Perception of Oral Health-Related Quality of Life in Children with Epidermolysis Bullosa: A Quantitative and Qualitative Study

KNOWLEDGE TRANSFER STATEMENT

The results of this study confirm the difficulties experienced by patients in the oral sphere. They also show that patients are able to adapt and that their demands go beyond functional rehabilitation. This work should encourage dental practitioners to be part of the overall management of the disease, involving regular checkups, preventive dental measures, and oral hygiene education. Therefore, more effective communication is required, not only between the dental and dermatological teams but also with the parents and caregivers.

Prevalence of secondary health conditions and mental status in persons with long-term spinal cord injury in South Africa: Comparison between public and private healthcare sectors

BACKGROUND

Spinal cord injuries typically result in a range of negative health outcomes and health states, which impacts overall functioning, health and well-being. It remains important to establish the prevalence (burden) of health outcomes to help with the development of optimal treatment strategies.

OBJECTIVES

To determine the prevalence and treatment rates of secondary health conditions (SHCs) and mental health states in persons with long-term spinal cord injury (SCI) receiving public compared with private healthcare services in South Africa.

METHODS

A cross-sectional survey included 200 community-dwelling persons with long-term SCI, 60% with paraplegia, 53% with complete injuries and 156 from the public and 44 from private healthcare sectors. The following modules of the International Spinal Cord Injury (InSCI) community survey were used: (i) demographic and injury characteristics; (ii) SHCs and treatment rates; and (iii) vitality and emotional well-being. All statistical analyses were stratified according to healthcare sector.

RESULTS

Pain (47% v. 57), sexual dysfunction (59% v. 41%) and muscle spasms (54% v. 43%) were the most common SHCs in both cohorts, and the period prevalence was significantly higher for sleeping problems (41% v. 25%), sexual dysfunction (59% v. 41%) and contractures (42% v. 20%) in the public compared with the private cohort. Persons with SCI in the private cohort received treatment more often for sleeping problems (100% v. 45%), autonomic dysreflexia (75% v. 27%) and pain (56% v. 33%) than their counterparts with public insurance. Negative mental health states were prevalent in both groups.

CONCLUSION

SHCs and negative mental health were common in persons with SCI in South Africa, while those with public insurance reporter a higher occurrence of sleep problems and contractures, as well as lower treatment rates. Overall, a need exists to better support persons with SCI in the long-term context to facilitate improved functioning and wellbeing.

Self-reported beta-lactam allergy in government and private hospitals in Cape Town, South Africa

BACKGROUND

Up to a quarter of inpatients in high-income countries (HICs) self-report beta-lactam allergy (BLA), which if incorrect,increases the use of alternative antibiotics, worsening individual health outcomes and driving bacterial resistance. In HICs, up to 95% ofself-reported BLAs are incorrect. The epidemiology of BLA in low- and middle-income African countries is unknown.

OBJECTIVES

To describe the epidemiology and de-labelling outcomes of self-reported BLA in hospitalised South African (SA) patients.

METHODS

Point-prevalence surveys were conducted at seven hospitals (adult, paediatric, government and privately funded, district andtertiary level) in Cape Town, SA, between April 2019 and June 2021. Ward prescription records and in-person interviews were conductedto identify and risk-stratify BLA patients using the validated PEN-FAST tool. De-labelling was attempted at the tertiary allergy clinic atGroote Schuur Hospital.

RESULTS

A total of 1 486 hospital inpatients were surveyed (1 166 adults and 320 children). Only 48 patients (3.2%) self-reported a BLA,with a higher rate in private than in government-funded hospitals (6.3% v. 2.8%; p=0.014). Using the PEN-FAST tool, only 10.4% (n=5/48)of self-reported BLA patients were classified as high risk for true penicillin hypersensitivity. Antibiotics were prescribed to 70.8% (n=34/48)of self-reported BLA patients, with 64.7% (n=22/34) receiving a beta-lactam. Despite three attempts to contact patients for de-labelling atthe allergy clinic, only 3/36 underwent in vivo testing, with no positive results, and 1 patient proceeded to a negative oral challenge.

CONCLUSION

Unlike HICs, self-reported BLA is low among inpatients in SA. The majority of those who self-reported BLA were low risk fortype 1 hypersensitivity, but outpatient de-labelling efforts were largely unsuccessful.

Upregulation of the EGFR/MEK1/MAPK1/2 signaling axis as a mechanism of resistance to antiestrogen‑induced BimEL dependent apoptosis in ER+ breast cancer cells

The epidermal growth factor receptor (EGFR) is commonly upregulated in multiple cancer types, including breast cancer. In the present study, evidence is provided in support of the premise that upregulation of the EGFR/MEK1/MAPK1/2 signaling axis during antiestrogen treatment facilitates the escape of breast cancer cells from BimEL‑dependent apoptosis, conferring resistance to therapy. This conclusion is based on the findings that ectopic BimEL cDNA overexpression and confocal imaging studies confirm the pro‑apoptotic role of BimEL in ERα expressing breast cancer cells and that upregulated EGFR/MEK1/MAPK1/2 signaling blocks BimEL pro‑apoptotic action in an antiestrogen‑resistant breast cancer cell model. In addition, the present study identified a pro‑survival role for autophagy in antiestrogen resistance while EGFR inhibitor studies demonstrated that a significant percentage of antiestrogen‑resistant breast cancer cells survive EGFR targeting by pro‑survival autophagy. These pre‑clinical studies establish the possibility that targeting both the MEK1/MAPK1/2 signaling axis and pro‑survival autophagy may be required to eradicate breast cancer cell survival and prevent the development of antiestrogen resistance following hormone treatments. The present study uniquely identified EGFR upregulation as one of the mechanisms breast cancer cells utilize to evade the cytotoxic effects of antiestrogens mediated through BimEL‑dependent apoptosis.

