POS0200 POST-mRNA VACCINE FLARES IN AUTOIMMUNE INFLAMMATORY RHEUMATIC DISEASES: INTERIM RESULTS FROM THE CORONAVIRUS NATIONAL VACCINE REGISTRY FOR IMMUNE DISEASES SINGAPORE (CONVIN-SING)

Background

Published data suggest no increased rate of flare of autoimmune inflammatory rheumatic diseases (AIIRD) after COVID-19 mRNA vaccination; however, the studies are limited by small sample size, short follow up or at risk of selection bias (voluntary physician reports or patient surveys).

Objectives

To study flares of AIIRD within three months of the first dose of an anti-SARS-COV2 mRNA vaccine.

Methods

A retrospective cohort study of consecutive AIIRD patients ≥ 12 years old, across six public hospitals in Singapore who received at least one dose of an mRNA (Pfizer/BioNTech or Moderna) vaccine. Data were censored at the first post-vaccine clinic visit when the patient had flared or if ≥ three months had elapsed since the first dose of the vaccine, whichever came first. Predictors of flare were determined by Cox proportional hazards analysis and time to flare was examined using a Nelson Aalen cumulative hazard estimate (Figure 1).

Figure 1.

Nelson-Aalen curve of flares over time

Results

2339 patients (74% Chinese, 72% female) of median (IQR) age 64 (53, 71) years were included in the interim analysis (Table 1). 2112 (90%) had the Pfizer/BioNTech vaccine and 195 (8%) had Moderna, with a median (IQR) interval of 21 (21, 23) days between the two doses. The most common AIIRD diagnoses were Rheumatoid arthritis (1063, 45%), Psoriatic arthritis (296, 12.6%) and Systemic lupus erythematosus (SLE) (288, 12.3%). 186 (8%) were treated with biologics/ targeted disease modifying agents. 2125 (91%) patients were in low disease activity or remission. Treatment was interrupted for vaccination in only 18 (0.8%) patients. Seven (0.3%) patients had previous COVID-19 infection.

Table 1.

Patient characteristics

Baseline characteristicsNo flares(n = 1887, %)Flares within 0—3 months of 1st vaccine dose (n= 272, %)Flares outside of 0 – 3 months after 1st vaccine dose (n = 180, %)Age (median years, IQR)64 (53, 71)61 (50, 69)65 (55, 71)RaceChinese1386 (73)206 (76)129 (72)Malay193 (10)28 (10)20 (11)Indian195 (10)27 (10)26 (14)GenderFemale1367 (72)200 (74)117 (65)Vaccine typePfizer/BioNTech1713 (92)239 (90)160 (90)Moderna149 (8)28 (10)18 (10)DiagnosisRheumatoid Arthritis831 (44)139 (51)93 (52)Systemic Lupus Erythematosus269 (14)20 (7)9 (5)Psoriatic Arthritis225 (12)42 (15)29 (16)Spondyloarthropathies141 (7)21 (7)17 (9)Sjogren’s Syndrome114 (6)15 (6)8 (4)Systemic sclerosis94 (5)4 (1)6 (3)Baseline Physician Disease ActivityRemission1007 (53)99 (36)63 (35)Low Disease Activity731 (39)128 (47)97 (54)Moderate Disease Activity134 (7)40 (15)20 (11)High Disease Activity15 (1)5 (2)0

452 (19%) flares were recorded during 9798.8 patient-months [4.6/100 patient-months, median (IQR) follow up duration 4.2 (3.3, 5.3) months], of which 272 (11.6%) patients flared within the 3-month period of interest and 180 (7.7%) flared outside of the 3-month period (Table 1). Median (IQR) time-to-flare was 40.5 (18, 56.6) days. 60 (22.1%) were mild and self-limiting, 170 (62.5%) were mild-moderate and 42 (15.4%) were severe. 190 (69.8%) of those who flared required escalation of treatment and 15 (5.5%) required hospital admission. 239 (10.2%) had improved disease activity after the vaccine.

On multivariate Cox regression analysis, patients in the oldest age tertile [median (IQR) 74 (71, 79) years] were less likely to flare [HR 0.80 (95% CI 0.63, 1.00), p = 0.05] Patients with inflammatory arthritis (compared with connective tissue disease, vasculitis and others) and patients with baseline active disease were more likely to flare [HR 1.72 (95% CI 1.35, 2.20), p < 0.001 and 1.82 (95% CI 1.39, 2.39), p < 0.001 respectively]

Conclusion

There was a moderately high rate of AIIRD flares after mRNA vaccination; however, there was no clustering of flares in the immediate post-vaccine period to suggest causality. Older patients were less likely to flare, while those with inflammatory arthritis and active disease at baseline were more likely to flare.

Disclosure of Interests

Margaret Ma Grant/research support from: Support grant from multiple companies for the Singapore Biologics registry, Amelia Santosa Speakers bureau: Amgen Talk, Consultant of: Pfizer ad board, Kok Ooi Kong: None declared, Chuanhui Xu: None declared, Johnston Tang Gin Xiang: None declared, Gim Gee Teng Speakers bureau: Boehringer Ingleheim, Anselm Mak Speakers bureau: J&J and GSK, Grant/research support from: GSK - the supported studies programme, Sen Hee Tay: None declared, Victoria Wei Wen Ng: None declared, Joshua Zhi En Koh: None declared, Warren Fong Speakers bureau: speaker for Abbvie, DKSH, GSK, Novartis, Li-Ching Chew Speakers bureau: pfizer and Abbvie, Consultant of: Pfizer and Abbvie Advisory Board meeting, Grant/research support from: Abbvie educational grant for ultrasound conference, Andrea Low Speakers bureau: Boehringer Ingeilheim, Consultant of: Consultant/steering group committee for BI and J&J, annie law: None declared, Yih Jia Poh: None declared, Siaw Ing Yeo Grant/research support from: Multiple pharmaceutical companies for the support of the National Biologics Registry, Ying Ying Leung Speakers bureau: Abbvie, DKSH, Jassen, Novartis and Pfizer, Wei-Rui Goh: None declared, Chuah Tyng Yu: None declared, Nur Emillia Roslan: None declared, Stanley Angkodjojo Speakers bureau: Boehringer Ingeilheim, Consultant of: Abbvie and DKSH, Kee Fong Phang: None declared, Thaschawee Arkachaisri: None declared, Melonie Sriranganathan: None declared, Teck Choon TAN: None declared, Peter Cheung Consultant of: Ad board for Boehringer Ingleheim, novartis, janssen and abbvie, Grant/research support from: Novartis, Manjari Lahiri Speakers bureau: J&J, DSKH, Consultant of: DSKH, Gilead, Grant/research support from: Multiple pharma companies contributed to the Singapore Biologics registry

Novartis

POS1411 EARLY IDENTIFICATION OF AXIAL SPONDYLOARTHRITIS IN A MULTI-ETHNIC ASIAN POPULATION

Background:

To facilitate earlier diagnosis of spondyloarthritis (SpA), we have previously cross-culturally adapted a self-administered screening questionnaire.

Objectives:

We aimed to improve the sensitivity of this questionnaire as a screening tool by comparing various scoring methods.

