Immunohistochemical Investigation into Protein Expression Patterns of FOXO4, IRF8 and LEF1 in Canine Osteosarcoma

Osteosarcoma (OSA) is the most common type of primary bone malignancy in people and dogs. Our previous molecular comparisons of canine OSA against healthy bone resulted in the identification of differentially expressed protein-expressing genes (forkhead box protein O4 (FOXO4), interferon regulatory factor 8 (IRF8), and lymphoid enhancer binding factor 1 (LEF1)). Immunohistochemistry (IHC) and H-scoring provided semi-quantitative assessment of nuclear and cytoplasmic staining alongside qualitative data to contextualise staining (n = 26 patients). FOXO4 was expressed predominantly in the cytoplasm with significantly lower nuclear H-scores. IRF8 H-scores ranged from 0 to 3 throughout the cohort in the nucleus and cytoplasm. LEF1 was expressed in all patients with significantly lower cytoplasmic staining compared to nuclear. No sex or anatomical location differences were observed. While reduced levels of FOXO4 might indicate malignancy, the weak or absent protein expression limits its primary use as diagnostic tumour marker. IRF8 and LEF1 have more potential for prognostic and diagnostic uses and facilitate further understanding of their roles within their respective molecular pathways, including Wnt/beta-catenin/LEF1 signalling and differential regulation of tumour suppressor genes. Deeper understanding of the mechanisms involved in OSA are essential contributions towards the development of novel diagnostic, prognostic, and treatment options in human and veterinary medicine contexts.

Interhemispheric coherence of EEG rhythms in children: Maturation and differentiation in corpus callosum dysgenesis

OBJECTIVES

To evaluate the evolution of interhemispheric coherences (ICo) in background and spindle frequency bands during childhood and use it to identify individuals with corpus callosum dysgenesis (CCd).

METHODS

A monocentric cohort of children aged from 0.25 to 15 years old, consisting of 13 children with CCd and 164 without, was analyzed. The ICo of background activity (ICOBckgrdA), sleep spindles (ICOspindles), and their sum (sICO) were calculated. The impact of age, gender, and CC status on the ICo was evaluated, and the sICO was used to discriminate children with or without CCd.

RESULTS

ICOBckgrdA, ICOspindles and sICO increased significantly with age without any effect of gender (p < 10-4), in both groups. The regression equations of the different ICo were stronger, with adjusted R2 values of 0.54, 0.35, and 0.57, respectively. The ICo was lower in children with CCd compared to those without CCd (p < 10-4 for all comparisons). The area under the precision recall curves for predicting CCd using sICO was 0.992 with 98.9 % sensitivity and 87.5 % specificity.

DISCUSSION

ICo of spindles and background activity evolve in parallel to brain maturation and depends on the integrity of the corpus callosum. sICO could be an effective diagnostic biomarker for screening children with interhemispheric dysfunction.

Bone density and proximal support effects on dental implant stability - Finite element analysis and in vitro experiments

OBJECTIVES

The application of dental implants presents the occurrence of implant failures associated with bone proximal support. This study aims to assess implant behavior, in particular implant stability and strain distribution in the bone at different bone densities, and the effect of proximal bone support.

MATERIAL AND METHODS

Three bone densities (D20, D15, and D10) were considered in the experimental in vitro study, represented by solid rigid polyurethane foam and two conditions of bone support in the proximal region. A finite element model was developed and validated experimentally and a Branemark model at a 3:1 scale was implanted in the experiments; the model was loaded and extracted.

RESULTS

The results of the experimental models validate the finite element models with a correlation R2 equal to 0.899 and NMSE of 7%. The implant extraction tests for the effect of bone properties in the maximum load were 2832 N for D20 and 792 N for D10. The effect of proximal bone support changes the implant stability was observed experimentally; at 1 mm less bone support decreases by 20% of stability and at 2 mm by 58% for D15 density.

CONCLUSIONS

Bone properties and bone quantity are important for the initial stability of the implant. A bone volume fraction of less than 24 g/cm3 exhibits poor behavior and is not indicated for implantation. Proximal bone support reduces the primary stability of the implant and the effect is critical in lower bone density.

Evaluating H295R steroidogenesis assay data for robust interpretation

The in vitro H295R steroidogenesis assay (OECD TG 456) is used to determine a chemical's potential to interfere with steroid hormone synthesis/metabolism. As positive outcomes in this assay can trigger significant higher tiered testing, we compiled a stakeholder database of reference and test item H295R data to characterize assay outcomes. Information concerning whether a Level 5 reproductive toxicity study was triggered due to a positive outcome in the H295R assay was also included. Quality control acceptance criteria were not always achieved, suggesting this assay is challenging to conduct within the guideline specifications. Analysis of test item data demonstrated that pairwise significance testing to controls allowed for overly sensitive statistically significant positive outcomes, which likely contribute to the assay's high positive hit rate. Complementary interpretation criteria (e.g., 1.5-fold change threshold) markedly reduced the rate of equivocal and positive outcomes thus improving identification of robust positive effects in the assay. Finally, a case study (positive H295R outcome and no endocrine adversity in vivo) is presented, which suggests that stricter data interpretation criteria could refine necessary in vivo follow-up testing. Overall, the described additional criteria could improve H295R data interpretation and help inform on how to best leverage this assay for regulatory purposes.

Mechanical circulatory support devices in left main occlusion: a multicenter study from 2008 to 2020

Introduction

Evidence of benefit in the use of mechanical circulatory support devices (MCS) in patients with acute myocardial infarction (AMI) is scarce. We aimed to evaluate the clinicalcharacteristics, prognosis and factors associated with the use of MCS in patients with AMI due to left main (LM) occlusion.

Methods

We performed a retrospective multicenter study of 128 consecutive patients with AMI with ≤12h of presentation with LM occlusion submitted to immediate reperfusion between January 1, 2008, until December 31, 2020 in three terciary hospitals of Portugal. Among this cohort, we divided patients into two groups according to the use of MCS devices.