Exploring the mylohyoid area as a reference for three-dimensional digital mandibular superimposition

INTRODUCTION

the quantification of tooth movements should be obtained at different specific times and compared at different stages for every orthodontic treatment. These movements are generally measured on teleradiographs or casts. The use of Cone Beam Computed tomography (CBCT) for maxillary superimposition is clearly established in the literature, but not well defined for mandibular superimposition. This study aims to explore and evaluate the accuracy of the mylo-hyoid area as a reference for mandibular Digital Dental Cast (DDC) three-dimensional (3D) superimposition.

MATERIALS AND METHODS

the study compared mandibular 3D overlays with profile teleradiographs in 30 patients followed at Nice Saint Roch University Hospital. The molar and incisor coordinates on the 3D superimposition based on the mylo-hyoid area were compared to the ones on the 2D lateral cephalogram. Differences between the two methods of superimposition were assessed using paired t-tests.

RESULTS

No statistically significant difference was observed between the lateral cephalogram-based and mandibular DDC superimposition methods in 3D sagittal and vertical displacements of the lower first molars and central incisors.

CONCLUSION

The study showed the mylo-hyoid area to be an accurate superimposition landmark for the 3D evaluation of mandibular orthodontic tooth displacement. This method is also applicable for patients with conventional orthodontic treatment records. Other studies should be conducted on larger populations, subgroups (malocclusions, therapeutics) and on the use of an intra-oral camera.

Significant procedure length reduction when utilizing active esophageal cooling – a six-year single center study

Background

A number of factors can influence procedure duration of left atrial ablation for the treatment of atrial fibrillation (AF). In addition to ablation techniques, the use of auxiliary tools such as intraoperative fluoroscopy and luminal esophageal temperature (LET) monitoring may impact procedure duration. However, unlike recent trends toward zero-fluoroscopy procedures, there has not been a widespread transition to alternative means of esophageal protection. Multi sensor LET monitoring leads to frequent pauses during ablations when dangerous esophageal temperatures have been reached. Although an increased risk of esophageal injury when utilizing LET monitoring as compared to active esophageal cooling has been suggested in recent studies, the degree to which LET monitoring impacts procedure duration has not been well documented. Consequently, we aimed to compare procedure duration in a large single center before and after active esophageal cooling was implemented in place of LET monitoring.

Objective

Review procedural timing data at a single large hospital before and after the implementation of active esophageal cooling in place of LET monitoring, and compare differences in procedure duration.

Methods

Using an existing hospital registry of ablation procedures, we obtained procedure durations for left atrial ablations for AF before and after the implementation of active esophageal cooling into the hospital protocol. Data was collected with IRB approval from a single hospital from January 2015 through November 2021. Prior to September 2018, multi-sensor LET monitoring was utilized in all patients, whereas all patients afterwards were treated with active esophageal cooling.

Results

Data was analyzed from a total of 412 patients. LET monitoring was utilized with 176 patients, while active esophageal cooling was utilized with 236 patients. In the LET monitored group the median procedure length was 191 minutes with an interquartile range (IQR) of 91 minutes. In the actively cooled group, the median procedure length was 147 minutes with an IQR of 61 minutes. This represents a median difference of 44 minutes, or 23% of total procedure time (p<0.001).

Conclusion

When compared to LET monitoring, the use of active esophageal cooling is associated with a significant time savings in PVI procedures.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Attune Medical

Esophageal cooling during ablation of persistent atrial fibrillation is associated with improved freedom from arrhythmia at one-year follow up

Background

Various factors influence successful freedom from atrial arrhythmia after pulmonary vein isolation (PVI) with radiofrequency (RF) ablation for the treatment of atrial fibrillation (AF). Lesion transmurality and continuity (as measured by the Continuity Index) are two important factors, and these can be worsened by pauses in RF energy application due to esophageal overheating. Proactive esophageal cooling precludes the need for premature cessation of power, avoiding partially-formed lesions and the need to “hop-scotch” in the left atrium. The resulting improvement in lesion continuity may improve long-term freedom from atrial arrhythmia after PVI, particularly in patients with persistent AF, where more posterior wall ablation is often necessary.

Purpose

Determine differences in freedom from arrhythmia at one year between patients receiving LET monitoring and those receiving esophageal cooling during PVI for persistent AF.

Methods

We reviewed data from two healthcare systems for patient rhythm status at one-year follow up after PVI for the treatment of persistent or long-standing persistent AF. We then determined Kaplan-Meier estimates of freedom from arrhythmia (AF, atrial flutter, and atrial tachycardia), and compared these between patients receiving esophageal cooling and those treated with traditional LET monitoring.

Results

A total of 252 patients received PVI for persistent or long-standing persistent AF and had data available for review. Of these, 148 received LET monitoring (with either a single or multi-sensor temperature probe), and 104 received active cooling with a dedicated esophageal cooling device. Mean age and gender for each group was similar (67.2, range 21 to 88 years, 36% female for LET monitoring, and 67.8, range 32 to 89 years, 30% female for esophageal cooling). KM estimates for freedom from AF at the one-year follow-up were 44.2% for LET monitored patients and 79.3% for actively cooled patients (P=0.01).

Conclusions

Freedom from atrial arrhythmia at one-year after PVI for persistent AF is associated with significant improvement when using active esophageal cooling rather than LET monitoring.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Attune Medical

Use of an active esophageal cooling device in zero-fluoroscopy settings without intracardiac echocardiography

Background

Active esophageal cooling is increasingly being utilized during radiofrequency (RF) ablation to achieve pulmonary vein isolation (PVI) for the treatment of atrial fibrillation (AF). In addition to data showing decreases in severe esophageal injury with active esophageal cooling, placement of a commercially available cooling device can be identified on intracardiac echocardiography (ICE), allowing implementation in zero-fluoroscopy settings. In the case of procedures that do not have ICE available, an alternative method to determine proper placement of an esophageal cooling device is needed in zero-fluoroscopy settings..

Purpose

To describe a large single-center approach to visualizing an active esophageal cooling device into a 3D mapping system.

