Remission and low disease activity in Polish patients with systemic lupus erythematosus - real-life, five-year follow-up outcomes

OBJECTIVE

Remission in systemic lupus erythematosus (SLE) or Lupus Low Disease Activity State (LLDAS) are associated with less organ damage and thus create new perspectives for effective damage-limiting treatment. The aim of this study was to assess the occurrence of remission defined by The Definition of Remission In SLE (DORIS) and of LLDAS as well as their predictors in the Polish SLE cohort.

PATIENTS AND METHODS

In this retrospective study data were collected on patients with SLE that achieved at least one year of DORIS remission or LLDAS and were followed up for 5 years. Clinical and demographic data were gathered; DORIS and LLDAS predictors were determined by univariate regression analysis.

RESULTS

The full analysis set included 80 patients at baseline and 70 at follow-up. Over half of patients with SLE (39; 55.7%) fulfilled the DORIS remission criteria. In this group, 53.8% (21) of patients were in remission on-treatment and 46.1% (18) in remission off-treatment. LLDAS was fulfilled by a cohort of 43 (61.4%) patients with SLE. Among patients that achieved DORIS or LLDAS at follow-up, 77% were not treated with glucocorticoids (GCs). The most important predictors for DORIS and LLDAS off-treatment were mean SLEDAI-2K score with cut-off of ≤8.0, treatment with mycophenolate mofetil or antimalarials, and the age at disease onset above 43 years.

CONCLUSIONS

Remission and LLDAS are achievable goals in treating SLE as over half of study patients fulfilled the DORIS remission and LLDAS criteria. The identified predictors for DORIS and LLDAS indicate the importance of effective therapy leading to reduction of GC use.

Characterization data of reference materials used for phase II of the priority program DFG SPP 2005 "Opus Fluidum Futurum - Rheology of reactive, multiscale, multiphase construction materials"

A thorough characterization of base materials is the prerequisite for further research. In this paper, the characterization data of the reference materials (CEM I 42.5 R, limestone powder, calcined clay and a mixture of these three components) used in the second funding phase of the priority program 2005 of the German Research Foundation (DFG SPP 2005) are presented under the aspects of chemical and mineralogical composition as well as physical and chemical properties. The data were collected based on tests performed by up to eleven research groups involved in this cooperative program.

Development and validation of COVID-19 Radiological Risk Score (COVID-RRS): a multivariable radiological score to estimate the in-hospital mortality risk in COVID-19 patients

OBJECTIVE

To develop and validate in-hospital mortality risk score comprising radiological aberrances in chest computed tomography (CT) performed on admission.

PATIENTS AND METHODS

Single-center, longitudinal cohort study in adult patients admitted with Coronavirus Disease 2019 (COVID-19) to our ward. Patients were followed-up during hospitalization until discharge or death. Eligibility criteria for the study comprised positive real-time reverse transcription-polymerase chain reaction test (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and ground-glass opacities in chest CT. In-hospital death was the outcome of interest. Radiological, laboratory, and clinical data were analyzed. Radiological determinants of mortality were used as variables in multivariate logistic regression analysis, and results were used to build a radiological risk score.

RESULTS

371 patients were enrolled in development and validation cohorts (181 and 190 respectively), with a total of 47 non-survivors. Univariate analysis data determined 12 predictive factors (nine risk and three protective). In multivariate analysis, we developed COVID-RRS (COVID-19 Radiological Risk Score) - a radiological score predicting in-hospital COVID-19 mortality risk comprising estimated lung involvement percentage, pleural effusion, and domination of consolidation-type changes in chest CT. Our score was superior in the prediction of COVID-19 mortality to the percentage of lung involvement alone, Chest Computed Tomography Severity Score (CTSS), and Total Severity Score (TSS) in both groups with AUC of 0.910 and 0.902, respectively (p <0.001).

CONCLUSIONS

Additional imaging features independently contribute to COVID-19 mortality risk. Our model comprising lung involvement estimation, pleural effusion, and domination of consolidations performed significantly better than scores based on the extent of the changes alone. COVID-RRS is a simple, reliable, and ready-to-use tool for clinical practice.

Puberty health intervention to improve menstrual health and school attendance among adolescent girls in The Gambia: study methodology of a cluster-randomised controlled trial in rural Gambia (MEGAMBO TRIAL)

BACKGROUND

Menstrual health (MH) is a recognised global public health challenge. Poor MH may lead to absence from school and work, and adverse health outcomes. However, reviews suggest a lack of rigorous evidence for the effectiveness of MH interventions on health and education outcomes. The objective of this paper is to describe the methods used in a cluster-randomised controlled trial to estimate the effect of a multi-component intervention to improve MH and school attendance in The Gambia.

METHODS

The design ensured half the schools (25) were randomised to receive the intervention which comprised of the following components: (i) Peer education camps and menstrual hygiene laboratories in schools, (ii) Mother's outreach sessions, (iii) Community meetings, and (iv) minor improvements of school Water Sanitation and Hygiene (WASH) facilities and maintenance. The intervention was run over a three-month period, and the evaluation was conducted at least three months after the last intervention activity was completed in the school or community. The other 25 schools acted as controls. Of these 25 control schools one Arabic school dropped out due to COVID-19. The primary outcome was the prevalence of girls missing at least one day of school during their last period. Secondary outcomes included: Urinary Tract Infection (UTI) symptoms, biochemical markers of UTI in urine, Reproductive Tract Infection symptoms, self-reported menstruation related wellbeing, social support and knowledge, perceptions and practices towards menstruation and MH in target school girls. In addition, a process evaluation using observations, routine monitoring data, survey data and interviews was undertaken to assess dose and reach (quantitative data) and assess acceptability, fidelity, context and possible mechanisms of impact (qualitative data). Cost and cost-effectiveness of the intervention package will also be assessed.

CONCLUSION

Results will add to scarce resources available on effectiveness of MH interventions on school attendance. A positive result may encourage policy makers to increase their commitment to improve operation and maintenance of school WASH facilities and include more information on menstruation into the curriculum and help in the reporting and management of infections related to adolescent menstruation. Trial Registration PACTR, PACTR201809769868245, Registered 14th August 2018, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3539.