Methods:

Subjects newly referred to a rheumatology clinic self-administered the questionnaire before seeing a rheumatologist. Identification of axial SpA by the questionnaire using original scoring (Method A) and scoring based on Assessment of SpondyloArthritis International Society (ASAS) inflammatory back pain (IBP) criteria (Method B), ASAS referral criteria (Method C), ASAS classification criteria (Method D) and a combination of ASAS referral and classification criteria (Method E) were compared to classification by the ASAS classification criteria and diagnosis by rheumatologist. Since Methods B-E were based on SpA features, we compared self-reported vs rheumatologist-documented features in subjects with axial SpA.

Results:

Of 1418 subjects (age: 54 ± 14 years, female: 73%), 39 were classified as axial SpA cases by classification criteria. Methods A-E yielded sensitivities of 39%, 72%, 67%, 49% and 85%, respectively, among patients newly referred to the rheumatology clinic (Table 1). Rheumatologist-documented clinical SpA features exceeded self-report for IBP (62 vs 44%) and uveitis (15 vs 5%). The reverse was true for arthritis (21 vs 80%), enthesitis (28 vs 33%), dactylitis (3 vs 18%), good response to NSAIDs (33 vs 41%) and family history for SpA (5 vs 10%).

Table 1.

Performance of the five scoring methods for the cross-culturally adapted Hamilton axial SpA questionnaire.

Scoring methodSensitivity(95% confidence interval)Specificity(95% confidence interval)Positive predictive value(95% confidence interval)Negative predictive value(95% confidence interval)Method A38.5(23.4 – 55.4)93.7(92.3 – 94.9)14.7(8.5 – 23.1)98.2(97.3 – 98.8)Method B71.8(55.1 – 85.0)73.1(70.7 – 75.4)7.0(4.7 – 10.0)98.9(98.1 – 99.5)Method C66.7(49.8 – 80.9)77.8(75.5 – 80.0)7.8(5.2 – 11.3)98.8(98.0 – 99.4)Method D48.7(32.4 – 65.2)74.9(72.5 – 77.2)5.2(3.2 – 8.0)98.1(97.1 – 98.8)Method E84.6(69.5 – 94.1)37.2(34.6 – 39.8)3.7(2.5 – 5.1)98.8(97.5 – 99.6)

Method A: the original scoring defined by the questionnaire developers; Method B: a scoring based on the ASAS IBP criteria; Method C: a scoring based on the ASAS referral criteria; Method D: a scoring based on the ASAS classification criteria for axial and peripheral SpA; Method E: a scoring based on a combination of the ASAS referral and classification criteria.

Conclusion:

A self-administered questionnaire scored based on a combination of ASAS referral and classification criteria achieved high sensitivity in identifying axial SpA in subjects referred to a rheumatology clinic. This supports its evaluation as a screening tool for axial SpA in the general population.

References:

[1]Xiang L, Teo EPS, Low AHL, Leung YY, Fong W, Xin X, et al. Cross-cultural adaptation of the Hamilton axial spondyloarthritis questionnaire and development of a Chinese version in a multi-ethnic Asian population. Int J Rheum Dis. 2019;22(9):1652-60.

[2]Sieper J, Rudwaleit M, Baraliakos X, Brandt J, Braun J, Burgos-Vargas R, et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Annals of the rheumatic diseases. 2009;68 Suppl 2:ii1-44.

[3]Poddubnyy D, van Tubergen A, Landewe R, Sieper J, van der Heijde D. Development of an ASAS-endorsed recommendation for the early referral of patients with a suspicion of axial spondyloarthritis. Annals of the rheumatic diseases. 2015;74(8):1483-7.

[4]Rudwaleit M, van der Heijde D, Landewe R, Akkoc N, Brandt J, Chou CT, et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Annals of the rheumatic diseases. 2011;70(1):25-31.

Acknowledgements:

This work was supported by a Health Services Research Grant (HSRG) from the Singapore Ministry of Health National Medical Research Council [grant number: NMRC/HSRG/0075/2017].

Disclosure of Interests:

None declared

POS1413 INTERVAL BETWEEN SYMPTOM ONSET AND DIAGNOSIS AMONG PATIENTS WITH AUTOIMMUNE RHEUMATIC DISEASES IN A MULTI-ETHNIC ASIAN POPULATION

Background:

The interval between symptom onset and diagnosis can often be longer than is ideal in autoimmune rheumatic diseases (ARDs).

Objectives:

We aimed to characterise this interval among patients newly diagnosed with ARDs in a multi-ethnic Asian population and to identify factors associated with a longer interval.

Methods:

We used Scott’s model of pathways to treatment to characterise the interval between symptom onset and diagnosis into 4 intervals: #1 between symptom onset and first seeking medical attention, #2 between first medical attention and rheumatology referral, #3 between rheumatology referral and first rheumatology assessment, and #4 between first rheumatology assessment and diagnosis. Linear regression models were used to identify factors associated with a longer the overall interval between symptom onset and diagnosis and Interval #1.

Results:

Among 259 patients (age: 51±15 years, female: 71%, most common three ARDs: rheumatoid arthritis (n = 75), axial spondyloarthritis (n = 40) and psoriatic arthritis (n = 35)), the median overall interval was 11.5 months. Interval #1 (median = 4.9 months) was significantly longer than the other intervals (Table 1). Patients with axial spondyloarthritis had a significantly longer overall interval (median = 38.7 months) and Interval #1 (median = 26.6 months) compared to patients with RA (median = 7.6 and 3.5 months, respectively), PsA (median = 7.0 and 2.6 months, respectively) and the other ARDs. Gender was the only patient-related factor significantly associated with the overall interval (reference = male, coefficient = -15.3, p = 0.033) in regression models.

Conclusion:

A longer than ideal interval between symptom onset and diagnosis was observed among patients with ARDs. This was primarily due to a relatively long interval between symptom onset and first seeking medical attention, and highlights the importance of interventions targeting patients prior to first medical attention in reducing the duration between symptom onset and diagnosis.

References:

[1]Scott SE, Walter FM, Webster A, Sutton S, Emery J. The model of pathways to treatment: conceptualization and integration with existing theory. Br J Health Psychol. 2013;18(1):45-65.

Table 1.

Interval between symptom onset and diagnosis

Overall interval, months, median (lower and upper quartiles)†Interval #1, months, median (lower and upper quartiles)Interval #2, months, median (lower and upper quartiles)Interval #3, months, median (lower and upper quartiles)Interval #4, months, median (lower and upper quartiles)Overall(n = 259)11.5(4.7 – 36.0)4.9(1.0 – 24.0)0.3(0.0 – 3.9)1.5(0.8 – 1.8)0.0(0.0 – 1.2)RA(n = 75)7.6(3.1 – 14.8)3.5(1.3 – 11.6)0.2(0.0 – 2.5)1.3(0.6 – 1.6)0.0(0.0 – 0.2)AxSpA(n = 40)38.7(9.6 – 66.7)26.6(4.2 – 56.1)1.6(0.0 – 7.6)1.6(1.2 – 2.3)0.0(0.0 – 2.0)PsA(n = 35)7.0(3.0 – 28.4)2.6(0.2 – 11.3)0.5(0.2 – 3.9)1.6(0.6 – 1.7)0.0(0.0 – 0.0)Seronegative IA(n = 21)12.0(4.7 – 22.8)6.4(1.9 – 34.4)0.1(0.0 – 4.6)1.4(1.3 – 1.5)0.0(0.0 – 0.8)SjS(n = 27)14.2(6.0 – 48.0)4.6(0.6 – 19.0)0.3(0.0 – 3.9)1.6(0.9 – 1.9)0.8(0.0 – 2.3)UCTD(n = 27)15.7(5.1 – 39.8)2.2(0.7 – 24.0)0.8(0.1 – 8.1)1.6(0.5 – 1.8)1.2(0.0 – 2.1)Other ARDs(n = 34)8.1(5.3 – 36.0)6.3(0.9 – 31.7)0.2(0.0 – 1.1)1.5(1.2 – 1.8)0.3(0.0 – 1.1)

