Progressive supranuclear palsy, a case report

Progressive Supranuclear Palsy (PSP), also known as Steele-Richardson-Olszewski syndrome, is a rare neurodegenerative disease characterized by a variety of motor and neuro-ophthalmological symptoms. We present the case of a 73-year-old male patient with a history of type 2 diabetes and high blood pressure, who consulted for gait disorders, tremors in the extremities, and difficulty controlling conjugate gaze. During physical examination, findings consistent with PSP were noted, including hypomimia, muscle rigidity, and abnormal movements. The initial misdiagnosis of Parkinson's disease and subsequent administration of levodopa highlight the importance of accurate diagnosis in complex neurological conditions. This clinical case highlights the need for a thorough evaluation of neuro-ophthalmological symptoms and signs to ensure an appropriate therapeutic approach and improve the quality of life of patients.

Dependency and frailty in the older haemodialysis patient

BACKGROUND

Frailty among older adults undergoing hemodialysis is increasingly prevalent, significantly impacting cognitive function, mobility, and social engagement. This study focuses on the clinical profiles of very older adults in hemodialysis, particularly examining the interplay of dependency and frailty, and their influence on dialysis regimens.

METHODS

In this observational, descriptive study, 107 patients aged over 75 from four outpatient centers and one hospital unit were examined over a year. Patient data encompassed sociodemographic factors, dialysis specifics, analytical outcomes, lifestyle elements, and self-reported post-treatment fatigue. Malnutrition-inflammation scale was used to measure the Nutritional status; MIS scale for malnutrition-inflammation, Barthel index for dependency, Charlson comorbidity index; FRIED scale for frailty and the SF12 quality of life measure.

RESULTS

The study unveiled that a substantial number of older adults on hemodialysis faced malnutrition (55%), dependency (21%), frailty (46%), and diminished quality of life (57%). Patients with dependency were distinctively marked by higher comorbidity, severe malnutrition, enhanced frailty, nursing home residency, dependency on ambulance transportation, and significantly limited mobility, with 77% unable to walk. Notably, 56% of participants experienced considerable post-dialysis fatigue, correlating with higher comorbidity, increased dependency, and poorer quality of life. Despite varying clinical conditions, dialysis patterns were consistent across the patient cohort.

CONCLUSIONS

The older adult cohort, averaging over four years on hemodialysis, exhibited high rates of comorbidity, frailty, and dependency, necessitating substantial support in transport and living arrangements. A third of these patients lacked residual urine output, yet their dialysis regimen mirrored those with preserved output. The study underscores the imperative for tailored therapeutic strategies to mitigate dependency, preserve residual renal function, and alleviate post-dialysis fatigue, ultimately enhancing the physical quality of life for these patients.

NIRS (Near Infrared Spectroscopy) classification of sliced Duroc dry-cured ham under various packaging systems and storage temperature and time

The potential of Near Infrared Spectroscopy (NIRS) was assessed for storage temperature discrimination (4 °C ± 2 vs. 20 °C ± 2) and for the prediction of the length of time that sliced Duroc dry-cured ham was in storage, considering the following packaging types; vacuum (n = 133) and modified atmosphere (MAP) (n = 133), without opening the package. The models, obtained by means of Partial least squares-discriminant analysis, indicated successful classification of the product according to storage temperature after validation (accuracy values of 100.00% in vacuum and between 92.00 and 100% in MAP). Furthermore, good accuracy was obtained for the assignments into storage times, with values comprised between 92.31% and 100.00% for samples under vacuum and between 91.00% and 97.00% for those under MAP, in both cases after validation. Thus, NIRS technology could help to support the preservation temperature traceability and the stocks of sliced dry-cured hams.

Atroposelective Brønsted Acid-Catalyzed Photocyclization to Access Chiral N-Aryl Quinolones with Low Rotational Barriers

Herein, a novel route to atropisomeric N-aryl quinolones with low rotational barriers is demonstrated, leveraging a dual photochemical/organocatalytic approach to the required ring closure in up to 94% yield and up to >99% ee. The use of a continuous flow system allows for impurity suppression and enables rapid scale-up to a decagram scale.

A Sarcopenia Index Derived from Malnutrition Parameters in Elderly Haemodialysis Patients

(1) Background: Persons with chronic kidney disease may have sarcopenia characterized by the loss of muscle mass and loss of muscle strength. However, EWGSOP2 criteria to diagnose sarcopenia are technically challenging, especially in elderly persons on hemodialysis. Sarcopenia may be associated with malnutrition. We aimed at defining a sarcopenia index derived from malnutrition parameters for use in elderly haemodialysis patients. (2) Methods: A retrospective study of 60 patients aged 75 to 95 years treated with chronic hemodialysis was conducted. Anthropometric and analytical variables, EWGSOP2 sarcopenia criteria and other nutrition-related variables were collected. Binomial logistic regressions were used to define the combination of anthropometric and nutritional parameters that best predict moderate or severe sarcopenia according to EWGSOP2, and performance for moderate and severe sarcopenia was assessed by the area under the curve (AUC) of receiver operating characteristic (ROC) curves. (3) Results: The combination of loss of strength, loss of muscle mass and low physical performance correlated with malnutrition. We developed regression-equation-related nutrition criteria that predicted moderate sarcopenia (elderly hemodialysis sarcopenia index-moderate, EHSI-M) and severe sarcopenia (EHSI-S) diagnosed according to EWGSOP2 with an AUC of 0.80 and 0.866, respectively. (4) Conclusions: There is a close relationship between nutrition and sarcopenia. The EHSI may identify EWGSOP2-diagnosed sarcopenia from easily accessible anthropometric and nutritional parameters.

EEG Interchannel Causality to Identify Source/Sink Phase Connectivity Patterns in Developmental Dyslexia

While the brain connectivity network can inform the understanding and diagnosis of developmental dyslexia, its cause-effect relationships have not yet enough been examined. Employing electroencephalography signals and band-limited white noise stimulus at 4.8[Formula: see text]Hz (prosodic-syllabic frequency), we measure the phase Granger causalities among channels to identify differences between dyslexic learners and controls, thereby proposing a method to calculate directional connectivity. As causal relationships run in both directions, we explore three scenarios, namely channels' activity as sources, as sinks, and in total. Our proposed method can be used for both classification and exploratory analysis. In all scenarios, we find confirmation of the established right-lateralized Theta sampling network anomaly, in line with the assumption of the temporal sampling framework of oscillatory differences in the Theta and Gamma bands. Further, we show that this anomaly primarily occurs in the causal relationships of channels acting as sinks, where it is significantly more pronounced than when only total activity is observed. In the sink scenario, our classifier obtains 0.84 and 0.88 accuracy and 0.87 and 0.93 AUC for the Theta and Gamma bands, respectively.

Origin of congenital coronary arterio-ventricular fistulae from anomalous epicardial and myocardial development

Coronary Artery Fistulae (CAFs) are cardiac congenital anomalies consisting of an abnormal communication of a coronary artery with either a cardiac chamber or another cardiac vessel. In humans, these congenital anomalies can lead to complications such as myocardial hypertrophy, endocarditis, heart dilatation, and failure. Unfortunately, despite their clinical relevance, the aetiology of CAFs remains unknown. In this work, we have used two different species (mouse and avian embryos) to experimentally model CAFs morphogenesis. Both conditional Itga4 (alpha 4 integrin) epicardial deletion in mice and cryocauterisation of chick embryonic hearts disrupted epicardial development and ventricular wall growth, two essential events in coronary embryogenesis. Our results suggest that myocardial discontinuities in the embryonic ventricular wall promote the early contact of the endocardium with epicardial-derived coronary progenitors at the cardiac surface, leading to ventricular endocardial extrusion, precocious differentiation of coronary smooth muscle cells, and the formation of pouch-like aberrant coronary-like structures in direct connection with the ventricular lumen. The structure of these CAF-like anomalies was compared with histopathological data from a human CAF. Our results provide relevant information for the early diagnosis of these congenital anomalies and the molecular mechanisms that regulate their embryogenesis.