Results

Regarding the baseline characteristics no statistically significant differences were found, except for the presence of cerebrovascular disease (2.9% in group with vs 16.9% in group without MCS, p=0.007) and peripheral artery disease (8.8% in group with vs 22% in group without MCS, p=0.037). We observed that the use of MCS devices was statistically different between the three centers (47.8%, 42%, 8.7%, p&lt;0.001). No differences were found at presentation for ST-segment elevation vs non-ST segment elevation AMI (p=NS). The presence of cardiogenic shock (72.4% vs 45.8%, p=0.002), cardiac arrest (27.5% vs 23.7%, p=0.034) and more severe thrombolysis in myocardial infarction (TIMI) flow at presentation (55.1% vs 35.6%, p=0.015) were more frequent in group with MCS. The rate of 1-year cumulative mortality was high in both groups (31/59=52.5% in the group without vs 47/69=68.1%, p=NS). Also, no statistically significant differences were found in terms of survival, but we observed a trend to higher mortality in those who received MCS as Kaplan-Meier survival curves show (log rank=0.062). Finally, in multivariable analysis, older age [odds ratio (OR), 0.935; 95% CI, 0.87–0.99], the presence of diabetes (OR, 0.223; 95% CI, 0.056–0.88), peripheral artery disease (OR, 0.070; 95% CI, 0.009–0.566) and extra-hospitalar cardiac arrest (OR, 0.06; 95% CI, 0.007–0.543) were characteristics associated with lower odds of receiving MCS. Contrarily, male sex (OR, 5; 95% CI, 1–20.4) and the presence of cardiogenic shock (OR, 5.7; 95% CI, 1.42–23) were factors associated with higher use of MCS.

Conclusion

The use of MCS does not seem to modify prognosis in patients admitted withAMI due to left main occlusion. Only cardiogenic shock and male gender were predictors of MCS use.

Funding Acknowledgement

Type of funding sources: None.

Clinical determinants and barriers to cardiac rehabilitation enrolment of patients with heart failure with reduced ejection fraction

Introduction

Cardiac rehabilitation (CR) is a recommended treatment for patients with heart failure with reduced ejection fraction (HFrEF). Despite the robust evidence supporting its safety and benefits, there is an incomplete understanding of the reasons of the underutilization of CR programs in HFrEF. These reasons are complex and probably encompass healthcare system- and patient-level barriers.

Purpose

To study the clinical determinants and barriers to enrolment in a CR program for HFrEF patients.

Methods

We conducted a study of consecutive heart failure patients followed at a dedicated HFrEF cardiology clinic from January 2019 to April 2021. Patients were divided according to previous enrolment in CR program. Data were collected from electronic health records, and in case of missing data patients were asked by telephone about the reason for not participating in CR using a structured and validated questionnaire for this purpose.

Results

Of 228 patients with HFrEF, 60% had not been enrolled in a CR program; they were older (63 vs 58 years; p&lt;0.01) and more likely to have comorbidities such as hypertension (56% vs 41%; p=0.03) or concomitant chronic obstructive pulmonary disease (20% vs 8%; p=0.01). Conversely, patients enrolled in CR programs were more likely to have a previous history of acute myocardial infarction (34% vs 20%; p=0.02). Regarding heart failure-related clinical features (NYHA functional class, LVEF, ICD/CRT), we did not find any significant differences between groups. The main reasons for not being enrolled in CR programs were: no medical referral (31%), concomitant medical problems (27%) such as musculoskeletal problems, patient refusal (11%) and geographical distance to the hospital (9%).

Conclusion

Despite the high proportion (40%) of HFrEF patients who underwent CR program compared to previous studies, the enrolment to CR can be further improved. The main barriers are related to health professionals (no referral), healthcare system (geographical distance to the hospital) and patients (concomitant noncardiac problems). Innovative strategies should target these factors to increase the delivery of CR program in HFrEF.

Funding Acknowledgement

Type of funding sources: None.

Anxiety in Multiple Sclerosis Patients: A Preliminary Examination of the Effect of Fatigue, Physical Disability, and Low Self-Compassionate Attitude

Introduction

Multiple Sclerosis (MS) is a demyelinating, neurodegenerative, and immune-mediated disease that affects the central nervous system. Usually co-occurs with difficulties in emotional regulation and psychopathology. Anxiety is one of the most common psychiatric manifestations in patients with MS. Nonetheless, empirical evidences on the joint predictive effect of MS clinical conditions and emotion regulation processes on the development of anxiety in MS patients are scarce.

Objectives

This preliminary study aimed to explore whether fatigue, physical disability (MS clinical conditions) and a low compassionate attitude (maladaptive emotion regulation process based on self-judgment, over-identification, and isolation) predict anxiety symptoms in MS patients.

Methods

A convenience sample of 107 patients with MS diagnosis and without other neurological disorders was used in this cross-sectional study. Participants completed the Anxiety Subscale of the Depression, Anxiety and Stress Scales-21, the Analogic Fatigue Scale, the World Health Organization Disability Assessment Schedule, and the Self-judgment, Isolation and Over-identification Subscales of the Self-Compassion Scale.

Results

All potential predictors showed significant correlations with anxiety symptoms and predicted this symptomatology through simple linear regressions. Therefore, they were selected as covariates of the multiple linear regression model, which explained 32% of the variance of anxiety symptoms. This model revealed that fatigue, physical disability, and low compassionate attitude are significant predictors.

Conclusions

The results support the relevance of psychological interventions for MS patients to implement effective strategies to regulate anxiety associated with fatigue and physical disability. Helping patients to adopt a more compassionate attitude toward the self can reduce their anxiety.

Disclosure

No significant relationships.

POS1285 IMMUNOGENICITY AND SAFETY OF THE CHADOX 1 COVID-19 VACCINE IN PATIENTS WITH AUTOIMMUNE DISEASES AND HEALTHY CONTROLS: DATA FROM SAFER STUDY

Background

Patients with autoimmune inflammatory diseases (AID) have been prioritized for urgent vaccination to mitigate COVID-19 risk. However, few studies in the literature assessed the immunogenicity and safety of the COVID-19 vaccine in patients with AID.

Objectives

In this context, the present study aims to evaluate the immunogenicity and safety of the vaccine against COVID-19 in patients with AID.

