albicans overgrowth, which may show with clinical signs. Preventive measures are of great importance to avoid and to treat this condition promptly.

Periodontitis, Edentulism, and Risk of Mortality: A Systematic Review with Meta-analyses

Periodontitis has been independently associated with the chronic noncommunicable diseases that most frequently lead to death worldwide. The aim of the present systematic review was to study whether people with periodontitis/edentulism are at increased risk of all-cause and cause-specific mortality as compared with those without periodontitis/edentulism. Cohort studies were included that 1) evaluated periodontitis or edentulism as exposures in relation to all-cause or cause-specific mortality as an outcome and 2) reported effect estimates as hazard ratios, risk ratios, or odds ratios with 95% CIs or crude numbers. Two review authors independently searched for eligible studies, screened the titles and abstracts, did full-text analysis, extracted the data from the published reports, and performed the risk-of-bias assessment. In case of disagreement, a third review author was consulted. Study results were summarized through random effects meta-analyses. A total of 57 studies were included, involving 48 cohorts and 5.71 million participants. Periodontitis was associated with increased risk of all-cause mortality (risk ratio, 1.46 [95% CI, 1.15 to 1.85]) and mortality due to cardiovascular diseases (1.47 [1.14 to 1.90]), cancer (1.38 [1.24 to 1.53]), coronary heart disease (2.58 [2.20 to 3.03]), cerebrovascular diseases (3.11 [2.42 to 3.98]), but not pneumonia (0.98 [0.69 to 1.38]). Edentulism (all types) was associated with increased risk of all-cause mortality (1.66 [1.46 to 1.88]) and mortality due to cardiovascular diseases (2.03 [1.50 to 2.74]), cancer (1.55 [1.24 to 1.94]), pneumonia (1.72 [1.07 to 2.78]), coronary heart disease (2.98 [2.43 to 3.65]), and cerebrovascular diseases (3.18 [2.24 to 4.51]). Periodontitis and its ultimate sequela (edentulism) are associated with an increased risk of all-cause and cause-specific mortality (PROSPERO CRD42018100095).

Increased in-hospital mortality from COVID-19 in patients with schizophrenia

Background

There is limited information describing the presenting characteristics and outcomes of patients with schizophrenia (SCZ) requiring hospitalization for coronavirus disease 2019 (COVID-19).

Aims

We aimed to compare the clinical characteristics and outcomes of COVID-19 SCZ patients with those of non-SCZ patients.

Method

This was a case-control study of COVID-19 patients admitted to 4 AP–HM/AMU acute care hospitals in Marseille, southern France. COVID-19 infection was confirmed by a positive result on polymerase chain reaction testing of a nasopharyngeal sample and/or on chest computed scan among patients requiring hospital admission. The primary outcome was in-hospital mortality. The secondary outcome was intensive care unit (ICU) admission.

Results

A total of 1092 patients were included. The overall in-hospital mortality rate was 9.0%. The SCZ patients had an increased mortality compared to the non-SCZ patients (26.7% vs. 8.7%, P = 0.039), which was confirmed by the multivariable analysis after adjustment for age, sex, smoking status, obesity and comorbidity (adjusted odds ratio 4.36 [95% CI: 1.09–17.44]; P = 0.038). In contrast, the SCZ patients were not more frequently admitted to the ICU than the non-SCZ patients. Importantly, the SCZ patients were mostly institutionalized (63.6%, 100% of those who died), and they were more likely to have cancers and respiratory comorbidities.

Conclusions

This study suggests that SCZ is not overrepresented among COVID-19 hospitalized patients, but SCZ is associated with excess COVID-19 mortality, confirming the existence of health disparities described in other somatic diseases.

AB0526 DIFFERENCES IN IMMUNOGLOBULIN LEVELS IN PATIENTS WITH ANCA-ASSOCIATED VASCULITIS AND RHEUMATOID ARTHRITIS TREATED WITH RITUXIMAB

Background:

Rituximab (RTX) is a chimeric monoclonal antibody against CD20 receptor, used in the treatment of rheumatic diseases. Hypogammaglobulinemia has been described as an adverse event. It has been reported that hypogammaglobulinemia is more frequent in patients with ANCA-associated vasculitis (AAV).

Objectives:

To study the basal characteristics of patients with AAV and rheumatoid arthritis (RA) in treatment with RTX and to analyze the risk factors of hypogammaglobulinemia.

Methods:

Retrospective observational study of patients treated with RTX. Patients diagnosed with AAV and RA with immunoglobulin levels prior to treatment and after each cycle were included. Clinical and demographic variables were analyzed. Both populations were compared using t-Student for continuous and chi-squared for categorical variables. The influence of the basal characteristics of the patients was analyzed using univariate and multivariate logistic regression models.