Coupling-Condensation Strategy for the Convergent Synthesis of an Imidazole-Fused 2-Aminoquinoline NLRP3 Agonist

The development of a convergent route to the NLRP3 (nucleotide-binding domain and leucine-rich repeat-containing protein 3) agonist BMS-986299 is reported. The synthesis relies on a key Miyaura borylation and a tandem Suzuki-Miyaura coupling between an iodoimidazole and an o-aminochloroarene, followed by acid-mediated cyclization to afford the aminoquinoline core. The subsequent Boc cleavage and regioselective acylation afford the target compound. Two routes to the iodoimidazole intermediate are presented, along with the synthesis of the o-aminochloroarene via Negishi coupling. The convergent six-step route leads to an 80% reduction in process mass intensity compared to the linear enabling synthesis.

Moderate exercise protects against joint disease in a murine model of osteoarthritis

Exercise is recommended as a non-pharmacological therapy for osteoarthritis (OA). Various exercise regimes, with differing intensities and duration, have been used in a range of OA rodent models. These studies show gentle or moderate exercise reduces the severity of OA parameters while high intensity load bearing exercise is detrimental. However, these studies were largely conducted in rats or in mouse models induced by severe injury, age or obesity, whilst destabilization of the medial meniscus (DMM) in mice has become a widely accepted model due to its lower variability, moderate progression and timescale. The present study was undertaken to provide insight into the effect of moderate exercise on early joint pathology in the DMM mouse model. Exercise was induced a week after induction by forced wheel walking for three or 7 weeks. Joints were analyzed by microcomputed tomography and histology. Assessment of skeletal parameters revealed that exercise offered protection against cartilage damage after 7 weeks of exercise, and a temporary protection against osteosclerosis was displayed after 3 weeks of exercise. Furthermore, exercise modified the metaphyseal trabecular microarchitecture of the osteoarthritic leg in both time points examined. Collectively, our findings corroborate previous studies showing that exercise has an important effect on bone in OA, which subsequently, at 8 weeks post-induction, translates into less cartilage damage. Thus, providing an exercise protocol in a surgical mouse model of OA, which can be used in the future to further dissect the mechanisms by which moderate exercise ameliorates OA.

Central retinal artery occlusion as an ophthalmic complication after snakebite

Snakebite causes 421.000-1.200.000 poisonings per year due to and hematotoxicity, neurotoxicity y vasculotoxicity. Ophthalmological manifestations secondary to snake bites are rare. If the snake belongs to the Viperidae family, the most frequent ophthalmologic manifestations are macular infarction, chronic open-angle glaucoma, and retinal or vitreous hemorrhage. Central retinal artery occlusion is an extremely rare ocular complication. We report the case of a 30-year-old patient, who consulted due to poor vision in her left eye weeks after suffering a snake bite (Bothrops atrox) in her left lower limb. The diagnosis was a central retinal artery occlusion in the left eye with abnormal findings in the ophthalmological physical examination and in complementary retinal and neuro-ophthalmological tests.

P-080 Intrauterine insemination (IUI) success rates in patients with suboptimal total processed motile sperm count (TPMSC) using a second consecutive semen sample

Study question

Is it effective to request a second consecutive semen sample in patients with less than 1 million TPMSC in a first semen sample for IUI?

Summary answer

In men with TPMSC under one million, the issuing of a second consecutive sample reached pregnancy rates similar to those published for IUI.

What is known already

IUI offers a comparable cumulative live birth rate in 3-4 cycles compared to IVF and can be preferred as a cost-effective first-line treatment in mild male factor or unexplained infertility. The quality of the processed semen sample is an important factor for the IUI success.

The WHO recommends an abstinence period to ensure best quality of semen samples. However, it has been observed that when men with moderate male factor who are unable to meet the minimum requirements for IUI are asked to produce a second sample better counts are obtained; questioning the time correlation between abstinence and semen quality.

Study design, size, duration

This was a retrospective study conducted in the reproductive medicine unit of a private hospital in Chile between July 2015 and March 2021. All patients who underwent IUI in the study period that had an TPMSC less than 1 million in the eyaculate and to whom a second consecutive sample was requested were included.

Participants/materials, setting, methods

118 patients who underwent 140 IUI cycles were included in the study. All the patients with an PMSC under 1 million at the time of the IUI were requested a second consecutive semen sample within an hour or two from the previous eyaculate. The second samples were processed and used for insemination. The primary outcome was pregnancy rate. The secondary outcomes were semen quality (TPMSC of first and second semen samples).

Main results and the role of chance

Between 2015 and 2021 there were 140 IUI cycles in which a second consecutive semen sample was requested, including 118 patients. Overall 17 pregnancies were achieved. The pregnancy rate per cycle was 12,14% and the pregnancy rate per patient was 14,4%. The live birth rate per patient was 10,2%.

Regarding the sperm sample analysis, the median TPMSC of the first semen sample was 261.437. The median PMSC of the second consecutive sample was 7.315.000. 126 patients had an TPMSC of 0 in the first semen sample while only 9 patients had an IMSC of 0 in the second sample. In five cases a third consecutive sample was requested of which 4 patients had their cycles canceled because they did not meet the target PMSC. One patient had an TPMSC of 1.687.000 in the third sample.

Finally, of the 118 patients who did not meet the requirements for IUI with the first sample, only 19 cycles were canceled.

Limitations, reasons for caution

The study has the limitation of being a retrospective and descriptive study with no contol group. Also the group is heterogeneous because it includes patients with different female factors for infertility.

Wider implications of the findings

In developing countries and low-income settings the IUI remains a more accessible alternative in patients with infertility. Routinely recollecting a second semen sample in men with TPMSC <1 million would reduce cycle cancellation rates due to not achieving an optimal TPMSC, reaching pregnancy rates similar to those published for IUI.

Trial registration number

Not applicable

AB0231 PROGNOSTIC UTILITY OF METACARPAL BONE MINERAL DENSITY MEASUREMENT IN PATIENTS WITH RECENT-ONSET ARTHRITIS BY ASSESSMENT OF RADIOGRAPHIC PROGRESSION AT 2-YEAR FOLLOW-UP

Background

Rheumatoid arthritis (RA) and osteoporosis (OP) have a complex interplay in terms of pathogenic mechanisms. In this regard, radiogrammetry (DXR) of the hand, a technique that measures the bone mineral density (BMD) at the central metacarpals (MC), is associated with a worse prognosis in patients with RA (1). However, DXR is an expensive technique, and not very accessible in our environment. Our group demonstrated an excellent reproducibility of the MC measurement by DXA (2) and good correlation between BMD measurements obtained by DXR and DXA (3).

Objectives

To evaluate if baseline BMD of the non dominant MC measured by DXA can be used as a prognostic marker, resembling DXR, in patients with early arthritis (EA).

Methods

A total of 378 subjects from the PEARL (Princesa Early Arthritis Register Longitudinal) study underwent DXA measurement of the 2nd to 4th MC’s diaphyseal area of the non dominant hand (Hologic 4500). In PEARL sociodemographic, clinical and laboratory parameters, therapeutic data and radiographic findings are collected by protocol. Radiographic progression was evaluated in hands by a blind expert rheumatologist assessing the erosion scale of modified SvdH index in both the baseline and two year follow-up visit. To study the predictive value of MC baseline BMD by DXA, two multivariate models were fitted using generalized linear models with Stata 14.0 for Windows (Stata Corp LP, College Station, TX, USA). The dependent variables were remission (SDAI<3.3) and radiographic progression after two 2 years of follow-up. Both models were adjusted by the classic variables that affect BMD such as age, sex and body mass index (BMI), cumulative DMARD treatment and baseline disease activity for the remission model.

Results

After adjustment by age, sex and BMI: a) those patients at remission tended to show higher baseline MC’s BMD by DXA (p=0.328); and b) those patients with higher radiographic progression had significantly lower baseline MC’s BMD as shown in Figure 1(p=0.001).

Conclusion

In our registry of patients with EA, we have detected that a lower basal BMD in the diaphysis of the central MC bones, assessed by DXA, is associated with greater radiographic progression at 2 years of follow-up after adjusting for the main factors influencing BMD. Therefore, we could conclude that a low initial bone mass could constitute a poor prognostic factor in patients with EA.

Figure 1.

Correlation of mean BMD of 2-4th MC bones with radiographyc progression assesed by the modified SvdH radiological index at 2 years, after adjusting for age, sex and BMI, calculated using Stata margins command base don the data obtained from multivariate analysis.

References

[1]Haugeberg G, Lodder MC, Lems WF, Uhlig T, Ørstavik RE, Dijkmans B a. C, et al. Ann Rheum Dis october 2004;63(10):1331-4.