POS1261 CLINICAL RESPONSE PREDICTORS OF TOCILIZUMAB THERAPY IN PATIENTS WITH SEVERE COVID-19

Background

Aberrant immune response is hallmark of severe COVID-19, irrespectively from viral replication. Immunomodulatory therapies such as interleukin-6 (IL-6) receptor inhibitors were proven to be beneficial in reducing in-hospital mortality1. Yet, it remains unclear which patients can benefit most from such therapy.

Objectives

To identify predictors of clinical response to tocilizumab (TCZ) added to dexamethasone in patients hospitalized with severe COVID-19.

Methods

We prospectively assessed clinical and laboratory details of 120 patients hospitalized due to severe COVID-19 treated with TCZ (two doses of 8 mg/kg 24h apart) in our ward between 1st Feb 2021 and 31st Dec 2021. Severe COVID-19 was defined as SpO2 <94% on room air with ground glass opacities in chest computed tomography (CT). Clinical response was defined as respiratory improvement on day 5 after TCZ infusion compared to day of treatment initiation, no further deterioration and survival. Decision of adding TCZ to dexamethasone as emergency therapy was made collectively by rheumatologists experienced in COVID-19 treatment. Laboratory and clinical parameters from hospital admission day and from TCZ institution day were analyzed. Statistical analysis was conducted with PQStat v.1.8.2 and predictors were identified in univariate logistic regression.

Results

We identified 86 (71.7%) clinical responders and 34 (28.3%) non-responders. 20 (58.8%) of the second group needed ICU admission, 18 (52.9%) died on ICU and 2 patients (5.9%) died on the ward. Responders were significantly younger (mean age 56.1 vs. 63.5 years, p=0.006), had lesser comorbidity burden (median Charleson Comorbidity Index 2 vs. 3, p=0.005), lower median lung involvement (50 vs. 70%, p<0.001), higher median baseline PaO2/FiO2 index (203 vs. 106, p<0.001) and less of them needed high-flow oxygen therapy on TCZ initiation day (12.7% vs 32.4%, p=0.025).

Identified predictors of clinical response are shown in Table 1.

Table 1.

Predictors of good response to TCZ therapy in severe COVID-19. Apart from PaO2/FiO2 all parameters identified as predictors were measured on TCZ initiation day.

PredictorOR95%CIp valueLDH <447 U/l12.674.42-36.31<0.001<70% of lungs involved in CT6.762.63-17.36<0.0019-12 days from symptoms onset6.431.82-22.730.004RR <20/min5.402.29-12.75<0.001hs-TnI <26 ng/l4.801.55-14.810.006BUN <22.2 mg/dl4.712.02-10.99<0.001SpO2/FiO2 >1224.471.92-10.40<0.001fibrinogen ≥490 mg/dl4.461.86-10.72<0.001no history of asthma/COPD4.391.55-16.710.030no history of atrial fibrillation4.201.23-14.330.022baseline PaO2/FiO2 >200 mmHg4.041.59-10.270.00325(OH)D3 ≥30 ng/ml3.981.40-11.280.009age <65 years3.691.60-8.460.002no history of ischaemic heart disease3.561.29-9.790.014procalcitonin 0.06-0.12 ng/ml3.201.20-8.540.020D-Dimer ≤1.28 µg/ml3.121.37-7.090.006IL-6 47.4-137.0 pg/ml3.071.90-4.98<0.001

OR – odds ratio, 95%CI – 95% confidence interval, LDH – lactate dehydrogenase, RR – respiratory rate, hs-TnI – high sensitivity troponin I, BUN – blood urea nitrogen, COPD – chronic obstructive pulmonary disease, 25(OH)D3 – 25-hydroxycholecalciferol, IL-6 – interleukin 6

Conclusion

Administration of TCZ early in severe disease, with moderate IL-6 concentration and low organ damage indices is most beneficial in patients with severe COVID-19, especially in younger patients without respiratory and cardiac comorbidities.

References

[1]RECOVERY Collaborative Group. Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet Lond Engl. 2021;397:1637-1645.

Disclosure of Interests

None declared

A cluster-randomised trial to evaluate an intervention to promote handwashing in rural Nigeria

Handwashing with soap at critical times helps prevent diarrhoeal diseases. Changing handwashing practices through behaviour change communication remains a challenge. This study designed and tested a scalable intervention to promote handwashing with soap. A cluster-randomised, controlled trial compared our intervention against standard practice. Subjects were men, women and children in 14 villages in Cross-River state, Nigeria. The primary outcome was the proportion of observed key events on which hands were washed with soap. Binomial regression analysis calculated prevalence differences between study arms. The intervention had minimal effect on the primary outcome (+2.4%, p = 0.096). The intervention was associated with increased frequency of handwashes without soap before food contact (+13%, p = 0.017). The intervention failed to produce significant changes in handwashing with soap at key times. The low dose delivered (two contact points) may have increased scalability at the cost of effectiveness, particularly in the challenging context of inconvenient water access.

Utilizing optical spectroscopy and 2',7'-difluorofluorescein to characterize the early stages of cement hydration

The increasingly sophisticated nature of modern, more environmentally friendly cementitious binders requires a better understanding and control particularly of the complex, dynamic processes involved in the early phase of cement hydration. In-situ monitoring of properties of a constantly changing system over a defined period of time calls for simple, sensitive, fast, and preferably also non-invasive methods like optical spectroscopy. Here, we exploit the time-dependent changes in the absorbance and fluorescence features of the negatively charged optical probe 2',7'-difluorofluorescein (DFFL) for the study of the hydration processes in pastes of white cement (WC), cubic tricalcium aluminate (C₃A), and tricalcium silicate (C₃S), the main phases of cement, and in pastes of quartz (Q) over 24 h after addition of the dye solution. For comparison, also conventional techniques like isothermal heat flow calorimetry were applied. Based upon the time-dependent changes in the spectroscopic properties of DFFL, that seem to originate mainly from dye aggregation and dye-surface interactions and considerably vary between the different pastes, molecular pictures of the hydration processes in the cement pastes are derived. Our results clearly demonstrate the potential of optical spectroscopy, i.e., diffuse reflectance, steady state and time-resolved fluorometry in conjunction with suitable optical reporters, to probe specific hydration processes and to contribute to a better understanding of the early hydration processes of cement at the molecular scale.