Methods

These data are from “Safety and efficacy on COVID-19 Vaccine in Rheumatic Disease” - SAFER study, a Brazilian multicentric prospective phase IV study to evaluate COVID-19 Vaccine in AID, in the real-life, in Brazil. Immunogenicity and adverse events (AE) from a single center were assessed, after 2 doses of ChAdOx1 (Oxford/AstraZeneca), 8 weeks of interval, in patients with AID and healthy controls (HC). Inclusion criteria were age ≥ 18 years and fulfilling criteria according to international classification for AID. Exclusion criteria: pregnancy, previous severe AE to any vaccine, other immunosuppression causes. Stratification of post-vaccination AE was performed using a diary, filled out daily and returned at the end of 28 days for each dose. Participants were followed up through blood collection for measurement of IgG antibodies against SARS-CoV-2 spike receptor-binding domain by chemiluminescence (SARS-CoV-2 IgG II Quant assay, Abbott Laboratories, Abbott Park, IL, USA) at baseline and 28 days after the second dose. The seropositivity was defined for titers ≥50 AU/mL. Quantitative analyses were presented as observed frequency, percentage, central tendency, and variability measurements. The sample’s normal distribution was verified through the Shapiro-Wilk test. The Kruskal-Wallis test and the post-hoc Dwass-Steel-Critchlow-Fligner pairwise comparisons test were used to compare the IgG-S titers between the groups through the evaluation period. Categorical data were addressed using the Fisher´s exact or Chi-squared (χ2) test. An alpha level of 5% significance was used in all analyses.

Results

A total of 377 volunteers with AID and 50 HC were included in the study. Patients with spondyloarthritis (N=64), systemic lupus erythematosus (N=63), rheumatoid arthritis (N=61), primary Sjögren’s syndrome (N=61), vasculitis (N=31), systemic sclerosis (N=14), inflammatory myopathy (N=9), Crohn´s disease (N=49), ulcerative colitis (N=11) and other systemics AID (N=12) were evaluated. Both groups had female predominance (73.5% vs. 74.0%, p=0.937) and were homogeneous for age (43.5 vs. 41.7,p=0.308). The seroconversion among those not reactive (IgG-S negative at baseline) (46 HC and 191 AID), 28 days after second dose was 97.1% for spondyloarthritis (p=0.425), systemic lupus erythematosus 88.2% (0.006), rheumatoid arthritis 93.5% (0.158), primary Sjögren’s syndrome 92.6% (0.133), systemic sclerosis or inflammatory myopathy 47.1% (0.001), inflammatory bowel disease 100% (0.999) and vasculitis 80% (0.006), while in healthy control was 100%. In comparison with HC, there was a statistically significant difference in IgG-S titles only in systemic sclerosis or inflammatory myopathy (1.694 AU/ml vs. 3.719 AU/ml; p=0.006). Both groups only presented mild AE. Pain at the injection (85.7% vs. 78.4%, p=0.239), headache (67.3% vs. 53.8, p=0.074) and fatigue (59.2% Vs. 46.2%, p=0.089) were more common in HC than AID. Overall, reactions like arthralgia (52.6 vs. 22.4%, p<0.001), hematoma (14.1 vs. 4.1%, p=0.05), cutaneous rash (9.5 vs. 0%, p=0.024) were more frequent in AID. Most participants related that they felt safer after receiving a COVID-19 vaccination, and 52.4% did not reported a worse patient global assessment (PGA) index.

Conclusion

In conclusion, our data indicated that ChAdOx1 vaccine is safe and induced high titers and seroconversion rate in AID. More severe AID, such as vasculitis, systemic lupus erythematosous, and systemic sclerosis and myositis showed a lower seroconversion rate. Further analysis will explore the association between immunossupressant and reactivity, and booster dose.

Acknowledgements

Acknowledgements to DECIT/MS and ICEPI/SESA for supporting the study.

Disclosure of Interests

None declared

Osimertinib and anti-HER3 combination therapy engages immune dependent tumor toxicity via STING activation in trans

Over the past decade, immunotherapy delivered novel treatments for many cancer types. However, lung cancer still leads cancer mortality, and non-small-cell lung carcinoma patients with mutant EGFR cannot benefit from checkpoint inhibitors due to toxicity, relying only on palliative chemotherapy and the third-generation tyrosine kinase inhibitor (TKI) osimertinib. This new drug extends lifespan by 9-months vs. second-generation TKIs, but unfortunately, cancers relapse due to resistance mechanisms and the lack of antitumor immune responses. Here we explored the combination of osimertinib with anti-HER3 monoclonal antibodies and observed that the immune system contributed to eliminate tumor cells in mice and co-culture experiments using bone marrow-derived macrophages and human PBMCs. Osimertinib led to apoptosis of tumors but simultaneously, it triggered inositol-requiring-enzyme (IRE1α)-dependent HER3 upregulation, increased macrophage infiltration, and activated cGAS in cancer cells to produce cGAMP (detected by a lentivirally transduced STING activity biosensor), transactivating STING in macrophages. We sought to target osimertinib-induced HER3 upregulation with monoclonal antibodies, which engaged Fc receptor-dependent tumor elimination by macrophages, and STING agonists enhanced macrophage-mediated tumor elimination further. Thus, by engaging a tumor non-autonomous mechanism involving cGAS-STING and innate immunity, the combination of osimertinib and anti-HER3 antibodies could improve the limited therapeutic and stratification options for advanced stage lung cancer patients with mutant EGFR.

Autoimmune anti-DNA and anti-phosphatidylserine antibodies predict development of severe COVID-19

COVID-19 induces high levels of autoimmune anti-DNA and anti-phosphatidylserine antibodies that are detected in some patients upon hospital admission and predict later development of severe disease.

High levels of autoimmune antibodies are observed in COVID-19 patients but their specific contribution to disease severity and clinical manifestations remains poorly understood. We performed a retrospective study of 115 COVID-19 hospitalized patients with different degrees of severity to analyze the generation of autoimmune antibodies to common antigens: a lysate of erythrocytes, the lipid phosphatidylserine (PS) and DNA. High levels of IgG autoantibodies against erythrocyte lysates were observed in a large percentage (up to 36%) of patients. Anti-DNA and anti-PS antibodies determined upon hospital admission correlated strongly with later development of severe disease, showing a positive predictive value of 85.7% and 92.8%, respectively. Patients with positive values for at least one of the two autoantibodies accounted for 24% of total severe cases. Statistical analysis identified strong correlations between anti-DNA antibodies and markers of cell injury, coagulation, neutrophil levels and erythrocyte size. Anti-DNA and anti-PS autoantibodies may play an important role in the pathogenesis of COVID-19 and could be developed as predictive biomarkers for disease severity and specific clinical manifestations.