[2]Llorente I, Merino L, Escolano E, Quintanilla DM, García-Vadillo JA, González- Álvaro I, et al. C Clin J Densitom 2020;23(4):678-84

[3]Ann Rheum Dis, volumen 78, supplement 2, year 2019, page A942

Disclosure of Interests

Irene Llorente Speakers bureau: UCB, Jannsen, Lilly, Gedeon Richter, Ana Ortiz: None declared, ANA MARIA FERNANDEZ ORTIZ: None declared, Alberto García-Vadillo: None declared, José Ivorra: None declared, Luis Rodriguez Rodriguez: None declared, Rosario Garcia-Vicuna: None declared, Santos Castañeda: None declared, Isidoro González-Álvaro: None declared

Child psychiatric emergency visits during the COVID-19 pandemic

Introduction

Paediatric and adult psychiatric emergency department (ED) visits decreased during the initial COVID-19 pandemic outbreak. Long-term consequences of the pandemic will include increases in mental healthcare needs especially among especially vulnerable groups such as children and adolescents.

Objectives

This study examined changes in the number of overall and diagnosis-specific mental health ED visits among patients aged <18 years following onset of the COVID-19 pandemic in Madrid, Spain.

Methods

We used electronic health records to extract the monthly numbers of total and diagnosis-specific mental health ED visits among patients aged <18 years, between October 2018 and April 2021, to La Paz University Hospital. We conducted interrupted time-series analyses and compared trends before and after the day of the first ED COVID-19 case (1^st March 2020).

Results

In March 2020, there was a marked initial decrease of -12.8 (95%CI -21.9, -7.9) less monthly mental health ED visits. After April 2020, there was a subsequent increasing trend of 3.4 (95%CI 2.6, 4.2) additional monthly mental health ED visits.

Conclusions

After onset of the COVID-19 pandemic, there was an increase in paediatric psychiatric ED visits, especially due to suicide-related reasons. These data reinforce the crucial role of the ED in the management of acute mental health problems among youth and highlight the need for renovated efforts to enhance access to care outside of and during acute crises during the pandemic and its aftermath.

Disclosure

No significant relationships.

Global diagnosis of nitrate pollution in groundwater and review of removal technologies

Clean water and sanitation for the world population is one of the most important challenges established by the Sustainable Development Goals of the United Nations since worldwide, one in three people do not have access to safe drinking water. Groundwater, one of the main sources of fresh water, has been considerably damaged by human activities. Nevertheless, while numerous plants are globally aimed at removing pollutants from surface waters, a much scarcer number of facilities have focused on groundwater remediation. Nowadays, there is increasing concern about the presence of nitrates (NO₃^-) in groundwaters as a consequence of the intensive use of fertilizers and other anthropogenic sources, such as sewage or industrial wastewater discharge. In this context, the selection and development of highly effective and low-cost solutions for the sustainable management of groundwater resources need to be addressed. Thus, this work collects data from the literature regarding the presence of nitrates in groundwater, and, simultaneously, it reviews the main alternatives available to remove NO₃^- from groundwater sources. A total of 292 sites have been analyzed categorized by continents, carefully discussing the possible origins of nitrate pollution. In addition, a discussion is carried out of the different technologies currently employed to treat groundwater, highlighting the progress made and the main challenges to be overcome. Finally, the review gathers the data available in the literature for nitrate treatment plants at full-scale.

Synthesis of Carbon-14 and Stable Isotope Labeled Censavudine

Censavudine is a nucleoside reverse transcriptase inhibitor (NRTI) explored clinically by Bristol Myers Squibb for the treatment of human immunodeficiency virus-1 (HIV-1). As part of the development process, a carbon-14 labeled analog was synthesized for use in a human absorption, distribution, metabolism, and excretion (ADME) study. A stable isotope labeled analog was also synthesized for use as a mass spectrum internal standard in bioanalytical assays to accurately quantify the concentration of the drug in biological samples. Carbon-14 labeled Censavudine was synthesized in ten steps in a 9% overall yield from carbon-14 labeled trimethylsilylacetylene. A total of 4.44 mCi of material was prepared with a specific activity of 0.25 μCi/mg. The radiochemical and UV purities were 99% and it met all of the specifications for use in a human clinical study. Deuterium labeled Censavudine was synthesized in two steps in a 68% overall yield from [D₄ ]-thymine. A total of 237 mg were prepared with a UV purity of 99%.

A prototype of pCT scanner: first tests

Proton therapy technique for cancer treatment offers a high selectivity with respect to conventional radiotherapy with X- and γ-rays due to the properties of the interaction of protons with matter. Very accurate and precise treatment plans and a good control on the dose deposition are required to exploit the full potential of the technique. The substitution of the currently used X-ray Computed Tomography (xCT) by proton Computed Tomography (pCT) in the design of treatment plans would allow for a reduction in proton range uncertainties. This would make possible an important improvement in the accuracy and precision of treatment plans. With this aim, a prototype of pCT scanner is under study. It includes two tracking detectors which provide information on the proton trajectories and a residual energy detector to determine the energy loss while traversing the object scanned. A proof-of-concept experiment has been performed using low-energy protons and a simplified prototype with only the two tracking detectors. The results obtained in the measurement are presented and discussed.

Performance and carcass quality traits of Iberian × Duroc crossbred pig subject to gender and age at the beginning of the free-range finishing phase

The traditional production of the Iberian breed pig involves a long production cycle. It might be shortened by using Iberian pigs crossed with Duroc and by reducing the growing phase, but the age-related changes on productive performance and carcass quality should be addressed. Thus, productive performance, live measurements and carcass and primal cut traits were evaluated on Iberian × Duroc 50:50 crossed pigs according to animal age at the beginning of the free-range finishing phase (Montanera): 10, 12 and 14 months old (IBxD10 (n = 15), IBxD12 (n = 17) and IBxD14 (n = 18) animal batches, respectively) and gender (immunologically castrated female -consisted of the Improvac® vaccination- and surgically castrated males). During the growing period, animals were fed with restrictions; 1.49, 1.29 and 1.20 ± 0.023 (mean ± SEM) kg/day of commercial feeds to start Montanera with similar BW; 103.9, 102.9 and 102.1 ± 0.22 kg, for IBxD10, IBxD12 and IBxD14, respectively. IBxD14 animals yielded the highest average daily gain (ADG) and BW after Montanera, as well as larger rump height and croup width. In contrast, these animals had the lowest carcass yield. Although animals from IBxD10 yielded hams of inferior size, this could be of interest to the sector, as there is a certain segment of the market that demands hams of smaller size and, generally, this is difficult to obtain with the traditional Montanera production system. The gender had no major effects on performance and carcass and primal cut traits, so both immunologically castrated female and surgically castrated males are suitable for finishing in Montanera.

Stereoselective and Divergent Aza-Adenosine and Aza-Guanosine Syntheses from Xylofuranose, the Key Fragments of a STING Cyclic Dinucleotide Agonist

The stereoselective and divergent synthesis of two aza-nucleosides is reported. Starting from xylofuranose 9, aza-adenosine 2 was prepared in 13 steps and 7% overall yield, and aza-guanosine 3 was prepared in 13 steps and 7.8% overall yield. Compared to the original syntheses, some advantages of these new routes are significant yield improvement, overall step-count reduction, an optimized protecting group strategy, the development of a versatile platform for nitrogenous base incorporation, and the elimination of hazardous reagents (e.g., benzyl isocyanate, Et₃N·HF).

AB0214 SURVIVAL, EFFICACY AND SAFETY OF GOLIMUMAB IN PATIENTS WITH RHEUMATOID ARTHRITIS AND SPONDYLOARTHRITIS: DATA FROM AN ARGENTINEAN COHORT

Background:

Golimumab is a human monoclonal antibody directed against TNFα in its soluble and transmembrane forms. It can be used subcutaneously or intravenously and has shown efficacy for use in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS).

Objectives:

The aim of this study was to evaluate the efficacy, safety, and cumulative survival of golimumab in patients with RA, PsA and AS from different rheumatology centers in Argentina.