Methods

We reviewed data on patients treated with RF ablation for PVI procedures over the time frame 1/1/2020 to 12/31/21. Active esophageal cooling was phased in towards the end of 2020. For all cases, transseptal puncture was performed with the use of transesophageal echocardiography (TEE). After successful transseptal puncture, the TEE probe was removed, and either a single-sensor LET probe or an active esophageal cooling device was placed. For the active cooling device, the distal tip was cut, and an SL-1 (0.032 inch, 150 cm length) guidewire was placed through the central lumen of the cooling device (used for gastric suctioning and enteral feeding). The guidewire was pinned via a pin block to the 3D mapping system (EnSite, Abbott). Unipolar configuration was used to generate a 3D map, which was then visualized during device placement. Placement was confirmed after visualizing the guidewire tip on the 3D map passing below the coronary sinus (Figure 1).

Results

A total of 417 cases were performed over the study timeframe. The mean age of patients was 65±10 years, and 40% were female. A total of 5 complications were recorded (3 pericardial effusions, 1 pseudoaneurysm, and 1 air embolism). A total of 156 patients received LET monitoring, and 261 received active esophageal cooling. The mean procedure length was 109±24 minutes for cases utilizing LET monitoring, and 93±11 minutes for cases utilizing active esophageal cooling. Visualization of the active esophageal cooling device on the cardiac mapping system was possible in all cases.

Conclusions

We describe here the largest series to date utilizing active esophageal cooling in a zero-fluoroscopy, zero-ICE setting. With increasing efforts to reduce fluoroscopy, this approach allows pursuit of zero-fluoroscopy even in systems without the availability of ICE, while maintaining procedural speed and safety.

Funding Acknowledgement

Type of funding sources: Private company. Main funding source(s): Attune Medical

Patient age, gender, and early outcome after PVI atrial ablation: analysis of a large regional database

Background

Demographics such as patient age and gender have been inconsistently found to be associated with outcome after ablation to achieve pulmonary vein isolation (PVI). A database created by the Dallas-Fort Worth Hospital Council (DFWHC) includes a collaboration of 90 member hospitals in North Texas reporting data on procedures, diagnoses, and discharges. All patients in this system can be followed longitudinally via unique identification number. The availability of this large, regional database offers opportunities to better characterize trends.

Objective

Characterize the association between age, gender, and 60-day outcome in patients receiving PVI over a 7-year time span.

Methods

Using the DFWHC database, all PVI procedures performed from January 2013 to December 2019 were identified. Follow up visits for this cohort of patients were then obtained, and outcomes recorded. Early mortalities (occurring less than 60 days from PVI), mean age and patient gender were determined for each of the groups and compared.

Results

A total of 11,880 unique PVI procedures were performed over this 7 year timeframe. Mean patient age was 64±10 years, with 66% male and 34% female. A total of 130 mortalities at any time after PVI occurred (1.1%), with 19 (0.16%) occurring within 60 days of the procedure. In multivariate analysis, the risk of 60-day mortality increased with year of procedure (OR 1.07, 95% CI 0.85 to 1.4) and female gender (OR 1.43, 95% CI 0.57 to 3.6), and decreased with age (OR 0.99, 95% CI 0.95 to 1.03); however no variable demonstrated statistically significant association with outcome.

Conclusions

Although trends towards increasing mortality over time and in female patients were seen, the total number of events remained low, and no statistically significant associations between age, gender, and early mortality were identified in this large regional database.

Funding Acknowledgement

Type of funding sources: None.

Abstract LB133: EGFR upregulation in breast cancer cells: A key mechanism of escape from antiestrogen induced death, autophagy, and senescence

EGFR is upregulated commonly in multiple cancer types, including breast cancer. However, the multiple role(s) of EGFR in breast cancer are not fully elucidated. In this study, we characterized a unique antiestrogen resistant breast cancer subline and provide compelling data that upregulation of the EGFR/MEK1/MAPK1/2 signaling axis during antiestrogen treatment facilitated escape from senescence, autophagy, and BimEL-dependent apoptosis. Our studies were conducted with the antiestrogen resistant TR5 cell line established by our laboratory, using a step-wise drug selection with the antiestrogen 4-hydroxytamoxifen (4-OHT) of the estrogen receptor α (ER+) MCF-7 breast cancer cells. A preliminary microarray comparing mRNA expression between 4-OHT-selected TR5 cells and MCF-7 parent cells identified upregulation of the epidermal growth factor receptor (EGFR). Western blot showed a greater than 5-fold upregulation of EGFR expression and downregulation of estrogen receptor alpha (ERα) compared to the levels in MCF-7 and T47-D (antiestrogen sensitive). Selective inhibition of EGFR, phosphorylated at Tyr 1068, was achieved with erlotinib. Inhibition blocked MEK1/MAPK1/2 signaling, which was also upregulated in 4-OHT selected TR5 cells, with detectable increases in the pro-apoptotic BH3 protein BimEL, and a fifty percent reduction in cell viability. However, a high number of cells survived erlotinib therapy due to autophagy induction determined to be cytoprotective. Autophagy induction was identified by analyzing the expression/turnover of autophagy proteins LC3-II and p62, a standard approach to ascertain autophagy levels in cells. Further, erlotinib treatment induced a 2-fold increase in the number of senescent cells in the surviving population. Senescent cells were identified by β-galactosidase staining of erlotinib-treated cells utilizing confocal microscopy. Interestingly, blockade of autophagy with the lysosomotrophic compound chloroquine enhanced the senescence cell population, suggesting that either autophagy blocked senescence induction or lysosome impairment increased senescence. Mechanistically, we have identified phosphorylated AMP-activated protein kinase (pAMPK) as being elevated under conditions of erlotinib treatment, and reduced in 4-OHT-selected TR5 cells relative to MCF-7 parent cells. This correlation supports the hypothesis that pAMPK was downregulated during 4-OHT selection of TR5 cells by elevated EGFR/MEK/MAPK1/2 signaling to allow surviving cells escape senescence induction and/or anti-proliferative autophagy. Overall we propose that EGFR mediated downregulation of pAMPK is a major regulatory pathway in breast cancer cells surviving endocrine treatment. Our current studies are dissecting the role of EGFR-mediated AMPK regulation with somatic cell-based studies and pharmacological intervention.