SERENA: Particle Instrument Suite for Determining the Sun-Mercury Interaction from BepiColombo

The ESA-JAXA BepiColombo mission to Mercury will provide simultaneous measurements from two spacecraft, offering an unprecedented opportunity to investigate magnetospheric and exospheric particle dynamics at Mercury as well as their interactions with solar wind, solar radiation, and interplanetary dust. The particle instrument suite SERENA (Search for Exospheric Refilling and Emitted Natural Abundances) is flying in space on-board the BepiColombo Mercury Planetary Orbiter (MPO) and is the only instrument for ion and neutral particle detection aboard the MPO. It comprises four independent sensors: ELENA for neutral particle flow detection, Strofio for neutral gas detection, PICAM for planetary ions observations, and MIPA, mostly for solar wind ion measurements. SERENA is managed by a System Control Unit located inside the ELENA box. In the present paper the scientific goals of this suite are described, and then the four units are detailed, as well as their major features and calibration results. Finally, the SERENA operational activities are shown during the orbital path around Mercury, with also some reference to the activities planned during the long cruise phase.

Efficacy of Retreatment After Failed Direct-acting Antiviral Therapy in Patients With HCV Genotype 1-3 Infections

Hepatitis C virus infection is causing chronic liver disease, cirrhosis, and hepatocellular carcinoma. By combining direct-acting antivirals (DAAs), high sustained virologic response rates (SVRs) can be achieved. Resistance-associated substitutions (RASs) are commonly observed after DAA failure, and especially nonstructural protein 5A (NS5A) RASs may impact retreatment options.^1-3 Data on retreatment of DAA failure patients using first-generation DAAs are limited.^4-7 Recently, a second-generation protease- and NS5A-inhibitor plus sofosbuvir (voxilaprevir/velpatasvir/sofosbuvir [VOX/VEL/SOF]) was approved for retreatment after DAA failure.⁸ However, this and other second-generation regimens are not available in many resource-limited countries or are not reimbursed by regular insurance, and recommendations regarding the selection of retreatment regimens using first-generation DAAs are very important. This study aimed to analyze patients who were re-treated with first-generation DAAs after failure of a DAA combination therapy.

Charge disproportionation and nano phase separation in [Formula: see text]

We have successfully grown centimeter-sized layered [Formula: see text] single crystals under high oxygen pressures of 120-150 bar by the floating zone technique. This enabled us to perform neutron scattering experiments where we observe close to quarter-integer magnetic peaks below [Formula: see text] that are accompanied by steep upwards dispersing spin excitations. Within the high-frequency Ni-O bond stretching phonon dispersion, a softening at the propagation vector for a checkerboard modulation can be observed. We were able to simulate the magnetic excitation spectra using a model that includes two essential ingredients, namely checkerboard charge disproportionation and nano phase separation. The results thus suggest that charge disproportionation is preferred instead of a Jahn-Teller distortion even for this layered [Formula: see text] system.

AB1193 WORK INSTABILITY AMONG POLISH RHEUMATOID ARTHRITIS PATIENTS

Background:

Rheumatoid arthritis (RA) affects patients’ capacity to work. Rheumatoid Arthritis Work Instability Scale (RA-WIS) is a reliable method to measure work instability (WI) (1–3). We lack data on relationship between RA and work instability among Polish patients.

Objectives:

The aim of our study was to assess WI and associated factors among patients with RA.

Methods:

315 patients from three rheumatology centres were enrolled and filled questionnaires including demographic and self-reported clinical data, RA-WIS, and The Health Assessment Questionnaire (HAQ). Swollen and tender joints count (SJC, TJC) were assessed by attending physician and current erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were collected. We excluded 41 patients due to incorrectly filled form and analysed questionnaires of 274 patients. DAS28 (Disease Activity Score in 28 joints) and DAS28-CRP were calculated. We performed statistical analysis with Statistica v. 13.3 using Mann-Whitney U test, chi-square test and Spearman’s correlation

Results:

140 (51 %) patients were employed and their characteristics are presented on Table 1. In univariable analysis we identified following risk factors for high risk WI: moderate-to-high disease activity (DAS28≥3.2 – OR 2.29, 95%CI 1.06-4.96, p=0.033; DAS28-CRP≥3.2 – OR 2.34, 95%CI 1.04-5.27, p=0.038), ESR ≥30 mm/h in women and ≥20 mm/h in men (OR 2.65, 95%CI 1.20-5.89, p=0.010), CRP≥1mg/dL (OR 4.02, 95%CI 1.78-9.10 p<0.001), HAQ-DI>1.0 (OR 2.23, 95%CI 1.04-4.81, p=0.037) and at least moderate pain on visual analogue scale (VASp ≥4.5 cm - OR 5.31, 95%CI 2.36-11.96, p<0.001). Correlations were moderate between RA-WIS and VASp (RS=0.59, p<0.001) and HAQ-DI (RS=0.52, p<0.001) whereas weak with disease activity indices (DAS28 - RS=0.31, p<0.001; DAS28-CRP - RS=0.28, p<0.001).

Table 1.

Demographic and clinical characteristics of employed patients according to work instability risk, N(%) or mean(±SD).

CharacteristicRA-WIS scorelow-to-moderate (0-17)high (>17)Patients94 (67.1%)46 (32.9%)Sex, female73 (77.7%)38 (82.6%)Age (years)47.9 (±11.8)50.4 (±9.3)Disease duration (years)13.0 (±8.4)14.0 (±8.7)RF, positive68 (72.3%)34 (73.9%)ACPA, positive59 (62.8%)29 (63.0%)ESR (mm/h)18.3 (±16.0)28.2 (± 21.9)*CRP (mg/dL)0.6 (± 1.0)1.1 (± 1.0)*TJC4.5 (±4.0)7.6(±6.3)*SJC2.7 (±3.0)5.2(±5.5)*HAQ-DI0.7 (±0.5)1.1 (±0.5)*pain - VAS 10 cm3.9 (±1.9)6.5 (± 2.2)*DAS283.5 (±1.2)4.2 (±1.4)*DAS28-CRP3.9 (±1.0)4.3 (±1.2)*

WI – work instability, RA-WIS – Rheumatoid Arthritis Work Instability Scale, RF – rheumatoid factor in IgM class, ACPA – anti-citrullinated protein antibodies, ESR – erythrocyte sedimentation rate, CRP – C-reactive protein, TJC – tender joints count, SJC – swollen joints count, HAQ-DI – Heath Assessment Questionnaire Disability Index, VAS – visual analogue scale, DAS28 – Disease Activity Score in 28 joints

*p<0.05, Mann-Whitney U test

Conclusion:

Pain and disability are main factors associated with work instability among patients with RA.