Methods:

We performed a longitudinal study of consecutive adults with RA (ACR/EULAR 2010 criteria), PsA (CASPAR criteria) and AS (ASAS 2009 criteria), who have started treatment with subcutaneous or intravenous golimumab according to medical indication in each center. Data was obtained by review of medical records. Sociodemographic and clinical data, musculoskeletal manifestations, comorbidities, previous treatments were recorded. In reference to golimumab treatment, start date, route of administration and concomitant treatments were identified. Disease activity was assessed using DAS28 for RA patients, DAPSA and MDA for PsA and BASDAI for AS. The presence of adverse events (AE) was recorded. If golimumab was stopped, date and cause was documented. Patients were followed up until golimumab discontinuation, loss of follow-up, or study completion (November 30, 2020). Statistical analysis: Chi2 test or Fischer exact test and T test or Mann Whitney and ANOVA or Kruskal Wallis, as appropriate. The incidence of EA was assessed in events every 100 patient/year. Kaplan-Meier curves and log Rank analysis. Cox proportional regression.

Results:

One hundred eighty two patients were included, 116 with a diagnosis of RA, 30 with PsA and 36 with AS. Most of them (70.9%) were female with a median (m) age of 55 years (IQR 43.8-64) and m disease duration of 7 years (IQR 4-12.7) at treatment initiation. Al least one prior biological DMARD or a small molecule was received by 63 patients (34.6%). The most frequent indication cause was conventional DMARD failure. In 94.8% of the patients Golimumab was administered subcutaneously, and in 80.8% in association with conventional DMARDs, the most frequently used was methotrexate. Total follow-up was 318.1 patients/year.

Golimumab treatment showed clinical improvement in all three groups of patients. In RA patients DAS28 significantly decreased during the first 12 months of follow-up, m 5.9 (IQR 4.9-6.6) at baseline, 3.8 (IQR 2.6-4.6) at 6 months and 2.8 (IQR 2.1-3.6) at 12 months, p <0.0001. In PsA, m DAPSA-ESR value was 32.2 (IQR 24.2-47.7), 10.1 (IQR 5.8-18.3) and 11.2 (IQR 3.4-24) at baseline, 6 and 12 months, respectably (p <0.0001). In AS, m BASDAI was 6.2 (IQR 4.8-7.3), 2.8 (IQR 1.7-4.1) and 2.2 (IQR 1.1-3.2), at baseline, 6 and 12 months respectively (p <0.0001).

The incidence of adverse events was 6.6 per 100 patients/year, being infections the most frequents ones. During follow-up, 50 patients (27.5%) discontinued golimumab, the most frequent cause was treatment failure (68%), followed by lack of health insurance (16%) and adverse events (10%). Golimumab persistence was 79% and 57.6% at 12 and 24 months, respectively. Treatment survival was 50.2 months (95% CI 44.4-55.9). Patients who had received prior treatment with biological DMARDs or small molecules showed lower survival (Figure 1). In the multivariate analysis, adjusting for age, sex and disease duration, those patients showed twice the risk of suspending treatment (HR 2.01, 95% CI 1.1-3.7).

Figure 1.

Golimumab survival according to prior b-DMARD o small molecule treatment.

Conclusion:

Golimumab treatment in real life patients in Argentina has shown good efficacy and safety. Drug survival was over 4 years and almost 80% were still using golimumab after one year. Prior treatment with other b-DMARDs o small molecules was associated with lower treatment survival.

Disclosure of Interests:

Carolina Ayelen Isnardi Speakers bureau: Bristol Myers Squibb, Janssen, Grant/research support from: Pfizer, Emma Estela Civit De Garignani Speakers bureau: Abbvie, Novartis, Agustín García Ciccarelli Speakers bureau: Janssen, Novartis, Consultant of: Novartis, Grant/research support from: Janssen, Novartis, Jimena Sanchez Alcover: None declared, Rodrigo Garcia Salinas Speakers bureau: Abbvie, AMGEN, Bristol-Myers Squibb, Eli Lilly, GSK, Janssen Cilag, Montpellier-UCB, Novartis, Roche – Genentech, Sanofi, Merck Serono., Sebastian Magri Speakers bureau: Abbvie, AMGEN, Bristol-Myers Squibb, Eli Lilly, GSK, Janssen Cilag, Montpellier-UCB, Novartis, Roche – Genentech, Sanofi, Merck Serono., Eduardo Albiero Consultant of: Janssen, Carla Gobbi Speakers bureau: Pfizer, Consultant of: Pfizer, Janssen, Edson Velozo Speakers bureau: Janssen, Novartis, Pfizer, Consultant of: Abbvie, Janssen, Novartis, Grant/research support from: Janssen, Novartis, Pfizer, Enrique Soriano Speakers bureau: AbbVie, Novartis, Bristol MS, Novartis, Eli Lilly, Genzyme, Pfizer, Amgen, and Roche, Consultant of: Novartis, AbbVie, Pfizer, Eli Lilly, Sanofi, Sandoz, Amgen., Grant/research support from: Roche, Novartis, AbbVie, Glaxo Smith Kline, BMS, Martín Brom: None declared, Johana Zacariaz Grant/research support from: Bristol Myers Squibb, Ingrid Strusberg Speakers bureau: Gema Biotech SAU, BMS, Abbvie, Consultant of: Gema Biotech SAU, Abbvie, Janssen, Grant/research support from: Abbvie, Lilly, Galápagos, Servier, GSK, Merck Serono, Marcos BARAVALLE Speakers bureau: Montepellier, Consultant of: Abbvie, Janssen, Grant/research support from: Abbvie, Lilly, Galápagos, Servier, GSK, Merck Serono, Sol Castaños Speakers bureau: Abbvie, Lilly, Galápagos, Servier, GSK, Merck Serono, Liliana Morales Speakers bureau: Lilly, Consultant of: Janssen, Grant/research support from: Abbvie, Lilly, Galápagos, Servier, GSK, Merck Serono, Sergio Paira: None declared, Romina Calvo: None declared, Alberto Ortiz: None declared, Rodolfo Perez Alamino Speakers bureau: Pfizer, Abbvie, Amgen, Bristol-Myers-Squibb, Lilly, Janssen, Novartis, Hernan Maldonado Ficco Speakers bureau: Pfizer, Abbvie, Jansen, Novartis, Bago, Bristol, Eli Lilly., Consultant of: Pfizer, Abbvie, Novartis, Jansen, Bago, Eli Lilly., Gustavo Citera Speakers bureau: Abbvie, BMS, Lilly, Jansen, Gema, Pfizer, Roche, Grant/research support from: Pfizer

Higher illness burden is associated with reduced heart rate variability in bipolar disorder

Introduction

Bipolar disorder (BD) is associated with premature death and ischemic heart disease is the main cause of excess mortality. The predictive power of heart rate variability (HRV) for mortality has been confirmed in patients with or without cardiovascular disease. While several studies have analyzed the association between HRV and BD, their results are incongruent; and none has analyzed the effect of the clinical factors characterizing illness burden on HRV.

Objectives

To assess the association between HRV and the following factors characterizing illness burden: illness duration, number and type of previous episode(s), duration of the most severe depressive or hypomanic/manic episode, severity of episodes, co-morbid psychiatric disorders, family history of BD or suicide, and duration and polarity of current episode in participants experiencing one.

Methods

We used a wearable device in 53 BD participants to assess the association between HRV using 4 measures (RMSSD, SDANN, SDNN and RR Triangular Index) and the abovementioned clinical factors characterizing illness burden. For each of the 4 HRV measures we ran 11 models, one for each burden of illness clinical factor as an independent variable.

Results

Longer illness duration, higher number of depressive episodes, and family history of suicide were negatively correlated with HRV; in the 14 participants experiencing a depressive episode, the MADRS score was negatively correlated with HRV

Conclusions

Our study analyzed the association between burden of illness and HRV in BD, while controlling for functional cardiovascular status, age, sex, BMI, education, and treatment. Our results showed that high illness burden is associated with reduced HRV.

Disclosure

No significant relationships.

Standardising clinical outcomes measures for adult clinical trials in Fabry disease: A global Delphi consensus

BACKGROUND

Recent years have witnessed a considerable increase in clinical trials of new investigational agents for Fabry disease (FD). Several trials investigating different agents are currently in progress; however, lack of standardisation results in challenges to interpretation and comparison. To facilitate the standardisation of investigational programs, we have developed a common framework for future clinical trials in FD.