Citation Format: Mackenzie L. Hagan, Michael McGrath, Carol Joseph, Allison Lewis, John R. Barrett, Muthusamy Thangaraju, David Gewirtz, Patricia V. Schoenlein. EGFR upregulation in breast cancer cells: A key mechanism of escape from antiestrogen induced death, autophagy, and senescence [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr LB133.

Abstract 3006: Effects of JNK/Jun blockade on breast cancer cell autophagy are dependent on breast cancer subtype

Our long-term goal is to elucidate the role of JNK/Jun signaling in breast cancer cell autophagy induced by anti-estrogen treatment and/or chemotherapy in ERα expressing and TNBC cells, respectively. In this study, we analyzed the role of JNK/Jun signaling in regulating the high basal autophagy levels in TNBC. To do so, we utilized the highly metastatic murine 4T1 and the human MDA-MB-231 TNBC models. In addition, we performed autophagic flux assays after treating breast cancer cells with JNK-IN8, a non-reversible small molecule JNK1/2 inhibitor. Treatments were performed for various times in the presence and absence of chloroquine (CQ) to allow analysis of steady state levels of atg8 (LC3-II) and sequestosome-1 (p62). These LC3-II and p62 proteins are involved in autophagosome formation and function, and are catabolized during autolysosomal turnover. To impair this process, CQ is a lysosomotropic agent that raises the pH of the lysosome and blocks such turnover. We also determined the effect of JNK-IN-8 on 4T1 and MDA-MB-231 cell number (proliferation). These studies determined that JNK-IN8 was an effective inhibitor of autophagic flux in the TNBC cells when used at concentrations that effectively blocked cJun phosphorylation, the downstream readout of JNK-IN8 efficacy used for our experiments. Blockade of autophagic flux by JNK-1/2 inhibition in TNBC was in stark contrast to results obtained with JNK-IN-8 treatment of ERα expressing MCF-7 and T47-D breast cancer cells, in which JNK-IN-8 induced a robust autophagy response with elevations in the steady state levels and flux of LC3-II and p62. Induction of autophagy by JNK-IN-8 in ERα expressing breast cancer cells occurred concomitantly with a substantial reduction in cell proliferation but minimal induction of apoptosis. Overall, these pre-clinical in vitro studies support the following conclusions: (1) JNK1/2 targeting in TNBC effectively blocks autophagic flux and may be particularly effective when used in combination with chemotherapies that induce pro-survival autophagy which is a current focus of our studies; and (2) JNK1/2 targeting in ERα expressing breast cancers has the potential to mediate a pro-survival autophagic activity in response to endocrine therapy or chemotherapy and should be cautiously approached. Ongoing studies are aimed at understanding the underlying mechanisms of the differential effects of JNK/Jun signaling on autophagy in TNBC versus ERα expressing breast cancer. Such an understanding should provide important information to aid in the ongoing interest in utilizing JNK1/2 as a molecular target for improved treatment of TNBC.

Citation Format: Michael K. McGrath, McKenzie L. Hagan, Timmothy Summers, Jesse Wayson, Carol Joseph, Amanda C. Barrett, John T. Barrett, Patricia V. Schoenlein. Effects of JNK/Jun blockade on breast cancer cell autophagy are dependent on breast cancer subtype [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3006.

Arrhythmia recurrence reduction with an active esophageal cooling device during radiofrequency ablation

Funding Acknowledgements

Type of funding sources: None.

Background

As the burden of atrial fibrillation continues to rise with an aging population, there have been contrasting positions on the efficacy of left atrial ablation. While ablation techniques have continued to improve over the past decades, arrhythmia recurrence rates must be further reduced given the burden of ablation on patients. Since continuity of lesion sets has been associated with greater lesion durability, it has been theorized that the use of active esophageal cooling may facilitate greater freedom from arrhythmia.

Purpose

In order to investigate the association between use of active esophageal cooling and arrhythmia recurrence, we performed a multicenter retrospective study of arrhythmia recurrence rates in patients that received active cooling and compared them to those that received luminal esophageal temperature (LET) monitoring.

Methods

In this study, follow up data were collected from patients that underwent pulmonary vein isolation (PVI) at three separate large medical centers. Data were contained in a prospective hospital registry, a prospective physician registry, or the electronic health record, depending on the center. For each patient included, we recorded whether their ablation utilized LET monitoring or active esophageal cooling, along with their rhythm status at 1-year follow up. Rhythm status at follow-up was determined by either electrocardiogram, Holter monitor, or wearable heart rate monitor. Kaplan-Meier (KM) curves were created for freedom-from-arrhythmia at one year comparing those in the LET monitoring group to those in the active cooling group.

Results

Follow up data were collected from 1035 patients. There were 560 patients that received LET monitoring during their original ablation, and 475 patients that underwent active esophageal cooling. KM estimates for freedom-from-arrhythmia at one year were 42% in the LET monitored group and 65% in the actively cooled group (P<.001).

Conclusion

In this large multicenter study, there is a significant increase in freedom-from-arrhythmia at one year follow-up among patients that received active esophageal cooling as compared to those that underwent LET monitoring.

Effect of a proactive esophageal cooling device on procedure length - a multicenter comparison of persistent and paroxysmal atrial fibrillation

Funding Acknowledgements

Type of funding sources: None.

Background

During left atrial ablation for the treatment of atrial fibrillation (AF), effective esophageal protection is essential for reducing or preventing thermal injury. Traditional methods include luminal esophageal temperature (LET) monitoring that lead to frequent pauses in the procedure when temperature alarms alert operators to dangerous temperature levels. While there have been recent studies that demonstrate an association between active esophageal cooling and a reduction in procedure duration regardless of AF type, these retrospective studies have been conducted at single or joint centers which may lead to confounding from other time-saving variables that have changed over time.