Overall interval and Intervals #1-4: refer to abstract for definitions; RA: rheumatoid arthritis; axSpA: axial spondyloarthritis; PsA: psoriatic arthritis; IA: inflammatory arthritis; SjS: Sjögren’s syndrome; UCTD: undifferentiated connective tissue disease; other ARDs: systemic lupus erythematosus, systemic sclerosis, idiopathic inflammatory myopathies, palindromic rheumatism and overlap syndromes.

†Intervals #1-4 did not sum to the overall interval mainly due to the fact that Intervals #1-4 might not available for all patients.

Disclosure of Interests:

None declared

AB0699 RESIDUAL DISEASE BURDEN PRESENT IN AXIAL SPONDYLOARTHRITIS AND PSORIATIC ARTHRITIS PATIENTS ACHIEVING LOW DISEASE ACTIVITY STATES

Background:

Despite achieving Low Disease Activity (LDA) states, patients with SpondyloArthritis (SpA) may have considerable residual disease. Sparse data is currently available from Asia.

Objectives:

We aimed to evaluate the burden of residual disease in patients with axial SpondyloArthritis (axSpA) or Psoriatic Arthritis (PsA) who achieved LDA.

Methods:

We used data from a registry of SpA from an outpatient setting in a tertiary hospital in Singapore. For axSpA, LDA was defined as Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) <4/10. For PsA, LDA was defined by achieving 5/7 cutoffs in the Minimal Disease Activity (MDA) or clinical Disease Activity index for Psoriatic Arthritis (cDAPSA) ≤13.

Results:

From 262 cases of axSpA (21% women; mean ± standard deviation (SD) age 42 ± 14 years), 58% of patients achieved LDA states. While from 142 cases of PsA (49% women; mean ± SD age 51 ± 14 years), 38% and 63% achieved MDA and cDAPSA LDA, respectively. Both axSpA and PsA patients with LDA had pain scores range from 17.2 to 25.7/100 and fatigue scores from 3.3 to 3.5/10. (Table 1). Substantial burden in physical disability and mental well-being were seen as a low physical and mental component summary of SF-36. cDAPSA classified nearly twice as many PsA patients into LDA than MDA. Compared to PsA patients in MDA, PsA patients in cDAPSA LDA had higher pain scores, Patient Global Assessment (PtGA), dactylitis, and enthesitis. axSpA patients in LDA classified by BASDAI had the highest pain and fatigue scores, and PtGA.

Table 1.

Residual disease burden in patients with axSpA and PsA who have achieved LDA

axSpAPsALDA (n=153)LDA by MDA (n=54)LDA by cDAPSA (n=90)Age, years¥42.2 (14.0)52.5 (13.2)52.5 (13.2)Female, n (%)26 (17.0)30 (55.6)45 (50.0)TJC¥0.1 (0.3)0.8 (1.0)1.0 (1.4)SJC¥0.1 (0.3)0.7 (1.3)0.9 (1.3)VAS-pain (0-100)¥25.7 (19.0)17.2 (17.8)20.8 (16.7)BASDAI (0-10)¥2.3 (1.0)2.4 (1.6)2.7 (1.7)BASDAI fatigue (0-10)¥3.5 (2.2)3.3 (2.3)3.4 (2.3)PtGA (0-100)¥27.8 (19.5)20.9 (17.9)23.5 (17.6)Dactylitis (0-20)¥–0.3 (0.5)0.5 (0.9)LEI (0-6)¥–0.1 (0.4)0.2 (0.5)HAQ (0-3)¥0.1 (0.1)0.1 (0.2)0.2 (0.4)HAQ < 0.5, n (%)149 (97.4)52 (96.3)77 (85.6)SF-36 PCS¥46.8 (9.9)45.8 (11.5)45.1 (11.7)SF-36 MCS¥46.4 (11.2)46.1 (11.3)45.6 (10.6)

axSpA, axial Spondyloarthritis; PsA, Psoriatic Arthritis; LDA, Low Disease Activity; MDA, Minimal Disease Activity; cDAPSA, clinical Disease Activity index for Psoriatic Arthritis; TJC, tender joint count; SJC, swollen joint count; VAS, Visual Analog Scale; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; PtGA, patient’s global assessment; LEI, Leeds Enthesitis Index; HAQ, Health Assessment Questionnaire; SF-36, Short-Form 36; SF-36 PCS, norm-based Physical Component Summary (mean=50, SD=10); SF-36 MCS, norm-based Mental Component Summary (mean=50, SD=10)

¥mean (SD)

Conclusion:

Despite being in LDA, axSpA and PsA patients experienced substantial pain, fatigue and poorer functional health and mental well-being.

Disclosure of Interests:

Venice Liu: None declared, Warren Fong Consultant of: Abbvie, Janssen, Novartis, Speakers bureau: Abbvie, Janssen, Novartis, Yu Heng Kwan: None declared, Ying Ying Leung Speakers bureau: Novartis, Janssen, Eli Lilly

SAT0371 ARE ENGLISH-LANGUAGE VIDEOS ON YOUTUBE A USEFUL SOURCE OF INFORMATION FOR SPONDYLOARTHRITIS?

Background:

Spondyloarthritis (SpA) is a family of chronic inflammatory disorders. Social media, such as YouTube, is a popular online platform where patients often visit for information. However, the validity of the content uploaded onto YouTube is not known.

Objectives:

This study aimed to evaluate the content, reliability and quality of the most viewed English-language YouTube videos on SpA.

Methods:

Keywords “spondyloarthritis”, “spondyloarthropathy” and “ankylosing spondylitis” were searched on YouTube on October 7th, 2019. The top 270 videos were screened. Videos were excluded if they were irrelevant, in non-English language or if they had no audio. Total number of views, duration on YouTube (days), video length, upload date, number of likes, dislikes, subscribers and comments were recorded for videos. A modified 5-point DISCERN tool1and the 5-point Global Quality Scale (GQS) score2were used to assess the reliability and quality of the videos, with higher scores indicating greater reliability and quality respectively.

Results:

Two hundred of 270 videos were included in the final analysis [61.5% from healthcare professionals, 37.0% from patients, 1.5% from news channels]. Of the 200 videos, 15 were uploaded within the last year and 112 in the last five years. 120 (60%) were categorized as useful information (Group 1), 6 (3%) as misleading information (Group 2), 52 (26%) as useful patient opinion (Group 3) and 22 (11%) as misleading patient opinion (Group 4). Useful videos were mainly from healthcare professionals or patients (86%). Useful videos (Group 1 and 3) had higher median (IQR) number of subscribers [2700 (14700) vs 211 (457), p < 0.01], reliability scores [3 (1) vs 2 (1), p < 0.01] and GQS scores [3 (1) vs. 2 (1), p < 0.001] compared to misleading videos (Group 2 and 4), respectively.