Results:

Among the 86 included patients, 10 (11.6%) had AAV and 76 (88.4%) RA. Patient’s characteristics stratified by disease are included in Table 1.

Table 1.

Characteristics of patients treated with RTX, according to their underlying disease.

Overall sample n=86ARn=76VAAn=10pAge at diagnosis, yearsm±SD57 ± 1256 ± 1263 ± 110,11Disease progression, yearsm±SD11,5 ± 913 ± 91 ± 1< 0,001Femalen/N (%)66/86 (76,6)60/76 (78,9)6/10 (60)0,18IGG <725 prior to initiation of treatmentn/N (%)10/86 (11,6)4/76 (5,3)6/10 (60)< 0,001IgG < 600n/N (%)12/86 (14)4/76 (5,3)8/10 (80)<0,001IgG <400n/N (%)2/86 (2,3)02/10 (20)<0,001IgM Hipogamaglobulinemian/N (%)26/86 (30,2)17/76 (22,4)9/10 (90)<0,001Pretreatment with non-antiTNF biologicsn/N (%)25/86 (29,1)24/76 (31,6)1/10 (10)0,15Pretreatment with antiTNFn/N (%)60/86 (69,8)59/76 (77,6)1/10 (10)<0,001Pretreatment with FAMESn/N (%)80/86 (93)72/74 (94,7)8/10 (80)0,08Pre-treatment with JAK inhibitorsn/N (%)11/86 (12,8)11/76 (14,5)00,19Cyclophosphamide pretreatmentn/N (%)3/86 (3,5)03/10 (30)< 0,001Infectionsn/N (%)21/86 (24,4)15/76 (19,7)6/10 (60)0,02Severe infectionn/N (%)7/86 (4,6)1/76 (1,3)3/10 (30)< 0,001Cumulative dose of steroids one year priorm±SD2923 ± 30032227 ± 18986199 ± 4621< 0,001Cumulative dose of steroids during treatmentm±SD2626 ± 23532303 ± 19135668 ± 39970,002

The overall sample was divided into two groups, patients who developed hypogammaglobulinemia and patients who did not. Of the 12 patients who developed hypogammaglobulinemia, 4 had RA and 8 AAV (p<0.001). In the univariate analysis, patients who developed hypogammaglobulinemia presented higher age at diagnosis (61 ± 15 vs 43 ± 11 years, OR=1.14 p<0.001), shorter time of disease progression (4.9 ± 8 vs 12.6 ± 9 years, OR=0.86 p0.02) and lower gammaglobulin rates at baseline (744 ± 504 vs 1145 ± 295 OR=0.16 p0.006). There were more severe infections in the group of patients with hypogammaglobulinemia than in the group without it (1/4 [25%] vs 1/74 [1.4%], OR=0.42 p<0.001). Patients with hypogammaglobulinemia received a higher cumulative dose of steroids during treatment (OR=1,000 p 0.019). Within the RA group, patients with hypogammaglobulinemia also received a higher cumulative dose of steroids (p 0.009).

In the multivariate study, only age at the beginning of treatment (OR=1.1 p=0.020) remained a risk factor for the appearance of hypogammaglobulinemia.

Conclusion:

A significantly higher percentage of hypogammaglobulinemia is observed in patients with AAV treated with Rituximab, compared to patients with RA. The development of hypogammaglobulinemia seems to be influenced by age at diagnosis, years of disease progression, IgG levels prior to initiation of treatment and a higher cumulative dose of glucocorticoids (targeted in both the overall sample and the RA group). In addition, there is a higher frequency of severe infections in the hypogammaglobulinemia group. Studies with larger sample sizes are needed to confirm these results.

Disclosure of Interests:

María Sanz: None declared, Gemma Bonilla: None declared, Diana Peiteado: None declared, Diego Benavent: None declared, Chamaida Plasencia: None declared, Laura Nuño: None declared, Irene Monjo: None declared, Alejandro Villalva: None declared, Alejandro Balsa Grant/research support from: BMS, Roche, Consultant of: AbbVie, Gilead, Lilly, Pfizer, UCB, Sanofi, Sandoz, Speakers bureau: AbbVie, Lilly, Sanofi, Novartis, Pfizer, UCB, Roche, Nordic, Sandoz

Periodontitis and Cardiovascular Diseases. Consensus Report

Background

In Europe cardiovascular disease (CVD) is responsible for 3.9 million deaths (45% of deaths), being ischaemic heart disease, stroke, hypertension (leading to heart failure) the major cause of these CVD related deaths. Periodontitis is also a chronic non-communicable disease (NCD) with a high prevalence, being severe periodontitis, affecting 11.2% of the world's population, the sixth most common human disease.