References:

[1]Gilworth G, Chamberlain MA, Harvey A, Woodhouse A, Smith J, Smyth MG, et al. Development of a work instability scale for rheumatoid arthritis. Arthritis Rheum. 2003;49(3):349–54.

[2]Gilworth G, Emery P, Gossec L, Vlieland TPMV, Breedveld FC, Hueber AJ, et al. Adaptation and cross-cultural validation of the rheumatoid arthritis work instability scale (RA–WIS). Ann Rheum Dis. 2009;68(11):1686–90.

[3]Revicki D, Ganguli A, Kimel M, Roy S, Chen N, Safikhani S, et al. Reliability and Validity of the Work Instability Scale for Rheumatoid Arthritis. Value Health J Int Soc Pharmacoeconomics Outcomes Res. 2015;18(8):1008–15.

Disclosure of Interests:

None declared

FRI0184 ATTRIBUTION OF NEUROPSYCHIATRIC MANIFESTATIONS TO SYSTEMIC LUPUS ERYTHEMATOSUS IN POLISH COHORT OF PATIENTS WITH THE USE OF THE ITALIAN MODEL

Background:

Distinguishing primary NPSLE (neuropsychiatric systemic lupus erythematosus) from secondary causes remains challenging (1). Attribution models were developed in order to aim clinicians in correct classification of NPSLE cases (2).

Objectives:

To investigate the prevalence of primary NPSLE manifestations assigned with Italian model of attribution (2).

Methods:

We retrospectively assessed clinical details of 164 patients with SLE classified with 2012 SLICC (Systemic Lupus International Collaborating Clinics) classification criteria, 21 were excluded due to incomplete information. Data was gathered with a questionnaire comprising demographics, medical history, laboratory results (concentrations of antibodies against double stranded DNA – anti-dsDNA, complement components C3 and C4), disease activity measured with Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and Physician Global Assessment (PGA) and damage determined with SLICC/ACR (American College of Rheumatology) Damage Index (SDI). Neuropsychiatric manifestations were categorized in accordance with 1999 ACR glossary and attribution of manifestations was performed with the use of Italian model with the score ≥7 out of 10 points enabling assignment to primary NPSLE group (2). Statistical analysis was conducted with Statistica v.13.3 using Mann-Whitney U, chi-square and Fisher exact test.

Results:

We encountered 155 NP manifestations in our cohort and 52 (34%) were attributed to SLE. Characteristics of the study groups are presented in Table 1. Exact manifestations and their attribution rates are presented on Graph 1. Patients with attributable NPSLE were younger, had earlier disease onset, presented higher disease activity, lower damage accrual without taking NP damage into account and more often had increased anti-dsDNA serum concentration.

Table 1.

Demographic and laboratory characteristics with disease activity and damage of the study groups, N(%) or mean(±SD).

CharacteristicPatients with attributed NPSLE manifestationsPatients without attributed NPSLE manifestationsPatients34 (23.8%)109 (76.2%)Sex, female30 (88.2%)102 (93.6%)Age (years)37.6 (±11.7)44.3 (±13.9)*Age of disease onset (years)32.5 (±11.4)37.6 (±12.6)*Disease duration (years)5.1 (±4.1)6.8 (±5.6)SLEDAI-2K29.2 (±10.7)12.2 (±8.1)*patients with clinically active disease (defined as SLEDAI-2K≥6 in clinical manifestations)34 (100%)93 (85.3%)*SLEDAI-2K without NP manifestations14.8 (±8.4)11.0 (±6.7)*PGA2.1 (±1.0)1.2 (±1.0)*SDI0.5 (±0.8)0.7 (±1.1)SDI without NP damage0.3 (±0.6)0.7 (±1.1)*low C3/C4 complement component concentration in serum21 (61.8%)55 (50.4%)elevated anti-dsDNA autoantibody concentration in serum27 (79.4%)55 (50.4%)*

NPSLE – neuropsychiatric systemic lupus erythematosus, SLEDAI-2K – Systemic Lupus Erythematosus Disease Activity Index version 2000, PGA – physician global assessment, SDI – SLICC/ACR (Systemic Lupus International Collaborating Clinics/American College of Rheumatology) Damage Index

*p<0,05, Mann-Whitney U, χ2or Fisher’s exact test, as appropriate

Conclusion:

Primary NP manifestations in patients with SLE occur mainly in young patients with high disease activity. Cerebrovascular disease, seizures, psychosis and cranial neuropathy are most frequent primary NPSLE manifestations.

References:

[1]The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthritis Rheum. 1999;42(4):599–608.

[2]Bortoluzzi A, Scirè CA, Bombardieri S, Caniatti L, Conti F, De Vita S, et al. Development and validation of a new algorithm for attribution of neuropsychiatric events in systemic lupus erythematosus. Rheumatol Oxf Engl. 2015;54(5):891–8.

Disclosure of Interests:

None declared

Characterization data of reference cement CEM III/A 42.5N used for priority program DFG SPP 2005 "Opus Fluidum Futurum - Rheology of reactive, multiscale, multiphase construction materials"

Two types of cements were selected as the reference cement in the priority program 2005 of the German Research Foundation (DFG SPP 2005). A thorough characterization of CEM I 42.5 R has been made in a recent publication [1]. In this paper, the characterization data of the other reference cement CEM III/A 42.5 N are presented from the aspects of chemical and mineralogical compositions as well as physical and chemical properties. The characterization data of the slag, which is the second main constituent of this specific cement besides the clinker, are presented independently. For all data received, the mean values and the corresponding errors were calculated. The data shall be used for the ongoing research within the priority program. Also, researchers from outside this priority program can benefit from these data if the same materials are used.