Videos uploaded by healthcare professionals tended to have more useful information [94% (116 of 123) vs. 66% (49 of 74), p < 0.001] and had higher median (IQR) reliability scores [3 (1) vs 2 (1), p < 0.001] and GQS scores [3 (2) vs 2 (1), p < 0.001] compared to patient uploaded videos respectively. Of the 5 (out of 123) videos from healthcare professionals that had misleading information, it was because of outdated information on diagnosis (3 videos) and treatment (5 videos) of SpA. Of the 22 videos that had misleading patient opinion, 9 (41%) wrongly described the clinical features for SpA and 14 (64%) portrayed the current evidence based treatment options as ineffective and described alternative treatment plans (i.e. diet restrictions, complementary and alternative medicine).

Conclusion:

The majority of English language YouTube videos have useful information on the topic of SpA, however, 31% of patient opinions have inaccurate information on the clinical features and treatment options, and viewers need to be cognisant of these “fake news”.

References:

[1]Charnock D, Shepperd S, Needham G, Gann R (1999) DISCERN: an instrument for judging the quality of written consumer health information on treatment choices. J Epidemiol Community Health 53(2): 105-111

[2]Bernard A, Langille M, Hughes S, Rose C, Leddin D, Veldhuyzen van Zanten S (2007) A systematic review of patient inflammatory bowel disease information resources on the World Wide Web. Am J Gastroenterol 102(9):2070-2077

Disclosure of Interests:

Sakktivel Elangovan: None declared, Yu Heng Kwan: None declared, Warren Fong Consultant of: Abbvie, Janssen, Novartis, Speakers bureau: Abbvie, Janssen, Novartis

THU0569 PHYSICAL ACTIVITY IN AXIAL SPONDYLOARTHRITIS AND RHEUMATOID ARTHRITIS: A CROSS-SECTIONAL STUDY IN A SOUTH-EAST ASIAN COHORT

Background:

Axial spondyloarthritis (AxSpA) and rheumatoid arthritis (RA) are two common rheumatic diseases that can result in joint damage and deformities, leading to reduced physical function and quality of life. Physical activity (PA) and exercise have been shown to improve general well-being and reduce cardiovascular risk in patients with AxSpA and RA, and are part of the non-pharmacological management in the EULAR guidelines. Despite this, PA levels are reduced in AxSpA and RA patients1,2. In addition, it has also been reported that Asians have lower levels of PA3.

Objectives:

This study aims to examine the patterns of PA in a multi-ethnic Asian cohort.

Methods:

This was a cross-sectional study conducted between May 2016 and Jan 2017. Consecutive patients with AxSpA and RA were recruited at an outpatient rheumatology clinic at Singapore General Hospital, the largest tertiary hospital in Singapore. Controls were based on a previous cross-sectional study4. PA was assessed using the Global Physical Activity Questionnaires (GPAQ) developed by the world health organization (WHO)5.

Results:

74 AxSpA and 69 RA patients were recruited and compared to 886 controls. AxSpA patients were younger (median age [IQR], 37.0 [26.3] years) and predominantly male (75.7%), while RA patients were the oldest (median age [IQR], 59.0 [16.5] years) and predominantly female (81.2%). BMI was similar between all three groups. RA patients had more comorbidities (such as hypertension, hyperlipidemia, diabetes mellitus) compared to AxSpA patients and controls.

All three groups had similar proportion of participants meeting WHO recommendations for PA (AxSpA = 77.0%, RA = 79.7%, controls = 83.1%, p=0.35) and median (IQR) time (95% CI) of PA per day [60 (107.1) vs 57.9 (122.9) vs 51.4 (94.3), p=0.93). More AxSpA patients had a high level of sedentary activity compared to RA or controls (AxSpA = 56.8%, RA = 23.2%, controls = 7.2%, p < 0.01). When comparing AxSpA and RA patients with inactive disease or in remission versus active disease, levels of PA did not differ between the 2 groups (p=0.33).

Conclusion:

Levels of PA did not differ significant between AxSpA and RA patients compared to the general population, and disease activity levels did not affect the level of PA in patients with AxSpA and RA. Of note was that patients with AxSpA and RA demonstrated higher levels of sedentary activity compared to the general population. Improving PA and decreasing sedentary activity could reduce the cardiovascular risk, especially in patients with RA.

References:

[1]Summers G, Booth A, Brooke-Wavell K, Barami T, Clemes S. <p>Physical activity and sedentary behavior in women with rheumatoid arthritis: a comparison of patients with low and high disease activity and healthy controls</p>.Open Access Rheumatol Res Rev. 2019;Volume 11:133-142. doi:10.2147/oarrr.s203511

[2]Sundstrom B, Ekergård H, Sundelin G. Exercise habits among patients with ankylosing spondylitis.Scand J Rheumatol. 2002;31(3):163-167. doi:10.1080/rhe.31.3.163.167

[3]Lip GY, Luscombe C, McCarry M, Malik I, Beevers G. Ethnic differences in public health awareness, health perceptions and physical exercise: implications for heart disease prevention.Ethn Health. 1996;1(1):47-53. doi:10.1080/13557858.1996.9961769

[4]Win AM, Yen LW, Tan KH, Lim RBT, Chia KS, Mueller-Riemenschneider F. Patterns of physical activity and sedentary behavior in a representative sample of a multi-ethnic South-East Asian population: A cross-sectional study.BMC Public Health. 2015;15(1):1-11. doi:10.1186/s12889-015-1668-7

[5]Bull FC, Maslin TS, Armstrong T. Global physical activity questionnaire (GPAQ): Nine country reliability and validity study.J Phys Act Heal. 2009;6(6):790-804. doi:10.1123/jpah.6.6.790

Disclosure of Interests:

Andrew Khor: None declared, Chin Teck Ng: None declared, Warren Fong Consultant of: Abbvie, Janssen, Novartis, Speakers bureau: Abbvie, Janssen, Novartis

FRI0328 PROFILING OF THE IMMUNE COMPARTMENT IN THE TISSUE ENVIRONMENT OF PSORIATIC ARTHRITIS USING RNASEQ

Background:

Psoriasis is a chronic inflammatory disease of the skin with a reported prevalence of 0.09-11.4% of the population (1). 1 in 4 psoriasis patients also have psoriatic arthritis (PsA) (2), with additional joint involvement that can be associated with significant morbidity. Despite its relative commonness, the aetiology of psoriasis is not well understood, and there is no cure for this disease. Additionally, up to 30% of PsA patients with active disease are recalcitrant to treatment. Thus it remains a prerogative to understand the immune mechanisms contributing to the development of the disease in order to inform strategies for novel therapies.

Objectives:

Our aim was to identify perturbations in local tissue immune networks that could contribute to the pathology of psoriasis and psoriatic arthritis. We hypothesise that psoriasis is driven by a disrupted tissue microenvironment, which then provides cues to a susceptible peripheral immune system to drive pathology. Thus as the first part of our study, we investigated the transcriptional profiles of normal and lesional skin.