METHODS AND FINDINGS

A broad consensus regarding clinical outcomes and ways to measure them was obtained via the Delphi methodology. 35 FD clinical experts from 4 continents, representing 3389 FD patients, participated in 3 rounds of Delphi procedure. The aim was to reach a consensus regarding clinical trial design, best treatment comparator, clinical outcomes, measurement of those clinical outcomes and inclusion and exclusion criteria. Consensus results of this initiative included: the selection of the adaptative clinical trial as the ideal study design and agalsidase beta as ideal comparator treatment due to its longstanding use in FD. Renal and cardiac outcomes, such as glomerular filtration rate, proteinuria and left ventricular mass index, were prioritised, whereas neurological outcomes including cerebrovascular and white matter lesions were dismissed as a primary or secondary outcome measure. Besides, there was a consensus regarding the importance of patient-related outcomes such as general quality of life, pain, and gastrointestinal symptoms. Also, unity about lysoGb3 and Gb3 tissue deposits as useful surrogate markers of the disease was obtained. The group recognised that cardiac T1 mapping still has potential but requires further development before its widespread introduction in clinical trials. Finally, patients with end-stage renal disease or renal transplant should be excluded unless a particular group for them is created inside the clinical trial.

CONCLUSION

This consensus will help to shape the future of clinical trials in FD. We note that the FDA has, coincidentally, recently published draft guidelines on clinical trials in FD and welcome this contribution.

Physico-chemical and sensory characterization of sliced Iberian chorizo from raw material of three commercial categories and stability during refrigerated storage packaged under vacuum and modified atmospheres

Physico-chemical and sensory analysis of Iberian chorizo manufactured from three commercial categories raw material compiled in the current Spanish Iberian Quality standard (Black, Red; 100% Iberian and 50% Iberian × Duroc pigs, respectively, under Montanera, and White; 50% Iberian × Duroc pigs commercially fed) and packed under vacuum and modified atmosphere (MAP) were carried out, in order to address the influence of the genotype and animal production system and packaging on quality parameters, as well as the stability of these throughout long-term storage. Montanera categories showed higher values of γ-tocopherol, mono- and poly-unsaturated fatty acids, greater scores of flavour and taste and higher lipid oxidation during the whole storage. MAP preserved better colour, especially redness and lipid oxidative status. Iberian chorizo could attain a differentiated quality because of physico-chemical and sensorial characteristics derived from the Montanera that would be adequate preserved in both vacuum and MAP throughout long-term storage.

Renin-angiotensin system and cancer: epidemiology, cell signaling, genetics and epigenetics

Day by day, the health and economical burden of cancer increases globally. Indeed it can be considered that there is ''cancer pandemic''. Blocking the renin-angiotensin system (RAS) by angiotensin-converting enzyme (ACE) inhibitors (ACEI) or angiotensin-receptor blockers (ARB) are widely used measures to treat hypertension and heart failure. It has been recently suggested the activation and blocking of RAS has been associated with various types of cancer in epidemiological and experimental studies. Various studies have shown that RAS blockage is protective in some cancers. However, although fewer, contradictory data also showed that RAS blockage is either not related or adversely related to cancer. Although the reasons for these findings are not exactly known, different types of receptors and effectors in RAS may account for these findings. In the current review, we summarize the different RAS receptors and cancer development with regard to epidemiology, and pathogenesis including cell signaling pathways, apoptosis, genetic and epigenetic factors.

AB1339-HPR SAFETY AND ADHERENCE OF THE JAK INHIBITORS IN CLINICAL PRACTICE IN RHEUMATOID ARTHRITIS

Background:

The Janus Kinase (JAKi) inhibitors Baricitinib (BAR) and Tofacitinib (TOF) are indicated for moderate to severe active rheumatoid arthritis (RA). Data about safety, effectiveness in refractory patients and adherence in real clinical practice in our population are scarce.

Objectives:

An evaluation of safety, adherence and reasons to consider suspension of JAKi in routine clinical practice.

Methods:

Retrospective observational study of patients with RA treated with BAR and TOF according to usual clinical practice between September 2017 - December 2019. Data were collected from the electronic medical record and from the Dominion® Outpatient Drug Dispensing program.

Demographic, clinical, laboratory and treatment-related variables were collected, including reasons for discontinuing JAKi (inefficiency and toxicity). Adherence was calculated using the Compliance Questionnaire on Rheumatology (CQR-5), and the average possession ratio (RMP), which is defined as the number of days with treatment dispensed between the total days of the period analyzed, considering the adherent patient when RMP had a ≥ 0.8.

Laboratory abnormalities were defined according to normal limit values (NLV) and specifications of data sheet. A descriptive analysis was performed using proportions, medians and interquartile ranges (IQR) using the SPSS v.15 program.

Results:

Thirty patients were included in treatment with BAR and nine with TOF. The median age was 62.9 (RIQ 49.9-74.4), 34 (87.2%) were women, 28 (71.2%) anti-CCP and 32 (82.1%) were rheumatoid factor positive, with erosive disease in 34 (87,2%) patients. In the previous treatment, 9 (23.1%) were naive to biological, 6 (15.4%) had received 1 biological, 18 (46.1%) 2 biologicals, and 6 (15.4%) ≥ 3 biologicals. The median treatment time was 8.4 months (RIQ 6.5-20.3) in BAR and 13.2 (RIQ 3.9-20.7) in TOF.

The reasons for consider suspension shown in Table 1.

Table 1.

Treatment Discontinuation

BARICITINIBInitial DAS28[median (IQR)]Final DAS28[median (IQR)]Continue treatmentn (%): 17/30 (55.6)4.20 (2.95-5.72)2.60 (1.70-2.77)Reasons for suspension-Refractory n (%): 7/13 (55.8%)4.38 (4.16-5.43)4,16 (3.56-5.23)-Side effects n (%): 4/13 (30.7)4.16 (3.45-4.84)3.15 (2.69-4.41) ◦Thrombocytosis (1) ◦Herpes Zoster (1) ◦Anemia (1) ◦Tubaritis (1)-Patient decisión n (%): 2/13 (15.4)TOFACITINIBContinue treatmentn (%): 6/9 (66.6)4.82 (3.28-6.20)2.61 (2.45-3.70)Reasons for suspension-Refractory n (%): 2/3 (66.6)5.27 (5.23-5.31)5.48 (5.04-5.92)-Side effects n (%): 1/3 (33.33)

Based on the CQR5 questionnaire, all patients treated with BAR and TOF were adherent “HIGH” class, and a median of RMP = 1.01 (IQR = 0.93-1.06) was obtained for BAR and RMP = 1, 00 (IQR = 0.91-1.01) for TOF, all adherents (≥ 0.8).

Table 2.

Safety results of the treatment shows the safety results.

Side EffectBaricitinib(n, %)Tofacitinib(n, %)Hb <11 g/dl7 (23,3)0Hb < 8 g/dl0 (0)/Hb Recovery >11 g/dl2/7 (28,6)/Neutrophils < 1500/mm30 (0)/Lymphocytes < 1000/mm33 (10,0)2 (22,2)Platelets > 600 × 103/mm31 (3,3)0AST o ALT > 1 NLV4 (13.3)0 (0)Hypercholesterolemia (> 1 NLV)13 (43.3)5 (55.5)Infections13 (43.3)0 (0)Herpes zoster6 (20,0)0 (0)

Conclusion:

In our population, mostly refractory to biological, more than half of the patients maintain treatment with JAKi, with optimal adherence. The main reason for the suspension of both drugs was inefficiency. The most frequent adverse effects were hypercholesterolemia in both groups and infections in BAR, with a high frequency of herpes zoster. No cardiovascular or thromboembolic events were observed.

Disclosure of Interests:

Cristina Valero: None declared, Alberto Calvo Garcia: None declared, Noelia García Castañeda: None declared, Ana Ortiz: None declared, Irene Llorente Speakers bureau: Gebro, Janssen, Sanofi, Lilly., Blanca Varas: None declared, Santos Castañeda: None declared, Rosario Garcia de Vicuna Grant/research support from: BMS, Lilly, MSD, Novartis, Roche, Consultant of: Abbvie, Biogen, BMS, Celltrion, Gebro, Lilly, Mylan, Pfizer, Sandoz, Sanofi, Paid instructor for: Lilly, Speakers bureau: BMS, Lilly, Pfizer, Sandoz, Sanofi, Esther Ramirez: None declared

FRI0264 EFFECTIVENESS, SAFETY AND PATTERNS OF USE OF RITUXIMAB IN SCLERODERMA, IN CLINICAL PRACTICE: 9 YEARS’ EXPERIENCE IN A TERTIARY HOSPITAL

Background:

Systemic sclerosis (SSc) is a clinically complex and heterogeneous disease. Interstitial lung involvement (ILD) is the main cause of mortality, but progression of skin fibrosis has also been associated with pulmonary dysfunction and mortality. Recently, Rituximab (RTX) has been postulated as a promising therapeutic alternative to cyclophosphamide (CF) or mycophenolate (MFM), but long-term experience is scarce.