Material and Methods

There is now a significant body of evidence to support independent associations between severe periodontitis and several NCDs, in particular CVD. In 2012 a joint workshop was held between the European Federation of Periodontology (EFP) and the American Academy of Periodontology to review the literature relating periodontitis and systemic diseases, including CVD. In the last five years important new scientific information has emerged providing important emerging evidence to support these associations.

Results and Conclusions

The present review reports the proceedings of the workshop jointly organised by the EFP and the World Heart Federation (WHF), which has updated the existing epidemiological evidence for significant associations between periodontitis and CVD, the mechanistic links and the impact of periodontal therapy on cardiovascular and surrogate outcomes. This review has also focused on the potential risk and complications of periodontal therapy in patients on anti thrombotic therapy and has made recommendations for dentists, physicians and for patients visiting both the dental and medical practices.

Oral lesions in patients with primary Sjögren's syndrome. A case-control cross-sectional study

BACKGROUND

To evaluate the presence of oral lesions in a group of patients with primary Sjögren's syndrome (pSS) and compare these results with a matched control group (CG).

MATERIAL AND METHODS

An observational cross-sectional study was conducted. 61 pSS patients (60 women, 1 man, mean age 57.64±13.52) diagnosed according to the American European Criteria (2002), and 122 matched control patients (120 women, 2 men, mean age 60.02±13.13) were included. Demographic and medical data, oral lesions and salivary flow rate were collected.

RESULTS

Compared with the controls, pSS patients were 3.95 more likely to have oral lesions (OR 3.95; 95% CI 2.06-7.58; p=0.0001). 57.4% pSS patients presented oral lesions compared to 25.4% in CG. The most common were candidiasis (13.1% vs 2.5%), traumatic lesions (13.1% vs 4.1%), apthae (8.2% vs 0), and fissuration of the tongue (8.2% vs 0.8%). pSS patients with oral lesions had lower salivary flow levels (stimulated and unstimulated), although these differences were not significant. Significant associations were found between the presence of oral lesions and systemic manifestations and history of parotid gland enlargement in pSS patients.

CONCLUSION

pSS patients suffer more oral lesions than general population and these lesions may aggravate the pSS disease.

Retinol-binding protein 4 (RBP4), a potential biomarker of frailty in HIV-infected people on stable antiretroviral therapy

OBJECTIVES

A quantitative biomarker for identification of pre-frail and frail persons is still lacking. This study aimed to identify biomarker predictors of frailty in HIV-infected patients.

METHODS

A cross-sectional study of HIV-infected patients who had been on antiretroviral therapy (ART) for at least 1 year and who presented an undetectable viral load (< 50 HIV-1 RNA copies/mL) at baseline was carried out. For each frail patient, up to four pre-frail and robust patients were randomly selected. The frailty status assessment was based on the five-item criteria described by Fried et al. Sociodemographic, anthropometric, biochemical and HIV-related characteristics were evaluated. Multiple potential biomarkers of frailty and a biological age biomarker were analysed.

RESULTS

A total of 73 HIV-infected patients on ART for at least 1 year were evaluated. The patients were categorized as robust (n = 33), pre-frail (n = 32) and frail (n = 8) using the Fried criteria. All patients were on ART, with 100% undetectable viral load (< 50 copies/mL) at baseline. No significant differences in demographic, clinical or analytical characteristics were observed among patients in the different categories based on Fried criteria, with the exception of the veterans aging cohort study index (VACS). Similarly, no differences were observed in HIV-related characteristics, although nucleoside reverse transcriptase inhibitor (NRTI) use was less common in frail persons. The distribution of biomarker values varied according to frailty status, with frail persons having higher levels of interleukin (IL)-8, IL-18, CXC chemokine ligand 10 (CXCL10) and retinol-binding protein 4 (RBP4). In multivariable analysis, the assocation of frailty with RBP4 showed a tendency to statistical significance (odds ratio 1.0; 95% confidence interval 0.99-1.00; P < 0.05).

CONCLUSIONS

Differential biomarker expression was present according to Fried status. Longitudinal studies will clarify the utility of these biomarkers as targets for diagnostic or therapeutic intervention.