P–643 Is Euploid blastocyst number higher in luteal versus follicular phase? A case-control study of IVF outcomes of follicular versus luteal phase ovarian stimulation

Study question

Is there a difference between IVF outcomes in patients undergoing follicular versus luteal phase ovarian stimulation in different menstrual cycles?

Summary answer

Number of euploid blastocyst were higher in luteal phase ovarian stimulation IVF cycles. All other outcomes were similar between follicular and luteal phase IVF cycles.

What is known already

It has been published that human beings can have two or three follicular recruitment waves as observed in animals studies a long time ago. From these findings, several recent studies showed that two egg retrievals at the same menstrual cycle, named as Duo Stim, optimize time and IVF outcomes in women with low ovarian reserve due to more eggs retrieved in a shorter period with consequently higher probability of having good embryos to transfer. However, there is no knowledge about diferences concerning IVF outcomes between folicular and luteal ovarian stimulation, performed at the same women in different menstrual cycles.

Study design, size, duration

Retrospective, case-control study in a single IVF center. One-hundred-two patients who had two IVF treatments – the first cycle initiating ovarian stimulation at follicular phase (FPS) and the second cycle initiating after a spontaneous ovulation at luteal phase (LPS) – in different menstrual cycles (until 6 months apart) between 2014 and 2020, were included. Statistical analysis was performed with Mann-Whitney test and was considered significant when p ≤ 0.05. Data is represented as mean±SD.

Participants/materials, setting, methods

Patients underwent two IVF treatments in different menstrual cycles; the FPS IVF treatment was initiating at D2/D3 of menstrual cycle and the LPS treatment started three or four days after spontaneous ovulation, if at least 4 antral follicles were detected. Both IVF treatments were performed with and antagonist protocol and freeze all strategy. The majority of patients presents low ovarian reserve/Ovarian age as primary infertility factor (84.3%).

Main results and the role of chance

Patient’s mean age was 39.30±3.15 years, BMI (22.66±3.16) and AMH levels (0.85±0.85 ng/mL). Comparison of hormonal levels at the beginning of ovarian stimulation showed differences for FPS vs LPS, as expected: E2 (39.69±31,10 pg/mL vs 177.33±214.26 pg/mL,p&lt; 0.0001) and P4 (0.76±2.47ng/mL vs 3,00±5.00 ng/mL,p&lt; 0.0001). However, E2 and P4 at the day of oocyte maturation trigger were not different between FPS and LPS (1355.24±895.73 pg/mL vs 1133.14±973.01 ng/mL,p=0.0883 and 1.12±1.49 ng/mL vs 2.94±6.51,p=0.0972 respectively). There was no difference for total dose of gonadotrofins (FPS 2786.43±1102.39.01UI vs LPS 2824.12±1188.87UI, p = 0,8578), FSH (FPS 9.50±4.98 vs LPS 11.90±12.99,p=0.7502) and AFC (FPS 7.13±4.25 vs LPS 6.42±4.65,p=0,0944). From 102 patients that started ovarian stimulation, 78 had 1 or more oocyte collect in FPS group and 75 in LPS group: OPU (FPS 4.78±4.93 vs LPS 4.65±5.54,p=0.7889), number of MII (FPS 3.21±3.52 vs LPS 3.40±4.53,p=0.7889). From those, 52 patients performed ICSI in both cycles; fertilization rate 64.9%±28.6% for FPS vs 62.1%±32.4% for LPS,p=0.7899) and blastocyst formation 2.15±2.15 for FPS vs 2.54±2.35,p=0.3496). Data from 25 patients who had embryo biopsy for PGT-A showed similar number of blastocyst biopsed (2.12±1.72 FPS vs 2.48±1.71 LPS,p=0.3101) and a statistically significant difference regarding number of euploid blastocyst (0,20±0,41 FPS vs 0,96±0,93 LPS,p=0,0008).

Limitations, reasons for caution

This is a retrospective study in a limited number of patients. Therefore, it is not possible to make a definitive conclusion that LPS proportionate higher number of euploid than FPS. More studies are necessary to investigate not only IVF outcomes but also the impact on pregnancy rates.

Wider implications of the findings: In our study, LPS protocol after spontaneous ovulation, presents similar IVF outcomes compared to routinely FPS protocol. Intriguingly, the number of euploid blastocyst was significant higher in LPS, which may be further investigated. In this way, LPS is another option of IVF treatment, and may optimize time and treatment results.

Trial registration number

Not applicable

P-643 Pre-selected for an award: Is Euploid blastocyst number higher in luteal versus follicular phase? A case-control study of IVF outcomes of follicular versus luteal phase ovarian stimulation

Study question

Is there a difference between IVF outcomes in patients undergoing follicular versus luteal phase ovarian stimulation in different menstrual cycles?

Summary answer

Number of euploid blastocyst were higher in luteal phase ovarian stimulation IVF cycles. All other outcomes were similar between follicular and luteal phase IVF cycles.

What is known already

It has been published that human beings can have two or three follicular recruitment waves as observed in animals studies a long time ago. From these findings, several recent studies showed that two egg retrievals at the same menstrual cycle, named as Duo Stim, optimize time and IVF outcomes in women with low ovarian reserve due to more eggs retrieved in a shorter period with consequently higher probability of having good embryos to transfer. However, there is no knowledge about diferences concerning IVF outcomes between folicular and luteal ovarian stimulation, performed at the same women in different menstrual cycles.

Study design, size, duration

Retrospective, case-control study in a single IVF center. One-hundred-two patients who had two IVF treatments – the first cycle initiating ovarian stimulation at follicular phase (FPS) and the second cycle initiating after a spontaneous ovulation at luteal phase (LPS) – in different menstrual cycles (until 6 months apart) between 2014 and 2020, were included. Statistical analysis was performed with Mann-Whitney test and was considered significant when p ≤ 0.05. Data is represented as mean±SD.

Participants/materials, setting, methods

Patients underwent two IVF treatments in different menstrual cycles; the FPS IVF treatment was initiating at D2/D3 of menstrual cycle and the LPS treatment started three or four days after spontaneous ovulation, if at least 4 antral follicles were detected. Both IVF treatments were performed with and antagonist protocol and freeze all strategy. The majority of patients presents low ovarian reserve/Ovarian age as primary infertility factor (84.3%).