Purpose

Consequently, we sought to perform a large-scale multicenter comparison to better elucidate the association between procedure length and the use of active cooling in patients with persistent and paroxysmal atrial fibrillation.

Methods

In this study, we collected data from three large hospital centers, one hospital-maintained registry, one physician-maintained registry, and one through EHR data review and aggregated in groups separated by AF type as well as whether the patients received active cooling or LET monitoring. We then compared median procedure durations in each group.

Results

There were a total of 753 patients included in this study. Of the 360 patients with paroxysmal AF, 179 received active esophageal cooling while 181 underwent LET monitoring. In the persistent AF group with 393 patients, 157 received active esophageal cooling and 236 underwent LET monitoring. Among patients with paroxysmal AF, the median mean procedure duration was 137 minutes in the LET monitored group, and 90 minutes in the actively cooled group with an overall reduction of 47 minutes (P<.001). In patients with persistent AF, the median procedure duration was 148 minutes in the LET monitored group and 94 minutes in the actively cooled group with an overall reduction of 54 minutes (P<.001). The relative reduction as a percent of total procedure time was 34%, and 36%, for paroxysmal and persistent AF cases, respectively.

Conclusion

In this large multicenter review, there is a significant reduction in procedure length when using active esophageal cooling, regardless of AF type.

Kinetics of SARS-CoV-2-Neutralising Antibodies of Residents of Long-Term Care Facilities

INTRODUCTION

Elderly residents of nursing homes (NHs) and long-term care units (LTCUs) have been shown to have a high risk of mortality and morbidity in cases of SARS-CoV-2 infection. The objective of this study was to examine the kinetics of neutralizing antibodies (NAbs) directed against the SARS-CoV-2 virus in residents of the NH and LTCU units of our University Hospital who were identified with positive serology after the first epidemic outbreak.

MATERIALS AND METHODS

The participants included were sampled every three months for qualitative serological testing, as well as quantitative testing by neutralization tests using retroviral particles containing the S glycoprotein of SARS-CoV-2. Vaccination using the Comirnaty (Pfizer BNT162b2) vaccine begun before the last serological follow-up.

RESULTS

The median NAb titer in June 2020 was 80 [40; 60] versus 40 [40; 160] three months later, showing a statistically significant decline (p < 0.007), but remained stable between the three- and six-month timepoints (p = 0.867). By nine months after vaccination, we observed a significant difference between vaccinated residents known to have positive serology before vaccination (SERO+, Vacc+) and those vaccinated without having previously shown COVID-19 seroconversion (SERO-, Vacc+), the latter group showing similar titers to the SERO+, Vacc- participants (p=0.166). The median antibody titer in SERO+, Vacc+ patients increased 15-fold following vaccination.

DISCUSSION

Humoral immunity against SARS-CoV-2 appears to be persistent in elderly institutionalized patients, with a good post-vaccination response by residents who had already shown seroconversion but a notably diminished response by those who were seronegative before vaccination. To evaluate immunity in its entirety and elaborate a sound vaccination strategy, the cellular immune response via T cells specific to SARS-CoV-2 merits analysis, as this response is susceptible to being affected by immunosenescence.

Impact of rifampicin dose in bone and joint prosthetic device infections due to Staphylococcus spp: a retrospective single-center study in France

BACKGROUND

Prosthetic joint infections (PJI) are a major cause of morbidity and mortality burden worldwide. While surgical management is well defined, rifampicin (RIF) dose remains controversial. The aim of our study was to determine whether Rifampicin dose impact infection outcomes in PJI due to Staphylococcus spp.

METHODS

single-center retrospective study including 411 patients with PJI due to Rifampicin-sensitive Staphylococcus spp. Rifampicine dose was categorized as follow: < 10 mg/kg/day, 10-20 mg/kg/day or > 20 mg/kg/day. The primary endpoint was patient recovery, defined as being free of infection during 12 months after the end of the initial antibiotic course.

RESULTS

321 (78%) received RIF for the full antibiotic course. RIF dose didn't affect patients recovery rate with 67, 76 and 69% in the < 10, 10-20 and > 20 mg/kg/day groups, respectively (p = 0.083). In univariate analysis, recovery rate was significantly associated with gender (p = 0.012) but not to RIF dose, or Staphylococcus phenotype (aureus or coagulase-negative). In multivariate analysis, age (p = 0.01) and treatment duration (p <  0.01) were significantly associated with recovery rate.

CONCLUSION

These data suggest that lower doses of RIF are as efficient and safe as the recommended high-dose French regimen in the treatment of PJI.

Clinical features and outcomes in children with bone and joint infections of the ankle or foot

BACKGROUND

The foot and ankle are uncommon sites of bone and joint infections (BJIs) in children. The objectives of the present study were to determine the clinical and bacteriologic features of BJIs and to assess any associated complications and orthopedic sequelae.

METHODS

We performed a retrospective, single-center study of children treated for foot or ankle BJIs between 2008 and 2018 in a French university medical center. A total of 23 children were included. The median age at diagnosis was 9.1 years. Osteomyelitis was noted in 14 cases; it involved the calcaneus in seven cases, the distal fibula in four cases, the first metatarsal in two cases, and the distal tibia in one case. Arthritis affected the ankle in six cases and the cuneiform-cuboidal joint in one case. In two cases, osteoarthritis of the ankle was associated with distal osteomyelitis of the tibia. Clinical, radiological, and bacteriological parameters, surgical procedures, complications, and sequelae were recorded and analyzed.

