[Translated article] Pericapsular nerves block (PENG) is an effective and safe alternative for postoperative pain management after primary total hip arthroplasty: A randomised clinical trial

BACKGROUND

Postoperative pain after total hip arthroplasty can affect postoperative rehabilitation and delay hospital discharge. The objective of this study is to compare pericapsular nerves group (PENG) block with pericapsular infiltration (PAI) and plexus nerve block (PNB) for postoperative pain management, response to physical therapy, opioid consumption, and length of hospital stay after a primary total hip arthroplasty.

METHODS

Randomised clinical trial of parallel and blinded groups was performed. Sixty patients who underwent elective THA between December 2018 and July 2020 were randomised into the different groups (PENG, PAI and PNB). The visual analogue scale was used to assess pain; and motor function was measured with the Bromage scale. We also record opioid usage, length of hospital stay, and related medical complications.

RESULTS

Pain level at discharge was similar in all groups. Hospital stay was 1 day shorter in the PENG group (p<0.001) and they also had lower opioid consumption (p=0.044). Optimal motor recovery was similar in the groups (p=0.678). Pain control when performing physical therapy was better in the PENG group (p<0.0001).

CONCLUSIONS

PENG block is an effective and safe alternative for patients undergoing THA as it reduces opioid consumption and hospital stay compared to other analgesic methods.

Pericapsular nerves block (PENG) is an effective and safe alternative for postoperative pain management after primary total hip arthroplasty: A randomized clinical trial

BACKGROUND

Postoperative pain after total hip arthroplasty can affect postoperative rehabilitation and delay hospital discharge. The objective of this study is to compare pericapsular nerves group (PENG) block with pericapsular infiltration (PAI) and plexus nerve block (PNB) for postoperative pain management, response to physical therapy, opioid consumption, and length of hospital stay after a primary total hip arthroplasty.

METHODS

Randomized clinical trial of parallel and blinded groups was performed. Sixty patients who underwent elective THA between December 2018 and July 2020 were randomized into the different groups (PENG, PAI and PNB). The visual analog scale was used to assess pain; and motor function was measured with the Bromage scale. We also record opioid usage, length of hospital stay, and related medical complications.

RESULTS

Pain level at discharge was similar in all groups. Hospital stay was 1 day shorter in the PENG group (p<0.001) and they also had lower opioid consumption (p=0.044). Optimal motor recovery was similar in the groups (p=0.678). Pain control when performing physical therapy was better in the PENG group (p<0.0001).

CONCLUSIONS

PENG block is an effective and safe alternative for patients undergoing THA as it reduces opioid consumption and hospital stay compared to other analgesic methods.

Second litter syndrome in Iberian pig breed: factors influencing the performance

Second litter syndrome (SLS) consists of a loss of prolificacy in the second parity (P2), when a sow presents the same or lower results for litter size than in the first parity (P1). This syndrome has been reported for modern prolific breeds but has not been studied for rustic breeds. The objectives of this study are to determine how and to what degree Iberian sows (a low productivity breed recently raised on intensive farms) are affected by SLS; to establish a target and reference levels; and to assess the factors influencing the performance. Analysed data correspond to 66 Spanish farms with a total of 126 140 Iberian sows. The average Iberian sow prolificacy in P1 was 8.91 total born (TB) and 8.47 born alive (BA) piglets, whereas in P2, it decreased by -0.05 TB and -0.01 BA piglets, suggesting some general incidence of SLS. At the sow level, 56.63% did not improve prolificacy in terms of BA piglets in P2, and 16.98% had a clear decrease in prolificacy, losing ≥3 BA piglets in P2. Within herds, a mean of 57.75% of sows showed SLS, with an evident decrease in the number of BA piglets in P2. The plausible target for the Iberian farm's prolificacy comes from the quartile of farms with the lowest percentage of SLS sows within the farms with the highest prolificacy between P1 and P2 (mean of 8.77 BA). So, in this subset of farms (N = 17), 47.3% of sows improved their prolificacy in P2 (i.e. did not show SLS). Hence, half the sows could be expected to show SLS even on farms with a good performance. Finally, this study brings out the main factors reducing P2 prolificacy through SLS in the Iberian breed: later age at first farrowing, long first lactation length, medium weaning to conception interval and large litter size in P1. In conclusion, improving the reproductive performance of Iberian farms requires reducing the percentage of sows with SLS, paying special attention to those risk factors. The knowledge derived from this study can provide references for comparing and establishing objectives of performance on Iberian sow farms which can be used for other robust breeds.

Perfil clínico y microbiológico de bacteremia primaria por Streptococcus pneumoniae en pacientes pediatricos hospitalizados a la red de atención terciaria Neumocolombia. 2017 – 2019

Objetivo: Describir las características clínicas, microbiológicas y los desenlaces de las bacteriemias primarias por S. pneumoniae ocurridas en población pediátrica hospitalizada en instituciones de alta complejidad, pertenecientes a la Red Neumocolombia (2017-2019). Metodología: Estudio observacional, descriptivo, longitudinal, exploratorio con alcance analítico, en donde se tomó información de las historias clínicas con hemocultivos positivos para S. pneumoniae sin otro foco infeccioso, realizados en los hospitales pediátricos, reportados a la Red Neumocolombia (2017-2019). Resultados: Durante el periodo de estudio se analizó información de 51 registros, 62,7% fueron hombres, la mediana de edad fue 25 meses (RIC 9-49). El síntoma predominante fue fiebre (78,4%), se reportó vacunación con Vacuna Neumocócica Conjugada decavalente (PCV-10) en 47%. El serotipo más frecuente fue 19A (39,4%). El porcentaje de resistencia antibiótica fue: eritromicina 43%, penicilina 25.4%, cefotaxima 11,7%. Los factores relacionados al ingreso a Unidades de Cuidado Intensivo Pediátrico (UCIP) fueron: dolor pleurítico (OR27,9; IC95%3,13 – 248,16 p=0,03), tos (OR6,04; IC95%1,46 – 24,88; p=0,013), dolor abdominal (OR 6,5; IC95%1,85 – 22,80; p=0,003), dificultad respiratoria (OR12; IC95%2,95 – 48,77 p=0,001), tirajes (OR22,71; IC95%4,65 – 141,90 p=0,001), cianosis (OR8,69; IC95%1,95 – 38,65 p=0,004), hipotermia (OR42,62; IC95%4,77 – 380,74 p=0,001), serotipo 19A (OR3,9;IC95%1,10 – 13,81 p=0,035). La letalidad fue del 11,7%. Conclusión: Después de la introducción de la vacuna PCV10 en Colombia en el año 2012 se reportaron cambios en la epidemiologia, con disminución de los serotipos vacunales, y aumento en el serotipo 19A, siendo uno de los factores que intervienen en el ingreso a UCIP por bacteriemia primaria. Se reporta aumento en la resistencia por eritromicina, penicilina y cefotaxima.