Degree of Quantumness in Quantum Synchronization

We introduce the concept of degree of quantumness in quantum synchronization, a measure of the quantum nature of synchronization in quantum systems. Following techniques from quantum information, we propose the number of non-commuting observables that synchronize as a measure of quantumness. This figure of merit is compatible with already existing synchronization measurements, and it captures different physical properties. We illustrate it in a quantum system consisting of two weakly interacting cavity-qubit systems, which are coupled via the exchange of bosonic excitations between the cavities. Moreover, we study the synchronization of the expectation values of the Pauli operators and we propose a feasible superconducting circuit setup. Finally, we discuss the degree of quantumness in the synchronization between two quantum van der Pol oscillators.

Obesity is a risk factor for acute promyelocytic leukemia: evidence from population and cross-sectional studies and correlation with FLT3 mutations and polyunsaturated fatty acid metabolism

Obesity correlates with hematologic malignancies including leukemias, but risk of specific leukemia subtypes like acute promyelocytic leukemia and underlying molecular mechanisms are poorly understood. We explored multiple datasets for correlation between leukemia, body mass index (BMI) and molecular features. In a population-based study (n=5.2 million), we correlated BMI with promyelocytic leukemia, and other acute myeloid, lymphoid or other leukemias. In cross-sectional studies, we tested BMI deviation in promyelocytic leukemia trial cohorts from that expected based on national surveys. We explored The Cancer Genome Atlas for transcriptional signatures and mutations enriched in promyelocytic leukemia and/or obesity, and confirmed a correlation between body mass and FLT3 mutations in promyelocytic leukemia cohorts by logistic regression. In the population-based study, hazard ratio per 5 kg/m² increase was: promyelocytic leukemia 1.44 (95%CI: 1.0-2.08), non-promyelocytic acute myeloid leukemias 1.17 (95%CI: 1.10-1.26), lymphoid leukemias 1.04 (95%CI: 1.0-1.09), other 1.10 (95%CI: 1.04-1.15). In cross-sectional studies, body mass deviated significantly from that expected (Italy: P<0.001; Spain: P=0.011; USA: P<0.001). Promyelocytic leukemia showed upregulation of polyunsaturated fatty acid metabolism genes. Odds of FLT3 mutations were higher in obese acute myeloid leukemias (odds ratio=2.4, P=0.007), whether promyelocytic or not, a correlation confirmed in the pooled promyelocytic leukemia cohorts (OR=1.22, 1.05-1.43 per 5 kg/m²). These results strengthen the evidence for obesity as a bona fide risk factor for myeloid leukemias, and in particular APL. FLT3 mutations and polyunsaturated fatty acid metabolism may play a previously under-appreciated role in obesity-associated leukemogenesis.

Analog simulator of integro-differential equations with classical memristors

An analog computer makes use of continuously changeable quantities of a system, such as its electrical, mechanical, or hydraulic properties, to solve a given problem. While these devices are usually computationally more powerful than their digital counterparts, they suffer from analog noise which does not allow for error control. We will focus on analog computers based on active electrical networks comprised of resistors, capacitors, and operational amplifiers which are capable of simulating any linear ordinary differential equation. However, the class of nonlinear dynamics they can solve is limited. In this work, by adding memristors to the electrical network, we show that the analog computer can simulate a large variety of linear and nonlinear integro-differential equations by carefully choosing the conductance and the dynamics of the memristor state variable. We study the performance of these analog computers by simulating integro-differential models related to fluid dynamics, nonlinear Volterra equations for population growth, and quantum models describing non-Markovian memory effects, among others. Finally, we perform stability tests by considering imperfect analog components, obtaining robust solutions with up to 13% relative error for relevant timescales.

Secure quantum remote state preparation of squeezed microwave states

Quantum communication protocols based on nonclassical correlations can be more efficient than known classical methods and offer intrinsic security over direct state transfer. In particular, remote state preparation aims at the creation of a desired and known quantum state at a remote location using classical communication and quantum entanglement. We present an experimental realization of deterministic continuous-variable remote state preparation in the microwave regime over a distance of 35 cm. By employing propagating two-mode squeezed microwave states and feedforward, we achieve the remote preparation of squeezed states with up to 1.6 dB of squeezing below the vacuum level. Finally, security of remote state preparation is investigated by using the concept of the one-time pad and measuring the von Neumann entropies. We find nearly identical values for the entropy of the remotely prepared state and the respective conditional entropy given the classically communicated information and, thus, demonstrate close-to-perfect security.

Continuous-variable remote state preparation in the microwave domain would allow to leverage the superconducting technology for quantum networks applications. Here, the authors show how to deterministically prepare squeezed Gaussian states across 35 cm using previously shared entanglement.

In vitro biofilm formation on different ceramic biomaterial surfaces: Coating with two bactericidal glasses

OBJECTIVES

To compare biofilm formation on the surface of different ceramic biomaterials to be used in implant dentistry.