RESULTS

The median (range) time to diagnosis was 3.18 days (0-10), and trauma was reported in four cases. Fever was present on admission in 18 cases, and the serum C-reactive protein level was elevated in 22 cases. Standard X-rays showed osteolysis in one case and bone sequestration in another. Staphylococcusaureus was identified in 10 cases. Surgery was performed in 17 cases. A subperiosteal abscess that required surgical drainage complicated 10 cases of osteomyelitis. No recurrence was observed. At the last follow-up, the median (range) age was 11.9 years (1.5-19). Sequelae (spontaneous tibia-talus fusion, first metatarsal epiphysis fusion, and varus deformity of the hindfoot) were observed in three cases, all of which were initially complicated by an abscess.

CONCLUSION

Physicians should be aware that pediatric BJIs of the lower limb may involve the foot and ankle. S. aureus is frequently involved. In cases of osteomyelitis, complications are closely associated with subperiosteal abscesses justifying an early diagnosis. These BJIs must be treated rapidly, and the risk of sequelae justifies long-term follow-up.

Mortality and secondary complications four years after traumatic spinal cord injury in Cape Town, South Africa

STUDY DESIGN

A prospective, regional, population-based study.

OBJECTIVES

(1) Determine the mortality rate and factors associated with it 4 years after a TSCI and (2) The point prevalence of secondary medical complications of survivors at 4 years.

SETTING

Communities of the Cape metropolitan area, South Africa.

METHODS

All persons (n = 145) sustaining a TSCI from 15 September 2013 to 14 September 2014 were eligible for follow-up at 4 years. Participants were contacted after 4 years. The next of kin, via verbal autopsy, was used to establish cause of death. Those who were alive at 4 years were asked to indicate any secondary medical complications. Logistic regression techniques were used to identify independently associated risk indicators for death and development of secondary complications, respectively.

RESULTS

Of the initial 145 persons, 87 were included and accounted for. Of these, 21 (24%) had died, 55 (63%) were alive and completed the survey, and 11 (13%) were classified as alive but did not submit the survey. The main cause of death reported was septicaemia (n = 7; 33%), followed by unknown natural causes (n = 7; 33%), then pressure injuries (n = 5; 24%). Out of the 55 persons alive, 89% had at least one medical complication at the time of enquiry, while more than 50% experienced 6 or more complications. The most common complications were pain (80%), muscle spasms (76%), sleeping problems (56%), and bladder dysfunction (44%).

CONCLUSIONS

Almost one-quarter of persons with TSCI have died 4 years after injury. Also, secondary complications were found to be highly prevalent at 4 years. This information could be used to develop secondary complications prevention programmes to reduce premature deaths.

SPONSORSHIP

This study was funded by the Medical Research Council of South Africa within the Research Capacity Development Initiative.

Genetic and non-genetic factors affecting semen production and quality characteristics of Gir cattle breed under semi-arid climate

Aim

This study aims to evaluate genetic and non-genetic factors influencing semen production potential of Gir bulls.

Materials and Methods

Data on semen quantity (n=6911) and quality (n=466) available from January 2011 to December 2018 at BAIF's frozen semen station, Jind, Haryana, India, were utilized for the study. Factors, namely, season of collection, age at collection, and bull (random effect) were studied for their effect on quantitative and qualitative semen traits. Least square means for the traits were obtained using a general linear model. The effect of age within bull for repeatable traits was analyzed using a longitudinal model with age as the control variable. Multivariate analysis using mixed repeatability model equation was utilized to estimate bull effect correlation (genetic + permanent environmental correlation), phenotypic correlations, and repeatability.

Results

The overall least square means of ejaculate volume, sperm concentration, total sperms, initial and post-thaw motility, hypo-osmotic swelling test, and acrosome integrity of frozen semen were 6.62±0.03 ml, 1.22±0.01 10⁹/ml, 8.09±0.05 10⁹/ejaculate, 75.78±0.001%, 55.92±0.0001%, 55.13±0.005%, and 71.08±0.001%, respectively. The season of the collection showed a significant effect on volume, concentration, total sperm, and initial motility. The performance of bulls was superior in summer season, followed by winter and monsoon. Increase in semen attributes during summer season was due to the effect of lower temperature on sensitive stages of spermatogenesis. Age at collection had a significant effect on all semen traits. Volume and total sperm count showed increasing trend while concentration showed a decreasing trend with an increase in age. Motility and quality traits did not show any particular pattern. Individual bulls showed differences in all the semen performance traits with age. The repeatability of the traits ranged from 0.04 (HOST) to 0.58 (acrosome integrity). Bull effect correlation ranged from -0.73 (initial motility and acrosome integrity) to 0.93 (HOST and acrosome integrity).

Conclusion

Individual bulls showed variation in traits measured over age. The result of the study could be utilized in suggesting suitable management plans to achieve the desired profit by improving semen quality in Gir bulls.

Abstract 1231: Targeting JNK1/2 induces a potent cytostatic response in estrogen receptor expressing breast cancer cells, with induction of autophagy and senescence as measurable outcomes

The c-Jun N-terminal kinases, JNK1/2 are members of the mitogen activated protein kinase (MAPK) family that can mediate inflammatory responses, cell differentiation, cell proliferation, and/or cell death. In breast cancer, JNK signaling has been associated with increased proliferation, angiogenesis, and tumor metastasis. Also, inhibition of JNK has been shown to promote tumor cytostasis, but this inhibition also attenuates the cytotoxic effects of certain chemotherapeutics, calling into question the therapeutic potential of JNK inhibitors. In this study, we hypothesized that JNK1/2 inhibition induced autophagy, as a mechanism of protection against chemotherapy- and endocrine-induced apoptosis. Autophagy is a normal physiologic process required for the elimination of damaged mitochondria and misfolded proteins that can be induced in cancer cells under certain stresses such as hypoxia and drug insult to provide protection from death. To characterize the role of JNK1/2 in autophagy, we utilized two ERα expressing human breast cancer cell lines, T47-D and MCF-7. Autophagy flux experiments were performed in which the steady state levels of the autophagy protein LC3 II were analyzed in control cells versus cells undergoing JNK1/2 inhibition with the non-reversible JNK-IN8 inhibitor. JNK-IN8 was used as a single agent or in combination with estradiol and/or antiestrogen treatment. These studies reproducibly identified JNK1/2 inhibition as a mechanism of autophagy activation. The induction of autophagy correlated with sustained inhibition of proliferation as determined by cell counts, MTT, and clonogenic assays, and induction of senescence (in T47-D cells) as determined by the expression of β-galactosidase. In contrast, induction of apoptosis was not a major outcome of JNK1/2 inhibition. These pre-clinical studies provide strong evidence that JNK1/2 is an attractive molecular target to improve the treatment of endocrine responsive breast cancer, but they also emphasize that cells are surviving by autophagy and/or senescence. Because cell survival by autophagy and/or senescence could ultimately lead to breast cancer relapse, ongoing studies are addressing approaches to effectively kill these surviving cell populations.