Methods:

Skin punch biopsies were obtained from both lesional and morphologically normal skin of 4 PsA patients with active disease. CD45+ cells were isolated using magnetic enrichment for RNA purification and subsequent RNAseq. Differently expressed genes (DEG) were identified and pathway analysis performed using the integrated Differential Expression and Pathway (iDEP) analysis tool. Gene set enrichment analysis was performed using GSEA.

Results:

Transcriptomic analyses of skin revealed that lesional skin, compared to non-lesional sites, was enhanced for expression of genes associated with immune processes (including genes such as such asIL17A,FCN1, andCTLA4) anti-microbial responses (such asDEF4BAandS100A8) and immune cell chemotaxis (notablyCXCL13andSELPLG), suggesting a possible inflammatory response to skin microbiota. Interestingly, lesional skin showed a deficiency in expression of genes associated with tRNA metabolic processes (includingAARS,YARS, and other aminoacyl tRNA synthetases), suggesting a possible defect in protein translation. Similarly, pathway analysis revealed an enrichment in humoral immune response pathways in PsA lesional skin, and a comparative deficiency in RNA metabolic pathways.

Conclusion:

Our transcriptional approach provides a comprehensive overview of localised immunity in psoriasis and predicts intimate interactions with the peripheral immune system. Further studies are ongoing to uncover cell types involved, as well as parallels at other disease sites (joints). These findings will facilitate the identification of novel targets for treatment of PsA.

References:

[1]World Health Organization (2016).Global report on psoriasis. [Online] (https://apps.who.int/iris/bitstream/handle/10665/204417/9789241565189_eng.pdf.psoriasis;jsessionid=54912784D28C9F36ECCD45471AC5775B?sequence=1,accessed 24 January 2020)

[2]Alinaghi F., Calov M., Kristensen L.E., Gladman D.D, Coates L.C., Julien D., Gottlieb A.B., Gisondi P., Wu J.J., Thyssen J.P., Egeberg A. (2019) Prevalence of psoriatic arthritis in patients with psoriasis: A systemic review and meta-analysis of observational and clinical studies.Journal of the American Academy of Dermatology.,80(1), 251-265.

Disclosure of Interests:

Gladys Ang: None declared, Pavanish Kumar: None declared, Dianyan Guo: None declared, Ahmad Lajam: None declared, Warren Fong Consultant of: Abbvie, Janssen, Novartis, Speakers bureau: Abbvie, Janssen, Novartis, Ying Ying Leung Speakers bureau: Novartis, Janssen, Eli Lilly, Salvatore Albani: None declared

AB0836 PREVALENCE AND DETERMINANTS OF FATIGUE IN PSORIATIC ARTHRITIS IN AN ASIAN POPULATION

Background:

Fatigue is one of the core domains to be measured in all clinical trials for psoriatic arthritis (PsA). Studies of fatigue in PsA in Asia are scarce.

Objectives:

To describe the prevalence and evaluate the factors associated with fatigue in PsA patients within a multi-ethnic Asian population.

Methods:

We used data from the PRESPOND registry for PsA patients attending an outpatient clinic of a tertiary institution in Singapore. Demographics data and disease characteristics were evaluated. Fatigue was assessed by question 1 of BASDAI (BASDAI-F) and the vitality domain of SF-36 (SF-36 VT).

Results:

131 patients (50.4% men, 63.4% Chinese, median PsA duration 1.78 years) with completed data for fatigue were included. The median (IQR) tender and swollen joint count was 2 (5) and 1 (3) respectively. 45 patients (34%) experienced high fatigue (defined by BASDAI-F ≥ 6/101,2). 5 clusters of factors were identified using principal component analysis that explained 66.2% of the variance of all factors, which mapped to disease activity, disease chronicity, demographics (ethnicity and gender), and BMI (Figure 1). Of these, disease activity and chronicity were significantly associated with BASDAI-F and SF-36 VT. In a multivariate analysis, back pain, peripheral joint pain and patient global assessment were associated with BASDAI-F, whereas peripheral joint pain, HAQ-DI, age and BMI were associated with SF-36 VT (Table 1).

Table 1.

Multivariable analysis for variables associated with fatigue

BASDAI-FSF-36 VTb95% CIβpb95% CIβpBack pain (0-10)0.335(0.180, 0.490)0.356<0.001----Peripheral joint pain (0-10)0.027(0.012, 0.042)0.2680.001-2.296(-3.410, -1.182)-0.320<0.001PGA (0-100)0.211(0.061, 0.361)0.2360.006----HAQ-DI (0-3)-----12.74(-17.97, -7.51)-0.386<0.001Age, y----0.260(0.065, 0.456)0.1790.009BMI, kg/m2-----0.644(-1.183, -0.105)-0.1650.020Figure 1.

Principal component analysis with 5 components and residuals (in dotted lines). Only factor loadings with magnitudes greater than 0.40 are shown.

Conclusion:

PsA-associated fatigue is prevalent in this Asian PsA cohort and is associated with disease activity and chronicity.

References:

[1]Gudu T, Etcheto A, de Wit M, Heiberg T, Maccarone M, Balanescu A, et al. Fatigue in psoriatic arthritis - a cross-sectional study of 246 patients from 13 countries. Joint Bone Spine. 2016;83(4):439-43.

[2]Walsh JA, McFadden ML, Morgan MD, Sawitzke AD, Duffin KC, Krueger GG, et al. Work productivity loss and fatigue in psoriatic arthritis. J Rheumatol. 2014;41(8):1670-4.

Disclosure of Interests:

Joel Shi Quan Tan: None declared, Warren Fong Consultant of: Abbvie, Janssen, Novartis, Speakers bureau: Abbvie, Janssen, Novartis, Yu Heng Kwan: None declared, Ying Ying Leung Speakers bureau: Novartis, Janssen, Eli Lilly

Association between beta-blocker use and obesity in Hong Kong Chinese elders: a post-hoc analysis

INTRODUCTION

Studies of Caucasian populations have shown that beta-blockers may exacerbate weight gain, a risk factor for many chronic diseases. Still, beta-blockers are the most prescribed antihypertensives in the Chinese population in Hong Kong. We aimed to explore the association between beta-blocker use, hypertension, and weight status of this population.

METHODS

A post-hoc analysis regarding body mass index (BMI) and the use of beta-blockers was performed based on the medication profile of community-dwelling older adults. Participants' BMI, hypertension diagnosis, name, dose, frequency, route of administration of beta-blockers, and other drugs that may alter body weight were recorded.

RESULTS

Of 1053 Chinese individuals aged ≥65 years (mean age 76.9±7.2 years, 80% female) from 32 elderly centres in Hong Kong, 18% (185/1053) of them consumed beta-blockers. That group also had a significantly larger proportion of obese individuals (45.9% vs 32.1%, P=0.002). After adjusting for other weight-altering drugs, beta-blockers remained a significant predictor of overweight and obesity (P=0.001). As the hypertensive population had significantly higher BMI than the normotensive population (24.3±3.6 vs 22.9±3.5, P<0.001), a sub-analysis on those with hypertension diagnosis confirmed that only the hypertensive population taking atenolol had a significantly larger population of obese individuals (BMI ≥25) compared with those who took metoprolol (58.9% vs 38.5%, P=0.03) and those who did not take any beta-blockers (58.9% vs 38.4%, P=0.007).