METHODS

In vitro biofilm formation was investigated from mixtures of standard reference strains of Streptococcus oralis, Veillonella parvula, Actinomyces naeslundii, Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis. Sterile ceramic calcium hydroxyapatite discs (HA) as control, sterile Al₂O₃/Ce-TZP nanocomposite sandblasted discs (material A1) and sterile Al₂O₃/Ce-TZP nanocomposite sandblasted discs and coated with two types of antimicrobial glasses (materials A2 and A3) were used. Biofilms were grown on the four surfaces and evaluated after 12, 24, 48 and 72 h of incubation. Biofilms were examined by confocal laser scanning microscopy (CLSM). In addition, counts of live bacterial cells of the target species A. actinomycetemcomitans, F. nucleatum and P. gingivalis were calculated by quantitative polymerase chain reaction (qPCR) combined with propidium monoazide (PMA). For data analysis, bacterial counts were compared with a multivariate general lineal model.

RESULTS

Using CLSM, cell vitality decreased in A2 and A3. With qPCR-PMA, significant differences in vitality were observed forA. actinomycetemcomitans in A3 after 48 and 72 h of incubation. With respect to the development of the biofilms, a significant increase in counts on HA and materials A1 and A2 was observed for A. actinomycetemcomitans and F. nucleatum. Conversely, for P. gingivalis, no differences were found for HA and materials A1 and A2.

SIGNIFICANCE

Differences in biofilm formation were detected among the different tested materials. The ceramic material A3 has an effect on the vitality of A. actinomycetemcomitans growing in an in vitro biofilm model.

Antibacterial effects of polymeric PolymP-n Active nanoparticles. An in vitro biofilm study

OBJECTIVE

to study the antibacterial effect of polymeric PolymP-n Active nanoparticles using an in vitro subgingival biofilm model.

METHODS

Hydroxyapatite discs coated with five modalities of nanoparticles (NPs): NPs, NPs doped with zinc, calcium, silver and doxycycline, PBS as control, and Streptococcus oralis, Actinomyces naeslundii, Veillonella parvula, Fusobacterium nucleatum, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans were studied in a static in vitro biofilm model (12, 24, 48, and 72h). Nano-roughness of the different disc surfaces (SRa, in nm) and morphological characteristic of the biofilms (thickness (μm) and bacterial viability) were studied by different microscopy modalities. Quantitative Polymerase Chain Reaction was used to assess the effect of the nanoparticles on the bacterial load (colony forming unit per milliliter) (CFUmL^-1). Analysis of variance and post-hoc testing with T3 Dunnett́s, and Student Newman Keuls correction was used. Results were considered statistically significant at p<0.05.

RESULTS

Surfaces containing the different nanoparticles showed significant increments in roughness when compared to controls (p<0.05). A similar biofilm formation and dynamics was observed, although reductions in bacterial viability were detected in biofilms in contact with the different nanoparticles, more pronounced with silver and doxycycline NPs. Doxycycline-NPs biofilms resulted in unstructured biofilm formation and significantly lower number of the six species when compared with the other nanoparticles specimens and controls (p<0.001 in all cases).

SIGNIFICANCE

Polymeric PolymP-n Active nanoparticles when combined with silver and doxycycline showed a significant antibacterial effect when tested in an in vitro subgingival biofilm model.

A precision medicine test predicts clinical response after idarubicin and cytarabine induction therapy in AML patients

Complete remission (CR) after induction therapy is the first treatment goal in acute myeloid leukemia (AML) patients and has prognostic impact. Our purpose is to determine the correlation between the observed CR/CRi rate after idarubicin (IDA) and cytarabine (CYT) 3 + 7 induction and the leukemic chemosensitivity measured by an ex vivo test of drug activity. Bone marrow samples from adult patients with newly diagnosed AML were included in this study. Whole bone marrow samples were incubated for 48 h in well plates containing IDA, CYT, or their combination. Pharmacological response parameters were estimated using population pharmacodynamic models. Patients attaining a CR/CRi with up to two induction cycles of 3 + 7 were classified as responders and the remaining as resistant. A total of 123 patients fulfilled the inclusion criteria and were evaluable for correlation analyses. The strongest clinical predictors were the area under the curve of the concentration response curves of CYT and IDA. The overall accuracy achieved using MaxSpSe criteria to define positivity was 81%, predicting better responder (93%) than non-responder patients (60%). The ex vivo test provides better yet similar information than cytogenetics, but can be provided before treatment representing a valuable in-time addition. After validation in an external cohort, this novel ex vivo test could be useful to select AML patients for 3 + 7 regimen vs. alternative schedules.