POS0600 ANGIOGENIC T-CELL DEPLETION OCCURS DURING THE EARLIEST PHASES OF RHEUMATOID ARTHRITIS LINKED TO SUBCLINICAL VASCULAR STIFFNESS

Background

vascular insult accounts for the cardiovascular (CV) risk excess in rheumatoid arthritis (RA). Angiogenic T cells (Tang), which are responsible of vascular repair, have been described to be reduced in established RA with overt CV disease. However, whether Tang are altered during the earliest stage of the disease and related to subclinical CV findings is unknown.

Objectives

to evaluate circulating Tang levels in the very early stage of RA, including clinically suspect arthralgia (CSA), and their associations with subclinical CV endpoints (subclinical atherosclerosis and vascular stiffness).

Methods

84 RA patients (2010 EULAR/ACR classification criteria), 14 CSA individuals (EULAR criteria) and 28 matched healthy controls (HC) were recruited. All patients were untreated at the time of sampling. Tang (CD3+CD31+CXCR4+) frequency was assessed by flow cytometry in peripheral blood samples. Plaque occurrence, cIMT and stiffness parameters were analyzed by Doppler ultrasound in internal carotid, middle cerebral and basilar arteries. Lipoprotein analyses were performed by NMR.

Results

Tang were decreased in RA and CSA groups compared to HC (both p<0.010). Whereas Tang frequency was negatively correlated with very low density lipoproteins features (cholesterol and triglyceride content, size distribution and particle number) in HC and positively with HDL (cholesterol content and particle number), these associations were lacking in RA and CSA groups. Tang levels were not related to individual traditional CV risk factors, body mass index, wait circumference (all p>0.050) nor with the modified SCORE (r=-0.070, p=0.542) or Framingham Risk Score (r=-0.013, p=0.907). On the contrary, disease activity accounted for the Tang depletion observed in RA (b[95% CI]; DAS28: -0.436 [-0.306, -0.109], p=<0.001; SDAI: -0.020 [-0.032, -0.008], p=0.002). Tang levels were unrelated to the duration of the symptoms both in RA and CSA.

In RA patients, Tang frequency was not associated with atherosclerosis plaque occurrence (p=0.556) or cIMT (r=0.136, p=0.245). However, Tang paralleled stiffness parameters: vascular strain (VS, r=0.373, p=0.013), vascular distensibility (VD, r=0.479, p=0.004), vascular stiffness (VSf, r=-0.400, p=0.007) and pressure-strain elastic modulus (PSEM, r=-0.373, p=0.013). Finally, Tang frequency was an independent predictor of stiffness parameters after adjusting for mSCORE, body mass index, DAS28, RF and ACPA positivity: VS (β=0.415, p=0.035), VD (β =0.361, p=0.028), VSf (β =-0.322, p=0.033) and PSEM (β =-0.346, p=0.016).

Conclusion

Tang depletion is an early event along RA development, associated with disease-related parameters and unrelated to traditional risk factors. Tang may be the missing, functional link between disease activity and CV outcomes. Altered Tang levels may be an early biomarker of premature vascular stiffness during the first stages of the disease.

REFERENCES

Disclosure of Interests

None declared

[Lumbar plexus nerve block provides better analgesic management than periarticular infiltration in primary total hip arthroplasty. Comparative, prospective, and single-blind clinical trial]

INTRODUCTION

joint replacement is a highly effective intervention that significantly improves the patient's quality of life, relieves symptoms, restores joint function, and improves mobility and independence. The optimal pain control after total hip replacement has become an important goal of postoperative management. The purpose of this paper is to compare periarticular infiltration (PAI) and lumbar plexus nerve block (LPNB) for the management of post-operative pain in primary total hip arthroplasty because we believe that LPNB provides better analgesic management and lower opioid consumption. We evaluated the opioid usage during hospitalization and the complications derived from either technique.

MATERIAL AND METHODS

we randomized 45 patients who underwent elective total hip arthroplasty between January 2019 and January 2020. Two groups were evaluated based on the association of PAI or LPNB. Both as part of a multimodal analgesic regimen.

RESULTS

a total of 45 patients were evaluated (22 PAI group, 23 LPNB group). Block group required less opioid administration (p = 0.069). Most of the patients in both groups reported mild/moderate pain. The LPNB group had lower pain scale with physiotherapy. We did not have complications derived from either technique.

CONCLUSION

lumbar plexus nerve block (LPNB) in patients undergoing total hip arthroplasty provides better pain management and reduced opioid consumption compared to PAI. The performance of this technique does not delay the beginning of physiotherapy and there were not any issues with the patient's recovery.

Satisfaction and experience with colorectal cancer screening: a systematic review of validated patient reported outcome measures

BACKGROUND

Patient satisfaction or experience with colorectal cancer screening can determine adherence to screening programs. An evaluation of validated patient reported outcome measures (PROMs) for measuring experience or satisfaction with colorectal cancer screening does not exist. Our objective was to identify and critically appraise validated questionnaires for measuring patient satisfaction or experience with colorectal cancer screening.

METHODS

We conducted a systematic review following the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. We conducted searches on MEDLINE, EMBASE, PsychINFO, CINAHL and BiblioPRO and assessed the methodological quality of studies and measurement properties of questionnaires according to the COSMIN guidelines for systematic reviews of PROMs. PROSPERO registration number: CRD42019118527.

RESULTS

We included 80 studies that used 75 questionnaires, of which only 5 were validated. Four questionnaires measured satisfaction with endoscopy: two in the context of colorectal cancer screening (for colonoscopy and sigmoidoscopy) and two for non-screening endoscopy. One questionnaire measured satisfaction with bowel preparation. The methodological quality of studies was variable. The questionnaires with evidence for sufficient content validity and internal consistency were: the CSSQP questionnaire, which measures safety and satisfaction with screening colonoscopy, and the Post-Procedure questionnaire which measures satisfaction with non-screening endoscopic procedures.

CONCLUSIONS

This systematic review shows that a minority of existing PROMs for measuring patient satisfaction with colorectal cancer screening are validated. We identified two questionnaires with high potential for further use (CSSQP and the Post-Procedure questionnaire).

Headache as main reason for consultation to a hospital Emergency Department in Spain: a prospective study

INTRODUCTION

Headache is common in the general population and a frequent reason for medical consultation.

OBJECTIVES

To describe the characteristics of patients attending the Emergency Department (ED) for headache.