Characterization data of reference cement CEM I 42.5 R used for priority program DFG SPP 2005 "Opus Fluidum Futurum - Rheology of reactive, multiscale, multiphase construction materials"

A thorough characterization of starting materials is the precondition for further research, especially for cement, which contains various phases and presents quite a complex material for fundamental scientific investigation. In the paper at hand, the characterization data of the reference cement CEM I 42.5 R used within the priority program 2005 of the German Research Foundation (DFG SPP 2005) are presented from the aspects of chemical and mineralogical compositions as well as physical and chemical properties. The data were collected based on tests conducted by nine research groups involved in this cooperative program. For all data received, the mean values and the corresponding errors were calculated. The results shall be used for the ongoing research within the priority program.

Sphenopalatine Ganglion Stimulation to Augment Cerebral Blood Flow

Background and Purpose—

Many patients with acute ischemic stroke are not eligible for thrombolysis or mechanical reperfusion therapies due to contraindications, inaccessible vascular occlusions, late presentation, or large infarct core. Sphenopalatine ganglion (SPG) stimulation to enhance collateral flow and stabilize the blood-brain barrier offers an alternative, potentially more widely deliverable, therapy.

Methods—

In a randomized, sham-controlled, double-masked trial at 41 centers in 7 countries, patients with anterior circulation ischemic stroke not treated with reperfusion therapies within 24 hours of onset were randomly allocated to active SPG stimulation or sham control. The primary efficacy outcome was improvement beyond expectations on the modified Rankin Scale of global disability at 90 days (sliding dichotomy), assessed in the modified intention-to-treat population. The initial planned sample size was 660 patients, but the trial was stopped early when technical improvements in device placement occurred, so that analysis of accumulated experience could be conducted to inform a successor trial.

Results—

Among 303 enrolled patients, 253 received at least one active SPG or sham stimulation, constituting the modified intention-to-treat population (153 SPG stimulation and 100 sham control). Age was median 73 years (interquartile range, 64–79), 52.6% were female, deficit severity on the National Institutes of Health Stroke Scale was median 11 (interquartile range, 9–15), and time from last known well median 18.6 hours (interquartile range, 14.5–22.5). For the primary outcome, improved 3-month disability beyond expectations, rates in the SPG versus sham treatment groups were 49.7% versus 40.0%; odds ratio, 1.48 (95% CI, 0.89–2.47); P =0.13. A significant treatment interaction with stroke location (cortical versus noncortical) was noted, P =0.04. In the 87 patients with confirmed cortical involvement, rates of improvement beyond expectations were 50.0% versus 27.0%; odds ratio, 2.70 (95% CI, 1.08–6.73); P =0.03. Similar response patterns were observed for all prespecified secondary efficacy outcomes. No differences in mortality or serious adverse event safety end points were observed.

Conclusions—

SPG stimulation within 24 hours of onset is safe in acute ischemic stroke. SPG stimulation was not shown to statistically significantly improve 3-month disability above expectations, though favorable outcomes were nominally higher with SPG stimulation. Beneficial effects may distinctively be conferred in patients with confirmed cortical involvement. The results of this study need to be confirmed in a larger pivotal study.

Clinical Trial Registration—

URL: https://www.clinicaltrials.gov . Unique identifier: NCT03767192.

Rotational Polymorphism of Methyl-Substituted Ammonium Perchlorates

The thermal transformations which take place in solid methyl-substituted ammonium perchlorates have been studied using high-temperature X-ray diffraction and differential thermal analysis techniques. In the temperature range from 20°C to their decomposition temperature (above 300°C), ammonium perchlorate and tetramethyl ammonium perchlorate undergo only one enantiomorphic phase transition, namely at 240 and 340°C (with decomposition), respectively. This I—II transition is ascribed to the beginning of the free rotation of the ClO4− ions. The rotation of the cations, however, begins below room temperature. If the symmetry of the cation is lowered by having both methyl groups and hydrogens arranged around the nitrogen (as in monomethyl, dimethyl, and trimethyl ammonium perchlorates), there is an additional enantiomorphic phase transition. This I—II transformation is ascribed to the rotation of the cations which have, in the partially substituted ions, two sets of non-equivalent symmetry axes (different moments of inertia). The temperatures of transformation are discussed in terms of the space requirements for rotation. Symmetries and cell dimensions of some modifications were determined.

Total haemoglobin mass, but not haemoglobin concentration, is associated with preoperative cardiopulmonary exercise testing-derived oxygen-consumption variables

Background

Cardiopulmonary exercise testing (CPET) measures peak exertional oxygen consumption ( V˙O2peak ) and that at the anaerobic threshold ( V˙O2 at AT, i.e. the point at which anaerobic metabolism contributes substantially to overall metabolism). Lower values are associated with excess postoperative morbidity and mortality. A reduced haemoglobin concentration ([Hb]) results from a reduction in total haemoglobin mass (tHb-mass) or an increase in plasma volume. Thus, tHb-mass might be a more useful measure of oxygen-carrying capacity and might correlate better with CPET-derived fitness measures in preoperative patients than does circulating [Hb].

Methods

Before major elective surgery, CPET was performed, and both tHb-mass (optimized carbon monoxide rebreathing method) and circulating [Hb] were determined.

Results

In 42 patients (83% male), [Hb] was unrelated to V˙O2 at AT and V˙O2peak ( r =0.02, P =0.89 and r =0.04, P =0.80, respectively) and explained none of the variance in either measure. In contrast, tHb-mass was related to both ( r =0.661, P <0.0001 and r =0.483, P =0.001 for V˙O2 at AT and V˙O2peak , respectively). The tHb-mass explained 44% of variance in V˙O2 at AT ( P <0.0001) and 23% in V˙O2peak ( P =0.001).

Conclusions

In contrast to [Hb], tHb-mass is an important determinant of physical fitness before major elective surgery. Further studies should determine whether low tHb-mass is predictive of poor outcome and whether targeted increases in tHb-mass might thus improve outcome.