Main results and the role of chance

Patient’s mean age was 39.30±3.15 years, BMI (22.66±3.16) and AMH levels (0.85±0.85 ng/mL). Comparison of hormonal levels at the beginning of ovarian stimulation showed differences for FPS vs LPS, as expected: E2 (39.69±31,10 pg/mL vs 177.33±214.26 pg/mL, p &lt; 0.0001) and P4 (0.76±2.47ng/mL vs 3,00±5.00 ng/mL,p &lt; 0.0001). However, E2 and P4 at the day of oocyte maturation trigger were not different between FPS and LPS (1355.24±895.73 pg/mL vs 1133.14±973.01 ng/mL,p = 0.0883 and 1.12±1.49 ng/mL vs 2.94±6.51,p = 0.0972 respectively). There was no difference for total dose of gonadotrofins (FPS 2786.43±1102.39.01UI vs LPS 2824.12±1188.87UI, p = 0,8578), FSH (FPS 9.50±4.98 vs LPS 11.90±12.99, p = 0.7502) and AFC (FPS 7.13±4.25 vs LPS 6.42±4.65,p = 0,0944). From 102 patients that started ovarian stimulation, 78 had 1 or more oocyte collect in FPS group and 75 in LPS group: OPU (FPS 4.78±4.93 vs LPS 4.65±5.54,p = 0.7889), number of MII (FPS 3.21±3.52 vs LPS 3.40±4.53,p = 0.7889). From those, 52 patients performed ICSI in both cycles; fertilization rate 64.9%±28.6% for FPS vs 62.1%±32.4% for LPS,p = 0.7899) and blastocyst formation 2.15±2.15 for FPS vs 2.54±2.35,p = 0.3496). Data from 25 patients who had embryo biopsy for PGT-A showed similar number of blastocyst biopsed (2.12±1.72 FPS vs 2.48±1.71 LPS,p = 0.3101) and a statistically significant difference regarding number of euploid blastocyst (0,20±0,41 FPS vs 0,96±0,93 LPS,p = 0,0008).

Limitations, reasons for caution

This is a retrospective study in a limited number of patients. Therefore, it is not possible to make a definitive conclusion that LPS proportionate higher number of euploid than FPS. More studies are necessary to investigate not only IVF outcomes but also the impact on pregnancy rates.

Wider implications of the findings

In our study, LPS protocol after spontaneous ovulation, presents similar IVF outcomes compared to routinely FPS protocol. Intriguingly, the number of euploid blastocyst was significant higher in LPS, which may be further investigated. In this way, LPS is another option of IVF treatment, and may optimize time and treatment results.

Trial registration number

Not Applicable

Exploring predictors of depressive symptoms in patients with multiple sclerosis: The effect of neuropathic pain, shame, and mindfulness

Introduction

Multiple Sclerosis (MS) is a chronic inflammatory, immune-mediated, demyelinating disease of the central nervous system, with a progressive course. It is potentially disabling and affects mainly young adults. Depression is the mental disorder with the greatest comorbidity with MS and tends to worsen its symptomatology and course. However, knowledge about the predictors of depression in patients with MS is scarce.

Objectives

This preliminary study aimed to verify whether neuropathic pain (NP), internal (IS) and external (ES) shame and mindfulness predict depressive symptoms in patients with MS.

Methods

This cross-sectional study included a convenience sample of 95 patients diagnosed with MS and without other identified neurological diseases. Participants completed the Depression Subscale of the Depression, Anxiety and Stress Scales-21, the Analogue Pain Scale of the Pain Detect Questionnaire, the External and Internal Shame Scale, and the Mindfulness Subscale of the Self-Compassion Scale.

Results

All potential predictors exhibited significant correlations with depressive symptoms and significantly predicted this symptomatology in simple linear regression models. Thus, they were included as covariates in the multiple linear regression model. This model explained a high percentage of the variance of depressive symptoms (40.5%) and identified NP, IS and mindfulness as significant predictors.

Conclusions

Interventions aimed at preventing/reducing depression in patients with MS should minimize IS and develop mindfulness and NP coping skills, in order to promote mental health in this target population and possibly prevent the exacerbation and progression of MS symptomatology.

Disclosure

No significant relationships.

Understanding stress in patients with multiple sclerosis: The joint predictive role of disease characteristics and emotion regulation processes

Introduction

Multiple sclerosis (MS) is a chronic inflammatory, demyelinating, and neurodegenerative disease of the central nervous system. This condition is enhanced by stress. In turn, stress symptoms are a risk factor for the onset and progression of MS. However, knowledge about predictors of stress in patients with MS is scarce.

Objectives

This preliminary study aimed to verify whether the number of relapses, fatigue, physical disability (MS characteristics), experiential avoidance and self-judgment (emotion regulation processes) predict stress symptoms in patients diagnosed with MS.

Methods

A convenience sample of 101 patients diagnosed with MS and without other neurological diseases participated in this study. Participants completed the Depression Scale of the Depression, Anxiety and Stress Scales-21, Analog Fatigue Scale, World Health Organization Disability Assessment Schedule-12, Acceptance and Action Questionnaire-II, and Self-Judgment Subscale of the Self-Compassion Scale.

Results

All predictors initially hypothesized and years of education have significant correlations with stress symptoms. Simple linear regression analyses showed that the variables significantly predicted stress symptoms and were, therefore, included in the multiple linear regression model. This model explained 51.8% of the variance of the stress symptoms and showed that years of education, the number of relapses, fatigue, and experiential avoidance significantly predicted those symptoms.

Conclusions

The promotion of mental health mental in patients with MS must develop functional skills to deal with stress induced by years of education (possibly responsible for the degree of awareness about MS and its consequences), recurrence of relapses and fatigue, and should minimize emotion regulation strategies focused on experiential avoidance.

Geospatial Distribution and Predictors of Mortality in Hospitalized Patients With COVID-19: A Cohort Study

BACKGROUND

The global coronavirus disease 2019 (COVID-19) pandemic offers the opportunity to assess how hospitals manage the care of hospitalized patients with varying demographics and clinical presentations. The goal of this study was to demonstrate the impact of densely populated residential areas on hospitalization and to identify predictors of length of stay and mortality in hospitalized patients with COVID-19 in one of the hardest hit counties internationally.