METHODS

A descriptive study with prospective collection of 100 consecutive patients over 15 years old who attended our ED due to headache as the main complaint.

RESULTS

Headache accounted for 1,4% of ED visits. The most common age range is between 31 and 45 years and the majority of the patients are females (61%). We diagnosed 67 primary and 33 secondary headaches. The most frequent diagnosis was migraine, with 36% of cases. One out of 3 patients had a history of headache and 4 out of 5 consulted by their own decision. Only a small percentage of patients were admitted as inpatients (12%), and 3 out of 5 were referred to Primary Care. Complementary tests were performed on 84% of the patients. One CT scan was performed for every 3 patients. A total of 80% patients was correctly diagnosed by the ED physicians.

CONCLUSIONS

Headache is a frequent complaint in the ED, where primary headaches are the most common with migraine being the most frequent reason for consultation. In our setting, there is a good screening and diagnosis of headaches, as well as an adequate use of the available resources in the ED for their diagnosis and management.

The Chilean socio-ethno-genomic cline

Studies of the current Chilean population performed using classical genetic markers have established that the Chilean population originated primarily from the admixture of European people, particularly Spaniards, and Amerindians. A socioeconomic-ethno-genetic cline was established soon after the conquest. Spaniards born in Spain or Chile occupied the highest Socioeconomic Strata, while Amerindians belonged to the lowest. The intermediate strata consisted of people with different degrees of ethnic admixture; the larger the European admixture, the higher the Socioeconomic Level. The present study of molecular genomic markers sought to calculate the percentage of Amerindian admixture and revealed a finer distribution of this cline, as well as differences between two Amerindian groups: Aymara and Mapuche. The use of two socioeconomic classifications - Class and Socioeconomic Level - reveals important differences. Furthermore, Self-reported Ethnicity (self-assignment to an ethnic group) and Self-reported Ancestry (self-recognition of Amerindian ancestors) show variations and differing relationships between socioeconomic classifications and genomic Amerindian Admixture. These data constitute a valuable input for the formulation of public healthcare policy and show that the notions of Ethnicity, Socioeconomic Strata and Class should always be a consideration in policy development.

Influence of social cognition as a mediator between cognitive reserve and psychosocial functioning in patients with first episode psychosis

BACKGROUND

Social cognition has been associated with functional outcome in patients with first episode psychosis (FEP). Social cognition has also been associated with neurocognition and cognitive reserve. Although cognitive reserve, neurocognitive functioning, social cognition, and functional outcome are related, the direction of their associations is not clear. Therefore, the main aim of this study was to analyze the influence of social cognition as a mediator between cognitive reserve and cognitive domains on functioning in FEP both at baseline and at 2 years.

METHODS

The sample of the study was composed of 282 FEP patients followed up for 2 years. To analyze whether social cognition mediates the influence of cognitive reserve and cognitive domains on functioning, a path analysis was performed. The statistical significance of any mediation effects was evaluated by bootstrap analysis.

RESULTS

At baseline, as neither cognitive reserve nor the cognitive domains studied were related to functioning, the conditions for mediation were not satisfied. Nevertheless, at 2 years of follow-up, social cognition acted as a mediator between cognitive reserve and functioning. Likewise, social cognition was a mediator between verbal memory and functional outcome. The results of the bootstrap analysis confirmed these significant mediations (95% bootstrapped CI (-10.215 to -0.337) and (-4.731 to -0.605) respectively).

CONCLUSIONS

Cognitive reserve and neurocognition are related to functioning, and social cognition mediates in this relationship.

THU0065 OXYLIPIN PROFILING DURING THE VERY EARLY PHASE OF RHEUMATOID ARTHRITIS: ASSOCIATIONS WITH DISEASE STAGE, CLINICAL FEATURES AND TREATMENT RESPONSE

Background:

traditional approaches and lipidomics support the relevance of eicosanoids in rheumatic conditions, such as rheumatoid arthritis (RA). Previous studies from our group and others have revealed altered levels of arachidonic acid in RA, pointing to a possible consumption or enhanced metabolisation. However, the potential alterations of its actual metabolites are difficult to assess with conventional approaches, and new, untargeted, high-throughput technologies are needed. More importantly, whether these alterations are related to the disease course and could be found at the very early stage of the disease is unknown.

Objectives:

to characterize the eicosanoid profiles during the earliest stages of RA and their potential clinical associations.

Methods:

60 very early RA patients (50 recruited at diagnosis and treatment-naïve) fulfilling 2010 ACR/EULAR criteria, 11 clinical suspect arthralgia (CSA) individuals and 28 healthy controls (HC) were recruited. Samples were collected at the moment of the diagnosis. Serum oxylipins profiles were analyzed by mass spectrometry (LC-MS/MS). Treatment-naïve patients underwent csDMARD treatment and were followed for 6 (n=49) and 12 months (n=38). Data analysis was performed in R and MetaboAnalyst.

Results:

A total of 75 oxylipins, mostly derived from arachidonic (AA), eicosapentanoic (EPA) and linoleic (LA) acid, were identified. No effect was observed for age, gender or BMI. Correlation and network analyses revealed different patterns among oxylipins across RA patients, CSA and HC (Figure 1A). The 8-HETrE, PGE3 and 20-HETE showed the pattern (linear increase) HC→CSA→RA (p=1.47·10-4, 5.34·10-4 and 5.68·10-4, respectively; and adjusted FDR<0.050) (Figure 1B). A PLS-DA (explaining 12.3% of the total variance, with a 71.0% cross-validation accuracy and permutation p=5·10-4) confirmed that oxylipins profiles differ among groups, although a certain overlap existed. A total of 22 oxylipins had VIP scores>1 (Figure 1C), which allowed the identification of two clusters (I and II). Cluster usage (I/II) differed among groups (p=0.003): HC (27/1), CSA (7/4) and RA (37/23). Patients exhibiting cluster II showed higher VAS global assessment (p=0.016) and pain (p=0.003) than their cluster I-counterparts. More importantly, cluster II patients were less likely to achieve DAS28 remission at 6 (12/17 vs 10/32, p=0.008) and 12 months (6/9 vs 9/29, p=0.066) upon conventional DMARD treatment compared to those showing cluster I.

OPLS-DA analyses revealed a good discrimination between CSA and HC groups, and 7 compounds (13-HODE, PGB2, 9-oxo-ODE, 12-oxo-ETE, 19,20-di-HDPA, 5-HETrE and 15-HEPE) were associated with the course HC->CSA. Different precursors (2 LA, 3 AAA, 1 EPA and 1 DHA) and pathways were noted (3 LOX, 4 CYP450). Regarding RA subsets, differences were noted by seropositivity. Whereas 9 compounds were associated with the pattern HC→seronegative RA (8-HETrE, PGE3, 20-HETE, 19,20-di-HDPA, PGEM, PGJ2, 12-oxo-LTB4, 14,15-EET and LTB4), a distinct set was observed for the pattern HC→seropositive RA (PGE3, 20-oh-PGE2, 5-HETE, PGE2, 12-oxo-ETE, 20-HETE, PGEM, 4-HDoHE, LTB4, 9-oxo-ODE, 12-oxo-LTB4, 8,9-EET). No differences in the major pathways were noted.