Melatonin expression in periodontitis and obesity: An experimental in-vivo investigation

BACKGROUND AND OBJECTIVE

Melatonin deficiency has been associated with obesity and systemic inflammation. This study aims to evaluate whether melatonin could interfere with the mechanisms of co-morbidity linking obesity and periodontitis.

MATERIAL AND METHODS

Twenty-eight male Wistar rats were randomly divided in 4 groups: control group (Con) (fed with standard diet); high-fat diet group (HFD) (fed with a diet containing 35.2% fat); Con group with induced periodontitis (Con-Perio) and HFD group with induced periodontitis (HFD-Perio). To induce periodontitis, the method of oral gavages with Porphyromonas gingivalis ATCC W83K1 and Fusobacterium nucleatum DMSZ 20482 was used. Circulating melatonin levels were analyzed by multiplex immunoassays. Periodontitis was assessed by alveolar bone loss (micro-computed tomography and histology) and by surrogate inflammatory outcomes (periodontal pocket depth, modified gingival index and plaque dental index).

RESULTS

Plasma melatonin levels were significantly decreased (P < .05) in the obese rats with periodontitis when compared with controls or with either obese or periodontitis rats. Alveolar bone loss increased 27.71% (2.28 µm) in HFD-Perio group compared with the Con group. The histological analysis showed marked periodontal tissue destruction with osteoclast activity, particularly in the HFD-Perio group. A significant negative correlation (P < .05) was found between periodontal pocket depth, modified gingival index and circulating melatonin levels.

CONCLUSION

Obese and periodontitis demonstrated significantly lower melatonin concentrations when compared with controls, but in obese rats with periodontitis these concentrations were even significantly lower when compared with either periodontitis or obese rats. These results may indicate that melatonin deficiency could be a key mechanism explaining the co-morbidity effect in the association between obesity and periodontitis.

Periodontal education and assessment in the undergraduate dental curriculum-A questionnaire-based survey in European countries

OBJECTIVES

This survey aimed to evaluate whether periodontal education and assessment in undergraduate dental curricula amongst the member countries of the European Federation of Periodontology (EFP) follow the competency-based curricular guidelines and recommendations developed by the Association for Dental Education in Europe.

MATERIALS AND METHODS

A multiple-choice questionnaire was emailed to 244 dental institutes amongst the 24 EFP member countries between November 2014 and July 2015.

RESULTS

Data were received from 16 (66.7%) EFP member countries. Out of 117 responding dental institutes, 76 (64.95%) were included as valid responders. In most of the institutes (86.3%), a minimum set of competencies in periodontology was taken into account when constructing their dental education programmes. Out of 76 responders, 98.1% included lecture-based, 74.1% case-based and 57.1% problem-based teaching in their periodontal curricula, whilst a minority (15.9%) also used other methods. A similar pattern was also seen in the time allocation for these four educational methods, that is, the highest proportion (51.8%) was dedicated to lecture-based teaching and only a small proportion (5.7%) to other methods. Periodontal competencies and skills were most frequently assessed by clinical grading on clinic, multiple-choice examination (written examination) and oral examination, whereas competency tests and self-assessment were rarely used. Only in 11 (14.5%) cases, access flap procedures were performed by students.

CONCLUSION

Great diversity in teaching methodology amongst the surveyed schools was demonstrated, and thus, to harmonise undergraduate periodontal education and assessment across Europe, a minimum set of recommendations could be developed and disseminated by the EFP.

Antimicrobial susceptibilities of Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis strains from periodontitis patients in Morocco

BACKGROUND AND OBJECTIVE

Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis have been frequently isolated in periodontitis patients in Morocco. Its persistence after the subgingival debridement of the biofilm has been correlated with worse clinical outcomes. The aim of this study was to evaluate the antimicrobial susceptibilities of A. actinomycetemcomitans and P. gingivalis, to amoxicillin, amoxicillin plus clavulanate, metronidazole, and azithromycin. In addition, microbiological profiles of patients harbouring A. actinomycetemcomitans, P. gingivalis, or both were compared.

MATERIAL AND METHODS

In 45 consecutive periodontitis Moroccan patients, subgingival samples were taken and processed by culture. Twenty-four A. actinomycetemcomitans and 30 P. gingivalis colonies were isolated (54 strains) and susceptibility tests, using the epsilometric method, were run for amoxicillin, amoxicillin plus clavulanate, metronidazole, and azithromycin. Minimum inhibitory concentrations for 50 (MIC50) and 90% (MIC90) of the organisms were calculated.