CONCLUSIONS

Our findings taken together with other guideline reservations cast doubt on whether beta-blockers, particularly atenolol, should be the major drug prescribed to older adults with hypertension.

A systematic review of factors affecting medication adherence among patients with osteoporosis

The aim of this review was to identify factors that influence patients' adherence to anti-osteoporotic therapy. Factors identified that were associated with poorer medication adherence included polypharmacy, older age, and misconceptions about osteoporosis. Physicians need to be aware of these factors so as to optimize therapeutic outcomes for patients.

INTRODUCTION

To identify factors that influence patients' adherence to anti-osteoporotic therapy.

METHODS

A systematic review of literature was performed for articles published up till January 2018 using PubMed®, PsychINFO®, Embase®, and CINAHL®. Peer-reviewed articles which examined factors associated with anti-osteoporotic medication adherence were included. Classes of anti-osteoporotic therapy included bisphosphonates, parathyroid hormone-related analogue, denosumab, selective estrogen receptor modulators, estrogen/progestin therapy, calcitonin, and strontium ranelate. Meta-analyses, case reports/series, and other systematic reviews were excluded. Identified factors were classified using the World Health Organization's five dimensions of medication adherence (condition, patient, therapy, health-system, and socio-economic domains).

RESULTS

Of 2404 articles reviewed, 124 relevant articles were identified. The prevalence of medication adherence ranged from 12.9 to 95.4%. Twenty-four factors with 139 sub-factors were identified. Bisphosphonates were the most well-studied class of medication (n = 59, 48%). Condition-related factors that were associated with poorer medication adherence included polypharmacy, and history of falls was associated with higher medication adherence. Patient-related factors which were associated with poorer medication adherence included older age and misconceptions about osteoporosis while therapy-related factors included higher dosing frequency and medication side effects. Health system-based factors associated with poorer medication adherence included care under different medical specialties and lack of patient education. Socio-economic-related factors associated with poorer medication adherence included current smoker and lack of medical insurance coverage.

CONCLUSION

This review identified factors associated with poor medication adherence among osteoporotic patients. To optimize therapeutic outcomes for patients, clinicians need to be aware of the complexity of factors affecting medication adherence.

An audit on technical quality of root fillings performed by undergraduate students

AIM

To evaluate radiographically the technical quality of root fillings performed by undergraduate dental students and to assess whether students were exposed to an appropriate endodontic case mix during their clinical training.

METHODOLOGY

A retrospective audit was undertaken evaluating the clinical records of patients who underwent endodontic procedures during the period from September 2015 to June 2016 in the Dental School at Queen's University Belfast, UK. Two final-year dental students were trained and calibrated to evaluate postoperative intra-oral periapical radiographs of completed root canal treatments using specific assessment criteria. Data were presented as frequencies, percentage and mean ± standard deviation (SD). Comparisons of treatment outcomes between groups (posterior and anterior teeth) were calculated using Fisher's exact test, and the level of significance was set at P < 0.05. Intra- and interexaminer reproducibility was assessed by Kappa statistics.

RESULTS

A total of 222 teeth and 381 canals were assessed, and of those, 253 (66%) of the root fillings were found to be acceptable in all the assessment parameters, namely taper, length and lateral adaptation of the root filling. Subanalysis of individual root filling parameters revealed that 372 canals (97%) exhibited good taper, and 275 canals (72%) were considered to be of an appropriate length, with 89 canals (23%) found to be underfilled and 17 canals (5%) overfilled. Overall 346 (91%) of canals had good lateral condensation. Students treated both single and multirooted teeth, and there was no significant association between tooth type and the quality of root filling provided (P > 0.05).

CONCLUSIONS

In the majority of the teeth treated by undergraduate students at Queen's University Belfast, the technical quality of the root filling was acceptable and students were exposed to an appropriate case mix for endodontic training.

Ejection of the Massive Hydrogen-rich Envelope Timed with the Collapse of the Stripped SN 2014C

We present multi-wavelength observations of SN 2014C during the first 500 days. These observations represent the first solid detection of a young extragalactic stripped-envelope SN out to high-energy X-rays ~40 keV. SN 2014C shows ordinary explosion parameters (Ek ~ 1.8 × 1051 erg and Mej ~ 1.7 M⊙). However, over an ~1 year timescale, SN 2014C evolved from an ordinary hydrogen-poor supernova into a strongly interacting, hydrogen-rich supernova, violating the traditional classification scheme of type-I versus type-II SNe. Signatures of the SN shock interaction with a dense medium are observed across the spectrum, from radio to hard X-rays, and revealed the presence of a massive shell of ~1 M⊙of hydrogen-rich material at ~6 × 1016 cm. The shell was ejected by the progenitor star in the decades to centuries before collapse. This result challenges current theories of massive star evolution, as it requires a physical mechanism responsible for the ejection of the deepest hydrogen layer of H-poor SN progenitors synchronized with the onset of stellar collapse. Theoretical investigations point at binary interactions and/or instabilities during the last nuclear burning stages as potential triggers of the highly time-dependent mass loss. We constrain these scenarios utilizing the sample of 183 SNe Ib/c with public radio observations. Our analysis identifies SN 2014C-like signatures in ~10% of SNe. This fraction is reasonably consistent with the expectation from the theory of recent envelope ejection due to binary evolution if the ejected material can survive in the close environment for 103-104 years. Alternatively, nuclear burning instabilities extending to core C-burning might play a critical role.

Optimization of monoclonal antibody production: combined effects of potassium acetate and perfusion in a stirred tank bioreactor

To increase the yield of monoclonal antibody in a hybridoma culture, it is important to optimize the combination of several factors including cell density, antibody productivity per cell, and the duration of the culture. Potassium acetate enhances the production of antibodies by cells but sometimes depresses cell density. The production of anti-(human B-type red blood cell surface antigen) antibody by Cp9B hybridoma was studied. In batch cultures, potassium acetate inhibited Cp9B cells growth and decreased the maximal cell density but the productivity of antibody per cell was increased. The balance of the two effects resulted in a slight decline of antibody production. In a stirred tank bioreactor, the inhibitory effect of potassium acetate on cell density was overcome by applying the perfusion technique with the attachment of a cell-recycling apparatus to the bioreactor. In such a reactor, potassium acetate at 1 g l(-1) did not cause a decrease in the cell density, and the antibody concentration in the culture supernatant was increased from 28 μg ml(-1) to 38 μg ml(-1). Potassium acetate also suppressed the consumption of glucose and the accumulation of lactate in batch cultures, but the glucose and lactate levels were kept stable by applying the perfusion technique in the stirred tank bioreactor.

Light echoes reveal an unexpectedly cool η Carinae during its nineteenth-century Great Eruption

η Carinae is one of the most massive binary stars in the Milky Way. It became the second-brightest star in our sky during its mid-nineteenth-century 'Great Eruption', but then faded from view (with only naked-eye estimates of brightness). Its eruption is unique in that it exceeded the Eddington luminosity limit for ten years. Because it is only 2.3 kiloparsecs away, spatially resolved studies of the nebula have constrained the ejected mass and velocity, indicating that during its nineteenth-century eruption, η Car ejected more than ten solar masses in an event that released ten per cent of the energy of a typical core-collapse supernova, without destroying the star. Here we report observations of light echoes of η Carinae from the 1838-1858 Great Eruption. Spectra of these light echoes show only absorption lines, which are blueshifted by -210 km s(-1), in good agreement with predicted expansion speeds. The light-echo spectra correlate best with those of G2-to-G5 supergiants, which have effective temperatures of around 5,000 kelvin. In contrast to the class of extragalactic outbursts assumed to be analogues of the Great Eruption of η Carinae, the effective temperature of its outburst is significantly lower than that allowed by standard opaque wind models. This indicates that other physical mechanisms such as an energetic blast wave may have triggered and influenced the eruption.