Conclusion:

Oxylipin networks differ across disease stages during the very early phase of RA, and can inform on specific signatures related to the disease progression. Oxylipins can delineate profiles with clinical relevance and are able to predict treatment response.

Figure:

Disclosure of Interests:

None declared

Clinical and subclinical cardiovascular disease in female SLE patients: Interplay between body mass index and bone mineral density

BACKGROUND AND AIMS

Since accelerated atherosclerosis has been reported in systemic lupus erythematosus (SLE), predictive biomarkers of cardiovascular disease (CVD) are needed. Among non-traditional risk factors, bone mineral density (BMD) has been related to CVD. However, its role in SLE remains controversial. This study aims to analyze the associations of subclinical atherosclerosis with traditional and non-traditional CV risk factors.

METHODS AND RESULTS

In a cross-sectional study, atherosclerosis burden was compared between 112 female SLE patients and 31 controls. Plaque number and carotid intima-media wall thickness (cIMT) were assessed by ultrasonography. In a retrospective study, BMD determinations obtained 5-years before the ultrasonography assessment were analyzed in a subgroup of 62 patients. Plaque frequency was increased in SLE, even in patients without CV events or carotid wall thickening. cIMT was increased in patients with CVD, positively correlated with body mass index (BMI). Interestingly, a paradoxical effect of BMI on carotid parameters was observed. Whereas underweight patients (BMI < 20) showed increased prevalence of carotid plaques with low cIMT, those with BMI > 30 showed higher cIMT and plaque burden. Overweight patients (25 < BMI<30) exhibited both elevated cIMT and plaque number. BMI was an independent predictor of BMD. In our retrospective study, patients with either clinical or subclinical CVD exhibited lower BMD levels than their CV-free counterparts. A low lumbar spine BMD independently predicted CVD development after adjusting for confounders.

CONCLUSION

SLE was associated with a higher subclinical atherosclerosis burden, a bimodal effect being observed for BMI. Decreased BMD can be a CV risk biomarker in SLE.

Lymphangiosarcoma in a Chronic Lymphedematous Limb: A Case Report

A 69-year-old-woman developed a lymphangiosarcoma of the limb on chronic lymphedema after radical mastectomy and radiotherapy for primary breast cancer 12 years before. Since 1948, when Stewart and Treves described this entity, 200 cases have been described. We report this case because of its extremely rare frequency. Concepts of etiology, treatment and prognosis are reviewed.

Outcome of Patients with Venous Thromboembolism and Factor V Leiden or Prothrombin 20210 Carrier Mutations During the Course of Anticoagulation

BACKGROUND

Individuals with factor V Leiden or prothrombin G20210A mutations are at a higher risk to develop venous thromboembolism. However, the influence of these polymorphisms on patient outcome during anticoagulant therapy has not been consistently explored.

METHODS

We used the Registro Informatizado de Enfermedad TromboEmbólica database to compare rates of venous thromboembolism recurrence and bleeding events occurring during the anticoagulation course in factor V Leiden carriers, prothrombin mutation carriers, and noncarriers.

RESULTS

Between March 2001 and December 2015, 10,139 patients underwent thrombophilia testing. Of these, 1384 were factor V Leiden carriers, 1115 were prothrombin mutation carriers, and 7640 were noncarriers. During the anticoagulation course, 160 patients developed recurrent deep vein thrombosis and 94 patients developed pulmonary embolism (16 died); 154 patients had major bleeding (10 died), and 291 patients had nonmajor bleeding. On multivariable analysis, factor V Leiden carriers had a similar rate of venous thromboembolism recurrence (adjusted hazard ratio [HR], 1.16; 95% confidence interval [CI], 0.82-1.64), half the rate of major bleeding (adjusted HR, 0.50; 95% CI, 0.25-0.99) and a nonsignificantly lower rate of nonmajor bleeding (adjusted HR, 0.66; 95% CI, 0.43-1.01) than noncarriers. Prothrombin mutation carriers and noncarriers had a comparable rate of venous thromboembolism recurrence (adjusted HR, 1.00; 95% CI, 0.68-1.48), major bleeding (adjusted HR, 0.75; 95% CI, 0.42-1.34), and nonmajor bleeding events (adjusted HR, 1.10; 95% CI, 0.77-1.57).

CONCLUSIONS

During the anticoagulation course, factor V Leiden carriers had a similar risk for venous thromboembolism recurrence and half the risk for major bleeding compared with noncarriers. This finding may contribute to decision-making regarding anticoagulation duration in selected factor V Leiden carriers with venous thromboembolism.

Pseudoautosomal abnormalities in terminal AZFb+c deletions are associated with isochromosomes Yp and may lead to abnormal growth and neuropsychiatric function

STUDY QUESTION

Are copy number variations (CNVs) in the pseudoautosomal regions (PARs) frequent in subjects with Y-chromosome microdeletions and can they lead to abnormal stature and/or neuropsychiatric disorders?

SUMMARY ANSWER

Only subjects diagnosed with azoospermia factor (AZF)b+c deletions spanning to the end of the Y chromosome (i.e. terminal deletions) harbor Y isochromosomes and/or cells 45,X that lead to pseudoautosomal gene CNVs, which were associated with abnormal stature and/or neuropsychiatric disorders.

WHAT IS KNOWN ALREADY

The microdeletions in the long arm of the Y chromosome (Yq) that include the loss of one to three AZF regions, referred to as Yq microdeletions, constitute the most important known etiological factor for primary spermatogenic failure. Recently, controversy has arisen about whether Yq microdeletions are associated with gain or loss of PAR genes, which are implicated in skeletal development and neuropsychiatric function.

STUDY DESIGN, SIZE, DURATION

We studied a cohort of 42 Chilean patients with complete AZF deletions (4 AZFa, 4 AZFb, 23 AZFc, 11 AZFb+c) from a university medical center, diagnosed over a period of 15 years. The subjects underwent complete medical examinations with special attention to their stature and neuropsychiatric function.