RESULTS

The prevalence of A. actinomycetemcomitans and P. gingivalis was 79.5 and 84.4%, respectively. A. actinomycetemcomitans showed susceptibility to amoxicillin, amoxicillin plus clavulanate, while 28% of the isolated strains were resistant to azithromycin and 61.7% towards metronidazole. No P. gingivalis resistance towards amoxicillin, amoxicillin plus clavulanate, metronidazole, and azithromycin was found.

CONCLUSION

A. actinomycetemcomitans and P. gingivalis were frequently detected in Moroccan patients with periodontitis, while antimicrobial resistance was only detected for A. actinomycetemcomitans to metronidazole and azithromycin.

CLINICAL RELEVANCE

A. actinomycetemcomitans resistance against some antimicrobials in periodontitis patients in Morocco can influence the selection of the therapeutic approaches.

Validation of a multiplex qPCR assay for the identification and quantification of Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis: In vitro and subgingival plaque samples

OBJECTIVE

To validate a multiplex qPCR (m-qPCR) assay for the simultaneous identification and quantification of Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis in subgingival samples.

MATERIAL AND METHODS

In vitro samples: DNA combinations of A. actinomycetemcomitans and P. gingivalis in similar or different concentrations were prepared. qPCR and m-qPCR were performed using the same primers and hydrolysis probes specific for 16SrRNA genes. Results were analyzed using intra-class (ICCs) and Lin's correlation coefficients (r) based on quantification cycle (Cq) values. Subgingival plaque samples: a cross-sectional study analyzing subgingival plaque samples harvested from periodontally-healthy and chronic periodontitis patients. Samples were processed by either qPCR or m-qPCR targeting both bacteria. Sensitivity, specificity, predictive values and Lińs correlation coefficients (r) were calculated using CFU/mL as primary outcome.

RESULTS

In vitro samples: m-qPCR yielded a good reproducibility (coefficients of variation around 1% and ICCs > 0.99) for both bacterial species. m-qPCR achieved detection limits and specificity similar to qPCR. An excellent concordance (r = 0.99) was observed between m-qPCR and qPCR for A. actinomycetemcomitans and P. gingivalis without statistical significant differences between both methods Subgingival plaque samples: a high sensitivity (above 80%) and specificity (100%) was obtained with the m-qPCR for both bacteria. The m-qPCR yielded a good concordance in Cq values, showing a good level of agreement between qPCR and m-qPCR.

CONCLUSION

The tested m-qPCR method was successful in the simultaneous quantification of A. actinomycetemcomitans and P. gingivalis, with a high degree of sensitivity and specificity on subgingival plaque samples.

Contour changes after guided bone regeneration of large non-contained mandibular buccal bone defects using deproteinized bovine bone mineral and a porcine-derived collagen membrane: an experimental in vivo investigation

OBJECTIVE

The objective of this study was to evaluate soft tissue contour changes after three different regenerative therapies in chronic ridge defects.

MATERIAL AND METHODS

Buccal bone defects were created in the mandible of nine beagle dogs. Augmentation procedures were performed 3 months later using a bone replacement graft (BRG), resorbable collagen membrane (MBG), or a combination of both procedures (CBG). Silicone impressions were taken before tooth extraction (T1), before the augmentation procedure (T2), and 3 months after the regenerative surgeries (T3). Casts were optically scanned and stereolithography files were superimposed to analyze the horizontal changes in ridge contours.

RESULTS

After defect creation, most part of the horizontal changes occurred 4 and 6 mm below the gingival margin. In the mesial defect (D1) at T3, the mean horizontal gain in MBG amounted to 0.47 ± 0.34 mm, 0.79 ± 0.67 mm in the BRG, and 0.87 ± 0.69 mm for the CBG. In the middle defect (D2), the mean changes for the MBG were 0.11 ± 0.31, 1.01 ± 0.91 for the BRG, and 0.98 ± 0.49 for the CBG. The mean changes in the distal defect (D3) amounted to 0.24 ± 0.72 for the MBG, 1.04 ± 0.92 for the BRG, and 0.86 ± 0.56 for the CBG. The differences reached significance in all defects for the comparison MBG-BRG and MBG-CBG, while similar parameters were observed for the comparison BRG-CBG.

CONCLUSION

BRG and CBG were equally effective and superior to MBG in increasing the horizontal tissue contours. The augmentation seldom reached the values before extraction.

CLINICAL RELEVANCE

Scaffolding materials are needed for contour augmentation when using resorbable collagen membranes.