Unusual extrathyroidal iodine accumulation in a post-ablative I-131 scan

A case of iodine-131 accumulation in the gall bladder following an ablative dose for thyroid carcinoma is presented.

Determination of right ventricular ejection fraction from reprojected gated blood pool SPET: comparison with first-pass ventriculography

Gated blood pool (GBP) studies are widely available and relatively inexpensive. We have previously published a simple and convenient method for measuring left ventricle ejection fraction (EF) with increased accuracy from single-photon emission tomography (SPET) GBP scans. This paper describes an extension of this method by which right ventricular EF may also be measured. Gated SPET images of the blood pool are acquired and re-oriented in short-axis slices. Counts from the left ventricle are excluded from the short-axis slices, which are then reprojected to give horizontal long-axis images. Time-activity curves are generated from each pixel around the right ventricle, and an image is created with non-ventricular pixels "greyed out". This image is used as a guide in drawing regions of interest around the right ventricle on the end-diastolic and end-systolic long-axis images. In 28 patients, first-pass ventriculography studies were acquired followed by SPET GBP scans. The first-pass images were analysed a total of four times by two observers and the SPET images were analysed three times each by two observers. The agreement between the two techniques was good, with a correlation coefficient of 0.72 and a mean absolute difference between first-pass and reprojected SPET EFs of 4.8 EF units. Only four of the 28 patients had a difference of greater than 8 EF units. Variability was also excellent for SPET right ventricular EF values. Intra-observer variability was significantly lower for SPET than for first-pass EFs: standard error of the estimate (SEE)=5.1 and 7.3 EF units, respectively (P<0.05). Inter-observer variability was comparable in the two techniques (SEE=5.2 and 6.9 EF units for SPET and first-pass ventriculography, respectively).

Purification and characterization of grass carp mitochondrial aldehyde dehydrogenase

The molecular biology and enzymology of aldehyde dehydrogenase (ALDH) have been extensively investigated. However, most of the studies have been confined to the mammalian forms, while the sub-mammalian vertebrate ALDHs are relatively unexplored. In the present investigation, an ALDH was purified from the hepatopancreas of grass carp (Ctenopharygodon idellus) by affinity chromatographies on alpha-cyanocinnamate-Sepharose and Affi-gel Blue agarose. The 800-fold purified enzyme had a specific activity of 4.46 U/mg toward the oxidation of acetaldehyde at pH 9.5. It had a subunit molecular weight of 55000. Isoelectric focusing showed a single band with a pI of 5.3. N-terminal amino acid sequencing of 30 residues revealed a positional identity of approximately 70% with mammalian mitochondrial ALDH2. The kinetic properties of grass carp ALDH resembled those of mammalian ALDH2. The optimal pH for the oxidation of acetaldehyde was 9.5. The K(m) values for acetaldehyde were 0.36 and 0.31 microM at pH 7.5 and 9.5, respectively. Grass carp ALDH also possessed esterase activity which could be activated in the presence of NAD(+).

Optimization in hybridoma cell culture

Based on the formation kinetics of monoclonal antibody, the bench-scale culture of hybridoma cells in a bioreactor was optimized by the application of perfusion culture mode, the supplement of potassium acetate, and the fortification of nutrients. When the bioreactor was operated with the daily perfusion of medium of 1/2 working volume, viable cell density in bioreactor was 11 x 10(5) cells/ml and antibody concentration 28 mg/L. After supplement with 1 g/L potassium acetate, the cell density kept constant and antibody production was improved to 38 mg/L. The fortification of nutrients such as amino acids and vitamins raised the cell density up to 42 x 10(5) cells/ml and, responsively, antibody concentration to 94 mg/L.

[An investigation of the polymorphism of HLA class II alleles in the Han population in Hubei Province of China]

OBJECTIVE

To investigate the polymorphism of HLA class II alleles in the Han population in Hubei province.

METHODS

The alleles of DRB1*(n=168), DQB1*(n=160) and DPB1*(n=93) were typed by using the polymerase chain reaction/sequence specific primer(PCR/SSP) and polymerase chain reaction/restriction fragment length polymorphism (PCR/RFLP) techniques.

RESULTS

39 HLA-DRB1, 15 DQB1 and 17 DPB1 alleles were found. Alleles with higher frequencies are DRB1*0901 (GF=14%), *1501(GF=11.3%), *0301(GF=7.1%), *0803(GF=4.8%); DQB1*0301(GF=18.8%), *0303(GF=18.4%), *0201(GF=10%), *0302(GF=8.4%); DPB1*0501(GF=31.2%), *0401(GF=15.1%), *0201(GF=14%), *0402(GF=11.8%), respectively. As compared with Caucasians, the Han people in Hubei province have higher gene frequencies of DRB1*0901, *1001, *0803; DQB1*0303, *0502 and DPB1*0501, *0202; and lower gene frequencies of DRB1*0301, *0401, *1301; DQB1*0201, *0603 and DPB1*0401, suggesting that Hubei Hans have their own layout of HLA class II allele frequencies.

CONCLUSION

These data may serve as normal reference values for the Han population in south China.

Synergism of energy starvation and dextran-conjugated doxorubicin in the killing of multidrug-resistant KB carcinoma cells

Here we report that 2-deoxyglucose/Na azide treatment and free/conjugated doxorubicin are synergistic in cell killing. As demonstrated by fluorescence confocal microscopy, KB-V1 cells retained more conjugated doxorubicin than free doxorubicin. Verapamil or 2-deoxyglucose/Na azide enhanced only the retention of the free drug and the small (<70 kDa) conjugates, indicating that P-glycoprotein (P-gp) is not effective against large conjugates. Conjugated doxorubicin was excluded from nuclei. Initially both free and conjugated doxorubicin accumulated in cytoplasmic organelles. Upon 2-deoxyglucose/Na azide treatment, fluorescence labeling of organelles dissipated. Prolonged (24 h) incubation of conjugate-preloaded cells resulted in redistribution of some of the organelle-associated fluorescence to nuclei, suggesting decoupling. The appearance of free doxorubicin was confirmed by capillary electrophoresis. 2-Deoxyglucose/Na azide treatment also retarded decoupling. Our results suggest that energy starvation, in addition to increasing cellular retention of P-gp substrates, may affect cellular fate of conjugated drugs with a possible enhancing effect in cancer cell killing.