Objectives:

Describe the effectiveness, safety and long-term use of RTX, in a series of cases with SSc.

Methods:

Retrospective observational study of patients with SSc (EULAR/ACR 2013 criteria) treated with RTX in a university hospital from 2010 to 2019. Sociodemographic data related to SSc and treatments were collected. The effectiveness of RTX was evaluated at 6-12 months and at the end of follow-up, by means of these main outcomes: Rodnan’s modified cutaneous index (mRSS) for skin fibrosis; CK leves for myopathy, variation >10% in forced vital capacity (FVC) and >15% in lung diffusion capacity of carbon monoxide (DLCO) for ILD. Adverse events (AE) were recorded. Statistical analysis performed with Stata v.14 and statistical significance set for p≤0.05.

Results:

14 women with SSc (mean age 47±13 years, mean evolution 6.2±4.5 years) were treated with RTX for ILD (n=9), skin involvement (n=11) and/or inflammatory myopathy (n=3). The mean±SD of follow-up was 3.36±2.17 years. SSc type: diffuse cutaneous 35.71%, limited cutaneous 21.44%, overlap 35.71% and sine scleroderma 7.14%. Type of antibodies: 50% anti-Scl-70, 14.3% anti-centromere, 21.4% anti-RNA polymerase III and 7.14% anti-Ku. ILD was classified as NINE in 8 patients and NIU in 1. The first cycle of RTX included 2 infusions of 1g and was initiated a mean of 3.36±2.17 years after diagnosis. The retreatments were initially fixed every 6 months and later on demand in 4 patients, and in the rest on demand from the beginning, according to duration of clinical response. A mean of 3.9±2.5 cycles/patient (range: 1-11) were administered. 30% of patients had previously received CF and 21.5% MFM. RTX was administered in association with other DMARDs (MTX 64.29%, hydroxychloroquine [HCQ] 35.71%, MFM 57.14%, others 14.28%), CF (14.29%), intravenous immunoglobulins (7,14%) and prednisone (78.57%). In the final visit, the percentage use of DMARDs (50% MTX, 50% MFM and 28.57% HCQ) and prednisone (62.5% patients, 30% doses) was reduced. mRSS improved significantly. Muscle weakness disappeared in 3/3 with normal CK levels in 2/3 patients with myopathy. The FVC improved or stabilized in 22% and 56% of ILD, respectively, and the DLCO stabilized in 66.70% (not significant). TACAR stabilized in 55.56% of ILD, with some degree of worsening in the rest. Outcomes evolution in the Table:

Functional ParametersBasal (mean±SD)6-12 m (mean±SD)CI 95%PFinal (mean±SD)CI 95%PFVC (n=9)63.2±16.870.3±18.6[-13.3–6.1]0,4071.9±21.1[-14.4–5.9]0.36DLCO (n=9)46.3±18.546.1±20.30,3445.2±22.03[-3.9–12.8]0.24Clinical ParametersBasal (mean±SD)Final (mean±SD)CI 95%PmRSS (n=11)13.1±7.28.8±7.1[0.9–9.4]0.02CK (n=3)1786.7±1483.8134.7±119[-2181.9 –5485.9]0.2

CK: Creatine kinase; SD: Standard deviation; CI: Confidence interval; m: months.

The AE were mostly mild: 13 infusional reactions (6 patients), 1 uncomplicated herpes zoster and 2 serious infections that required admission. There were no exitus.

Conclusion:

Our results, with a limited sample, suggest that the long-term use of RTX in real world clinical practice may be beneficial for the cutaneous, pulmonary and myopathic manifestations of SSc, with an acceptable security profile.

Disclosure of Interests:

Esther Vicente Speakers bureau: BMS, Roche., Javier Fernández: None declared, Irene Llorente Speakers bureau: Gebro, Janssen, Sanofi, Lilly., Lorena Vega: None declared, Santos Castañeda: None declared, Alberto García-Vadillo: None declared, Isidoro González-Álvaro Grant/research support from: Roche Laboratories, Consultant of: Lilly, Sanofi, Paid instructor for: Lilly, Speakers bureau: Abbvie, MSD, Roche, Lilly, Alicia Humbría: None declared, Ana Ortiz: None declared, Esther Patiño: None declared, Eva Tomero Muriel: None declared, Rosario Garcia de Vicuna Grant/research support from: BMS, Lilly, MSD, Novartis, Roche, Consultant of: Abbvie, Biogen, BMS, Celltrion, Gebro, Lilly, Mylan, Pfizer, Sandoz, Sanofi, Paid instructor for: Lilly, Speakers bureau: BMS, Lilly, Pfizer, Sandoz, Sanofi

FRI0071 ANALYSIS OF DATA GAPS IN RHEUMATOID ARTHRITIS

Background:

Although ideally Recommendations for the management of rheumatoid arthritis (RA) should be supported by the highest level of evidence, many of which are based on “expert opinion”. This means that there are knowledge gaps to which a part of the research efforts in this disease should be directed.

Objectives:

1.- Analyze the causes of the low level of evidence in some of the recommendations on diagnosis and management of RA in the main published documents

2.- Identify the knowledge gaps that justify said low level of evidence

3.- Design actions to respond to the knowledge gaps identified.

Methods:

Qualitative study. A group of six experts in systematic review of the literature was selected. Fourteen documents of national and international recommendations on RA (EULAR, ACR and SER) of the last 5 years were analyzed by a peer review. They selected recommendations with low level of evidence (Oxford 4 and 5) / grade of recommendation (C and D), and classified by areas (diagnosis, monitoring, treatment, others) and then possible causes of low level of evidence were analyzed. These were submitted to a Delphi to select the 10 recommendations in which participants considered it more critical to obtain quality evidence. Subsequently, actions were proposed to improve the levels of evidence in general and, through the PICOS structure (population, intervention, comparator, study design) specific studies were proposed to respond to the issues raised in these 10 recommendations

Results:

185 recommendations were found that had a low level of evidence / grade of recommendation, most related to the treatment of RA. The two most frequent causes of this low level of evidence and / or the degree of recommendation were the absence of studies and an incorrect classification of the level of evidence and / or degree of recommendation. In addition, other reasons and methodological barriers were found for which nine critical recommendations were finally selected for which new PICOs were developed with which to propose targeted research projects

Conclusion:

It is necessary to improve the methodological approach in the RA recommendations guidelines to correct errors and fill gaps with appropriate studies.

Table 1.

Actions to increase the level of evidence / recommendation.

#Action1Prioritization of research towards knowledge gaps with the design and development of specific studies2Increase knowledge of experts in the methodology of consensus documents (including RSL, formulation of recommendations, etc.)3Supervision of the entire process by expert methodologists, to ensure a correct allocation of the levels of evidence and degree of recommendation4Review and select those topics that are really of interest and should be reviewed and can be answered5Expert opinion should never become a recommendation, but will be included in the text that accompanies that recommendation.6Clear syntax will be used and short recommendations will be made7Establishment and application of homogeneous criteria to formulate recommendations

Key words: Rheumatoid arthritis, recommendations, data gaps

Disclosure of Interests:

gloria candelas: None declared, Lucía Silva-Fernández: None declared, Maria Montoro Employee of: Pfizer employee, Abad Hernández: None declared, Jose Ramón Maneiro: None declared, Virginia Villaverde: None declared, Loreto Carmona Grant/research support from: Novartis Farmaceutica, SA, Pfizer, S.L.U., Merck Sharp & Dohme España, S.A., Roche Farma, S.A, Sanofi Aventis, AbbVie Spain, S.L.U., and Laboratorios Gebro Pharma, SA (All trhough institution), Estíbaliz Loza Grant/research support from: Roche, Pfizer, Abbvie, MSD, Novartis, Gebro, Adacap, Astellas, BMS, Lylly, Sanofi, Eisai, Leo, Sobi, Susana Gómez Employee of: Pfizer employee, Monica Valderrama Consultant of: Pfizer employee, Ana Ortiz: None declared

Development of a telescoped synthesis of 4-(1H)-cyanoimidazole core accelerated by orthogonal reaction monitoring

Telescoped synthesis enabled by reaction monitoring.