PARTICIPANTS/MATERIALS, SETTING, METHODS

All subjects were characterized for Yq breakpoints by PCR, and for CNVs in PARs by multiplex ligation-dependent probe amplification (MLPA), followed by qPCR analysis for genes in PAR1 (SHOX and ZBED1), PAR2 (IL9R) and two single copy genes (SRY and DDX3Y, respectively located in Yp11.3 and AZFa). In addition, karyotypes revision and fluorescence in situ hybridization (FISH) for SRY and centromeric probes for X (DXZ1) and Y (DYZ3) chromosomes were performed in males affected with CNVs.

MAIN RESULTS AND THE ROLE OF CHANCE

We did not detect CNVs in any of the 35 AZF-deleted men with interstitial deletions (AZFa, AZFb, AZFc or AZFb+c). However, six of the seven patients with terminal AZFb+c deletions showed CNVs: two patients showed a loss and four patients showed a gain of PAR1 genes, with the expected loss of VAMP-7 in PAR2. In these patients, the Yq breakpoints localized to the palindromes P8, P5 or P4. In the four cases with gain of PAR1, qPCR analysis showed duplicated signals for SRY and DDX3Y and one copy of IL9R, indicating isodicentric Yp chromosomes [idic(Y)] with breakpoint in Yq11.22. The two patients who had loss of PAR1, as shown by MLPA, had an additional reduction for SRY and DDX3Y, as shown by qPCR, associated with a high proportion of 45,X cells, as determined by FISH and karyotype. In agreement with the karyotype analysis, we detected DYZ3++ and DYZ3+ cells by FISH in the six patients, confirming idic(Y) and revealing additional monocentric Y chromosome [i(Y)]. Five patients had a history of major depressive disorders or bipolar disorder, and three had language impairment, whereas two patients showed severe short stature (Z score: -2.75 and -2.62), while a man with bipolar disorder was very tall (Z score: +2.56).

LARGE SCALE DATA

N/A.

LIMITATIONS, REASONS FOR CAUTION

The number of males studied with Y-chromosome microdeletions and normozoospermic controls with normal karyotypes may not be enough to rule out an association between AZF deletions and PAR abnormalities. The prevalence of Y isochromosomes and/or 45,X cells detected in peripheral blood does not necessarily reflect the variations of PAR genes in target tissues.

WIDER IMPLICATIONS OF THE FINDINGS

This study shows that CNVs in PARs were present exclusively in patients with terminal AZFb+c deletions associated with the presence of Y isochromosomes and 45,X cells, and may lead to neuropsychiatric and growth disorders. In contrast, we show that men with interstitial Yq microdeletions with normal karyotypes do not have an increased risk of PAR abnormalities and of phenotypical consequences. Moreover, our results highlight the importance of performing molecular studies, which are not considered in the usual screening for patients with Yq microdeletions.

STUDY FUNDING/COMPETING INTERESTS

This work was supported by the National Fund for Scientific and Technological Development of Chile (FONDECYT), grant no. 1120176 (A.C.). The authors declare that no conflicting interests exist.

Oestrogen activity of the serum in adolescents with Type 1 diabetes

AIMS

To assess serum oestrogen levels and oestrogenic activity in adolescents with Type 1 diabetes compared with a healthy control group.

METHODS

We conducted a cross-sectional study that evaluated adolescents with Type 1 diabetes (n = 38) and healthy adolescents (control group; n = 32). Serum oestrogens, urinary oestrogen metabolites and serum oestrogenic activity were assessed. Oestrogenic activity was evaluated in an in vitro cell proliferation assay using a modified E-screen assay with MCF-7/BUS cells.

RESULTS

Adolescents with Type 1 diabetes had lower oestrogenic activity levels in both phases of the menstrual cycle compared with the control group (follicular phase: 76 vs 94%; luteal phase: 97 vs 131%; P < 0.01), even after adjusting for BMI, oestradiol and oestrone levels. Postmenarcheal adolescents with Type 1 diabetes had lower oestradiol levels compared with control subjects in the follicular phase (63.3 pmol/l vs 89.4 pmol/l; P < 0.01) and higher oestrone levels compared with controls in the luteal phase (196 vs 151.9 pmol/l; P < 0.05).

CONCLUSIONS

Adolescents with Type 1 diabetes had lower levels of serum oestrogenic activity, and these were lower than expected based on their serum oestradiol levels. We postulate that changes in the serum milieu of oestrogens in patients with Type 1 diabetes may explain their decreased oestrogenic activity and may play a role in their adverse metabolic profile.

Diastolic dysfunction in the critically ill patient

Left ventricular diastolic dysfunction is a common finding in critically ill patients. It is characterized by a progressive deterioration of the relaxation and the compliance of the left ventricle. Two-dimensional and Doppler echocardiography is a cornerstone in its diagnosis. Acute pulmonary edema associated with hypertensive crisis is the most frequent presentation of diastolic dysfunction critically ill patients. Myocardial ischemia, sepsis and weaning failure from mechanical ventilation also may be associated with diastolic dysfunction. The treatment is based on the reduction of pulmonary congestion and left ventricular filling pressures. Some studies have found a prognostic role of diastolic dysfunction in some diseases such as sepsis. The present review aims to analyze thoroughly the echocardiographic diagnosis and the most frequent scenarios in critically ill patients in whom diastolic dysfunction plays a key role.

Epidemiology of systemic lupus erythematosus in a northern Spanish population: gender and age influence on immunological features

The present work was planned to research epidemiological and immunological features of systemic lupus erythematosus (SLE) in a Caucasian population from the north of Spain (Asturias). There is only one specialized immunology laboratory in this region where samples from all patients with a plausible or a firm diagnosis of SLE are referred for immunological analysis. Since 1992 we have reviewed registered data from samples submitted to the immunology laboratory with a firm, definitive diagnosis of SLE, based on the fulfillment of the American College of Rheumatology (ACR) criteria. We have constructed a database, which included 367 SLE patients. The point prevalencewas 34.12/100 000 (95% CI: 30.63-37.61/100 000), whereas the incidence rate calculated during the last five years was 2.15/100 000/year (95% CI: 1.76-2.54/100 000/year). The female/male ratio varied according to the age at diagnosis, being maximum (50: 1) between 22 and 28 years. The median age at diagnostis was significantly lower in females than in males. Immunological features also yielded sex and age peculiarities. The percentage of patients with anti-SSa antibodies yielded significant differences between males (18.6%) and females (34.6%). Anti-RNP and anti-Sm antibodies were more frequently present in childhood-onset patients, the difference with the oldest-onset group being statistically significant. Other analyses did not show significant differences, although, as a whole, we observed a trend towards a higher presence of autoantibodies related to an early disease onset.