CT-simulator based brachytherapy planner: seed localization and incorporation of biological considerations

Radiation dose prescription, interpretation, and planning can be problematic for brachytherapy due to high spatial heterogeneity, varying and various dose rates, absence of superimposed calculated isodose distributions onto affected tissues, and lack of dose volume histograms. A new treatment planner has been developed to reduce these limitations in brachytherapy planning. The PC-based planning system uses a CT-simulator to sequentially scan the patient to generate orthogonal images (to localize seed positions) and subsequently axially scan the patient. This sequential scanning procedure avoids using multiple independent patient scans, templates, external frames, or fiducial markers to register the reconstructed seed positions with patient contours. Dose is computed after assigning activity to (low dose rate) Ir192, linear Cs137, or I125 seeds or dwell times (high dose rate) to the Ir192 source. The planar isodose distribution is superimposed onto axial, coronal, or sagittal views of the tissues following image reconstruction. The treatment plan computes (1) direct and cumulative volume dose histograms for individual tissues, (2) the average, standard deviation, and coefficient of skewness of the dose distribution within individual tissues, (3) an average (over all tissue pixels) survival probability (S) and average survival dose DASD for a given radiation treatment, (4) normal tissue complication probability (NTCP) delivered to a given tissue. All four computed quantities account for dose heterogeneity. These estimates of the biological response to radiation from laboratory-based studies may help guide the evaluation of the prescribed low- or high-dose rate therapy in retrospective and prospective clinical studies at a number of treatment sites.

A tobacco and alcohol use profile of San Francisco's Chinese community

Relatively little is known about Asian American tobacco and alcohol use patterns. This is particularly true of Chinese living in the United States--either U.S.-born or non-U.S.-born Chinese. This article presents data from a research project studying tobacco and alcohol use patterns in San Francisco's Chinese community. Data were secured both from focus groups and a self-report telephone survey of a random sample of 1,808 Chinese residents in San Francisco. This results indicate that the prevalence of both tobacco and alcohol use is lower for San Francisco's Chinese population than for the general population. Moreover, those persons who report smoking tend to be different from those who report consuming alcohol. The study concludes that specific, culturally relevant tobacco and alcohol prevention programs should be designed to better reach this target population.

Budd-Chiari syndrome: diagnosis with ultrasound and nuclear medicine calcium colloid liver scan following non-diagnostic contrasted CT scan

Budd-Chiari syndrome is a rare condition characterized by thrombosis within the hepatic veins and inferior vena cava. A case of Budd-Chiari syndrome is presented in a patient who presented acutely 3 days following laparoscopic cholecystectomy for acalculous cholecystitis. A discussion of pathology and findings on calcium colloid scintigram, CT scan and Doppler ultrasound is provided.

[Chemical components of decoction of radix Paeoniae and radix Glycyrrhizae]

Eleven compounds were isolated from the water extract of the decoction of Radix Paeoniae and Radix Glycyrrhizae, namely benzoic acid, formononetin, isoliguiritigenin, liquiritigenin, 4',7-dihydroxyflavone, formononetin-7-glucoside, liquiritin, gallic acid, paeoniflorin, isoliquiritin and glycyrrhizin acid.

Reversible ischaemia in hypertrophic cardiomyopathy

Atypical and typical chest pains are common symptoms in patients with hypertrophic cardiomyopathy. Some of these chest pains seem to be caused by ischaemia. It is difficult to objectively demonstrate ischaemia in hypertrophic cardiomyopathy. The first line treatment for chest pain considered to be ischaemic in patients with hypertrophic cardiomyopathy is the use of either a beta blocker or calcium blocker. Septal myectomy can be effective in patients with symptoms refractory to conventional treatment but is associated with significant morbidity and mortality. Recently dual chamber pacing has been advocated in such patients. In some cases dual chamber pacing alleviates chest pain in hypertrophic cardiomyopathy by an anti-ischaemic action, presumably by reducing the left ventricular outflow tract gradient and perhaps by causing an associated decrease in left ventricular outflow tract gradient and perhaps by causing an associated decrease in left ventricular end diastolic pressure.

Identification and characterization of a cell envelope protein of Haemophilus influenzae contributing to phase variation in colony opacity and nasopharyngeal colonization

Haemophilus influenzae undergoes spontaneous phase variation in colony morphology. Organisms from transparent colonies efficiently colonize the nasopharynx in an infant rat model of H. influenzae carriage, whereas organisms from more opaque colonies are deficient at colonization. A genetic approach relying on the transformability of H. influenzae was used to identify a locus contributing to opacity variation. By screening a library of chomosomal DNA from an opaque variant of strain Rd, it was possible to isolate a single clone capable of transforming a transparent Rd host to a more opaque phenotype. A region containing two genes, designated oapA and oapB, was identified. The deduced amino acid sequence of oapB has similarity to a consensus sequence for bacterial lipoproteins. Genetically defined mutations in oapA were transformed into the transparent Rd to confirm that this gene is required for expression of the transparent colony phenotype. Although oapA lacks a signal sequence, gene fusions to phoA show that OapA is secreted in H. influenzae and undergoes phase variation in expression. Mutagenesis of oapA in strain Rd, and type b strain Eagan, resulted in loss of the ability to colonize the nasopharynx of infant rats. The type b mutant, however, was as virulent as its parent strain when inoculated intraperitoneally. This suggests that the contribution of OapA to pathogenesis is limited to events associated with colonization of the mucosal surface.

Low holotranscobalamin II is the earliest serum marker for subnormal vitamin B12 (cobalamin) absorption in patients with AIDS

In AIDS, as previously found in pernicious anemia (PA), the earliest serum marker of subnormal vitamin B12 (cobalamin) absorption, and therefore of negative B12 balance, is low serum holotranscobalamin II (holo-TC II; B12-TC II) despite normal total serum B12 level, normal serum homocysteine, and normal classic (oral free radio-B12) Schilling test. This may be accompanied by subtle and insidious damage to hematopoietic, immunologic, neuropsychiatric, nutritional and alimentary systems, confirmed by correction on therapeutic trial with B12 therapy. Our studies suggest such selective B12 deficiency occurs in about half of the HIV-1 infected, in part due to frequent depression of B12 absorption by HIV-1 attack on the gastric mucosa and/or opportunistic infection attack on the small bowel, and in part due to a telescoping of the continuum of the stages of negative B12 balance in relation to damage to B12 delivery by the infective and/or systemic disease process. In AIDS, when total serum B12 is normal despite tissue depletion of B12, if the classic Schilling test does not reveal subnormal food B12 absorption, the food Schilling test does. We hypothesize that DNA-synthesizing cells of the hematopoietic, immunologic, neurologic and other systems which have surface receptors solely for holo-TC II, and which have low B12 stores, rapidly become dysfunctional due to B12 deficiency when holo-TC II is low, while cells (such as liver cells) which also have surface receptors for holohaptocorrin (B12-haptocorrin) remain B12-replete. We believe this to be another example of the concept of selective nutrient deficiency in one cell line but not another.

D-Mannitol Interferes with Amino Acid Analysis of Marine Organisms

Acid hydrolysis of a protein in the presence of D-mannitol, a common constituent of marine algae, can cause significant reductions in the recovery of a number of amino acids. The new compounds formed by the interactions of D-mannitol and these amino acids may interfere in the chromatographic analysis of other amino acids. The recoveries of most of the amino acids appear to be either directly or inversely proportional to the amount of D-mannitol added to a protein sample before acid hydrolysis. These results suggest that it is necessary to determine the effects of contaminants in a sample of protein(s) on the recoveries of amino acids during routine acid hydrolysis. Key words: kelp, amino acids, carbohydrates, D-mannitol