Citation Format: Kyler Herrington, Carol Joseph, Samar Abdulmoneim, Allison Lewis, Jingwen Cai, Hannah Youngblood, Yutao Liu, Patricia Schoenlein. Targeting JNK1/2 induces a potent cytostatic response in estrogen receptor expressing breast cancer cells, with induction of autophagy and senescence as measurable outcomes [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1231.

THU0205 RESPONSE TO SMALL MOLECULES IS MOSTLY DRIVEN BY PATIENT GLOBAL ASSESSMENT OF DISEASE: A REAL WORLD OBSERVATION

Background:

Two Small molecules (Tofacitinib and Baricitinib) have been licensed in the UK for the use in rheumatoid arthritis. Their licensing came from several studies that showed good efficacy with baricitinib (1) study showing superior efficacy to adalimumab and tofacitinib showing non inferiority to TNF drugs (2). The response has also been shown in patient reported outcomes (find reference). Response when measure using the DAS score has two relatively subjective components (tender joints and patient global assessment) and two relatively objective components (Swollen joints and inflammatory markers)

Objectives:

To determine in a real world setting if the response to small molecules is mostly due to a drop in subjective or objective components of the DAS score

Methods:

A retrospective chart review was done on all new starters on small molecules in a district hospital in the North of England. Data were collected at baseline, three months and six months from October 2018 to date. Drop in the components of the DAS28 score was calculated and overall drop in DAS28 was modelled as the explanatory variable using linear regression modelling. This was the done Adjusting for age gender and duration of disease. Sensitivity of the model was examined using a logistic model of EULAR moderate/good response and using adjusted R squared estimates for linear model of improvement of the DAS28 score.

Results:

76 patients were included in the analysis from 85 starters on small molecules.61 (71.8 %) were on baricitinib and the baseline median DAS28 score was .5.97 (IQR 5.35,6.55)The median drop at three months in the DAS28 score was 2.42 (IQR 1.33,3.31). and at six months was 2.77 (IQR 2.01,3.83). There was numerical relative increased efficacy of baricitinib but this was not statistically significant (DAS drop at three months 2.54 IQR 1.73,3.09 vs 2.12 IQR 1.51,3.5). The relative contribution of the individual components of the DAS score to the drop ae in DAS are shown in table 1 below. Sensitivity analysis looking at predictors of a DAS drop of >0.6 confirmed this finding.

Table 1.

Results of the adjusted linear regression models.

Component of DAS dropping at three monthsAdjusted R squared at 3 monthsAdjusted R squared at six monthsSwollen Joints0.120.05Tender Joints0.280.18Patient global assessment0.310.48Erythrocyte sedimentation rate0.040.17

Conclusion:

In this real world observational study, there was a good response to both small molecules with numerical better response to baricitinib. Tender joint count and patient global response accounted for more of the drop in DAS28 than swollen joints and inflammatory markers. At six months the biggest contributor to response was patient global assessment. This shows that JAK inhibitors might mediate their response initially mostly through pain modulation then by inflammation as exposure to drug continues.

References:

[1]N Engl J Med. 2017 Feb 16;376(7):652-662

[2]N Engl J Med. 2014 Jun 19;370(25):2377-86

Disclosure of Interests: :

Clerin Joseph: None declared, Syed Mujtaba Bilgrami Speakers bureau: Pfizer, Lesley Ottewell: None declared, Leanne Gray: None declared, William Mitchell: None declared, Fiona Wood: None declared, Marco Massarotti: None declared, Marwan Bukhari Speakers bureau: Bristol-Myers Squib, UCB celltech, Roche/Chugai, Pfizer, Abbvie, Merck, Mennarini, Sanofi-aventis, Eli-Lilly, Janssen, Amgen and Novartis.

Medical versus surgical treatment in native hip and knee septic arthritis

OBJECTIVE

Antibiotic treatment and arthroscopic or open drainage is the gold standard for septic arthritis. Full recovery takes time after surgery and hospital stay is longer than for arthrocentesis at the bedside. We aimed to evaluate the effectiveness of arthrocentesis (medical approach) versus a surgical approach.

METHOD

We retrospectively included 97 cases of native joint arthritis (hip and knee) between 2010 and 2017. The primary outcome was treatment failure of medical and surgical approaches (defined as surgical intervention within 7 days following diagnosis). Risk factors of failure were identified by univariable and multivariable logistic regression.

RESULTS

We included 72 cases of knee arthritis, of which 43 and 29 were treated medically and surgically, respectively; 25 cases of hip arthritis, of which 8 and 17 were treated medically and surgically, respectively. Failure was observed in 39.2% of cases in the medical group and in 30.4% in the surgical group (P=0.2) (37.5% vs. 52.9% and 39.5% vs. 17.2% for hip and knee, respectively). The univariate analysis identified age and male sex as risk factors for failure (P=0.048 and P=0.02, respectively), but only age was independently associated with failure (P=0.04). Hospital length of stay was 12 days shorter in the medical group (21 vs. 33 days, P=0.02), sequelae were less frequent and less important in the medical group (31.7% vs. 60%).