A mycotoxin-dedicated total diet study in the Netherlands in 2013: Part II – occurrence

The occurrence of 59 natural toxins was determined in 88 composite food and drink samples of a mycotoxin-dedicated total diet study performed in the Netherlands in 2013. Composite food samples were prepared by pooling foods from a food category (as consumed, e.g. peeled, cooked, etc.) according to their consumption by population groups in the Netherlands. A multi-targeted method based on QuEChERs extraction, dilute and shoot and analysis by liquid chromatography-tandem mass spectrometry was applied to the 88 composite samples. Dedicated methods with lower detection limits for patulin, aflatoxins and trichothecenes were also applied to specific food types. Thirty samples (34%) were positive for one or more mycotoxins. Patulin, aflatoxin M1, zearalenone and plant toxins, with the exception of scopolamine in liquorice, were not detected in any of the composite samples. Aflatoxin B1 was only detected, but not at quantifiable levels, in the composites that contained peanuts. Fumonisin B1 was only found at 18 μg/kg in breakfast cereals consumed by the population group of 7-69 years, whereas ochratoxin A occurred at low levels around 1 μg/kg in liquorice, legumes and coffee. Grains and grain-based food composites were positive for ergot alkaloids, enniatins B and B1 and deoxynivalenol (DON). The levels of DON in the positive samples were lower compared to other studies, with the exception of breakfast cereals for infants with a DON concentration of 116 μg/kg. This specific composite sample may have contained an ingredient with a concentration exceeding the maximum legal limit of 200 μg/kg. Alternaria toxins (alternariol and alternariol methyl ether) were detected at levels ranging from 1.0 to 8.9 μg/kg in a number of composite samples, including tomato products, nuts, cereal products, chocolate and wine. Mycophenolic acid and roquefortine C cooccurred in mould-ripened cheese composites, while mycophenolic acid also was found in dried fruit and liquorice composite samples.

Cannabis and bipolar disorder: does quitting cannabis use during manic/mixed episode improve clinical/functional outcomes?

OBJECTIVE

To examine whether bipolar disorder patients who stop cannabis use during a manic/mixed episode have better clinical and functional outcomes than continued use or never use.

METHOD

Data from the European Mania in Bipolar Longitudinal Evaluation of Medication (EMBLEM), a 2-year prospective observational study in adults with a manic/mixed episode of bipolar disorder, was used. Three cannabis use groups were: current use (between 12-week and 24-month visits); no current but previous use (during first 12 weeks); and never use. Associations between cannabis use and outcomes were analyzed using regression models.

RESULTS

Of 1922 patients analyzed, 6.9% were current users, 4.6% previous users, and 88.5% never users. Clinical outcomes differed between groups (P<0.019): previous users had highest rates of remission (68.1%) and recovery (38.7%), and lowest rates of recurrence (42.1%) and relapse (29.8%). Logistic regression showed previous users had similar outcomes to never users (all P>0.05), whereas current users had lower recovery (P=0.004) and remission (P=0.014), higher recurrence (P=0.014), greater work impairment (P=0.016), and were more likely not to be living with partner (P=0.006) than never users.

CONCLUSION

Bipolar patients who stop using cannabis during manic/mixed episode have similar clinical and functional outcomes to never users, while continued use is associated with higher risk of recurrence and poorer functioning.

Microsatellite isolation and characterization for Colletotrichum spp, causal agent of anthracnose in Andean blackberry

The genus Colletotrichum, comprised of pathogenic fungi that affect plants grown worldwide, causes the disease known as anthracnose in several fruit and vegetable species. Several studies conducted on plants have shown that the disease is characterized by the presence of one or several species of the fungus attacking the fruit or other organs of the same host. To develop and implement effective control strategies, it is vital to understand the genetic structure of the fungus in agricultural systems, identify associated Colletotrichum species, and define the subpopulations responsible for the disease. Molecular tools were accordingly developed to characterize genotypic populations of Colletotrichum spp, causal agent of anthracnose in commercial crops of Andean blackberry (Rubus glaucus Benth.). A microsatellite-enriched library for Colletotrichum gloeosporioides was developed to identify and characterize microsatellite loci among isolates collected in R. glaucus plantations. Thirty microsatellites were developed and tested in 36 isolates gathered from eight different blackberry-production areas of Colombia. Ten pairs of microsatellites were polymorphic.

Inhibition of PKC-dependent extracellular Ca2+ entry contributes to the depression of contractile activity in long-term pressure-overloaded endothelium-denuded rat aortas

We examined the contractile responsiveness of rat thoracic aortas under pressure overload after long-term suprarenal abdominal aortic coarctation (lt-Srac). Endothelium-dependent angiotensin II (ANG II) type 2 receptor (AT₂R)-mediated depression of contractions to ANG II has been reported in short-term (1 week) pressure-overloaded rat aortas. Contractility was evaluated in the aortic rings of rats subjected to lt-Srac or sham surgery (Sham) for 8 weeks. ANG I and II levels and AT₂R protein expression in the aortas of lt-Srac and Sham rats were also evaluated. lt-Srac attenuated the contractions of ANG II and phenylephrine in the aortas in an endothelium-independent manner. However, lt-Srac did not influence the transient contractions induced in endothelium-denuded aortic rings by ANG II, phenylephrine, or caffeine in Ca²⁺-free medium or the subsequent tonic constrictions induced by the addition of Ca²⁺ in the absence of agonists. Thus, the contractions induced by Ca²⁺ release from intracellular stores and Ca²⁺ influx through stored-operated channels were not inhibited in the aortas of lt-Srac rats. Potassium-elicited contractions in endothelium-denuded aortic rings of lt-Srac rats remained unaltered compared with control tissues. Consequently, the contractile depression observed in aortic tissues of lt-Srac rats cannot be explained by direct inhibition of voltage-operated Ca²⁺ channels. Interestingly, 12-O-tetradecanoylphorbol-13-acetate-induced contractions in endothelium-denuded aortic rings of lt-Srac rats were depressed in the presence but not in the absence of extracellular Ca²⁺. Neither levels of angiotensins nor of AT₂R were modified in the aortas after lt-Srac. The results suggest that, in rat thoracic aortas, lt-Srac selectively inhibited protein kinase C-mediated activation of contraction that is dependent on extracellular Ca²⁺ entry.

Anti-ribosomal P antibodies are associated with elevated circulating IFNα and IL-10 levels in systemic lupus erythematosus patients

OBJECTIVE

The objective of this paper is to analyze the relationship of anti-protein ribosomal P (RibP) antibodies with circulating levels of IFNα, TNFα, IFNγ, IL-17 and IL-10 in SLE. Disease activity and other systemic lupus erythematosus (SLE) features were also analyzed.

METHODS

Anti-RibP and other SLE-related antinuclear antibodies (ANA) were determined by fluoro-enzyme immunoassay in the sera of 107 SLE patients. Circulating cytokines were quantified by flow cytometry (IFNα, IL-10 and IL-17) or ELISA (TNFα and IFNγ).