Kinetics and dosimetry of MAb-170: Evaluation of possibilities for intraperitoneal radioimmunotherapy

The monoclonal antibody MAb-170 is directed against adenocarcinomas of different origin. Recent experience in radioimmunoscintigraphy revealed a positive uptake of this MAb in peritoneal metastases of ovarian carcinoma (FIGO lll/IV). Aim: The present investigation should clarify the question whether this antibody could be of use in an adjuvant intraperitoneal radioimmunotherapy (RIT) in patients with minimal residual disease after first-look surgery. Methods: Four patients underwent intraperitoneal application of Tc-99m MAb-170. Subsequent quantitative whole-body scintigraphy, serum and urine sampling were performed for a 48 h period. In one case tumour tissue specimen were sampled during the first surgical procedure 15 h p.L Results: The quantitative evaluation revealed no relevant accumulation in liver, spleen and bone marrow never exceeding 5 % of the whole-body activity. The critical organs are the kidneys that showed 8 to 11 % uptake at 24 h pi. The effective serum curve had a maximum at 24 h pi, the second phase gave a elimination half-time of 53 h. Assuming the worst case, the mean dose to red bone marrow was 0.3 Gy/370 MBq injected dose (ID). Conclusion: These results confirm that a RIT with Re-186 MAb-170 is feasible with activities of up to 3.7 GBq. A kit for labelling MAb-170 with Perrhenate is under investigation.

Ultraschall bei Vaskulitiden

Mittels Ultraschall lässt sich eine pathognomonische Gefäßwandschwellung bei Vaskulitiden an Temporalarterien und an extrakraniellen Arterien nachweisen. Die Sonografie ist wichtiger Bestandteil in der Diagnostik der Arteriitis temporalis, der Riesenzellarteriitis großer Gefäße und der Takayasu Arteriitis geworden. Durch „Fast Track Clinics“ in denen gleichzeitig fachärztliche klinische Untersuchung und Sonografie mindestens von Temporal- und Axillararterien angeboten wird, kann die Inzidenz von Erblindungen reduziert werden.

Randomized clinical trial of Appendicitis Inflammatory Response score-based management of patients with suspected appendicitis

BACKGROUND

The role of imaging in the diagnosis of appendicitis is controversial. This prospective interventional study and nested randomized trial analysed the impact of implementing a risk stratification algorithm based on the Appendicitis Inflammatory Response (AIR) score, and compared routine imaging with selective imaging after clinical reassessment.

METHOD

Patients presenting with suspicion of appendicitis between September 2009 and January 2012 from age 10 years were included at 21 emergency surgical centres and from age 5 years at three university paediatric centres. Registration of clinical characteristics, treatments and outcomes started during the baseline period. The AIR score-based algorithm was implemented during the intervention period. Intermediate-risk patients were randomized to routine imaging or selective imaging after clinical reassessment.

RESULTS

The baseline period included 1152 patients, and the intervention period 2639, of whom 1068 intermediate-risk patients were randomized. In low-risk patients, use of the AIR score-based algorithm resulted in less imaging (19·2 versus 34·5 per cent; P < 0·001), fewer admissions (29·5 versus 42·8 per cent; P < 0·001), and fewer negative explorations (1·6 versus 3·2 per cent; P = 0·030) and operations for non-perforated appendicitis (6·8 versus 9·7 per cent; P = 0·034). Intermediate-risk patients randomized to the imaging and observation groups had the same proportion of negative appendicectomies (6·4 versus 6·7 per cent respectively; P = 0·884), number of admissions, number of perforations and length of hospital stay, but routine imaging was associated with an increased proportion of patients treated for appendicitis (53·4 versus 46·3 per cent; P = 0·020).

CONCLUSION

AIR score-based risk classification can safely reduce the use of diagnostic imaging and hospital admissions in patients with suspicion of appendicitis. Registration number: NCT00971438 ( http://www.clinicaltrials.gov).

Similar efficacy and tolerability of raltegravir-based antiretroviral therapy in HIV-infected patients, irrespective of age group, burden of comorbidities and concomitant medication: Real-life analysis of the German 'WIP' cohort

Only limited efficacy and tolerability data on raltegravir (RAL) use are currently available. Study objectives were to describe the efficacy and tolerability profile of RAL-based antiretroviral therapy (ART) in routine clinical practice in Germany. The WIP study (WIP = “Wirksamkeit von Isentress unter Praxisbedingungen”, Efficacy of Isentress under routine clinical conditions) was a prospective, multi-centre cohort study in Germany. Human immunodeficiency virus (HIV)-infected patients aged ≥ 18 years in whom combinational ART with RAL 400 mg BID was indicated were enrolled. The primary endpoint was virologic response (HIV-RNA <50 copies/mL; non-completion equals failure) after 48 weeks. Of 451 patients, 85.1% (n = 384) were still receiving RAL at week 48. At baseline (BL), the prevalence of concomitant diseases was higher in patients of the age group ≥50 years (94.2% vs. 75.7%) as well as concomitant medications (74.8 % vs. 55.4%). Virologic response at week 48 was 74.7% (overall), 75.0% (naïve at BL), 81.5% (suppressed at BL), 47.1% (interrupted previous treatment at BL) and 64.9% (failing at BL), without significant differences by age group. A significant correlation of achievement of HIV-RNA <50 copies/mL was seen with treatment status at BL (p = 0.004). In addition, 77.3 % of the patients with a CD4 cell count >200 cells/µL at BL achieved HIV-RNA <50 copies/mL (p = 0.029). RAL was well tolerated with 80 adverse events (AEs) in 49 patients (10.9%) and 8 serious AEs (SAEs) in 6 patients (1.3%) reported to be drug related. A total of 22 patients (4.9%) discontinued treatment due to AEs. The WIP study shows that the previously reported efficacy and safety profile of RAL can be achieved in a population with multiple comorbidities and comedications, with no major difference observed in ageing patients (≥50 years) vs. younger patients. RAL is therefore an attractive treatment option in routine medical care in Germany.

Sensitivity of Diffusion-Weighted STEAM MRI and EPI-DWI to Infratentorial Ischemic Stroke

OBJECTIVES

To assess the sensitivity of stimulated echo acquisition mode diffusion weighted imaging (STEAM-DWI) to ischemic stroke in comparison to echo-planar imaging diffusion weighted imaging (EPI-DWI) in the infratentorial compartment.

METHODS

Fifty-seven patients presenting with clinical features of infratentorial stroke underwent STEAM-DWI, high-resolution EPI-DWI (HR-DWI, 2.5 mm slice thickness) and low-resolution EPI-DWI (LR-DWI, 5 mm slice thickness). Four readers assessed the presence of ischemic lesions and artifacts. Agreement between sequences and interobserver agreement on the presence of ischemia were calculated. The sensitivities of the DWI sequences were calculated in 45 patients with a confirmed diagnosis of infratentorial stroke.