METHODS

This was a single-center cohort study of 1325 sequentially hospitalized patients with COVID-19 in New York between March 2, 2020, to May 11, 2020. Geospatial distribution of study patients' residences relative to population density in the region were mapped, and data analysis included hospital length of stay, need and duration of invasive mechanical ventilation (IMV), and mortality. Logistic regression models were constructed to predict discharge dispositions in the remaining active study patients.

RESULTS

The median age of the study cohort (interquartile range [IQR]) was 62 (49-75) years, and more than half were male (57%) with history of hypertension (60%), obesity (41%), and diabetes (42%). Geographic residence of the study patients was disproportionately associated with areas of higher population density (r s = 0.235; P = .004), with noted "hot spots" in the region. Study patients were predominantly hypertensive (MAP > 90 mmHg; 670, 51%) on presentation with lymphopenia (590, 55%), hyponatremia (411, 31%), and kidney dysfunction (estimated glomerular filtration rate < 60 mL/min/1.73 m2; 381, 29%). Of the patients with a disposition (1188/1325), 15% (182/1188) required IMV and 21% (250/1188) developed acute kidney injury. In patients on IMV, the median (IQR) hospital length of stay in survivors (22 [16.5-29.5] days) was significantly longer than that of nonsurvivors (15 [10-23.75] days), but this was not due to prolonged time on the ventilator. The overall mortality in all hospitalized patients was 15%, and in patients receiving IMV it was 48%, which is predicted to minimally rise from 48% to 49% based on logistic regression models constructed to project disposition in the remaining patients on ventilators. Acute kidney injury during hospitalization (odds ratioE, 3.23) was the strongest predictor of mortality in patients requiring IMV.

CONCLUSIONS

This is the first study to collectively utilize the demographics, clinical characteristics, and hospital course of COVID-19 patients to identify predictors of poor outcomes that can be used for resource allocation in future waves of the pandemic.

Influence of prenatal exposure to dexamethasone on neurodevelopmental behaviour

Introduction Early life stress, such as prenatal exposure to exogenous glucocorticoids (GC), can have a negative impact on brain development. Dexamethasone (DEX) is a synthetic GC used in preterm pregnancies to promote lung maturation. However, prenatal exposure to DEX induces an anxious-like behaviour in male and female offspring at adulthood. Notably, only males respond positively to therapeutics with a proposed anxiolytic.

Objectives Since the influence of prenatal DEX on neurodevelopmental behaviour remains to be elucidated and could help explain this difference in drug efficacy, we aim to clarify the effects of this GC on neurodevelopment during infancy, comparing male and female offspring neurodevelopment at this early age.

Methodology To obtain an animal model of chronic anxiety, Wistar pregnant dams were injected subcutaneously with DEX (1mg/kg) on gestational days 18 and 19. The vestibular system development, locomotion, upper limbs strength, discriminatory ability, auditory response and eye opening day were assessed in male and female offspring between P5 and P17. Animal procedures were approved by the Animal Welfare Committee and done in agreement with the law.

Results Male and female offspring prenatally exposed to DEX had a better performance in the tests assessing the vestibular system development and discriminatory ability, especially at P5 and P6. Additionally, DEX anticipated the day of eye opening and had a positive impact in the upper limb strength of the offspring of both sexes. However, the locomotor ability and auditory response were impaired comparing with controls.

Conclusion Exposure to DEX improves limb strength, balance, spatial orientation and anticipates eye opening. These results may suggest that prenatal DEX exposure promotes offspring development and maturation in both males and females. Prenatal DEX did not differently affect male and female neurodevelopment at early age. It remains to clarify the underlying motives that induce a dimorphic gender response to anxiolytic therapy in adulthood.

New record of preclinical diagnosis of American visceral leishmaniasis in Amazonian Brazil encourages optimizing disease control

The clinical-immunological spectrum of human Leishmania (L.) infantum chagasi-infection in Amazonian Brazil has recently been reviewed based on the combined use of the delayed-type hypersensitivity (DTH) and indirect fluorescence antibody test (IFAT-IgG/IgM), both with homologous L. (L.) infantum chagasi-antigens, and associated with the clinical evaluation of infected individuals. This diagnostic approach has allowed to identify the broadest clinical-immunological spectrum of human L. (L.) infantum chagasi-infection composed by five clinical-immunological profiles of infection: three asymptomatic, 1) Asymptomatic Infection (AI) [DTH^+/++++, IFAT⁻], 2) Subclinical Resistant Infection (SRI) [DTH^+/++++, IFAT^+/++], and 3) Indeterminate Initial Infection (III) [DTH⁻, IFAT^+/++], and two symptomatic ones, 4) Symptomatic Infection (SI) [=American visceral leishmaniasis - AVL] and, 5) Subclinical Oligosymptomatic Infection (SOI), both with the same immune profile [DTH⁻, IFAT^+++/++++]. Herein, we confirm for the third time the preclinical diagnosis of AVL through IgM-antibody response in an early asymptomatic case of infection (profile III), a 17-year-old boy who evolved to AVL (=profile SI) six weeks after the initial infection diagnosis, confirming that the combined use of DTH and IFAT-(IgG/IgM) assays associated with the clinical evaluation of infected individuals is potentially useful for monitoring human L. (L.) infantum chagasi-infection in endemic areas as well as optimizing AVL control.

Using numerical methods from nonlocal optics to simulate the dynamics of N-body systems in alternative theories of gravity

The generalized Schrödinger-Newton system of equations with both local and nonlocal nonlinearities is widely used to describe light propagating in nonlinear media under the paraxial approximation. However, its use is not limited to optical systems and can be found to describe a plethora of different physical phenomena, for example, dark matter or alternative theories for gravity. Thus, the numerical solvers developed for studying light propagating under this model can be adapted to address these other phenomena. Indeed, in this work we report the development of a solver for the HiLight simulations platform based on GPGPU supercomputing and the required adaptations for this solver to be used to test the impact of new extensions of the Theory of General Relativity in the dynamics of the systems. In this work we shall analyze theories with nonminimal coupling between curvature and matter. This approach in the study of these new models offers a quick way to validate them since their analytical analysis is difficult. The simulation module, its performance, and some preliminary tests are presented in this paper.