RESULTS

Anti-RibP-positive patients (14.9%) displayed significantly higher serum levels of IFNα (p = 0.023) and IL-10 (p = 0.016) than their negative counterparts. This cytokine upregulation was independent of the presence of other ANA even though, in our patient cohort, anti-dsDNA was found to be associated with anti-RibP (OR, CI 95%: 6.03, 1.32-27.93, p = 0.021) and to correlate with IL-10 levels (r = 0.204, p = 0.036). In fact, patients positive for anti-RibP but negative for anti-dsDNA exhibited the highest amounts of both IL-10 and IFN-α that were not related to disease activity since these patients showed lower SLEDAI than patients also positive for anti-dsDNA (p = 0.018). Anti-RibP positivity was also associated with early diagnosis, hypocomplementemia and leukopenia.

CONCLUSIONS

Presence of anti-RibP was found to be related to increased serum IFNα and IL-10 levels independently of both antibody status and disease activity.

Health care costs of complex perianal fistula in Crohn's disease

AIM

To evaluate the use of health care resources and the associated costs of complex perianal Crohn's disease (CD) from the National Health System perspective.

METHODS

We conducted a multicenter, retrospective, observational study in which gastroenterologists from 11 hospitals in the Community of Madrid took part. Data was collected on the direct healthcare resources (pharmacological treatments, surgical procedures, laboratory/diagnostic tests, visits to specialists and emergency departments, and hospitalizations) consumed by 97 adult patients with complex perianal CD which was active at some point between January 1, 2005, and case history review.

RESULTS

We recorded 527 treatments: 73.1% pharmacological (32.3% antibiotic, 20.5% immunomodulator, 20.3% biological) and 26.9% surgical. Mean annual global cost was €8,289/patient, 75.3% (€6,242) of which was accounted for by pharmacological treatments (€13.44 antibiotics; €1,136 immunomodulators; €5,093 biological agents), 12.4% (€1,027) by hospitalizations and surgery, 7.7% (€640) by medical visits, 4.2% (€350) by laboratory/diagnostic tests, and 0.4% (€30) by emergency department visits.

CONCLUSIONS

Pharmacological therapies, and in particular biological agents, are the main cost driver in complex perianal CD; costs due to surgery and hospitalizations are much lower.

Potential adverse effects of inorganic pollutants on clinical parameters of loggerhead sea turtles (Caretta caretta): results from a nesting colony from Cape Verde, West Africa

A large number of nesting loggerhead sea turtles (n = 201) were sampled to establish the blood levels of 11 elements (Cu, Mn, Pb, Zn, Cd, Ni, Cr, As, Al, Hg, and Se). Almost all of the samples showed detectable levels of these 11 elements, and Zn and Se exhibited the highest concentrations (median values as high as 6.05 and 2.28 μg/g, respectively). The median concentrations of the most toxic compounds, As, Cd, Pb, and Hg, were relatively low (0.38, 0.24, 0.06, and 0.03 μg/g, respectively). We also determined the haematological and biochemical parameters in a subsample of 50 turtles to evaluate the potential effects of these contaminants on clinical parameters and found several associations. Our study reinforces the usefulness of blood for the monitoring of the levels of contaminating elements and their adverse effects on blood parameters in sea turtles.

A new β⁰-thalassemia frameshift mutation [β 48 (-T)] in a Uruguayan family

We describe here a new frameshift mutation of β-thalassemia in a Uruguayan family with Italian ancestry [β48 (-T); HBB:c.146delT]. This frameshift results in formation of premature stop codon (TGA) 40 bp downstream and in a short unstable product that is degraded in the cell.

Increased fertilization rates after in vitro culture of frozen-thawed testicular immotile sperm in nonobstructive azoospermic patients

Objective. To optimise the use of freeze/thaw testicular immotile spermatozoa from nonobstructive azoospermia patients and to analyse the outcome of intracytoplasmic sperm injection (ICSI) of such spermatozoa. Methods. Testicular specimens were retrieved and cryopreserved from forty patients with nonobstructive azoospermia and underwent one cycle with thawed spermatozoa (Group I) that led to pregnancy in sixteen cases. Twenty-four patients of group I underwent treatment with the same batch of thawed spermatozoa (Group II). For the first ICSI attempt, injection was performed when motile spermatozoa were found. In group II, injection was performed when maximum motility was reached. We compared mean of fertilization rate, embryo quality, clinical pregnancy rate and embryo implantation rate. Results. The mean percentage of motility was significantly higher in the group II than in the group I (18, 6 versus 8, 2). Group I showed a significant decrease in fertilization rates when compared with cryopreserved testicular spermatozoa in group II (54% versus 72%, P < 0.05). No difference was noted between the cleavage rate, embryo quality, clinical pregnancy rates and implantation rates among group II and I. Conclusion. Fecundation rate can be significantly improved after in-vitro culture and sperm selection of frozen-thawed immotile testicular spermatozoa in patients with nonobstructive azoospermia.

Evaluation of yogurt and various beverages as carriers of lactic acid bacteria producing 2-branched (1,3)-β-D-glucan

Probiotic cultures are increasingly being incorporated into a wide variety of food products. Although lactobacilli and bifidobacteria are the most frequently used, other lactic acid bacteria (LAB) have been reported to be potential probiotics. Of these, the cider isolates Pediococccus parvulus (strains 2.6 and CUPV22) and Lactobacillus suebicus CUPV221 produce a 2-branched (1,3)-β-d-glucan exopolysaccharide that decreases serum cholesterol levels and affects the activation of human macrophages. For this reason, these 3 strains were incorporated into yogurt, orange juice, and 2 juice-milk beverages to evaluate the effect of the food matrix on the resistance of these strains to simulated gastrointestinal tract conditions. Our results showed that incorporation of the LAB did not significantly affect the physical and rheological properties of the food matrices tested. When incorporated in yogurt, LAB strains population decreased by 2 to 3 log orders of magnitude during the shelf life of the product (28 d). However, no significant decrease was observed in the juice and juice-milk beverages during the same storage period, except for Lb. suebicus, whose viability decreased by 3 log orders of magnitude. When strains were subjected to gastrointestinal tract conditions, a decrease in the survival was observed at the lower pH (1.8). However, incorporation of these LAB strains into orange juice increases their resistance to lower pH conditions, thus improving survival to gastrointestinal stress. Moreover, a protective effect was observed for P. parvulus CUPV22 and 2.6 to gastric stress in juice-milk beverages and to gastrointestinal stress in yogurt. Lactobacillus suebicus CUPV221 did not survive when incorporated into yogurt and juice-milk beverage.