CONCLUSION

The medical treatment seems to be as effective as the surgical treatment for native joint septic arthritis with a shorter hospital stay and better functional outcome. Further prospective studies are warranted.

Daptomycin versus Vancomycin as Post-Operative Empirical Antibiotic Treatment for Prosthetic Joint Infections: A Case-Control Study

Purpose: To compare safety and efficacy of Vancomycin (Van) versus Daptomycin (Dap) as post-operative empirical antibiotic treatment (PEAT) in patients with periprosthetic joint infections (PJIs).

Methods: Medical charts of patients treated empirically with Van or Dap in the post-operative period of total hip/knee prosthesis septic revision until the results of intra-operative culture were reviewed. Cefotaxime, cefepime or aztreonam were used in combination with Dap or Van.

Results: Twenty Dap patients were matched with 20 other Van patients according to the age and type of prosthesis. The ASA score and the distribution of the pathogens was similar in the two groups especially regarding the number of methicillin-resistant staphylococci. The mean duration of the PEAT was 6.07 ± 0.85 days. A total of 17 episodes of adverse events (AE) in 10 patients (25%) were recorded during the PEAT which led to discontinue the treatment in 5 patients, all of them treated with Van (P=0.02). At the end of a mean post-treatment follow-up of 618 +/- 219 days, 36 patients remained in remission of infection; 2 patients failed in each group.

Conclusions: Our observations suggest that PEAT with Van for septic revision of PJIs is associated with a higher discontinuation rate due to AE but with a similar outcome than it is with Dap.

Flunixin meglumine improves pregnancy rate in embryo recipient beef cows with an excitable temperament

Objectives were to determine effects of: 1) handling temperament and administration of flunixin meglumine, an inhibitor of prostaglandin F2a (PGF2a) synthesis, given at the time of embryo transfer, on pregnancy rates in beef cattle embryo transfer recipients; 2) handling temperament and flunixin meglumine on peripheral concentrations of progesterone, cortisol, substance-P, prostaglandin F metabolites (PGFM, (13,14-dihydro-15-keto-PGF2a) and isoprostane 8-epi PGF2a; and 3) flunixin meglumine treatment on proportion of non-pregnant recipient cows returning to estrus within an expected interval. Angus cross beef cows (n = 710) at 7 locations were assigned a body condition score (BCS: 1, emaciated; 9, obese) and a temperament score [0, calm, slow chute exit; walk (n = 352), 1, excited, fast chute exit; jump, trot or run (n = 358)] and were synchronized with Select-Synch with a controlled internal drug release (CIDR) protocol. Estrus detection aids were applied at CIDR removal and cows were observed thrice daily for estrus until 72 h. Recipient cows that expressed estrus and had a corpus luteum received a frozen-thawed embryo on Day 7 after estrus. At the time of transfer, recipient cows were randomly allocated to receive 10 mL of flunixin meglumine im, immediately after transfer (n = 365) or served as an untreated control (n = 345). In a subset of cows (n = 80), ovarian ultrasonography was performed on the day of embryo transfer to determine corpus luteum volume and blood samples were collected twice, at the time of embryo transfer and 7 d later. All cows received estrus detection aids again on Day 14 (7 d after embryo transfer) and were observed for estrus twice daily until Day 24. Accounting for treatment (P > 0.1), embryo transfer difficulty score (P < 0.1), temperament by treatment interaction (P < 0.05), recipient cows with calm temperament had a higher pregnancy rate compared to those with an excited temperament [59.4 (209/352) vs 51.7% (185/358)]. The pregnancy rate for excitable cows without flunixin meglumine was lower (46.3% 81/175) compared to excitable cows that did received flunixin meglumine [56.8% (104/183)], and calm cows that did [59.3% (108/182)] or did not [59.4% (104/170)] receive flunixin meglumine. Proportions of non-pregnant recipient cows returning to estrus on Days 18-24 were not different between flunixin meglumine and control groups, 87.6% (134/153) and 84.0% (137/163), respectively (P > 0.1). At the time of embryo transfer and 7 d later, there were moderate to strong correlations among circulating concentrations of progesterone, cortisol, substance-P, PGFM and isoprostane 8-epi PGF2a. Among excitable cows, progesterone concentrations were lower and cortisol, substance-P, PGFM and isoprostane 8-epi PGF2a concentrations were greater for cows in the control group compared to cows that received flunixin meglumine. In conclusion, administration of flunixin meglumine improved pregnancy rates in excitable recipient cows following embryo transfer without affecting the proportion of non-pregnant cows returning to estrus.

Kidney transplant outcomes following the introduction of hand-assisted laparoscopic living donor nephrectomy: a comparison of recipient groups

BACKGROUND

Laparoscopic donor nephrectomy has become the procedure of choice for living donor kidney transplantation in many centres. We report on our experience with hand-assisted laparoscopic donor nephrectomy (HALDN). We concentrated on graft function and postoperative surgical complications in the recipient population, and compared outcomes to a similar recipient group who had received kidneys procured by open living-donor nephrectomy (OLDN).

METHOD

Following the receipt of institutional approval, the files of all patients who received a kidney transplant between September 2008 and June 2011 were reviewed. One hundred patients with end-stage renal disease received kidney transplantations from living donors. OLDN was performed in 65 donors, and 35 underwent HALDN. Delayed graft function (DGF) and postoperative complications were recorded.

RESULTS

Six adverse events were reported, during which five patients presented with DGF. One DGF was reported in the HALDN group, and four in the OLDN group. The morbidity in the HALDN group (1/35, 3%) was a graft rupture secondary to acute rejection which required exploration and transplant nephrectomy. Reoperation was required in five patients in the OLDN group (5/65, 8%). This amounted to overall morbidity of 6%, with no recipient mortalities.

CONCLUSION

As previously documented, HALDN is safe for the donor, and not inferior to OLDN. In this study, it was associated with neither an increased incidence of DGF, nor a higher complication rate in the transplant recipient, when compared to the cohort that received a kidney harvested using the OLDN technique.