Evaluation of the sensitivity of the Express View function in the Mirocam® capsule endoscopy software

Background: A new computer algorithm called Express-View has recently been introduced by Mirocam, but data concerning its application and efficacy are scarce.Objective: To evaluate the lesion detection rate, per-patient sensitivity and the diagnostic accuracy using Express-View.Methods: All patients who performed CE between January 2018 and June 2019, whose indication was obscure gastrointestinal bleeding (OGIB) and with findings on CE, were included. Lesions identified in conventional reading were selected and considered as reference.Results: Eighty-nine patients were included, 50.6% male, with a mean age of 68.4 years-old (±12.3). The Express-View mode detected 85.5% of lesions previously detected by conventional reading (524 out of 613). There were 89 missed lesions, mainly erosions or ulcers (44.9%) and angioectasias (38.2%). The lesion detection rate was found to be lower in the jejunum and ileum compared to extra-small bowel locations and duodenum (p = .04). Although Express-View had a per-patient sensitivity for all lesions of 56.2% and a per-patient sensitivity for all clinically significant lesions of 83.1%, it achieved a diagnostic accuracy of 91%.Conclusions: The per-patient sensitivity for all lesions was shown to be below expectations, although the lesion detection rate, the per-patient sensitivity for all clinically significant lesions, and the diagnostic accuracy were shown to be higher.

P229 PillCamCrohn’sCapsule: the use of a panenteric capsule endoscopy in a Portuguese centre

Background

Crohn’s disease (CD) is a complex chronic inflammatory gastrointestinal condition with variable age of onset, disease location and behaviour. PillCamCrohn’sCapsule (PCC) was recently introduced as a new system composed of a two-headed capsule which allows an extensive coverage of the gastrointestinal (GI) tract. This panenteric capsule endoscopy plays an important role in the diagnosis and monitoring of CD patients and has the potential to reduce multiple procedures in CD, consequently increasing patients’ satisfaction. However, its role in clinical practice remains undefined due to limited data. A recent study in children demonstrated its importance ina treat-to-target approach and a randomised trial is currently under-recruiting in order to evaluate the likelihood of panenteric mucosal healing in CD patients treated with Vedolizumab. The authors present an analysis of the application of this system.

Methods

A cross-sectional analysis of SBC from patients with suspected or established CD was performed. Data were collected retrospectively. Patients performed 2L of polyethylene glycol (PEG) prior to PCC ingestion. After PCC ingestion, patients underwent sequentially: 2 boosters of sodium phosphate (NaP). The authors assessed: indication of PCC, bowel preparation, completeness (when the capsule was naturally excreted), Lewis and CECDAI scores and complications. Diagnosis confirmation and changes in stage disease were also evaluated.

Results

Eighteen patients (median age 43 years, 55.6% female, established CD in 83.3%) were included in the analysis. Indications were suspected CD (16.7%), definition of disease activity and extension (27.8%) and assessment of treatment response (44.4%). All procedures were complete and had an adequate bowel cleansing (Brotzqualitative excellent n = 1, Good n = 15, fair n = 2; Brotz quantitative median 9.5). 72.2% patients presented inflammatory lesions. In established CD median Lewis was 900 and CECDAI 8.5. PCCcorroborated the diagnosis in 1 of 3 patients with suspected CD and changed the staging of the disease in known CD in 13.3% (L1 to L3 n = 1 and B1 to B2 n = 1). No complications were reported including capsule retentions.

Conclusion

This preliminary study showed that PCC is an effective and safe tool to use in suspected or established CD patients. In our study, this method was more frequently used for assessment of treatment response. PCC could be of great advantage in our clinical practice since it provides a complete examination of mucosal healing of the gastrointestinal tract in a single procedure, helping physicians in disease management.

P829 Cardiac uptake level in 99mTc-DPD scintigraphy in ATTR amyloidosis: is there any association with the prognosis?

Introduction

The uptake of bone-seeking radiotracers in 99mTc-DPD scintigraphy has been shown to be highly sensitive for cardiac transthyretin (ATTR) amyloid. Progressive levels of cardiac involvement are associated with poor prognosis.

Purpose

Evaluation of the prognostic impact of the tracer uptake level in the heart through 99mTc-DPD scintigraphy.

Methods

Single center retrospective analysis of patients’ data referred to perform a 99mTc-DPD between September 2014- July 2018 due to an abnormal echocardiogram or family history of ATTR. Data was collected regarding clinical, echocardiographic and 99mTc-DPD parameters to evaluate prognostic impact of the uptake level on cardiovascular events, namely hospitalizations due to acute heart failure, myocardial infarction or stroke, and all-cause mortality.

Results

35 patients were reviewed of whom 12 (34.3%) had a positive 99mTc-DPD, performing the diagnosis of an ATTR amyloidosis: mean age 78.4 ± 7.3 years, 100% male. 33.3% had a cardiac uptake level 2 (group 1) and 66.6% level 3 (group 2). Group 1 patients were younger (mean age 72.3 ± 4.6 versus 81.5 ± 6.5 years, p 0.03). At the time of diagnosis, most patients in both groups were in NYHA class II. Mean value of NTproBNP in group 1 patients was 4322.4 ± 35.0 versus 6387.7 ± 60.0 pg/ml (p 0.03); troponin level was not statistically different between groups (88.3 ± 63.1 versus 54.5 ± 16.1 pg/ml, p 0.228). On transthoracic echocardiogram evaluation, there were no significant differences between groups regarding cardiac function: mean ejection fraction 48.8 ± 6.3 versus 43.9 ± 11.5% (p 0.453) and mean global longitudinal strain -10.4 ± 2.8 versus -9.0 ± 2.9% (p 0.531). Although almost patients presented a nearly normal ejection fraction, almost have diastolic dysfunction (75 versus 100%, p 0.140) and pericardial effusion (100% in both groups). Hypertrophy level was similar between groups: septum thickness was 19.5 ± 0.7 in group 1 and 19 ± 1.4mm in group 2 (p 0.386). During follow-up, 25% of group 1 patients were hospitalized due to acute heart failure and 25% died. In group 2 patients, there were 25% of hospitalizations due to heart failure and all-cause mortality rate of 50%.