RESULTS

Median time from symptom onset to imaging was 24 hours. STEAM-DWI agreed with LR-DWI in 89.5% of cases (kappa = 0.72, p<0.0001) and with HR-DWI in 89.5% of cases (kappa = 0.68, p<0.0001). STEAM-DWI showed fewer intraparenchymal artifacts (1/57) than HR-DWI (44/57) and LR-DWI (41/57). Ischemia was visible in 87% of cases for LR-DWI, 93% of cases for HR-DWI, and 89% of cases for STEAM-DWI. Interobserver agreement was good for STEAM-DWI (kappa = 0.62, p<0.0001).

CONCLUSIONS

Compared to the best currently available MR sequence for detecting ischemia (HR-DWI), STEAM-DWI shows fewer artifacts and a similar sensitivity to infratentorial stroke.

Ten Days of Intermittent, Low-dose Carbon Monoxide Inhalation does not Significantly Alter Hemoglobin Mass, Aerobic Performance Predictors, or Peak-power Exercise Tolerance

Carbon monoxide (CO) rebreathing procedures are used to assess hemoglobin mass (Hbmass) but recent evidence suggests that CO is a signaling molecule that may alter physiological functions. We examined the effects of 10 days of intermittent, low-dose CO inhalation on Hbmass, aerobic performance predictors, and peak-power exercise tolerance. 18 recreationally-active men were randomized to either CO or placebo inhalation groups in a single-blind, pre-post parallel-groups trial. Primary outcomes were assessed before and after an intervention period during which subjects inhaled a bolus of 1.2 ml kg(-1) CO or placebo (room air) for 30 s, once per day on 10 days over a 12-day period. Cycling tests were performed >16 h following CO inhalation to exclude acute effects of CO exposure. CO inhalation elevated carboxyhemoglobin by 4.4±0.4% (mean±SD) following each exposure. Compared to placebo, chronic CO inhalation did not significantly alter Hbmass (p=0.99), peak oxygen uptake (p=0.59), peak power output (p=0.10), submaximal oxygen uptake (p=0.91), submaximal RER (p=0.22), lactate threshold (p=0.65), or peak-power exercise tolerance (p=0.60). In conclusion, our data support the ability to perform repeated measurements of Hbmass using CO rebreathing over a 12-day period without altering physiological responses.

Can gossip change nutrition behaviour? Results of a mass media and community-based intervention trial in East Java, Indonesia

OBJECTIVE

It is unclear how best to go about improving child feeding practices. We studied the effect of a novel behaviour change intervention, Gerakan Rumpi Sehat (the Healthy Gossip Movement), on infant and young child feeding practices in peri-urban Indonesia.

METHODS

The pilot intervention was designed based on the principles of a new behaviour change theory, Behaviour Centred Design (BCD). It avoided educational messaging in favour of employing emotional drivers of behaviour change, such as affiliation, nurture and disgust and used television commercials, community activations and house-to-house visits as delivery channels. The evaluation took the form of a 2-arm cluster randomised trial with a non-randomised control arm. One intervention arm received TV only, while the other received TV plus community activations. The intervention components were delivered over a 3-month period in 12 villages in each arm, each containing an average of 1300 households. There were two primary outcomes: dietary diversity of complementary food and the provision of unhealthy snacks to children aged 6-24 months.

RESULTS

Dietary diversity scores increased by 0.8 points in the arm exposed to TV adverts only (95% CI: 0.4-1.2) and a further 0.2 points in the arm that received both intervention components (95% CI: 0.6-1.4). In both intervention arms, there were increases in the frequency of vegetable and fruit intake. We found inconsistent evidence of an effect on unhealthy snacking.

CONCLUSION

The study suggests that novel theory-driven approaches which employ emotional motivators are capable of having an effect on improving dietary diversity and the regularity of vegetable and fruit intake among children aged 6-24 months. Mass media can have a measurable effect on nutrition-related behaviour, but these effects are likely to be enhanced through complementary community activations. Changing several behaviours at once remains a challenge.

Acute, Low-dose CO Inhalation does not Alter Energy Expenditure during Submaximal Exercise

Carbon monoxide, a gas known most widely for its toxic effects at high doses, is receiving increased attention for its role as a physiological signaling molecule and potential therapeutic agent when administered in low doses. We sought to quantify any changes to oxygen consumption and energy expenditure during submaximal exercise after low-dose CO inhalation. 9 active individuals completed 4 graded submaximal exercise tests, with each test occurring during a separate visit. For their first exercise test, subjects inhaled CO or room air (1.2 mL·kg(-1) body mass) in a randomized, subject-blind fashion. A second test was repeated 24 h later when the inhaled gas should have cleared the system. Subjects repeated study procedures with the alternate dose after a washout period of at least 2 days. Low-dose CO administration did not affect oxygen consumption or energy expenditure during submaximal exercise immediately or 24 h following its administration. Increases in heart rate, blood [lactate], and perceived exertion were observed following acute CO inhalation but these effects were absent after 24 h. The results of this study suggest that low-dose CO administration does not influence the energetics of submaximal exercise, but it acutely increases the relative intensity associated with absolute workloads below the lactate threshold.

Educational recommendations for the conduct, content and format of EULAR musculoskeletal ultrasound Teaching the Teachers Courses

OBJECTIVE

To produce educational guidelines for the conduct, content and format of theoretical and practical teaching at EULAR musculoskeletal ultrasound (MSUS) Teaching the Teachers (TTT) Courses.

METHODS

A Delphi-based procedure with 24 recommendations covering five main areas (Duration and place of the course; Faculty members; Content of the course; Evaluation of the teaching skills; TTT competency assessment) was distributed among a group of experts involved in MSUS teaching, in addition to an advisory educational expert being present. Consensus for each recommendation was considered achieved when the percentage of agreement was >75%.

RESULTS

21 of 24 invited participants responded to the first Delphi questionnaire (88% response rate). All 21 participants also responded to the second round. Agreement on 19 statements was obtained after two rounds.