Protected State Transfer via an Approximate Quantum Adder

We propose a decoherence protected protocol for sending single photon quantum states through depolarizing channels. This protocol is implemented via an approximate quantum adder engineered through spontaneous parametric down converters, and shows higher success probability than distilled quantum teleportation protocols for distances below a threshold depending on the properties of the channel.

Hematology oncology practice in the Asia-Pacific APHCON survey results from the 6th international hematologic malignancies conference: bridging the gap 2015, Beijing, China

This report serves as a snapshot of the state-of-knowledge in the Asia Pacific (APAC) Hematology Oncology community, and establishes a baseline for longitudinal investigations to follow changes in best practices over time. The objective of this study was to understand the approach to hematologic diseases, common standards of care and best practices, issues that remain controversial or debated, and educational or resource gaps that warrant attention. We used mobile application to disseminate and distribute questionnaires to delegates during the 6th international hematologic malignancies conference hosted by the APAC Hematology Consortium at Beijing, China. User responses were collected in an anonymous fashion. We report survey results in two ways: the overall responses, and responses as stratified between Chinese physicians and "Other" represented nationalities. Overall geographical concordance in survey responses was positive and strong. Perhaps more interesting than instances of absolute agreement, these data provide a unique opportunity to identify topics in which physician knowledge or opinions diverge. We assigned questions from all modules to broad categories of: patient information; diagnosis; treatment preference; transplantation; and general knowledge/opinion. On average, we observed a geographic difference of 15% for any particular answer choice, and this was fairly constant across survey modules. These results reveal utility and need for widespread and ongoing initiatives to assess knowledge and provide evidence-based education in real time. The data will be made more valuable by longitudinal participation, such that we can monitor changes in the state of the art over time.

[Circuit life span of continuous renal replacement therapy in critically ill patients with or without conventional anticoa-gulation: an observational prospective study]

BACKGROUND

The aim of this study was to describe the efficacy, security and viability of an anticoagulation system with continuous infusion of unfractionated heparin (UFH) versus one without any type of anticoagulant using 0.9% physiological saline washings, in critically ill patients with continuous renal replacement therapy (CRRT) and different risks of bleeding.

METHODS

From October 2013 to April 2015 we conducted an observational prospective study in the intensive care unit (ICU). Sixty-one patients with acute kidney injury (AKI) and requiring CRRT were included, with 122 filters. Patients and filters were divided in two groups: anticoagulated (AC) and not anticoagulated (No AC). The main outcome measure was filter life span. Different analytical parameters were also collected at the beginning of treatment and at the moment of circuit coagulation Results. The number of patients was similar in both groups. We did not find statistically significant differences between the two groups in filter life span (30.5 hours AC vs 34.9 hours No AC). Patients with increased morbidity (severe thrombocytopenia, coagulopathy, etc.) were included in the group that did not received anticoagulation but saline flushes.

CONCLUSIONS

CRRT without anticoagulation with saline flushes is a viable, safe and effective strategy in critically ill patients with high risk of bleeding. This approach achieves a circuit life span similar to that observed in anticoagulated patients with UFH; avoiding the risks and costs associated with anticoagulation.

Comparative gene expression analysis of Porphyromonas gingivalis ATCC 33277 in planktonic and biofilms states

Background and objective

Porphyromonas gingivalis is a keystone pathogen in the onset and progression of periodontitis. Its pathogenicity has been related to its presence and survival within the subgingival biofilm. The aim of the present study was to compare the genome-wide transcription activities of P. gingivalis in biofilm and in planktonic growth, using microarray technology.

Material and methods

P. gingivalis ATCC 33277 was incubated in multi-well culture plates at 37°C for 96 hours under anaerobic conditions using an in vitro static model to develop both the planktonic and biofilm states (the latter over sterile ceramic calcium hydroxyapatite discs). The biofilm development was monitored by Confocal Laser Scanning Microscopy (CLSM) and Scanning Electron Microscopy (SEM). After incubation, the bacterial cells were harvested and total RNA was extracted and purified. Three biological replicates for each cell state were independently hybridized for transcriptomic comparisons. A linear model was used for determining differentially expressed genes and reverse transcription quantitative polymerase chain reaction (RT-qPCR) was used to confirm differential expression. The filtering criteria of ≥ ±2 change in gene expression and significance p-values of <0.05 were selected.

Results

A total of 92 out of 1,909 genes (4.8%) were differentially expressed by P. gingivalis growing in biofilm compared to planktonic. The 54 up-regulated genes in biofilm growth were mainly related to cell envelope, transport, and binding or outer membranes proteins. Thirty-eight showed decreased expression, mainly genes related to transposases or oxidative stress.

Conclusion

The adaptive response of P. gingivalis in biofilm growth demonstrated a differential gene expression.