Conclusions

In our population, there was no significant association between the cardiac uptake level in 99mTc-DPD scintigraphy and cardiac symptoms or cardiac function evaluated through transthoracic echocardiogram at the time of diagnosis. However, higher levels of cardiac uptake were associated with higher mortality in the follow-up period. This data suggests that 99mTc-DPD scintigraphy should be performed not only for diagnosis but also for prognosis assessment in these patients.

P983 ATTR cardiac amyloidosis and aortic stenosis: the same physiopathology, different prognosis?

Introduction

Degenerative aortic stenosis and age-related amyloidosis share common demographic and clinical characteristics. Both surgical and transcatheter aortic valve replacement provide excellent outcomes in elderly patients with isolated aortic stenosis, however previous reports have suggested the potential negative impact of concomitant transthyretin amyloidosis.

Purpose

Evaluation of the association of ATTR amyloidosis and degenerative aortic stenosis.

Methods

Single center retrospective analysis of patients’ data referred to perform a 99mTc-DPD between September 2014- July 2018 due to an abnormal echocardiogram or family history of ATTR. Data was collected regarding clinical, echocardiographic and 99mTc-DPD parameters to evaluate prognostic impact of concomitant cardiac ATTR amyloidosis and aortic stenosis.

Results

35 patients were reviewed. 12 (34.3%) had a positive 99mTc-DPD, performing the diagnosis of an ATTR amyloidosis. 33.3% had a cardiac uptake level 2 and 66.6% level 3. 16.7% of patients with ATTR amyloidosis had at the same time of amyloidosis diagnosis, a diagnosis of at least moderate degenerative aortic stenosis (mean maximal velocity 3.73 m/sec and mean gradient 22mmHg). These patients were older (mean age 80.5 ± 14.1 versus 77.9 ± 6.4 years, p 0.527) and all male gender in both groups. There was no evidence of higher level of cardiac uptake in patients with aortic stenosis. Cardiac function was not significantly different between groups: mean ejection fraction 45.5 ± 13.4% in patients with concomitant aortic stenosis versus 45.5 ±10.1% in patients without (p 0.672); mean global longitudinal strain -8.7 ± 2.4% versus -7.3 ± 3.0% (p 0.402). Most patients in both groups were at NYHA class II at the diagnosis. There was no difference regarding mean value of NTproBNP (7381.5 ± 32.6 versus 43332.1 ± 23.7 pg/ml, p 0.267). During follow up, 30% of patients without aortic stenosis was hospitalized due to acute heart failure and 50% died. In the group of aortic stenosis, the hospitalization and all-cause mortality rate was 100%.

Conclusions

In this study, although there were no differences regarding demographic neither clinical parameters between groups, patients with aortic stenosis presented more cardiac events and higher mortality, dying yet before the aortic stenosis became symptomatic. More studies are needed to evaluate the prognosis of cardiac amyloidosis on the postoperative.

Amazonian Phlebovirus (Bunyaviridae) potentiates the infection of Leishmania (Leishmania) amazonensis: Role of the PKR/IFN1/IL-10 axis

BACKGROUND

Leishmania parasites are transmitted to vertebrate hosts by phlebotomine sandflies and, in humans, may cause tegumentary or visceral leishmaniasis. The role of PKR (dsRNA activated kinase) and Toll-like receptor 3 (TLR3) activation in the control of Leishmania infection highlights the importance of the engagement of RNA sensors, which are usually involved in the antiviral cell response, in the fate of parasitism by Leishmania. We tested the hypothesis that Phlebovirus, a subgroup of the Bunyaviridae, transmitted by sandflies, would interfere with Leishmania infection.

METHODOLOGY/PRINCIPAL FINDINGS

We tested two Phlebovirus isolates, Icoaraci and Pacui, from the rodents Nectomys sp. and Oryzomys sp., respectively, both natural sylvatic reservoir of Leishmania (Leishmania) amazonensis from the Amazon region. Phlebovirus coinfection with L. (L.) amazonensis in murine macrophages led to increased intracellular growth of L. (L.) amazonensis. Further studies with Icoaraci coinfection revealed the requirement of the PKR/IFN1 axis on the exacerbation of the parasite infection. L. (L.) amazonensis and Phlebovirus coinfection potentiated PKR activation and synergistically induced the expression of IFNβ and IL-10. Importantly, in vivo coinfection of C57BL/6 mice corroborated the in vitro data. The exacerbation effect of RNA virus on parasite infection may be specific because coinfection with dengue virus (DENV2) exerted the opposite effect on parasite load.

CONCLUSIONS

Altogether, our data suggest that coinfections with specific RNA viruses shared by vectors or reservoirs of Leishmania may enhance and sustain the activation of host cellular RNA sensors, resulting in aggravation of the parasite infection. The present work highlights new perspectives for the investigation of antiviral pathways as important modulators of protozoan infections.

Estenose ureteral após cistectomia radical associada à ureterostomia cutânea abdominal: relato de caso

RESUMO O presente trabalho tem como objetivo relatar a realização de cistectomia total associada à ureterostomia abdominal, uma técnica ainda pouco descrita na veterinária, bem como descrever as complicações pós-operatórias observadas. Um canino da raça Akita, macho, 11 anos, castrado, foi atendido com histórico de prostração, hiporexia, disúria, hematúria e incontinência urinária havia aproximadamente 10 dias. No exame clínico, foi observada leve algia abdominal; demais parâmetros estavam dentro da normalidade. Os exames complementares de imagem revelaram presença de massa envolvendo grande parte da vesícula urinária. O paciente foi submetido à cirurgia de cistectomia total associada à implantação cutânea abdominal dos ureteres, e o exame histopatológico chegou ao diagnóstico de carcinoma de células de transicionais (CCT) infiltrativo não papilar. No pós-operatório, o paciente desenvolveu dermatite urêmica leve no local de inserção dos ureteres e estenose ureteral em região distal, de maneira que reintervenções cirúrgicas foram necessárias para a correção. Além disso, observaram-se pielonefrite e hidronefrose secundárias ao quadro obstrutivo. Devido às complicações pós-operatórias, a tutora optou pela eutanásia do cão. Dessa maneira, conclui-se que a estenose ureteral e a pielonefrite são possíveis complicações da técnica de cistectomia associada à implantação abdominal dos ureteres.

Post hoc support vector machine learning for impedimetric biosensors based on weak protein–ligand interactions

We develop a simple, open source machine learning algorithm for analyzing impedimetric biosensor data using a mobile phone.