CONCLUSIONS

This project has led to the development of guidelines for the conduct, content and format of teaching at the EULAR MSUS TTT Courses that are organised annually, with the aim of training future teachers of EULAR MSUS Courses, EULAR Endorsed MSUS Courses, as well as national and local MSUS Courses. The presented work gives indications on how to homogenise the teaching at the MSUS TTT Courses, thus resolving current discrepancies in the field.

Adopting oculopressure tonometry as a transient in vivo rabbit glaucoma model

Glaucoma represents a group of eye disorders partly related to raised intraocular pressure (IOP) leading to progressive optic nerve damage resulting in impaired vision and possibly blindness. To assess the suitability of new IOP lowering therapeutic strategies, such as the implantation of glaucoma drainage devices, appropriate animal models have to be used. Currently, a number of rodent glaucoma models are available [1], however, especially for surgical interventions rodent eyes are too small. Rabbits are much more suitable with respect to dimension. Unfortunately, rabbit glaucoma model systems described in literature are difficult to reproduce or fail totally, associated with a high level of discomfort and pain for treated animals. Therefore, development of an in vivo rabbit glaucoma model is one of the most important goals in glaucoma research. Here, we describe the adaptation of the oculopressure tonometry, an existing method to quantify the outflow of aqueous humor in humans, to generate a transient glaucoma model in rabbits. The existing suction-cup oculopressor (SCOP) is extended with newly designed suction-cups, which are adjusted to the anatomy of the rabbit eye. The modification of the oculopressure tonometry method facilitates an increase in IOP over a time frame of 9 minutes by vacuum induced deformation of the rabbit eye. This method can be used to test functionality of fistulating glaucoma surgeries or implanted drainage devices in a long term follow-up without any side effects and suffering of the animals.

Test setup for characterizing the efficacy of embolic protection devices

Systems for embolic protection are applied during the dilatation and the implantation of stents in the carotid artery. They are used to avoid downstream drift of arterial plaque particles which may be released during the intervention. Such particulate debris increases the risk of stroke when reaching and occluding even minor cranial vessels. Embolic protection devices (EPD) are intended to collect such particles during intervention and to finally remove them.

A test setup was developed in order to assess the effi-cacy of commercially available EPDs. The setup considers the introduction of relevant particles, as well as typical anatomic conditions. The EPDs could be tested using curved and ovalized vessel types to simulate stressed vessel conditions. Furthermore, a method for counting the particles was established to quantify collected particles in the EPD, the leaked particles and those which were left behind in the vessel.

Investigation of the dynamic diameter deformation of vascular stents during fatigue testing with radial loading

Endovascular stents are exposed to cyclic loads resulting from daily activity and pulsatile arterial blood pressure. DIN EN ISO 25539-2 and FDA guideline 1545 recommend durability testing, exposing stents to physiological cyclic loads for a 10 year equivalent. For accelerated testing, the simulated deformation has to be comparable to physiological in-vivo deformation. A new test setup is presented to determine diameter deformation of vascular stents during fatigue testing with radial loading.

Methods

The new setup allows the investigation of stents (n = 1–10) up to a length of 200 mm using a CCD line camera independent from special configurations. For demonstration, the radial deformation of two peripheral stents (stent 1: 8.0×40 mm, stent 2: 4.5×40 mm) and coronary stents (stent 3: 2.5×22 mm, stent 4: 4.0×40 mm) is determined as a function of the longitudinal measuring position. The stents are implanted in polyurethane tubes and exposed to physiologically relevant pressure at test frequencies 100 Hz.

Results

In addition to the verification of test frequencies for fatigue testing the setup can also be used for the investigation of radial deformation performance. The results show that radial deformation may vary along the stent length. Larger radial deformation was detected at the middle of the stent. For stent 1 a maximum deformation of 0.21 ± 0.07 mm (± 2.65 %) was measured at 50 ± 40 mmHg, 90 Hz. It was also measured that the radial deformation is dependent on stent design, geometric dimension and external loading.

Conclusion

The new setup allows for test frequency verification for accelerated fatigue testing with radial loading. It is also suitable for more detailed investigation of the radial deformation performance of stents along their longitudinal axis. This is necessary for a better understanding of potential mechanical failure especially in the case of long or overlapping stents.

NUEVOS ESTÍMULOS PARA EL DEPORTE ESCOLAR

La educación física y el deporte se desarrollan de dos maneras diferentes en la escuela. Por un lado, el deporte es el objeto de una materia de enseñanza obligatoria para todos los alumnos. Pero, junto a esto el deporte también se lleva a cabo y se realiza independientemente de la educación física obligatoria y siempre que la escuela permita la práctica libre del deporte, respectivamente, no prohíbe las actividades de movimiento de los alumnos. Los nuevos estímulos para el deporte pertenecen a esta segunda área del deporte escolar. Ellos no representan exigencias obligatorias, sino que los alumnos por decisión propia y libremente, los aceptan o los rechazan.

Microstructure analysis of complex CuO/ZnO@carbon adsorbers: what are the limits of powder diffraction methods?

Activate carbon impregnated with a mixture of copper oxide and zinc oxide performs well as active adsorber for NO2 removal in automotive cabin air filters. The oxide-loaded activated carbon exhibits superior long-term stability in comparison to pure activated carbon as has been shown in previous studies. The carbon material was loaded only with 2.5 wt% of each metal oxide. Characterization of the oxide nanoparticles within the pores of the activated carbon is difficult because of the rather low concentration of the oxides. Therefore, a systematic study was performed to evaluate the limits of line profile analysis of X-ray powder diffraction patterns. The method allows evaluation of crystalline domain size distributions, crystal defect concentrations and twinning probabilities of nanoscopic materials. Here, the analysis is hampered by the presence of several phases including more or less amorphous carbon. By using physical mixtures of defined copper oxide and zinc oxide particles with activated carbon, potential errors and limits could be identified. The contribution of the activated carbon to the scattering curve was modeled with a convolution of an exponential decay curve, a Chebyshev polynomial, and two Lorentzian peaks. With this approach, domain size distributions can be calculated that are shifted only by about 0.5-1.0 nm for very low loadings (≤4 wt%). Oxide loadings of 4 wt% and 5 wt% allow very reliable analyses from diffraction patterns measured in Bragg-Brentano and Debye-Scherrer geometry, respectively. For the real adsorber material, mean domain sizes have been calculated to be 2.8 nm and 2.4 nm before and after the NO2 removal tests.