Is production system a relevant attribute in consumers' food preferences? The case of Iberian dry-cured ham in Spain

Spanish consumers have a strong preference for Iberian meat products, as they perceive them to be of extra sensorial and nutritional quality. The production of these meat products depends on multiple variables, such as genetics, livestock production systems and, above all, the feed provided. The aim of this paper is to study the preferences of Spanish consumers for the various types of Iberian dry-cured ham, analysing whether they are willing to pay the premium required by the highest-quality products. The methodological approach combined a sensory analysis and a choice-based conjoint experiment with obtained through tasting sessions in Extremadura (SW of Spain). Findings of the sensory test have shown that there are significant differences in odour, texture and taste, explained mainly by the type of feed pigs were fed. The main results of the choice experiment have also shown that the type of feed is the most preferred attribute by consumers, in line with the sensory analysis.

Characteristics of high- and low-risk individuals in the PRIORITY study: urinary proteomics and mineralocorticoid receptor antagonism for prevention of diabetic nephropathy in Type 2 diabetes

AIM

To compare clinical baseline data in individuals with Type 2 diabetes and normoalbuminuria, who are at high or low risk of diabetic kidney disease based on the urinary proteomics classifier CKD273.

METHODS

We conducted a prospective, randomized, double-blind, placebo-controlled international multicentre clinical trial and observational study in participants with Type 2 diabetes and normoalbuminuria, stratified into high- or low-risk groups based on CKD273 score. Clinical baseline data for the whole cohort and stratified by risk groups are reported. The associations between CKD273 and traditional risk factors for diabetic kidney disease were evaluated using univariate and logistic regression analysis.

RESULTS

A total of 1777 participants from 15 centres were included, with 12.3% of these having a high-risk proteomic pattern. Participants in the high-risk group (n=218), were more likely to be men, were older, had longer diabetes duration, a lower estimated GFR and a higher urinary albumin:creatinine ratio than those in the low-risk group (n=1559, P<0.02). Numerical differences were small and univariate regression analyses showed weak associations (R² < 0.04) of CKD273 with each baseline variable. In a logistic regression model including clinical variables known to be associated with diabetic kidney disease, estimated GFR, gender, log urinary albumin:creatinine ratio and use of renin-angiotensin system-blocking agents remained significant determinants of the CKD273 high-risk group: area under the curve 0.72 (95% CI 0.68-0.75; P<0.01).

CONCLUSIONS

In this population of individuals with Type 2 diabetes and normoalbuminuria, traditional diabetic kidney disease risk factors differed slightly between participants at high risk and those at low risk of diabetic kidney disease, based on CKD273. These data suggest that CKD273 may provide additional prognostic information over and above the variables routinely available in the clinic. Testing the added value will be subject to our ongoing study. (European Union Clinical Trials Register: EudraCT 2012-000452-34 and Clinicaltrials.gov: NCT02040441).

Mutations in osteoprotegerin account for the CCAL1 locus in calcium pyrophosphate deposition disease

OBJECTIVE

Mutations on chromosomes 5p (CCAL2) and 8q (CCAL1) have been linked to familial forms of calcium pyrophosphate deposition disease (CPDD). Mutations in the ANKH gene account for CCAL2, but the identity of CCAL1 has been elusive. Recently, a single Dutch kindred with a mutation in the Tumor Necrosis Factor Receptor Super Family member 11B (TNFRSF11B) gene coding for osteoprotegerin (OPG) was described as a gain-of-function mutation. Affected family members had premature generalized osteoarthritis (PGOA) and CPDD. As the TNFRSF11B gene is on 8q, we sought additional evidence that TNFRSF11B was CCAL1, and investigated potential disease mechanisms.

DESIGN

DNA from two novel PGOA/CPDD families was screened for sequence variants in the TNFRSF11B gene. Mutations were verified by genotype analysis of affected and unaffected family members. We also investigated effects of normal and mutant OPG on regulators of CPP crystal formation in porcine cartilage.

RESULTS

The identical TNFRSF11B mutation described in the Dutch family was present in two novel PGOA/CPDD families. ANKH was normal in affected patient fibroblasts. Exogenous OPG did not alter ANKH mRNA or protein levels, affect translocation of ANKH to the membrane, nor increase [pyrophosphate (PPi)] or other key regulators of CPDD.

CONCLUSION

We have firmly established the identity of CCAL1 as TNFRSF11B (OPG). Our findings suggest that this mutation produces disease in an ANKH-independent manner via novel mechanisms not primarily targeting cartilage. This work rationalizes further investigation of OPG pathway components as potential druggable targets for CPDD.

Uso potencial de la tecnología NIRS en la determinación de la calidad de los recursos naturales (bellotas y pastos) de dehesa destinados a la alimentación del cerdo Ibérico

La tecnología NIRS se utilizó como alternativa a los métodos convencionales para determinar el contenido de nutrientes en bellotas y pastos de la dehesa. Materia seca (MS), contenido en grasa (G), proteína total (TP), almidón, compuestos fenólicos totales (FT), α-tocoferol, γ-tocoferol, ácidos grasos, fibra neutro detergente (FND), actividad antioxidante total (AAT) y energía total (ET) fueron determinadas por métodos convencionales para el posterior desarrollo de las ecuaciones de predicción del NIRS. Se han realizado todos los espectros NIR de cada una de las muestras para todos los parámetros estudiados obteniendo un modelo predictivo y una validación externa. Se han obtenido buenas ecuaciones de predicción para la humedad, contenido en grasa, proteína total, energía total y γ –tocoferol en muestras de bellotas obteniendo un alto coeficiente de correlación (1-VR) y un bajo error estándar de predicción (SEP) (1-VR=0.81, SEP=2.62; 1-VR=0.92, SEP=0.54; 1-VR=0.86, SEP=0.47; 1-VR=0.84, SEP=0.2; 1-VR=0.88, SEP=5.4, respectivamente), así como la proteína total, NDF, α-tocoferol y contenido de ácido linolénico en muestras de pasto (1-VR=0.9, SEP=1.99; 1-VR=0.87, SEP=4.13; 1-VR=0.76, SEP=10.9; 1-VR=0.82, SEP=0.6, respectivamente). Por lo tanto, estos modelos de predicción podrían ser utilizados para determinar la composición nutricional de los recursos naturales de la Montanera.

Evaluación de la tecnología NIRS para el control de calidad de productos curados loncheados y envasados del cerdo Ibérico

En los últimos años, el consumo de jamón Ibérico loncheado y envasado ha aumentado significativamente. Pero la vida útil de estos productos es menor que la de la pieza entera, lo que requiere que se lleven a cabo un gran número de análisis físico-químicos para el control y evolución de la calidad de los mismos. Esto requiere una gran inversión de tiempo, dinero así como la destrucción de la muestra. Por lo tanto, el objetivo principal de este trabajo fue evaluar el potencial de la Espectroscopia de Reflectancia de Cercano Infrarrojo (NIRS) como una alternativa a los métodos convencionales para la predicción a tiempo real del contenido de los principales parámetros de calidad, ya que se trata de una técnica no destructiva, rápida y versátil. Las ecuaciones predictivas se desarrollaron mediante el método de regresión multivariante por mínimos cuadrados parciales (PLS) y se evaluó el efecto de diferentes pretratamientos espectrales (1ª y 2ª derivada, EMSC, SNV y sus combinaciones). Los resultados mostraron una buena habilidad predictiva para el contenido en NaCl (SNV, R2 = 0,96, SEC = 0,12, 1-VR = 0,85, SEVC = 0,23 y RPD = 2,6), C16: 0 (1,11,15 + EMSC, R2 = 0,87; SEc = 0,93; 1-VR = 0,81; SEVC = 1,14 y RPD = 2,12) y C18: 1 (1,11,15 + SNV, R2 = 0,80; SEc = 1,70; 1-VR = 0,83; SEVC = 1,47 y RPD = 2,28). Sin embargo, los resultados para α-tocoferol, γ-tocoferol, C18: 0, C18: 2, C18: 3 y oxidación de lípidos, no fueron tan buenos, aunque podrían usarse para control interno y se podrían mejorar aumentando el número de muestras o el rango de cada parámetro.