Molecular and flow cytometry characterization during the follow-up of three simultaneous lymphoproliferative disorders: hairy cell leukemia, monoclonal B-cell lymphocytosis, and CD4(++) /CD8(+/- dim) T-large granular lymphocytosis--a case report

The simultaneous diagnosis of hairy cell leukemia and monoclonal B-cell lymphocytosis with the characteristics of "indolent" chronic lymphocytic leukemia is rare but not unknown. However, an association with a third clonal lymphoproliferative disorder has not previously been described. We report the simultaneous presence of hairy cell leukemia, monoclonal B-cell lymphocytosis, and alpha beta CD4(++) /CD8(+) T-cell large granular lymphocytosis in a 63-year-old man. After the diagnosis, the three lymphoproliferative disorders (i.e., two of B-cell lineage and one of T-cell lineage) were characterized by analysis of multiple sequential bone marrow and peripheral blood samples using flow cytometry and molecular techniques. We discuss these findings in the context of chronic antigen stimulation, immunosuppression, and apoptotic pathway alterations, which might be implicated in the accumulation of these abnormal clones in the same patient. Because the phenotype of the three clones is compatible with fully differentiated B lymphocytes (consistent with a postgerminal origin) and T-CD4(++) cells, we favor the possibility of an antigen-driven mechanism and a dysregulation of homeostatic apoptosis in this patient.

Optimization and development of analytical methods for the determination of new brominated flame retardants and polybrominated diphenyl ethers in sediments and suspended particulate matter

With more stringent legislation on brominated flame retardants, it is expected that increasing amounts of substitutes would replace polybrominated diphenylethers (PBDEs). Therefore, the development and optimization of analytical methodologies that allow their identification and quantification are of paramount relevance. This work describes the optimization of an analytical procedure to determine pentabromochlorocyclohexane, tetrabromo-o-chlorotoluene, 2,3,5,6-tetrabromo-p-xylene, tetrabromophthalic anhydride, 2,3,4,5,6-pentabromotoluene, tris(2,3-dibromopropyl)phosphate, decabromodiphenylethane and 1,2-bis(2,4,6-tribromophenoxy)ethane together with PBDEs in sediments and in suspended particulate matter. This method comprises a pressurized liquid extraction followed by three cleanup steps (gel permeation chromatography and solid phase extraction on Oasis™ HLB and on silica cartridges). Gas chromatography-mass spectrometry, using electron capture negative chemical ionization, is used for the final analysis. The proposed method provides recoveries >85%. The method was applied to sediment and suspended particulate matter samples from different locations in the Western Scheldt estuary (the Netherlands). To the best of our knowledge, this is the first time that the occurrence of the additive flame retardants 2,3,5,6-tetrabromo-p-xylene, 3,4,5,6-tetrabromo-o-chlorotoluene and 2,3,4,5,6-pentabromochlorocyclohexane is reported in the literature. The concentrations of these new flame retardants ranged from 0.05 to 0.30 μg/kg dry weight.

Anti-inflammatory effect of Lithrea molleoides extracts and isolated active compounds

AIM OF THE STUDY

In this study the anti-inflammatory activity of aqueous, dichloromethane (CH₂Cl₂) and methanolic (MeOH) extracts and two major compounds isolated from Lithrea molleoides (Vell.) Engl. (Anacardiaceae) were evaluated.

MATERIALS AND METHODS

Two classical experimental models were used, carrageenan-induced rat paw edema and 12-O-tetradecanoylphorbol-13 acetate (TPA) induced mouse ear edema.

RESULTS

MeOH extracts exhibited a significant systemical anti-inflammatory effect in the carrageenan (inhibition of 46% at 3 h) and in the TPA-ear edema test (inhibition of 21%). The presence of methyl gallate (inhibition of 63% in TPA ear edema), as one of the main compounds in the active fraction from MeOH extract may be explained the effect observed. Also, 1,3-dihydroxy-(Z,Z)-5-(tridec-4',7́dienyl) benzene obtained from CH₂Cl₂ extract showed a significant topical anti-inflammatory activity (inhibition of 68%). Furthermore, no signs of toxicity were observed with doses up to 3g/kg in an acute toxicity assay.

CONCLUSIONS

The results of this study present evidence that Lithrea molleoides given either systemically or topically has anti-inflammatory properties.

Observational transversal study to relate functional status and age with the doublet or triplet chemotherapy based on capecitabine in advanced gastric cancer patients

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Background: The available evidence suggests that selection of treatment for advanced gastric cancer (AGC) correlates with age and ECOG PS. This study was conducted to analyze whether previously mentioned variables are relevant for the choice of doublet or triplet regimens with capecitabine and determining prognosis.

Methods: Multicenter, cross-sectional, observational study in patients with AGC who received at least 2-cycles of capecitabine-based doublet or triplet chemotherapy, with or without measurable disease. The age, as a continuous and categorical (> 64 vs ≤ 64) variable, and ECOG PS were analyzed by logistic regression.

Results: A total of 175 patients were evaluated. Median age 65.5 (56-72) years, male: 68% ECOG 0/1/2: 32.7%/55.6%/11.1%. 33% underwent doublet and 67% triplet chemotherapy. Tumour histology: signet-ring cell carcinoma (29%), papillary (13%), mucinous (12%) and tubular (3.5%). Most common sites of metastases: lymph nodes (48%), peritoneum (41%), liver (38%) and lung (12%). Multivariante analysis demonstrated that age ≤ 64 (OR 2.326; p = 0.016) and ECOG 0 (vs 2) (OR 3.937; p = 0.016) were risk factors for the choice of triplet chemotherapy, and failed to show an association between ECOG 1 and regimen. While in patients underwent triplet regimen 51% were aged ≤ 64 and 49% > 64, in those treated with doublet these rates were 32% and 68% respectively; (p = 0.016, Chi-square test). A statistical difference was found for ECOG 0/1/2/4 and regimen chosen. Concretely, among patients who received triplet regimen, 15% had ECOG 2 and 85% ECOG 0 while in case of doublet regimen these rates changed to 43 and 57%; (p = 0.01, Fisher's exact test). Main grade 1/2 capecitabine-related toxicities: diarrhea (10%), mucositis (7%), hand-foot syndrome (5%) and emesis (4%). Most frequent grade 3 were diarrhea in 5% and emesis, asthenia and febrile neutropenia in 2%. No toxicity grade 4 occurred.

Conclusions: Age ≤ 64 years and ECOG 0 are risk factors of choice of capecitabine-based triplet chemotherapy in AGC. These results support previous reports showing that age and ECOG PS are associated with treatment choices for AGC.

No significant financial relationships to disclose.