The anatomy of the musculocutaneous latissimus dorsi flap for neophalloplasty

In transgender surgery, the ideal neophallus is one that: (a) is constructed using a reproducible procedure, (b) possesses tactile and erogenous sensation, (c) is large and rigid enough (naturally, or using a prosthesis) to permit penetrative intercourse, (d) leaves acceptable donor site morbidity, (e) results in esthetically satisfactory appearance, and (f) allows for voiding while standing. The musculocutaneous latissimus dorsi (MLD) flap has favorable results in the area of neophalloplasty. Among its advantages are acceptable donor site appearance, stiffness sufficient for intercourse, and esthetically satisfactory genital appearance. The anatomy of the MLD flap supports the creation of a neophallus for transsexual anatomy revision. Herein, we give an overview of the advantages and disadvantages of the procedure, and the anatomical details and surgical steps involved. Novel illustrations were created from standard surgical text descriptions to clarify this topic for surgical training and patient understanding and decision making. A review of the relevant literature regarding the anatomy, procedure development, and outcomes is presented. The MLD flap uses part of the latissimus dorsi muscle with branches of the thoracodorsal vessels and nerve to construct a neophallus. A thin strip of muscle around the pedicle is harvested, resulting in a slightly curvilinear scar. The blood supply is connected to the femoral artery and saphenous vein or the deep inferior epigastric artery and vein, while the nerve is connected to the ilioinguinal nerve or the obturator nerve. The MLD flap for neophalloplasty is a reliable graft with a well concealed scar and low donor site morbidity. Clin. Anat. 31:152-159, 2018. © 2017 Wiley Periodicals, Inc.

Ensemble of random forests One vs. Rest classifiers for MCI and AD prediction using ANOVA cortical and subcortical feature selection and partial least squares

BACKGROUND

Alzheimer's disease (AD) is the most common cause of dementia in the elderly and affects approximately 30 million individuals worldwide. Mild cognitive impairment (MCI) is very frequently a prodromal phase of AD, and existing studies have suggested that people with MCI tend to progress to AD at a rate of about 10-15% per year. However, the ability of clinicians and machine learning systems to predict AD based on MRI biomarkers at an early stage is still a challenging problem that can have a great impact in improving treatments.

METHOD

The proposed system, developed by the SiPBA-UGR team for this challenge, is based on feature standardization, ANOVA feature selection, partial least squares feature dimension reduction and an ensemble of One vs. Rest random forest classifiers. With the aim of improving its performance when discriminating healthy controls (HC) from MCI, a second binary classification level was introduced that reconsiders the HC and MCI predictions of the first level.

RESULTS

The system was trained and evaluated on an ADNI datasets that consist of T1-weighted MRI morphological measurements from HC, stable MCI, converter MCI and AD subjects. The proposed system yields a 56.25% classification score on the test subset which consists of 160 real subjects.

COMPARISON WITH EXISTING METHOD(S)

The classifier yielded the best performance when compared to: (i) One vs. One (OvO), One vs. Rest (OvR) and error correcting output codes (ECOC) as strategies for reducing the multiclass classification task to multiple binary classification problems, (ii) support vector machines, gradient boosting classifier and random forest as base binary classifiers, and (iii) bagging ensemble learning.

CONCLUSIONS

A robust method has been proposed for the international challenge on MCI prediction based on MRI data. The system yielded the second best performance during the competition with an accuracy rate of 56.25% when evaluated on the real subjects of the test set.

A Mild, Functional Group Tolerant Addition of Organozinc Nucleophiles to N-Activated Quinolines and Isoquinolines

An addition of organozinc nucleophiles to N-acyl activated quinolines and isoquinolines is described. Simple transmetalation with the corresponding Grignard reagents using ZnCl₂ forms organozinc compounds which are functional group tolerant and stable to reactive acyl chloride reagents for extended periods. A wide variety of substrates which include reactive electron-withdrawing groups are well tolerated to form 2-substituted dihydroquinolines and dihydroisoquinolines. This methodology has been applied toward an improved synthetic route of uncialamycin and its analogs.

Parents' reading history as an indicator of risk for reading difficulties

Children from families whose members have reading impairments are found to be poorer performers, take less advantage of instruction, and require more time to reach the reading level of children whose relatives are good readers. As a family's reading history may not be available, a self-report of reading abilities is used to identify children's background. In this paper, we explored the contribution of phonological, literacy, and linguistic abilities and reported parental reading abilities to predict reading achievement at the end of the school year in a Spanish sample. Children who were starting to read were assessed in a variety of oral language, phonological, and literacy tasks at the beginning and end of the school year. Parents filled out a self-report questionnaire about their reading abilities. Their answers were used to assign children to good or poor reader parent groups (GRP vs PRP). A logistic and ROC analysis were used to assess the variables' discriminative capability, considering literacy scores at the end of the year as a measure of reading achievement. GRP children obtained higher scores than PRP children did. Performance on tasks of rapid naming assessment (RAN) letters (78.6%), Word Reading (75.7%), and Deletion (75.6%) were the most accurate predictors of children's reading achievement. IPRA showed slightly lower accuracy (73.8) than did the behavioral measures and as high specificity as RAN letters (96.2%), similarly to the percentages found in previous studies. Although behavioral measures were shown as the best predictors, parents' self-reports could also provide a quick estimation of family risk of difficulties in literacy acquisition.

Revisiting a Classic Transformation: A Lossen Rearrangement Initiated by Nitriles and "Pseudo-Catalytic" in Isocyanate

The direct conversion of a hydroxamic acid to an amine has been accomplished in a single step in the synthesis of HIV drug candidate BMS-955176. This process utilizes catalytic base and proceeds under mild conditions (CH₃CN, cat. DBU, 60 °C), without the need for strong electrophiles required for typical Lossen rearrangements, and can be applied to aliphatic and aromatic hydroxamic acids. Through investigation of the kinetics of this transformation, a mechanism was revealed involving a novel initiation pathway and a self-propagation cycle. The initiation pathway involves activation of hydroxamic acid by nitriles and subsequent Lossen rearrangement to generate the corresponding isocyanate. The isocyanate functions as a "pseudo-catalyst" for this system, leading to generation of product through a second Lossen rearrangement and regeneration of a new isocyanate molecule. Thorough mechanistic understanding allowed for this highly efficient process to be implemented on a 55 kg scale in 95.5% isolated yield.

Synthesis of HIV-Maturation Inhibitor BMS-955176 from Betulin by an Enabling Oxidation Strategy

A concise and scalable second generation synthesis of HIV maturation inhibitor BMS-955176 is described. The synthesis is framed by an oxidation strategy highlighted by a Cu^I mediated aerobic oxidation of betulin, a highly selective PIFA mediated dehydrogenation of an oxime, and a subsequent Lossen rearrangement which occurs through a unique reaction mechanism for the installation of the C17 amino functionality. The synthetic route proceeds in 7 steps with 47% overall yield and begins from the abundant and inexpensive natural product betulin.

Influence of incidental radiation dose in the subventricular zone on survival in patients with glioblastoma multiforme treated with surgery, radiotherapy, and temozolomide

PURPOSE

To determine if there is an association between the incidental radiation dose to the subventricular zone and survival in patients with glioblastoma multiforme treated with surgery, radiotherapy and temozolomide.

METHODS AND MATERIALS

Sixty-five patients, treated between 2006 and 2015, were included in this retrospective study. The doses (75th percentile; p75) administered to the ipsilateral, contralateral and bilateral subventricular zone were compared to overall survival and progression-free survival using Cox proportional hazards models. Covariates included: age, sex, surgery, tumor location, and concomitant and adjuvant temozolomide.

RESULTS

Median progression-free survival and overall survival were 11.5 ± 9.96 and 18.8 ± 18.5 months, respectively. The p75 doses to the ipsilateral, contralateral and bilateral subventrivular zone were, respectively, 57.30, 48.8, and 52.7 Gy. Patients who received a dose ≥48.8 Gy in the contralateral subventricular zone had better progression-free survival than those who received lower doses (HR 0.46; 95% CI 0.23-0.91 P = 0.028). This association was not found for overall survival (HR 0.60; 95% CI 0.30-1.22 P = 0.16). Administration of adjuvant temozolomide was significantly associated with improved progression-free survival (HR 0.19; 95% CI 0.09-0.41 P < 0.0001) and overall survival (HR 0.11; 95% CI 0.05-0.24 P = 0.001). In the subgroup of 46 patients whose O6-methylguanine-DNA methyltransferase gene promoter status was known, the methylation had no effect on either progression-free survival (P = 0.491) or overall survival (P = 0.203).

CONCLUSION

High-dose radiation in the contralateral subventricular zone was associated with a significant improvement in progression-free survival but not overall survival in patients treated for glioblastoma multiforme.